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Health & Exercise Forum

Use of Exoskeleton Suits for Gait Training

Jul 22, 2019

Special Feature “ Health & Exercise Forum” with Geisinger Commonwealth School of Medicine the 3rd Monday of every month!

Mary M. Pelkowski, Joseph Hornak, & Cecelia Allison

Mary Pelkowski, MD2 is a student in the Geisinger Commonwealth School of Medicine MD Class of 2022. She grew up in Sayre, PA and graduated from Notre Dame High School. She received her undergraduate degree in biology with a minor in chemistry from Saint John Fisher College in Rochester, NY.

Joseph Hornak, MD received his Doctor of Medicine from GCSOM in May 2019. He grew up in Hazelton, PA. and will train as a resident in Physical Medicine & Rehabilitation at University of California, Davis in Sacramento, CA. Following residency, he plans to pursue fellowship training in pediatric physiatry. Currently, he resides in Allentown, PA, where he is completing his internship year at Lehigh Valley Cedar Crest Hospital.

Cecelia Allison, MD2 medical student at Geisinger Commonwealth School of Medicine. Cecelia grew up in the South Hills of Pittsburgh and graduated from the University of Notre Dame with majors in Neuroscience and Spanish. In her free time, she enjoys practicing yoga and traveling to new places.

Military exoskeleton suits are reality’s version of Marvel’s Iron Man suit. Just as Tony Stark used his suit’s superpowers to fight evil, the military Raytheon XOS 2 exoskeleton suit uses high pressure hydraulics to enhance the wearer’s strength, agility, and endurance. In fact, one soldier in this suit can perform the same amount of work as three army personnel. This has allowed soldiers in the U.S. army to achieve extra-human functions and prevent injuries and strain on their bodies. Industrial exoskeletons use the same design to prevent work related injuries, enhance employee productivity, and extend employees’ time in the workforce. Now, exoskeleton suits have become a groundbreaking medical intervention to help patients who have suffered from spinal cord injuries or strokes.

The preliminary design for exoskeleton suits came from General Electric in the late 1960s. General Electric’s “Hardiman Suit” enhanced the user’s strength, allowing one to lift extremely heavy objects. Researchers soon saw the opportunity for Hardiman technology to restore lost function in people suffering from musculoskeletal problems. In the early 1970s, the Hardiman Suit evolved its first medical use as an exoskeleton, after the work by researchers at the Mihajlo Pupin Institute in Serbia and the University of Wisconsin-Madison in the early 1970s. Since then, exoskeleton suits have focused on teaching or re-teaching users how to walk. The Lokomat (made by the company Hocoma in Switzerland ) was one of the first designs to improve walking abilities of patients who had suffered spinal, cerebral, neurogenic, osseous, and neurogenic injuries. This novel machine is a combination of a treadmill and body weight support, and it allows guided movements and repetition of gait movements to facilitate motoric learning. However, body weight supported treadmill training (BWSTT), like the Lokomat, has not been shown to have any superiority over traditional physical therapy.

Modern, non- BWSTT exoskeleton suits assist patients in achieving over-ground walking in their natural gait pattern (hip extension and full loading of lower limbs) while at the same time promoting active involvement of the patient. The suit, worn over the legs and upper body, contains an intricate network of technology to help its users ambulate. Sensors in the lower limbs capture any postural cue or movement that is initiated by the user. A computer, located in either a backpack or the suit’s torso, will then process this information to activate movements such as sitting, standing, walking, or turning. The exact function depends on the setting that is controlled by a remote worn on the user’s wrist or operated by a licensed therapist. Depending on the extent of the user’s injuries and remaining function, the exoskeleton can be set to completely move the individual’s legs or to assist with the movement, allowing the user to contribute to their own movement however much they are able. While these suits weigh between 50 and 65 pounds, users are still required to use crutches, canes, or walkers to help stabilize their upper bodies and keep the user safe. In the event of a malfunction, the different suits are programmed with failsafe features that lock or slowly collapse the lower limbs.

Currently, the most prominent use for exoskeletons is to help retrain a patient’s gait following an injury or stroke as part of a rehabilitative program with the hope of helping the patient to ultimately regain the ability to walk independently. However, recent FDA approval of the ReWalk exoskeleton for personal use outside of the clinic can provide individuals with a permanent means of maneuvering independently as the exoskeleton can be used at home and in the community. This could impart greater opportunities for freedom and social engagement to the user.Important additional physical benefits of exoskeleton use include increasing physical activity and energy expenditure through the assisted movement of muscles, which may help combat the development of a sedentary lifestyle and obesity. This allows the user to spend less time sitting and more time in an upright position, which may decrease the risks of heart disease and cancer. Furthermore, by helping to support the patient’s weight and movement during rehabilitative exercises, exoskeletons can reduce the physical burden placed on physical therapists in helping patients to execute rehabilitative exercises. Doing so can allow for more effective and efficient utilization of the therapist’s attention to patients. If you are interested in learning more about exoskeletons and their use, and provide information about their respective suits.

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.