Exoskeleton "What is it?": The word exoskeleton comes from the Greek and includes the words "exo" (outside) and "skeletos" (desiccated body). An exoskeleton (also called a robotic suit) is a scaffold, usually mechanical and motor-assisted, that is attached to the outer body of a human and serves as a support corset for the wearer. Exoskeletons will also become more popular in the future under the heading of augmented mobility.
Short and sweet:
Exoskeletons can enhance the performance of unimpaired users and restore movement to individuals with walking disabilities.
The animal kingdom served as the engineering template for biomechanics, as primarily limbed animals use exoskeletons, including crustaceans and arachnids, since limbed animals do not have an internal skeleton, but use this type of exoskeleton (external skeleton) for stabilization. Probably the first recorded attempt to build a modern mechanical exoskeleton was the Hardiman, an unsuccessful experimental prototype built by General Electric in 1965. The Hardiman was intended to allow the user to carry loads weighing up to 680 kg. However, the user was unable to control the exoskeleton, so the project was abandoned. The Fraunhofer Institute for Production Systems and Design Technology was the first research institute in the world to succeed in developing a walking simulator called "HapticWalker," which is intended to enable stroke patients to relearn how to walk. The first exoskeleton without drive was patented by the Russian inventor Nicholas Yagn back in 1890 It consists of two leaf springs arranged parallel to the legs to improve the walking speed of infantry.
Development until today:
Among other advances in the late twentieth and early twenty-first centuries, funding from the U.S. Defense Advanced Research Projects Agency's (DARPA) Exoskeleton for Human Performance Augmentation Program 6 enabled the development of wearable lower extremity robots (specifically, the Berkeley lower extremity exoskeleton and the Sarcos Guardian XO to increase strength and reduce effort during load transport). The technology was then adapted to other fields, including rehabilitation and industry.
The exoskeleton functionality easily explained: Today's exoskeletons are easy to assemble and are used in Industry 4.0 as a form of occupational health care as well as in medicine. Specifically in medical rehab (rehabilitation), these motor-assisted exoskeletons are used for the lower extremities. For example, patients with paraplegia, multiple sclerosis or paralysis after a stroke can benefit from training with the system.
There are exoskeletons upper body systems and exoskeleton robots for legs as well as exoskeleton gloves.
In medical rehabilitation, e.g. in rehabilitation clinics, exoskeletons are limited to temporary local treatments. Here, for example, they serve as a training device for the duration of the inpatient or outpatient rehab measure.
Thanks to technical developments in the form of improved drive technology and long-lasting batteries, exoskeletons are now also used for personal use. Wearers can thus stand and walk independently again and become more independent of third parties. These modified exoskeletons are suitable for permanent use and personal use in the private everyday environment and are now also used there.
In medical practice, especially after a spinal cord injury, an exoskeleton can be a valuable addition to the provision of assistive devices. This is particularly true if the structural and functional properties of the neuromuscular and skeletal system are impaired to an extent that makes mobilization with the aid of an orthosis difficult.
For patients with complete paraplegia, exoskeletons are considered as an alternative solution to orthoses, especially if the lesion level is above the thoracic vertebra. This enables improved mobility and independence for the affected person.
Even in patients with incomplete paraplegia, orthoses can help to promote the patient's own activity as much as possible, even for lesion heights above T12. This is an important prerequisite for increasing the chances of success of mobility measures.
The structure of an exoskeleton varies depending on the area of application and the specific body region that needs to be supported. Exoskeletons can be divided into two basic types in terms of their power support: passive and active exoskeletons.
While active exoskeletons provide their power assistance electrically or pneumatically, this happens mechanically with springs in the passive variants. Passive exoskeletons do not require an external energy supply. For active exoskeletons, a distinction is made between batteries or gas cylinders to be carried along and stationary supplies such as the power grid or compressed air systems.
Exoskeletons are available for hands, arms, shoulders, trunk and legs.
Exoskeletons are divided according to their support function: those for strength support, those for increasing the wearer's endurance, and those for higher movement speed.
Active exoskeletons weigh significantly more than the passive ones. They start at 15 kg to 25 kg.
Lightweight, passive exoskeletons are often used to correct posture (when lifting or sitting) or to support the weight of tools during overhead work. Active exoskeletons offer the possibility of relieving the wearer during lifting work.
Passive and active exoskeletons are revolutionizing the world of work and enable considerable energy savings by providing targeted support when moving loads. The primary area of application for these exoskeletons is in monotonous work where constant weights have to be handled.
Compared to passive exoskeletons Active exoskeletons powered by an external energy source, which makes them more dynamic and versatile. These exoskeletons are characterized by their ability to receive a continuous supply of energy and thus perform a wide range of tasks. The main difference between passive and active exoskeletons lies in the type of energy supply. Passive exoskeletons are limited to mechanical support, while active exoskeletons are powered by an external energy source and thus offer extended functionality.
In both cases, they help to reduce workload and increase worker efficiency, making them a promising technology in various industries.
Basically, exoskeletons can be divided into three types in terms of their type of power support:
Passive exoskeletons support the wearer by means of mechanical aids such as spring or cable systems. Energy is stored mechanically by means of springs, and the potential energy with which the springs are preloaded when a body part moves in a certain way subsequently assists the employee in moving in the opposite direction. They therefore do not require the use of motors and sensors, are usually lighter or quieter, and are significantly easier to set up.
Active exoskeletons create active mechatronic force support for single or combined physical loads. Since they are operated pneumatically or by motors, are powered by electricity and are usually modular and expandable, they have a much higher complexity, weight and instruction. The energy supply for active exoskeletons is usually electrical. Either there is an integrated battery in the support structure or the exoskeleton is directly connected to the power grid. In addition, the drive can also be pneumatic.
A passive exoskeleton draws its energy from the pre-tensioned spring mechanism or from the tension of a rubber band, which is returned in the opposite direction by the user's effort after each support. This process results in an efficient redistribution of force, which is available again for the next load movement. This innovative technology enables the load to be harmoniously adapted to the natural movement sequences of the human body. The exoskeleton supplements human strength when lifting above the head and supports the musculoskeletal system, particularly in the shoulders and arms. During the downward movement process, the actuators of the passive exoskeleton are re-energized by the user in order to be ready for the next lifting process.
The effective support force of the passive exoskeleton is limited by the force applied by the user to pretension the system. For more demanding tasks, such as moving heavy loads, this requires correspondingly higher pre-tensioning forces. However, this constant tensioning and relaxing of the exoskeleton can be tiring for very monotonous and repetitive movements. In such cases, it is recommended that the exoskeleton is only used for activities of up to 45 minutes of continuous use to ensure that the exoskeleton can adequately counterbalance the weight of the tool being lifted. This not only ensures the effectiveness of the exoskeleton, but also the comfort and health of the user during use. The ability of the passive exoskeleton to support human performance holds great potential for various applications, from heavy industry to healthcare.
Often, the preload is variable and can be individually adjusted in terms of force level and maximum spring force using knurled nuts or tools. This allows the support characteristics to be adjusted, but not during the work process. Depending on the structure and system design, the passive exoskeleton must be removed and partially converted for this purpose, which is time-consuming and often impractical.
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Copyrighted by Tom Illauer
Scientifically, exoskeletons are studied in rehabilitation robotics and empirically researched at many universities. Especially for therapeutic purposes it is part of an interdisciplinary research field. Feel free to visit our studies and researching universities section for lists and contacts. You will find an exoskeleton use overview in our overview.
The choice of the right exoskeleton depends on various factors, including the Manufacturer and the specific solutionthat you need. Likewise, the intended Application area and your individual diagnoses or general conditions play an important role. It is crucial how you wear the exoskeleton in order to reduce back pain, for example.
Below you will find a detailed breakdown of the criteria and recommendations for choosing the right exoskeleton:
Type of support: Exoskeletons can support one or both legs, depending on the patient's needs. There are models for people who are still able to walk independently, as well as those for people who can no longer walk.
Skeletal condition: The patient's skeleton should not have any fractures to ensure that the exoskeleton can be used.
Bone density: A healthy and sufficiently strong bone density is of great importance in order to safely bear the load of the exoskeleton.
Physical condition: The patient should be in good physical condition to cope with the demands of the exoskeleton.
Body size: The patient's height should be between 160 cm and 195 cm to ensure that the exoskeleton fits properly.
Weight: The patient's weight should not exceed 100-120 kg to ensure that the exoskeleton functions effectively and safely.
The exoskeleton systems are primarily designed for people with complete or incomplete paraplegia who can support themselves on crutches. It is important that the bone density is sufficient and that the range of movement of the individual joints (hip, knee, foot) meets the requirements. Regular standing training, for example with a standing table or standing wheelchair, can be beneficial in advance to improve the stability of the cardiovascular system and trunk control.
Before using an exoskeleton, a clearance from the attending physician is required to ensure suitability for testing. In addition, a current measurement of bone density, ideally in the form of a DXA measurement on the thigh, should be carried out to ensure the safety and effectiveness of the exoskeleton. Adherence to these criteria and recommendations is crucial to ensure the best possible support and safety from an exoskeleton.
The use of an exoskeleton should be avoided if patients fulfill the following criteria:
Severe neurological injuries: Exclusive spinal cord injuries (such as multiple sclerosis, cerebral palsy, amyotrophic lateral sclerosis or traumatic brain injury). In such cases, use of the exoskeleton is not recommended, as the specific requirements of the patient may require a different type of support.
Heterotopic ossification: If the presence of heterotopic ossification is known, the exoskeleton should not be used. This bone formation outside the skeleton can impair the function of the exoskeleton.
Psychiatric or cognitive disorders: Patients with psychiatric or cognitive disorders that could affect the proper operation of the exoskeleton should not use the device. Safe use requires adequate mental capacity and cognitive abilities.
Significant contractures: If patients have significant contractures, the use of the exoskeleton is not recommended. These muscle shortenings can impair the functionality of the exoskeleton.
Pregnancy: Pregnant women should refrain from using an exoskeleton in order to minimize possible risks for the mother and the unborn child.
Serious concomitant diseases: The exoskeleton should not be used if patients suffer from serious concomitant illnesses such as infections, circulatory disorders, heart or lung diseases or pressure ulcers. These conditions can impair the patient's ability to bear weight and increase the risk of complications.
Severe spasticity: The use of the exoskeleton is not recommended if severe spasticity is present, which is rated as grade 4 on a scale such as the Ashworth Spasticity Scale. Muscle stiffness can hinder movement in the exoskeleton.
Unstable spine or unhealed fractures: If the patient has an unstable spine or unhealed fractures in the limbs or pelvic area, the exoskeleton should not be used. The stability of the skeleton is crucial for safe use.
Compliance with these criteria is essential to ensure the safety and effectiveness of exoskeleton use. Patients and healthcare professionals should carefully review these guidelines and consider individual needs and limitations.
Potentially, the aid can simplify the following activities: (Please read studies and seek advice from your doctor! According to manufacturer's information:)
Personal use systems are lightweight, body-worn exoskeletons with motors at the hip and knee joints. The user controls the movements with slight shifts of his center of gravity. Using a sensor, forward flexion of the upper body is sensed by the system, which initiates the first step. A repeated shift of the body weight initiates a series of steps that mimics the normal movement of the legs.
An exoskeleton is a mechanical framework that is attached to a person's external body and acts as a type of support device. The term "exoskeleton" originated in Greek and literally means "outside" (exo) and "desiccated body" (skeletos). This concept was originally inspired by limbed animals such as crustaceans that use an external skeleton for stabilization. Biomechanics has further developed this concept.
Nowadays, motorized exoskeletons are already used in medicine, especially in the field of orthoses. In medical rehabilitation, motorized exoskeletons are used for the lower extremities. People with paraplegia, multiple sclerosis or paralysis after a stroke can benefit from training with such systems. Until now, these devices have often been used for temporary local treatments, for example during an inpatient or outpatient rehabilitation measure.
Thanks to advances in drive technology and battery technology, it is now possible to develop exoskeleton systems that can be operated independently by users and enable them to walk unaided. Such exoskeletons are suitable for permanent use in private everyday life and are now being applied in this context. Furthermore, numerous occupational solutions exist, especially for workers in the fields of logistics, care and crafts. These solutions mainly focus on relieving the back and the upper part of the body, and products are also available that support reaching or sitting.
Motor mechanics specifically relieve and causally support the areas from the back to the knees.
The cost exoskeleton models vary greatly. This depends on the case of the individual. The health insurance company for, for example, training in a rehabilitation center, the health insurance company for, among others, paraplegics, company health insurance companies and company cooperatives for occupational integration, pension insurance companies, etc. come into question. The probability of a positive decision increases with the probability of disability compensation. Furthermore, it plays a role whether the exoskeleton is to provide cosmetic or functional support. Most exoskeletons (except ReWalk) do not have an assistive device number, which in turn makes the application process more difficult, though not impossible. However, there are a few providers of exoskeletons with certified permission to bill the exoskeleton as an aid with the aid number (23.29.01.2001 and 23.29.01.3001) to health insurance companies or long-term care insurance companies.
Alternatively, there is also a stair-climbing wheelchair with aid number in the premium range called Scewo.
You want to buy an exoskeleton? The cost of an exoskeleton averages five to six figures. The common exoskeleton prices for personal use are settled on average with at least 100,000 EUR. If your insurance company approves your application, you will only have to pay your statutory co-payment up to a maximum of €10. You would like to borrow an exoskeleton? This is also possible. You can rent the exoskeleton, whether exoskeleton with motor or exoskeleton without motor.
This depends specifically on the manufacturer, the model, the wearer and the training course. In principle, you can achieve a walking speed of up to 4 km/h with exoskeletons.
The positive effect of exoskeletons has been analyzed and proven in numerous studies. Here you can find more information about the studies. They are also listed for you below.
This depends specifically on the model and the area of use. Military exoskeletons usually have a significantly higher load capacity. However, exoskeletons should always be protected from extreme sunlight (- 15 to 45 degrees Celsius). Furthermore, direct contact with fire, embers and heat should be avoided.
An exoskeleton can be a very effective tool for relieving heavy physical activities, for example the back.
In the field of medicine, a clear no. In the field of industrial use, "yes", because they relieve rather than increase the own performance, nevertheless, exoskeletons in Industry 4.0 improve the ergonomics of the employee and thus increase employee satisfaction, which most employers find performance-enhancing.
This depends on the model. Industrial exoskeletons can be put on and taken off in under 30 seconds. Medical exoskeletons can be used within a few minutes (approx. five minutes).
Industry:
The wearing time of exoskeletons is not limited. Due to the simple donning and doffing, exoskeletons can be easily taken off in the meantime, for example when rotating workstations or during breaks.
Medicine:
The wearing time of exoskeletons is limited. It is recommended to always take longer breaks and not to exceed the wearing time for several hours at a time.
The fabrics of an exoskeleton are removable and washable, which enables their reusability. The technology can be easily cleaned with a damp cloth.
It is recommended to use the exoskeleton individually and personally to ensure the best possible effectiveness through precise fitting on the device.
In addition, for hygienic reasons, it is not recommended to give the device to another user.
In total, we have more than +90 Manufacturer of exoskeletons listed. Feel free to read our overview by application, diagnosis, industry, etc. Here are a few examples, leading in Germany in our opinion are OttoBock, Keeogo, ReWalk and Myomo. Exoskeletons with propulsion are currently being developed in the USA, South Korea, Japan and Germany, among others. Usable models have been developed first by military-related institutions since the beginning of the millennium, but there are no reports of deployments yet. We have listed the following exoskeleton suppliers and exoskeleton companies, among others:
An overview of all manufacturers with filter options can be found in our Exoskeleton Manufacturer Overview.
According to the German Statutory Accident Insurance: "Employers are also obliged to carry out a risk assessment. As a result, protective measures including instructions must be derived and implemented. In particular, the protection goals and requirements of the Ordinance on Industrial Safety and Health and, if applicable, the Ordinance on Safety and Health in the Use of Personal Protective Equipment at Work must be taken into account."
The commercial trade association Berufsgenossenschaft Handel und Warenlogistik in Germany rates the use of exoskeletons by employees in their industry as "an exciting innovation, but one that still needs development work."
It is essential to get intensive advice before ordering, because the following problems could occur:
The skeletal system in organisms plays a crucial role in supporting and protecting the body. There are two basic types of skeletons: the endoskeleton and the exoskeleton. The endoskeleton is an internal, hard part of the body, while the exoskeleton forms a hard, external protection. To take a closer look at these two types of skeletons, it is important to understand the origins and characteristics of each type.
The endoskeleton forms the inner hard frame of the body. It is assigned to selected organisms, in particular vertebrates such as mammals, birds and fish. This skeleton consists of living tissues, especially bone and cartilage. These tissues provide support, protect vital organs and enable movement. The endoskeleton develops from the endoderm, one of the three primary germ layers that appear in the very early stages of embryonic development.
In contrast, the exoskeleton is a hard external protection that surrounds the body. This exoskeleton is found in organisms such as arthropods, which include insects, crustaceans and spiders. In contrast to the living tissue of the endoskeleton, the exoskeleton consists of a rigid outer layer, often made of chitin or calcium compounds. This external shell provides protection and structural integrity for the organism and enables movement. The exoskeleton develops from the ectoderm, the outermost of the three primary germ layers.
It is important to note that the hydrostatic skeleton is another type of skeleton found in worms. It is based on a water system that allows the worm to maintain its shape through the expansion and contraction of fluids in a muscle-filled chamber.
Overall, endoskeletons and exoskeletons differ not only in their position in the body, but also in their composition and function. While endoskeletons contain living tissues such as bone and cartilage, the exoskeleton consists of a non-living, hard outer layer. These differences reflect the adaptations that different organisms have evolved to best cope with their lifestyle and environment.
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Advantages of exoskeleton human: exoskeleton disadvantages
Exoskeleton Disadvantages:
Yes! After a non-binding consultation, you have the opportunity to try out the exoskeleton on site in your area with a certified partner. We will gladly obtain offers, depending on the exoskeleton use, and create an exoskeleton Germany partner list in your area. So before you order the exoskeleton, check the exoskeleton cost coverage and get intensive advice from us, your therapist, doctor or BG.
Visit our opposition service with certified specialist lawyers, here you will also find an overview of all current BGH and court decisions on the subject of exoskeletons.
Exoskeletons are only one solution of many, because automation could also make exoskeletons superfluous. In work areas with stationary workstations, these can be ergonomically designed in most cases so that exoskeletons can be dispensed with. Furthermore, there is the risk assessment whether exoskeletons can be used at all. Exoskeletons are expensive and not maintenance-free. Also, exoskeletons cannot be ISO free. It would be conceivable to classify them as technical aids in accordance with Directive 2006/42/EC (Machinery Directive). In this way, binding protection targets are described. These can already provide indications for the avoidance of hazards to safety and health when using exoskeletons. In Germany, this EC Directive is implemented into national law by the Ninth Ordinance to the Product Safety Act (Machinery Ordinance - 9th ProdSV). Malfunctions cannot be completely ruled out, especially with active exoskeletons with electronics or with pneumatic drives. When using an exoskeleton, hazards can arise in connection with tripping or falling accidents. In addition, it must be questioned in what way it is possible to escape quickly and safely from a suddenly occurring dangerous situation with an applied exoskeleton. The considerable dead weight of some models, for example, could be critical.
Exoskeletons support and reinforce movements so that people can walk and stand again. Joints are driven by servo motors. The exoskeleton design depends on the passive or active use.
The term "exoskeleton" stands for an external structure. With the help of this external structure, which mimics the musculoskeletal system, forces can be redirected and sensitive areas of the body can be protected. An example of this is the lumbar region, which is particularly susceptible to disc problems.
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