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In January, Adam Gorlitsky completed the Charleston Half Marathon while using an exoskeleton, breaking his own Guinness World Record time set the previous year.

Following a 2005 car accident, Gorlitsky was told he would never walk again. But a decade later, a chance discovery of an exoskeleton set his life on a new course.

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After learning to use one of these cutting-edge medical devices, Gorlitsky challenged himself to complete a 10-km race. Then he kept going. The marathon completions started piling up, as did the world records. To date, Gorlitsky has competed in nearly 50 such events, determined to take 1 million total steps to call attention to the value of exoskeletons for the paralysis community. His mission even led him to the standards world – with Gorlitsky speaking at the 2023 ASTM International Exo Games organized by ASTM International’s Exo Technology Center of Excellence (ET CoE).

Exo technology has continued to make strides since Gorlitsky’s first race in 2016. A few years ago, this technology may have sounded like something from a sci-fi movie – even to ASTM members. But meeting conversations are shifting according to Rita Vazquez-Torres, CEO/senior technology strategist of New Stone Soup VT LLC and a founding partner of the ET CoE. “I have a rule,” she says. “Whoever brings up Iron Man has to put money in the swear jar.”

More needs to be done to quiet the Hollywood talk altogether. Growth is especially important for medical exoskeletons, which have a high potential to benefit many people experiencing disability, illness, or injury.

At ASTM, the ET CoE has been particularly instrumental in accelerating the adoption of exo devices. Their recently published survey on the usage of medical exoskeletons is just one example, identifying who is using these devices – and what can be done to get the word out to others.

Medical Exo Technology

According to the standard terminology for exoskeletons and exosuits (F3323), an exoskeleton is a “wearable device that augments, enables, assists, and/or enhances physical activity through mechanical interaction with the body.” Exo technology varies significantly in terms of complexity and function. It can range from soft, unpowered devices that resemble braces, to electrified full-body equipment that provides considerable assistance or protection to the user.

Medical exoskeletons are being used by patients in clinical settings and as a form of assistive technology. They can increase a wearer’s mobility and stability, allow them to participate in physical therapy, or provide an opportunity to return to work and engage in social activities with greater independence.

“Currently the main focus for the use of medical exoskeletons is people who’ve experienced spinal cord injuries, who are paralyzed to some degree, complete or incomplete paralysis,” says Matthew Marino, CEO of Prime Performance LLC and another founding partner of the ET CoE. “There are also applications for patients who’ve experienced stroke and are post-stroke, doing rehab. There are other areas where the devices may have great potential application, like multiple sclerosis, cerebral palsy, Parkinson’s disease, ALS, and other types of neurological and orthopedic issues.”

Marino adds that exo devices could be transformative for many individuals.

“If people can get up in an exoskeleton and they don’t have to hold stuff in their hands, they are free to shake hands with friends or have a drink with a buddy at the bar,” Marino says. “That’s the direction that I hope to see these things go for grown-ups and children – in the direction of promoting independence and health.”

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There have been recent signs that medical exo technology is beginning to catch on. In November 2023, the longstanding Medicare definition of braces was clarified to include certain exoskeleton-type devices, potentially making exoskeletons more affordable to a wider range of patients. That same month, a bill was announced that could expand access to medical exoskeletons for veterans with spinal cord injuries/disabilities. And in January, researchers from Harvard and Boston University published a Nature study showing how soft, wearable robotic apparel might avert freezing of gait (FoG), one of the biggest contributors to falls among people with Parkinson’s disease.

According to William Billotte, Ph.D., executive director of the ET CoE, we are just seeing the tip of the iceberg. “There is a lot of excitement around the medical area,” Billotte says. “There’s absolutely a market out there.”

Learning and Educating

Despite their potential, medical exoskeletons are still an emerging technology, and there are many developments needed to facilitate widespread adoption of these devices. In order to better understand who is using medical exoskeletons, the ET CoE developed a study titled “Global Survey of Healthcare Professionals Using Medical Exoskeletons,” published in fall 2023.

According to Vazquez-Torres, the guiding questions of the study were simple: “Are exoskeletons being used? Where are they being used? How are they being used?”

The project was led by Vazquez-Torres and Marino, along with the third founding partner of the ET CoE, Bobby Marinov, co-founder of Exoskeleton Report. The survey targeted physicians, physical therapists, occupational therapists, prosthetics/orthotics professionals, and clinical researchers, aiming to understand their experiences and perceptions.

In the end, the survey produced several interesting results. Respondents indicated that exoskeletons are being used in medical applications. They also reported using these devices with a wide range of patient populations, including adults experiencing spinal cord injury, stroke, acquired brain injury, and traumatic brain injury, as well cerebral palsy, amyotrophic lateral sclerosis, Parkinson’s disease, and more. Importantly, 74% of respondents rated medical exoskeletons as having a high potential to improve a patient’s quality of life.

“It was pretty encouraging as far as people seeing potential for these devices to help improve the quality of rehabilitation in some cases,” Marino says. “It seems that people felt like they were safe to use and effective for the people using them. They also may have a benefit for the treating therapist.”

The survey also made clear that there are areas where growth is required to bolster the adoption of medical exoskeletons. According to the results, it will be important for the public to have access to affordable and practical devices, for medical practitioners to feel confident employing these devices, and for patients to trust them.

Additionally, 78% of survey respondents reported that the level of education about exoskeletons was low across their professions. Education is a major refrain in discussions of this technology. Marino, Vazquez-Torres, and Billotte were in unilateral agreement that greater awareness is one of the core priorities for helping to accelerate medical exoskeletons.

“There’s a lot that can be done,” Vazquez-Torres says. “We’re getting to a good point where we can start an education process, to let people know that these capabilities are out there. The news is starting to come out. But there is a population that does not know these technologies exist. Part of the education process is to change people’s mindset. To help with educating about what these devices can do and help the market find a way to promulgate exoskeleton technology.”

There are many ways people are working to educate the public about exo technology, from Gorlitsky’s historic accomplishments to broader discussions in the media. Standards represent one key avenue, helping to ensure confidence in exoskeletons and push commercialization forward.

“The more we can get standards out there for all types of exoskeletons, not just medical ones, the more that will build trust and confidence in the market,” Billotte says. “It’s an exciting area right now, and I think it’s just going to grow.”

 JP Ervin is content editor for Standardization News.