Analysis: robotic exoskeletons enable a paralysed person to stand up and therapeutically walk for rehabilitation or health benefits
The public health messaging has been clear for quite some time now: if you work a sedentary job, prolonged sitting is damaging your health and shortening your life expectancy. You must get up and move on the hour - and, oh yes, get a standing desk. This is undeniably great advice and we should all take the stairs more often too.
But as is so often the case, people with disabilities are excluded from this public health messaging. In fact, healthcare services in Ireland are depriving wheelchair users of the chance to sit less.
Robotic exoskeletons have been commercially available for over 10 years now and enable a paralysed person to stand up and therapeutically walk. It has been described as therapeutic walking as it is used for rehabilitation or health benefits rather than as a mobility device.
From Wired, how exosekeleton technology can transform healthcare
In Ireland, there are four sites where wheelchair users can access this robotic walking on a pay per walk basis. All of these sites have been funded through community fundraising or philanthropy and rely on the generosity of service users or large contribution donors to allow them to continue offering robotic walking to paralysed people.
Helpful Steps in Cork, No Barriers in Letterkenny, Step West in Leitrim and the Dublin City University Exoskeleton Programme, which I run, have demand that outstrips the amount of walking we can deliver. There is an urgent need for healthcare services in Ireland to acknowledge that exoskeleton assisted therapeutic walking should be a standard of care for the management of paralysis and other neurological conditions.
Since the 1950s, the identity of the wheelchair has evolved from that of patient transport device to a tool for independence. It has become the key for self-actualisation of the paralysed person allowing them to access meaningful vocation, elite level sport and personal fulfilment.
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From RTÉ Radio 1's Morning Ireland, Mark Pollock on the DCU Exoskeleton Programme to provide access to robotic rehabilitation
But these functional benefits of the wheelchair come at a cost to the user. Sitting all day poses many risks for paralysed people: the development of pressure sores; stiffening of the joints; reduced respiratory function; reduced bone density, bladder/bowel dysfunction and pain. These issues devastatingly counterbalance the benefits that the wheelchair affords. We have users that travel up to two hours for the feeling of standing from their chair, pain relief and the experience of being back at eye level with their loved ones.
Research around the risks of sitting too much highlights that the risks of sedentary work for the general population can be offset by 60 to 75 minutes of moderate intensity physical activity per day. Additionally, exoskeleton research has demonstrated that robotic walking is comparable to a moderate intensity physical activity. What a wonderful way this would be to achieve exercise recommendations and allow a person to stand out of their wheelchair, stretch out their tight limbs and allow their organs the space to function optimally.
In our work in DCU, we have noticed a further disturbing trend in the younger population of wheelchair users. For those people born with forms of paralysis like spina bifida, cerebral palsy or childhood spinal cord injury, the transition to adulthood causes catastrophic change to the body. It seems that sitting in a wheelchair during the period of bone growth may cause drastic changes.
From DCU, how the DCU Exoskeleton Programme works
When tall enough (approx 150 cm) to access our adult exoskeleton, we have found candidates' body shape has rendered them unable to stand in an exoskeleton. The levels of spinal curvature and joint stiffness leaves people incapable of getting appropriately upright and certainly, the skeletal freedom required for walking is absent.
Could it be that we could reduce some of this unacceptable body shape change if these children were facilitated to walk in an exoskeleton on a regular basis while growing? This is a question we hope to answer in DCU. At a minimum, it would normalise the experience of walking for a generation of children for whom robotic walking devices will be the norm.
Most market projections predict the exoskeleton industry will grow from a multi-million dollar industry to a multi-billion one over the next five to ten years. This technology is begging to be embraced and judging by sheer patient demand and its rise is inevitable. Sitting will continue to be demonised, so why are we ignoring a viable solution for the wheelchair user to explore this form of mobility? Given the potential health benefits for both adults and children with physical disabilities, we believe it is time to shift the conversation from wheels to walking.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
