Independence and Mobility through Robotics – How Exosuits Can Help Those with Parkinson’s Disease

Humble But Life-Changing Exoskeletons

Since the publication of Heinlein’s classic Starship Trooper in 1959, science fiction has always been eager to forecast the use of mobile armor called ‘exosuits’ or ‘exoskeletons’. In real life, we are pretty far from such a system to be routinely deployed by cool-looking space marines.

But more realistic forms of robotic exoskeletons are now developed to help people suffering from limited mobility or help workers in factories and warehouses.

Such an example is a new robotic exosuit designed by the Harvard John A. Paulson School of Engineering and Applied Sciences. It helps patients suffering from Parkinson’s Disease regain mobility.

More precisely, it helps solve the problem of “gait freezing”, which is when a step is suddenly interrupted by a neurodegenerative disease. This can reduce mobility, cause falls, and even block Parkinson’s patients from walking entirely.

“The robotic garment, worn around the hips and thighs, gives a gentle push to the hips as the leg swings, helping the patient achieve a longer stride. ”

This mechanical help can make patients walk further, faster, and easier.  This is the latest iteration of Conor Walsh’s Biodesign Lab robotic technology for assisting mobility.

Previous systems have been showed to help people post-stroke, ALS (Amyotrophic Lateral Sclerosis) patients, and other mobility-impacting diseases.

Why Now?

While prototypes of such robotic assistance have been designed for more than a decade, the step of commercialization and widespread usage is a lot closer today.

A key factor has been the development of much more powerful batteries. It helps keep the robotic suits powered longer, in addition to being lighter and less bulky.

There have also been advancements with advanced materials that can flex and contract like biological muscle more than initial approaches that used primitive pistons and gears. This is a key part of the Harvard exosuit, with a “soft” design allowing for smoother movements and lighter weight.

And, of course, the widespread adoption of smartphones also allows for convenient apps to monitor the exosuit.

A Nascent Market

The exoskeleton market is estimated at $523M in 2022 and could grow to $2.2B by 2032, or a 15.5% CAGR. For now, it is driven by medical uses – mostly rehabilitation – along with neurological issues.  Protecting the spine from injury when lifting heavy weight is another growing market. By the end of the 2020s, this usage for exoskeletons might be a lot more common.

Powered exoskeletons actively providing strength are probably the step coming after, with a wider usage unlikely to happen before 2030-2040 and might lead to varied industrial and military applications.

Power-Charged Innovation

Another step of exosuit innovation will probably come from integrating other innovations into the existing designs.

Artificial Intelligence (AI)

With advances in machine learning, AI will be a major step toward making exosuits more reactive and useful. If Boston Dynamics (now a part of Hyundai – HYMTF) can make its Atlas robot dance and do a backflip, a similar AI-powered exosuit could help its wearer stay stable and moving comfortably.

Once the technology is fully mature, some even envision solutions like Atlas being able to walk for paralyzed or amputees, replacing entirely wheelchairs. Limited exosuits, for example, replacing just one leg, could be used similarly without reaching the level of a full bionic implant.

Additive Manufacturing

Another helpful technology will be 3D printing / additive manufacturing. This can first be used to design complex parts at a lower cost and sometimes design parts that would be entirely impossible to manufacture using traditional methods. It will also help produce spare parts and repair them one by one instead of having to rely on batch manufacturing and inventories.

Finally, 3D printing will allow for much more customizable exosuits, with variable sizes, fittings, strength, etc., with each adapted to the exact requirement of each user.

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Exoskeleton & Exosuits Companies

Medical Exosuits

1. Ekso BIONICS

Ekso BIONICS is a leader in exoskeleton technology, with the first commercial medical rehabilitation exoskeleton launched in 2012. Since then, it has received approval for its ABI and EVO suits.

While it is expanding in the work/heavy-duty segment, the company is still mostly focused on therapies and medical mobility.

The company revenues have been growing quickly (+38% year-to-year in 2023).

It recently acquired the Human Motion and Control (HMC) Business Unit from Parker Hannifin Corporation to add its powered exoskeletons for people with paralysis to its offering.  This could indicate that Ekso has good potential to become a serial acquirer in the exoskeleton sector, growing its offering through a mix of internal R&D and strategic acquisitions.

2. ReWalk Robotics

ReWalk offers exoskeleton solutions for stroke rehabilitation and for people who have suffered spinal cord injury.  The company has sold more than 600 units so far, with a focus on Germany and the USA.

ReWalk has seen its first Medicare coverage at the start of 2024, opening the possibility of a much larger market thanks to insurance coverage.  ReWalk acquired AlterG in August 2023 for $19M, a manufacturer of treadmills specialized for rehabilitation therapies, a complementary offer to ReWalk exoskeletons.

The synergies between the two companies, targeting the same rehabilitation centers and therapists, should help both companies grow by combining their sales efforts. The expanding coverage for exoskeleton therapies and AlterG products is estimated by the company to create a TAM (Total Addressable Market) of more than 2.255B in just Germany + USA.

3. Cyberdyne

Cyberdyne is best known for producing the HAL (Hybrid Assistive Limb) exoskeleton. This is a solution designed to detect and amplify small nerve impulses to assist in desired movements by the patient.

Besides HAL, Cyberdyne has an exoskeleton for the upper limbs and knees, supporting a single joint.  The system is currently used for medical purposes, but this design might be the future of more powerful exoskeletons, able to fully increase with robotics the physical movements of workers, much closer to an Iron Man-style suit.

Detecting minute nerve impulses can also be used to help patients communicate, even with impaired speaking abilities, using the company’s CYIN technology.

The company also leverages its expertise in robotics and sensors to sell cleaning robots, as well as transportation robots, and a system of photoacoustic imaging.

4. Trexo Robotics

Trexo specializes in designing robotic assistance for children suffering from disabilities like for example cerebral palsy.

This is a niche but important role, as children will not have the same needs and abilities as adults in rehabilitation. It is also a life-changing ability for a child to finally be able to move more freely.

It is also a powerful therapeutic and quality-of-life tool for rare diseases that might not have functional therapies for years or decades.

Commercial Exosuits

1. SUITX by Ottobock

SUITX is another non-powered exoskeleton with a focus on industries like automotive and logistics to help employees lift heavy weights and reduce the risks of spinal injuries. The company has already 2000+ companies using its products.

Unfortunately for non-accredited investors, it is not publicly traded yet.

Military Exosuits

The SABER (Soldier Assistive Bionic Exosuit for Resupply) is a 3-pound suit developed by the US Army in partnership with the Vanderbilt University. To the disappointment of science-fiction or Iron Man fans, the suit is unlikely to see combat and was designed for a much more mundane (but equally important) purpose: logistics.

Military personnel have to lift a lot of heavyweight, putting them at great risk of back injuries. This is a “lightweight, low-profile, non-powered wearable tool”.

Previously, Vanderbilt University worked on similar exoskeleton with HeroWear, a leading exosuit manufacturer; and Interwoven Design, a leading apparel and product design firm.  Herowear sells its own design of civilian exosuit for lifting, the Apex 2, for a bit more than $1,000/suit.

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