Running head: BENEFITS OF BIONICS

Benefits of Bionics:

Technology Improves Lives with Every Step

Emma London

Saint Louis University

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BENEFITS OF BIONICS

Abstract

In this paper I will address the purchasing department of University of Florida Health Shands

Hospital located in Gainesville, Florida in attempts to advocate for the buying of two Ekso

Bionics exoskeleton bionic suits. These suits have recently been developed and altered so as to

better assist the patient in regaining walking capabilities. The sensation of being upright and

walking is one that many individuals never thought they would be able to experience after a

debilitating event or disease. The paper explores the causes of paralysis and the history and

context of the Ekso Bionic suits and the benefits and functionality of the suits are explained. An

argument against purchasing the suits can be made based on the inflexibility of the equipment to

fit every individual patient, however, this is countered and refuted in support for the desire being

decreased bu those who cannot use them. This in turn lessens the pressure of the University of

Florida to purchase more than two bionic suits. Each suit costs approximately 150,000 dollars,

nevertheless, previous purchases by the University of Florida have far surpassed this price tag.

The paper emphasizes Shand’s current rankings as well as its further desire to be a top tier

hospital with pride in its technological innovations. Shands currently utilizes alternative neonatal

systems and robotic surgery mechanisms that further support the belief that the hospital should

be possessors of Ekso Bionic suits, allowing their patient population with limited lower limb

function to be able to experience walking again.

Keywords: Ekso Bionics, robot-assisted therapy, University of Florida Health Shands

Hospital, Robotic Surgeries, paralysis

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BENEFITS OF BIONICS

Benefits of Bionics: Technology Improves Lives with Every Step

There is a large population bound to the seat of their wheelchairs and bound further to the

belief that they will never walk again. For these individuals, daily tasks such as getting out of

bed in the morning, ascending staircases, cooking in the kitchen, using the restroom and getting

into a car have becoming incredibly difficult and time consuming, if not impossible. While

images of walking again were once ephemeral, hope is now growing alongside the development

of robot-assistive therapeutic devices. As modern day society has witnessed a dramatic increase

in technological advancements, the medical field is no exception. The appearance of Ekso Bionic

suits will forever change the lives of the disabled. For patients who have experienced spinal cord

or traumatic brain injuries, stroke, or disease leaving them with any level of paralysis or

hemiparesis, the benefits of bionics are immeasurable. Many clinics across the globe like

Technomex clinic in Gliwice, Poland and Magee Rehabilitation in Philadelphia, Pennsylvania

have adopted the bionic suits and the outcomes are remarkable (Ekso Bionics, 2013). As a large

teaching hospital devoted to delivering the best care possible and invested in improving the lives

of every patient, it is advisable that the University of Florida Health Shands Hospital also

provide patients with the opportunity to wear the Ekso Bionic suit in rehabilitation therapy.

The causes of wheelchair confinement are expansive and unfortunately no individual is

spared from the possibility of one day experiencing a traumatic injury leading to paralysis.

Paralysis is defined as total or partial loss of muscle functionality in an individual (“Paralysis”,

2014). Paralysis can be either partial or complete, dependent on the level of function, and when

the paralysis affects both legs of a person, it is called paraplegia (“Paralysis”, 2014). Strokes are

one of the leading causes of paralysis, yet spinal cord injuries, neck injuries, traumatic brain

injuries, nerve diseases and autoimmune diseases can all bring about paralysis (“Paralysis”,

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2014). As individuals age, they are far more likely to experience one of these causes. This alone

marks the United States as being of grand significance. The issue of wheelchair confinement and

immobility of the population is especially pertinent within this country as the baby-boomer

population is entering this high-risk period. Florida, in particular, is home to approximately 4.2

million citizens above the age of 60 years (Beach, 2011). There are more than six million

individuals worldwide living with paralysis, which equates to one in every fifty persons

(“Paralysis Resource Center”, 2014). This shocking statistic reveals the extreme prevalence and,

therefore, the likelihood that fully functioning individuals know someone with paralysis. Once a

person becomes paralyzed, their independence is incredibly weakened, hope is often lost, various

abilities become absent and personalities and behavior can experience alterations. We are all

impacted and affected by these conditions and efforts should be made to restore function and

increase quality of living.

Rehabilitation efforts for those with paralysis historically involved physical therapists

assisting in exercise techniques as well as massaging and stretching of the patient’s limbs and

muscles. As the disabled individual is unable to move their own body parts, the benefits of

manually moving these areas are obvious. There was not, however, a strong emphasis on the

possibility of being able to walk again (Chang & Kim, 2013). Approximately two decades ago,

robot-assisted therapy first entered the scene (Chang & Kim, 2013). Within these past twenty

years, development has skyrocketed as new knowledge is obtained and efficiency strived for.

While a common citizen may not recognize what robot-assisted therapy means, those within the

medical profession are becoming more and more familiar with it, if not having first-hand

experiences themselves. Robot-assisted therapy refers to rehabilitation efforts taking place while

a therapist or trained professional manipulates the mechanical apparatus so as to best suit the

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patient (Chang & Kim, 2013). One of the most highly regarded and most beneficial types of

robot is the exoskeleton.

The exoskeleton, which has been developed by Ekso Bionics as the ekso bionic suit, “is a

wearable bionic suit which enables individuals with any amount of lower extremity weakness to

stand up and walk over ground with a natural, full weight bearing, reciprocal gait” (Ekso

Bionics, 2013). The photo below illustrates a patient wearing the bionic suit transferring from a

seated position in his wheelchair to an upright and standing position with the assistance of arm

canes. The exoskeletons maintain a low-profile and are incredibly noninvasive, as revealed

below.

Figure 1. The evolution of a disabled man from his seated wheelchair to an upright standing position parallels the evolution of emotional excitement experienced by a patient using the Ekso Bionic.

The exoskeleton possesses sensors, which detect the user’s body shifts and influence the device

to initiate steps. Based on the patient’s level of comfort and experience with the bionics, there are

four different walk modes achieved (Ekso Bionics, 2013).

One of the most advantageous components of the ekso bionic is its ability to mimic

normal walking movements. As with any effort to master a skill or to learn something new,

proper techniques are strived for. Many technological advancements are faulty in this regard, and

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may overcompensate for the lacking movements of the user, thus creating impractical or

uncomfortable positions. The ekso bionic uses battery-powered motors and a high-tech computer

mechanism to collect data on the particular patient’s anticipated range of motion and gait

performance (Ekso Bionics, 2013). There are no jerky motions involved, and the suit easily

transfers over many ground types. Patients can even walk efficiently outside and on dirt or gravel

paths (“Bionic exoskeleton”, 2013). Patients also have the ability to walk up and down stairs

while wearing the bionic suits, a difficult feat for those with such limited function (Ekso Bionics,

2013). This level of versatility is important so as users are not limited solely to the clinical

environment. Patients come as close as possible to real-life situations throughout their therapy

sessions.

Another level of versatility remains in the fact that the bionic suits are designed and

produced with extreme flexibility to fit the patient’s body size and shape. It is noted that the

robots can be quickly altered and adjusted by a physical therapist to suit each individual (Ekso

Bionics, 2013). Transition between patients can take as little as five minutes, again illustrating

the efficiency within the therapeutic setting (Ekso Bionics, 2103). Many patients can benefit

from wearing the exoskeleton suit in any given day, with little effort to switch from one person

to another. At a hospital operating with as high traffic as the University of Florida has, these suits

will not only serve to benefit the patients but also the therapists and professionals. As Ekso

Bionics explicitly states, these suits were constructed with the busy therapist in mind (2013).

An argument can be made against the purchase of these bionic suits by Shands Hospital

due to the limitations placed on the weight and height of each patient. While the suits can easily

be altered for patients who fall between 5’2” and 6’4”, those outside this range are unable to use

the bionics (ReWalk, 2014). Similarly, a patient must weigh less than 220 pounds in order to be

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fully supported by the upright setting of the bionic (ReWalk, 2014). While initially this seems to

be a drawback, fewer items will need to be purchased by Shands because not every patient will

be able to use the bionic suits. In other words, this argument actually supports the movement to

acquire these devices and to provide patients with the opportunity to walk. The demand would

drastically increase if every patient were capable of using the bionics, which would therefore put

pressure on the hospital to make more purchases, causing more money to be siphoned from the

hospital.

Logistically, the price per unit will likely pose the greatest threat to the movement toward

attainment. As the Ekso Bionic company has dramatically developed since its start in 2005, the

company has increased its own purchasing and allocated more money toward its own research.

As mentioned earlier, each device is fully equipped with computer programming instruments,

providing the ability to record data throughout each patient’s session. This data is later used to

make the bionics more efficient and valuable to the target patients. That being said, each unit

costs roughly 150,000 dollars (Ekso Bionics, 2013). As extreme as this appears, if University of

Florida Health Shands Hospital decides to purchase two devices, it can be assumed that one of

the exoskeletons will be paid off in less than five years. Patients with severe injuries and/or

disabilities, requiring the need for wheelchairs and preventing them from walking on their own,

are likely to be covered under insurance plans. These individuals will only need to make a co-

payment prior to each therapy session with the bionics.

According to the American Physical Therapy Association (APTA), a typical physical

therapy session without the exoskeloton costs approximately 60 dollars to be delivered by the

patient through a co-payment (“Fair physical therapy copays”, 2014). An average session lasts

45 minutes to an hour (“Fair physical therapy copays”, 2014). For a session in which

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professionals offer the patient the chance to wear the Ekso Bionic suit, it is not unreasonable to

believe that patients would be willing to pay only three times that price. Hypothetically speaking,

if each session costs a patient 200 dollars out-of-pocket, and each patient uses the machines three

times a year, the hospital will receive 600 dollars per year, per patient. The clinics within Florida

that have already adopted the Ekso Bionic suits, serve a comparable number of patients per year.

These clinics have witnessed anywhere from 50 to 100 patients using the bionic suits. Shands

will, therefore, be paid anywhere from 30,000 dollars to 60,000 dollars annually. In five years,

one of the bionic suits will be covered in its entirety based solely on the co-payments from the

individual patients. This does not include the insurance companies’ portion of the payment nor

does this account for donations from outside sources. Adding these two resources, the bionic

suits would be paid off in far less time.

The price of these suits should not deter the purchasing department from providing this

technology to your patients. The University of Florida Health Shands is a large teaching hospital,

which receives funding from various locations. There is a great deal of grant money allocated to

areas focused on research. The bionic suits, outfitted with their research computer devices, fall

comfortably into this category. In 2012, the University of Florida received 644.4 million dollars

to fund research (Kays, 2012). As these figures are from 2012, it is assumed that the department

will have gained even more funding for the 2014 year. That being said, each Ekso Bionic

purchase only consumes 0.02% of the total allotment. Making barely a dent in the total funding,

the benefits of bionics surpass the slight financial drawback.

University of Florida Health Shands Hospital prides itself in being one of the top ranked

hospitals across the nation and should therefore be invested in bringing the most innovative care

to its patients. It is ranked extremely high in seven specialties including 23rd in urology, and 27th

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in cardiology and heart surgery (“Patient care”, 2014). UF Health Shands also holds the highest

ranking among Florida hospitals in five of these seven areas of healthcare (“Patient care”, 2014).

Shands serves as a role model for many of the smaller clinics and hospitals around the state, and

should continue this through the purchase of the innovative Ekso Bionics. Being a pioneer in the

medical field creates positive press for both the hospital and the university as a whole, as well as

providing better care to the population to improve the quality of life of the patients; the priority

of every medical care provider.

Shands and the UF Health Science Center have a close affiliation, which allows patients

to profit from the newest medical knowledge and technology (“Patient care”, 2014). As of 2004,

Shands has implemented the use of a specific cooling technique within the neonatal clinic (Reid,

2009). This technological advancement, referred to as systematic hypothermia, has allowed

doctors and surgeons to better care for their patients and minimize the amount of brain injury

incurred by the babies (Reid, 2009). This approach lowers the infant’s body temperature for 72

hours to seven degrees Fahrenheit below normal temperatures with the assistance of the control

machine and brain monitors (Reid, 2009). Urology specialists Dr. Michael Weiss and Dr.

Johannes Vieweg are strong advocates for the implementation of technological discoveries into

the care provided by Shands. Vieweg is quoted as announcing that he “think[s] UF has a lot of

highly intelligent investigators who are working to get new therapies to patients. We want to be

known as a hub for innovative therapies” (Reid, 2009). It is important that the medical center

continues this initiative and exposes patients to the benefits of bionics. Within the first five years

that the systematic hypothermia was used, only ten babies were helped (Reid, 2009). That being

said, Shands, one of the few institutions with these systems available, has insinuated that all life

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is invaluable and if the Ekso Bionics suits can benefit approximately 100 patients per year, the

support should be overwhelming and opposition slim.

Another department in which Shands put forth a great deal of money is that of robotic

surgeries. First introduced to the United States in 2001, robotic surgeries have been adopted by

many institutions allowing for “reduce[d] recovery time, blood loss, post surgery pain and

scarring compared with so-called “open surgery’ in which large incisions are made in the body to

remove diseased tissues and organs” (Reid, 2009). Having the robot and telescopic binocular

lenses reveals multifarious benefits, however, the expenditures cannot be ignored. One type of

robotic-surgery system costs anywhere from 1 million dollars to 2.5 million dollars (Turchetti,

G., Palla, I., Pierotti, F., & Cuschieri, A., 2012). The University of Florida Health Shands

Hospital had no hesitation in purchasing such excessive technologies, as it was the first location

in the United States to use such devices after gaining approval by the Food and Drug

Administration in 2006 (Reid, 2009). Furthermore, the cost of the Ekso Bionics exoskeletons are

far less than that of other technological advancements that Shands has purchased, and should

therefore be heavily contemplated by the purchasing department to be added to the list.

The innumerable testimonials of patients who have worn Ekso Bionics further support the

movement toward offering patients the experience walking again. Ekso Bionic Ambassador

Amanda Boxtel repots that “when a person becomes paralyzed, a level of their independence is

also rubbed from them. And that affects us psychologically, and our spirits. There’s a part of us

that dies” (Bionic exoskeleton, 2013). She later reveals that her life was drastically changed once

she received information on the advancement, and later walked for the first time in the bionic

suits (Bionic exoskeleton, 2013). It is crucial that all disabled individuals fight this ‘death’ and

gain the opportunity to perform the unthinkable. The University of Florida Health Shands

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Hospital should purchase two Ekso Bionic suits, benefiting both the patient population as well as

the UF community at large by maintaining status as a leader in innovative practices. The costs of

the devices, which serve as the greatest drawback, are incomparable to other technological

purchases made by the purchasing department, and patients alone will cover an exoskeleton’s

cost in less than five years. Physical therapy, which once relied solely on the medical

professional, is now taking a technological route allowing for full walking movements to be

achieved by limited patients. It is advisable for the University of Florida to continue its pursuit of

improving the quality of life of others and purchase these Ekso Bionics.

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Chang, W. H., & Kim, Y. (2013). Robot-assisted therapy in stroke rehabilitation.

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Reid, C. M. (2009, September 11). The innovators: How UF is using new technology to help

patients and save lives. UFHealth: University of Florida Health. Retrieved from

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