Robotic exoskeletons provide an external frame with motors providing movement of the knee and hip joints, with various amounts of trunk support, to enable an individual to move in a simulated walking pattern, or exercise in different standing postures.

The use of exoskeletons within neurorehabilitation offers a range of physiological and therapeutic benefits to the client. These include:

• Benefits to health and fitness
• Reduction in spasms 
• Improvement in bladder and bowel regime 
• Improvements in cardiopulmonary health/ exercise tolerance
• Improvements / maintenance in bone density 
• Maintenance of range of movement 
• Anecdotal improvements in neuropathic pain, musculoskeletal pain, sleep hygiene and trunk stability and balance in and out of an exoskeleton
• Being at eye-level with others
• Engagement with rehabilitation sessions 

Exoskeletons are not condition dependent and can benefit anybody with mobility difficulties, helping to increase the time spent on their feet with less fatigue, practising balance and strengthening exercises in standing and walking with motorised support, to either help improve what can be achieved without the exoskeleton, or provide a means of upright mobility for exercise and therapeutic walking.

Physiofunction is one of few facilities in the country incorporating exoskeleton technology into our rehabilitation provision. We work with three of the six devices: the Rex, ReWalk and FREEWalk, which enable us to match the most appropriate device to the needs of our clients based upon their presentation and goals.

Much of our recent work with exoskeletons in our clinical population has involved working with individuals with acquired brain injury, stroke, primary ataxia, and multiple sclerosis. Goals of these sessions have been to encourage supported standing in a well aligned posture, with equal weight bearing through both feet, and in particular when using the FREEWalk, allowing the forefoot to engage with the ground to help activate proprioceptive (the ability to sense movement, action and location) pathways in the nervous system. This is of even greater benefit when walking as the foot can move naturally through the cycle helping to improve re-education of independent walking. With the REX we can combine various standing postures with exercises such as tennis, throwing and catching, band resisted strengthening and even use virtual rehabilitation platforms such as the Mindmotion Go.

Exoskeleton therapy can be delivered both as a standalone treatment, and part of a larger rehabilitation programme, such as a component of our intensive packages or discharge continuity service.

REX – Self-supporting exoskeleton operated by a joystick and allowing handsfree movement, as well as the completion of standing exercises such as squats and lunges. Stroke clients or quadriplegics lack control on at least one side of their body and REX can help stabilise the client in an upright position without requiring any additional support from the physiotherapist or a walking frame, this enables a greater range of rehabilitative exercises and movements to be performed while being totally balanced and supported. Tailored rehabilitation programmes are designed for each user so that the maximum outcomes can be achieved.

ReWalk – Designed by a tetraplegic engineer with the intention of allowing independent upright mobility, this ‘passive’ (motors always active) exoskeleton requires the use of crutches to balance the user and can be used to walk in the community and climb up and down stairs.

FREEWalk – A rehabilitation exoskeleton that provides higher levels of trunk support, a half foot plate and abducting limbs for fitting, plus varied levels of motor assistance to allow user engagement and re-education. For independent use crutches are required to manage balance, but the device can be safely supported by a therapist to practice handsfree walking rehabilitation.