Exoskeleton suits: can "superhuman" frames cross into the mainstream?

Wearable machines are gaining approval from medical insurers and state health providers

Companies that make exoskeleton suits are hoping the devices might soon become as commonly provided as wheelchairs.

Private medical insurers and at least three state health providers have agreed to cover the cost of the cyborg-type wearables for people unable to walk.

Germany made a landmark decision this year when it registered exoskeletons – normally prohibitively expensive at prices in the tens of thousands of pounds – on its official list of medical aids, providing a degree of obligation on insurers to pay.

In Italy, the Israeli-made ReWalk suit was added to a state-run workplace insurance body. The US Department of Veterans Affairs has expanded its policy to include the devices at private rehabilitation clinics for veterans with spinal cord injuries.

The trend is expected to continue in 2019, and other countries are in talks on whether to include the devices in their policies, according to ReWalk.

Exoskeletons – powered mechanical frames that wrap around parts or all of the body – have promised superhuman abilities including faster movement and strength, and are tipped as a future mainstay in the military and construction field.

Companies developing the products say the technology is more likely to move into mainstream markets through medical use, such as rehabilitation for stroke victims or as a fully automated walking aid for people who have been paralysed.

While the kit is expensive for most, the manufacturers hope insurers will increasingly accept the cost as they might with metal hip implants or pacemakers.

So far, commercial insurers have done so on a case-by-case basis, and they keep the data private. But ReWalk said its cover came from 38 different providers and said one of the top five insurers in the US was in the final stages of review. It did not name the firm.

Larry Jasinski, ReWalk’s CEO, said public and private insurers were increasingly covering the product, either for the entire device or to supply it as a physiotherapy aid.

“The German one is the ideal example – they really led the way,” he said by phone. The Dutch and French governments are undergoing policy considerations, as well as New Zealand and Australia, ReWalk says.

A significant development came in 2014 when the US Food and Drug Administration approved the ReWalk, affording clout to insurance claims.

Others have refused to cover the cost but at least one claimant, a surgeon with a spinal injury, had a success when an external independent review overturned his health plan’s initial denial and deemed the suit medically necessary.

Indego, another exoskeleton made in the US, said in an email that it was also covered by some policies in the US and Europe. RSA Insurance Group in the UK has been looking at how providing exoskeletons might, in fact, reduce total costs as the rehabilitation success means patients might be out of care soon, helping claimants to get self-dependent much faster.

Jasinski said ReWalk was now working on a lighter, cheaper design that would not fully support a human body but still provide assistance. Unlike the sturdy, metallic exoskeleton, the “soft-suit” will be made of fabric, small motors and cables and is designed for people who retain a degree of mobility but need extra help.

“For someone who has had a stroke, or somebody who has had multiple sclerosis, or someone who has Parkinson’s, they can actually still stand,” he said. “They don’t need a device to hold them up, they just need assistance to walk. It’s roughly one-seventh of weight and size of the current product and one-seventh of the cost.”

The suit, currently named Restore, could be on the market in mid-2019; the company said it would be covered in clinics once available.

“Frankly, from a financial point of view, it’s more than likely our other products are going to have more to do with our financial success, even if they are not quite as dramatic a product,” Jasinski added.