The purpose of this blog post is to address three questions that we are frequently asked about our robotic exoskeleton:

1) What is a robotic exoskeleton?

2) How does the Indego exoskeleton work?

3) What are the benefits of exoskeleton physical therapy?

This post will give you a basic understanding of robotic exoskeletons and the benefits someone may receive from using one. If you’re interested in trying exoskeleton therapy for yourself or loved one, please schedule a free consultation with us! We’d love to talk with you and together will determine if exoskeleton therapy is right for you.

1. What is a robotic exoskeleton?

Robotic exoskeletons are wearable devices that attach to the outside of the body to make movement easier. Exoskeletons are battery-operated machines and are powered by electric motors. There are different types of exoskeletons.

  • Some are worn in the manufacturing environment to help workers pick up heavy equipment and to prevent injury.
  • Others are worn by military personnel to improve strength and endurance, and reduce the risk of injury while lifting, or carrying out repetitive motion.
  • Others help patients improve their mobility by moving weak or injured parts of their bodies.

The exoskeleton used at Next Level Rehab is called Indego, and it is in the third category above. The Indego exoskeleton is a pair of powerful robotic legs that allow someone with muscle weakness or paralysis to stand up, walk around, and exercise in an upright position. It helps people who are recovering from a stroke or brain injury retrain their brain and body how to walk. Also, it helps people with neuromuscular disorders like Multiple Sclerosis, Parkinson Disease, Cerebral Palsy or Muscular Dystrophy improve their strength, balance, and endurance. The Indego exoskeleton is a safe and effective physical therapy tool.

Robotic exoskeletons are called different names- robotic suit, exoskeleton robot, exosuit, powered armor, exo-frame or just simply exo. Often people refer to the exoskeleton that they use by the brand name. As mentioned above, at Next Level Rehab we use the Indego exoskeleton which is made by the Parker Hannifin Corporation. There are two other brands of wearable robotic exoskeleton that are widely used in the US for personal use and rehabilitation- the ReWalk, and Ekso Bionics EksoNR exoskeletons.

2. How does the Indego exoskeleton work?

The Indego exoskeleton has two modes of operation: a robotic mode and a rehabilitation mode.

The robotic mode is designed for folks who are unable to stand and walk. The patient controls walking by shifting body weight forward and backwards. It operates in a similar way to a Segway. For example, if the patient shifts their weight forward and onto their toes, the exoskeleton device responds by walking the patient forward. The Physical Therapist will provide assistance to trigger the exoskeleton to perform motions like standing up and sitting down. 

Settings like walking speed and step length are adjusted through an application on a mobile device to create an optimal walking experience.

This mode is designed to allow patients to:

  • Walk again after a spinal cord injury
  • Walk again after having a stroke
  • Walk again after losing muscle strength

Conditions we’ve treated using robotic mode include:

Spinal cord injury, Stroke, Muscular Dystrophy, Cerebral Palsy, Multiple Sclerosis

The rehabilitation mode is designed for patients wanting to improve their current level of walking. Rehabilitation mode requires that patients have enough strength and balance to stand up and take a few steps on their own. The exoskeleton will provide robotic assistance as needed to help the patient advance their impaired legs, and to provide stability at the knees to prevent any bucking or hyperextension that might occur. This allows the patient to perform high quality gait training and walk 5-10 times as far compared to traditional physical therapy.

This mode is designed to help patients with:

  • Leg weakness, knee buckling and/or hyperextension after stroke
  • Gait instability after incomplete spinal cord injury
  • Low walking endurance after COVID-19
  • Heavy legs from Multiple Sclerosis
  • Fear of falling
  • And much more

Conditions we’ve treated using rehabilitation mode include:

Spinal cord injury, Stroke, Muscular Dystrophy, Cerebral Palsy, Multiple Sclerosis

In both modes, the patient will use an assistive device like a walker to maintain good upright posture and balance. The Physical Therapist will maintain contact at all times and provide assistance as needed.


3) What are the benefits of exoskeleton therapy?

Exoskeleton therapy creates physical, emotional, and quality of life improvements that are backed by clinical research. The exoskeleton is a powerful physical therapy tool that allows people with muscle weakness and paralysis to stand up, walk around and exercise. This can improve heart and lung function, improve bowel and bladder function, reduce spasticity and nerve pain, and improve sleep. In addition, the exoskeleton is a rehabilitation tool that improves functional mobility, physical strength, endurance, and confidence while walking. The exoskeleton reduces the physical burden that a patient may experience during therapy. The exo makes walking easier, which creates the opportunity for patients to walk further, faster, and with higher quality than they are able to without it. This means more work is completed during each therapy session, creating a better chance for recovery.

People who spend most of their time seated in wheelchairs or laying down often experience a wide range of secondary health complications.

The National Spinal Cord Injury Statistical Center (NSCISC) states that “Since 2015, about 30% of persons with Spinal Cord Injuries (SCI) are re-hospitalized one or more times during any given year following injury. Among those re-hospitalized, the length of hospital stay averages about 18 days. Diseases of the genitourinary system [genital or urinary] are the leading cause of re-hospitalization, followed by disease of the skin. Respiratory, digestive, circulatory, and musculoskeletal diseases are also common causes.” More data related to SCI Facts and Figures can be found at this resource.

For people living with a chronic injury like an SCI, which makes up an estimated 296,000 people in the US (per the NSCISC), walking in a wearable exoskeleton can prevent the development of secondary health complications which saves money and reduces the likelihood of hospital stay(s). Also, this exercise helps people feel better and improves their quality of life.

One client with an SCI says that “It’s true that the physical benefits are great. But, for me, it’s more about the psychological benefits of walking. When walking in the exoskeleton I don’t feel disabled, or able-bodied. I feel re-enabled. I’m a paralyzed man walking… it’s a real empowering feeling!”

Have additional questions about exoskeletons? Please ask your question by commenting below the post, by commenting on our Facebook or Instagram pages @nextlevelrehabasheville or by contacting us directly. We would love to hear from you!