Exoskeleton – Marvel or Madness

October 16, 2019

I was sent the following link the other day, the latest in a line of reports in the development of bionics for the purpose of enabling the paralysed man to walk again.


The science and technology is truly incredible, who would have thought that one day Robocop would start to become a reality, while at the same time it’s frightening! It’s with good reason that an image of the future, where machines dominate, is always presented in dystopian films. So let’s look at what is really going on here and what’s at stake for the paralysed man.

Living with paralysis is never easy. The tasks of daily living all become much harder and not only do you have to adapt to a new set of circumstances, you also have to accept that so much is no longer possible. Putting the day to day living aside, the limits placed on the more outgoing side of life are enormous. Before my injury I was a very active man. I walked and cycled a great deal, not just to get from A to B, but also for pleasure, climbing hills with my dog on my days off. I enjoyed motorcycling, camping and rafting down rivers. Not all of this became impossible and, apart from the walking, much of it I continued to enjoy in some way or another. There are always limitations, though, and the desire for the freedom and independence, that you once took for granted, niggles away at the back of your mind. What if there was a way to once again to go and climb a hill, just you and your dog, wouldn’t it be great. I believe this is the spirit that drives people to want to embrace the bionic man approach and the exoskeleton.

At the moment such technology is a long way from becoming a functional reality, but even if it could one day get there, would it really be such a good idea? The vast majority of disabled people use mobility aids of some description or another. Where would we be without wheelchairs? I do not live in a wheelchair I use it as a ‘mobility aid’, but life would be unthinkable without it. I would be totally reliant upon the help of others. I also have a handcycle which my husky worked in harness with for many years. At the moment we are at a stage in my rehabilitation where it is unsuitable for me to be undertaking vigorous exercise with a handcycle, and the husky’s old and wouldn’t pull much anymore even if I harnessed her up, so these days I walk the dogs with an electric mobility scooter. I value my mobility aids, so isn’t an exoskeleton simply the logical progression of technology? After all a wheelchair won’t go up steps and even my tramper (a good off road mobility scooter) is extremely limited when it comes to climbing hills.

In terms of technology an exoskeleton may well be the logical progression, but from the human perspective the answer is no. A manual wheelchair you interact with by pushing it along with your arms, but the wheelchair does not interact with you. With a mobility scooter there is no interaction either way, it is simply a moveable platform upon which you have a seat. An exoskeleton, however, is a forced interaction with your body and that is another ball game altogether. I won’t even use a set of calipers to get me up on my feet because of the negative effect on the development of my body, despite the fact that I could probably get about reasonably well with them, and I definitely wouldn’t go anywhere near an exoskeleton for reasons that I will do my best to explain.

With the condition of paraplegia, and tetraplegia, there is damage to the spinal cord causing paralysis, in my case from the waist down. If it was simply a case of paralysis of the muscles , then propping yourself up on your feet would be a reasonable thing to do. When I left hospital following a spinal injury I was given a standing frame (we all were) and encouraged to use it on a daily basis. It was a wooden frame with straps to keep your knees locked, and then, when you haul yourself upright you fix a strap around your backside to keep you there. I persisted with it for a while, but never liked it and soon decided it would do more harm than good. What must be understood here is that a spinal injury is about far more than paralysis of the muscles. Alongside the paralysis there is catastrophic collapse of the structures of the body. Thanks to all the ABR Therapy my body is in pretty good structural shape these days, at least in comparison, however, when I was using a standing frame, in the past, this was not the case. My trunk was so depleted that my chest had collapsed down onto my pelvis. The lumbar region barely existed with the bottom of my ribcage sitting below the top of my pelvis. My pelvis, in turn, was so collapsed in upon itself that the hips weren’t properly inserted. So imagine the trauma to the body trying to force it into an upright position when it can’t even hold its own in a less demanding sitting position, and this is the case with paraplegics, tetraplegics and all severely disabled people.

Forcing a spinally injured and seriously depleted body into a standing position will cause enormous pressures on the weakened structure, particularly, in my case, at the lumbar sacral junction, the hip joints and the knees, but also along the length of the spine and throughout the trunk, none of which has the capacity to support such a demanding position. Even with straps and supports your body will inevitably use all its strengths to maintain the position, overshadowing and further ingraining the weaknesses, and if you’re not careful, further deforming the structure. Take that to the next level of strapping your body into an exoskeleton and you not only force it into an upright position, but you force it to articulate when it is not truly capable of doing so, dramatically increasing undue stress upon the structure. The depleted trunk and compressed spine will be severely overloaded, especially at the disconnection of the lumbar sacral junction. The hip joints can’t even work as the joints they should be due to their lack of insertion into the pelvis. Rather than articulate at the hips a spinally injured body simply hinges in that region with ventral tightness and overstretched dorsal tendons. The knees and ankle joints will have very little, if any, hydraulic capacity to them so will be incapable of supporting proper separation of the bones. All of this risks damage to the joints and the ligaments, over tightening of what muscles and tendons are still functioning, over stretching of others and is generally an extremely abusive way of treating a spinally injured body. Do I need to say any more, because I haven’t even touched upon the insertion of sensors into the skull!

At first glance the use of an exoskeleton may sound like a great thing to do, but when we see the reality it is something to run a mile from (metaphorically speaking). Many para and tetraplegics have no feeling in their bodies below the level of paralysis and may be blindly unaware of the damage they are doing to their bodies, but I can assure you, that even if they feel no pain in the short term, they will suffer in the long term. Furthermore, even if the technology was perfected and you could accept the damage you would be doing to your body and afford the high price tag, what do you actually achieve by using one? Last year there was a walk up Leith Hill, the highest point in South East England. It was a ‘Save Leith Hill’ walk as the natural beauty spot was under threat from the oil drillers. Maybe I could have walked it with a perfected exoskeleton, but it’s a big maybe. The last stretch is super steep with tree roots and loose sand. If you lost your balance you’d be in big trouble. All you actually needed, though, was a couple of straps on the front of your wheelchair and a few strong lads, which is exactly what I had. People to help you will get you places that technology never will, with no damage to the body and companionship to go with it. The buzz of getting to the top of the hill was great.

An exoskeleton is nothing more than a gimmick and a dangerous one at that.

One comment

  1. Hello Steve,
    I think you’re right that (re)building the structure of the body has to be done first, and after that you can use that better structure for the improvement of function.
    It’s not very likely that it will work in the opposite direction, and I think therefore your fear for ruining the body tissues and joints by walking in a exoskeleton is justified…
    Keep on building!

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