Ekso exoskeleton for rehabilitation in people with neurological weakness or paralysis

The technology described in this briefing is the Ekso GT robotic exoskeleton. It is a motorised orthosis device for use in rehabilitation activities for people who have weak or paralysed legs and sufficient arm strength to use crutches. It is intended to help people to relearn to stand and walk.

The innovative aspect is the SmartAssist software that is incorporated in the device. This allows physiotherapists to set the power for each leg independently to best suit the user. Multiple patients can use each Ekso GT robotic exoskeleton, with it being adapted to their specific needs.

The intended place in therapy would be instead of, or in addition to, existing rehabilitation activities including physiotherapy, exercise, strength training, walking therapies with or without support, and functional electrical stimulation.

The key points from the evidence summarised in this briefing are from 1 systematic review and 5 case series, involving a total of 41 patients in a rehabilitation setting. After using Ekso, these patients were able to walk without assistance from physiotherapists and their walking speed and distance increased. No serious adverse events were reported.

Key uncertainties around the evidence are that the included studies were done outside the UK so the results may not be generalisable to the NHS. Also, the studies were small and non-comparative.

The cost of the Ekso GT exoskeleton is £98,000 per unit (excluding VAT), which includes staff training, software and all supporting equipment but not ongoing maintenance and support costs. The resource impact is currently unclear because of a lack of evidence.