World Exoskeleton Day has recently been celebrated on 2 May 2025, and our Spinal Injury Technical Unit have reviewed the recommendations for exoskeletons in the context of lower limb paralysis in spinal injury claims.
There are as many as six different types of exoskeletons potentially delivering varying outcomes.
|
Type of Exoskeleton |
Purpose |
|
Passive |
Reduce muscle strain and fatigue by redistributing loads or assisting joint motion |
|
Active |
Enhance strength endurance or mobility beyond natural capability |
|
Rehabilitation |
Help patients regain mobility after stroke, spinal cord injury or other disabilities |
|
Industrial |
Reduce injury risk, increase productivity, reduce fatigue |
|
Military |
Enhance soldier endurance, load carrying and reduce injury risk |
|
Soft |
Provide assistive force while maintaining comfort and flexibility |
Whilst in the United States, ambulatory lower limb exoskeletons are being gradually introduced into clinical practice to compliment walking rehabilitation programmes, their use within the NHS is currently extremely limited with resource cost being a likely significant factor.
At the time the NICE Guideline was published (2017) Overview | Ekso exoskeleton for rehabilitation in people with neurological weakness or paralysis | Advice | NICE in respect of the use of Ekso GT robotic powered exoskeleton, there was only one in use in an NHS unit. Whilst acknowledging the use of the Ekso may help patient mobility and reduce pain, there was no evidence for such benefits at the time of publication.
It is in the private sector that there appears to be greater traction, where in the context of paraplegia claims, various health professionals will recommend the use of an exoskeleton, but we know these recommendations do not always address whether a claimant has met the suggested manufacturer’s eligibility criteria, for example:
- Height and weight restrictions.
- Sufficient upper body strength to support crutches or a walker.
- Healthy bone density.
- Sufficient standing tolerance.
- Appropriate range of motion in hips, knees and ankles.
Furthermore, the extent to which an exoskeleton can deliver improvements in mobility and functionality over and above, for example, the more traditional use of a standing frame, can be absent from experts’ reports.
The suitability of a particular make and model of exoskeleton clearly needs to be matched to the profile of the individual as there may be contra indicators such as:
- Osteoporosis
- Osteoarthritis
- Respiratory issues
- Orthostatic hypertension
There is also the simple fact that the claimant may not be interested in using this type of technology, in preference to the more traditional routes (physiotherapy/hydrotherapy/gym exercises) for maintaining strength and mobility. The exoskeletons are bulky and inconvenient and, crucially, make toileting problematic.
However, the advancement of technology in the development of exoskeletons, which includes the use of AI to monitor the progress of the patient, suggests to us that recommendations for exoskeletons as a rehabilitation cost are only likely to increase in spinal injury claims.
All forecasts predict that the entire exoskeleton market is set to grow due to advancements in robotics, AI, rising workplace safety concerns, and the need for assistive technologies in the healthcare and military sectors. This might ultimately mean lower cost but for now they remain high.
Our Spinal Injury Technical Unit continues to monitor development as well as how frequently they appear in claims.
For further information or to discuss any of the issues in this update, please contact Kerris Dale.
