Complex External Prosthesis Systems to Rehabilitate Movement

Fig. 1

The instrument, a robotic assisted system as a wearable exoskeleton integrated

The design of the device was made possible by scientific collaboration among international university schools of science and technology, bringing together the world’s leading experience on robotics applied to bioengineering.

The ReAbility system consists of a wearable exoskeleton integrated with a motor activated in correspondence with the wearer’s joints, a series of movement sensors, and an IT system based on sophisticated controls and safe and secure algorithms, as well as a rechargeable battery.

The patient is actively involved and has full control of all the movement functions, through unique control processes. Walking around is controlled by variations in the center of gravity, and stability is guaranteed by the use of crutches.

In detail, the device is a motorized exoskeleton that is worn on the lower limbs either over or under clothes. The electric motors commanding the knee and hip joints, and powered by a battery carried in a backpack on the shoulders, are controlled by a computerized system that is also carried in the backpack. The exoskeleton, designed to be used with two Canadian crutches to guarantee stability, both when walking and when stationary in the erect position, is activated by sensors positioned on the front of the upper body, and controlled by the patient through slight changes in their center of gravity, or, in other words, through inclination of the upper body.

The device is available in two versions, one for rehabilitation centers, to be used during the rehabilitation treatment, and the other personalized for the patient at the end of the rehabilitation period.

Results

The device allows for multiple results.

From a bioethical and psychological perspective the person is reborn, able to determine their daily life for themselves and dedicate themselves to their preferred activities, and those who are sporty excel, with surprising results.

From a social perspective, a return to socializing and integration between equals is evident.

From a strictly medical point of view, the advantages include regaining the capacity to walk around and the prevention of complications connected to paraplegia (in particular, rehospitalization, bedsores, osteoporosis and consequent pathological fractures and muscular atrophy, spasms, and chronic pain), not to mention a net reduction in the percentage of patients abandoning their classic braces (currently between 15 and 71 %).

From an economic aspect, there are also benefits due to the great reduction in healthcare costs (it is enough to think of the costs of the multidisciplinary treatment needed for difficult wounds such as bedsores, femoral fractures, and daily physiotherapy to reduce spasticity and muscular atrophy). In the United States, the cost of medical and intensive rehabilitative treatment for those with spinal cord injuries is estimated to be ten times that necessary for tumor treatment, six times that of a heart attack and three times that of a stroke. The American Food and Drug Administration (FDA) has, accordingly, approved the principles of the ReAbility device technology.

To highlight the enormous potential that this innovation holds, we note that a young paraplegic boy wearing an exoskeleton kicked the first ball (Fig. 2) [2] at the World Football Cup on 12 June 2014 in Sao Paolo, Brazil, thereby symbolically kicking off the great sporting event.

Fig. 2

The first ball that a young paraplegic boy wearing an exoskeleton kicked on 12 June 2014 at the World Football Cup in Sao Paolo, Brazil

Discussion

Advantages of the Device

We can offer paraplegic patients and those with serious paraparesis the opportunity to discover the sensation of standing and walking once more. In fact the exoskeleton enables people with disabilities of the lower limbs to reinstate the lost functions, and thereby improve their physical health and quality of life.

The principal characteristics of the device are modularity, manageability, and wearability for the patient. Its light weight (16 kg) renders it easy to wear for the patient without help and makes it competitive on the market. From an esthetic perspective it can be worn under clothes, with obvious and important psychological and social advantages. The instrument is thus innovative, modular, light, flexible, and easy to use. The cost is also well contained.

There is also a very real positive effect on healthcare costs: in fact, on the one hand the device reduces the need for physiotherapy and rehospitalization caused by immobility, which many patients are constricted by, and on the other hand, by maintaining the patient in a vertical position daily, it alleviates many of the problems caused by long-term wheelchair use.

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