Designing for dignity: Ekso Bionics’ robotic exoskeleton gives hope and strength

A quick glance at the objects that surround us will reveal the integral role that technology plays in our lives. It is easy to see how connected we are to technology and by technology - society's amalgamation with technology is often evident in phrases like "they are surgically attached to their phone". While hyperbolic, these do have a vein of truth to them. Design, art, architecture, and visual culture have evolved to accommodate these changes. However, it would be a fallacy to state that these modulations have universal applications. We have to acknowledge that when we design, we design for an able-bodied individual. At a TED Talk in 2018, architect and writer John Cary pointedly claimed, “Dignity is to design what justice is to law, and health is to medicine." We often forget the significance of a statement as simple as this, unintentionally creating an ‘other’ through our design. Buildings, public transport and cities continue to be designed for fully abled-bodies. This has led to an interesting new market directed towards enabling differently abled bodies to adapt to these designs. Combining Cary’s ideas of dignity and health, for what many may consider an exclusive clientele, is Ekso Bionics’ robotic exoskeleton. There is more acceptance towards seeing an individual in an exoskeleton or with bionic limbs than it is to see a wheelchair user.

Founded in 2005 in Richmond, California, Ekso Bionics was set up in collaboration with the Berkeley Robotics and Human Engineering Laboratory of the University of California. Set up primarily to enhance and further explore the potential of human exoskeletons, these wearable robotic armours amplify the human body by supporting or enhancing strength, endurance and mobility, with applications in both medical and industrial sectors. One of their initial innovations, the Human Universal Load Carrier (H.U.L.C), was designed to allow people to lift loads of up to 90 kg. Its applications far exceed the tenets of medical use and has since been undertaken by the US Military for further development. This anthropomorphic technology and form brings us one step closer to the imagined futures of amalgamated human and robotic bodies like the ones seen in Avatar and Fullmetal Alchemist.

By 2010, the company presented its first exoskeleton for patients with paralysis of the lower extremities. Initially known as eLegs, the exoskeleton was worked on and is now known as EksoNR. Designed as a therapeutic gait training mechanism, EksoNR helps individuals with paralysis because of strokes, spinal cord injuries, multiple sclerosis (MS) and cerebral palsy (CP) or other neurological disorders, and can be tailored based on individual rehabilitation requirements. An earlier iteration of this lower body exoskeleton, EksoGT, has completed 65 trials investigating the application of the mechanism on people who have limited mobility. In total, more than 1800 patients are involved in the ongoing and completed trials. One of the prerequisites, however, is that the patients must have some residual muscle function, this then enables them to use their own muscle strength.

So while the equipment is executing the bulk of the movement, the patient is not just moved passively, but can actively walk using the strength they still possess. They further expanded on their mobility-centered medical portfolio by introducing EksoUE, an exoskeleton that works as a rehabilitation tool for the upper extremities. The wearable upper body exoskeleton assists patients to further enhance their upper body movement and widen their range of motion and increase their endurance. While EksoNR and EksoUE are wearable technology, it is not the same as buying a smartwatch. The products require an intense and detailed two-phase training programme. Working with more than 270 rehabilitation clinics and hospitals, the training programme includes working with physical therapists maintaining an element of human to human interaction.

What constitutes a normal body? With the contemporary discourse surrounding universal design principles, the innovations and products created by Ekso Bionics, does highlight the journey we still need to take in order to create spaces with the intention of ‘access for all’. As a technology, the exoskeleton is an important mechanism towards enabling and including a larger group of individuals who are often left homebound. The differently abled body is no longer restricted as medical science and engineering coexist in an interesting collaboration. Not only empowering and benefiting humans who have endured injuries, but also with the data collected by Ekso Bionics, which helps us further understand how the human body works. In a recent development Ekso Bionics was able to get FDA approval in the United States to work on an exoskeleton directed towards individuals with brain injuries. These developments have larger implications beyond the physical advantages. An analysis of this data would help us understand and discover aspects of the human brain that we are yet to discover. However, it continues to be important to keep in mind that in order to address inclusion and increase visibility of the differently abled-body, will also require a systemic change, which goes beyond directed products.