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Experts Discuss the Future of Exoskeletons, Neuro-rehabilitation

Sales of exoskeletons are expected to rapidly increase in the next decade.

LAS VEGAS — Sales of robotic exoskeletons are expected to reach an estimated $1.8 billion, with more than 100,000 units sold by 2025, signaling high expectations for the specialty in the coming years, according to Kern Bhugra, MSEE, CEO of NeuroLutions.

Bhugra, who is also cofounder of Tibion and founder of Leonis, made his comments during a panel at the American Orthotic & Prosthetic Association World Congress, along with Hugh Herr, PhD, director of biomechanics at the MIT Media Lab and founder of Bionx; Larry Jasinski, MBA, CEO of Rewalk Robotics; and Jonathan Naft, CPO, vice president and general manager of Myomo.

Kern Bhugra, MSEE
Kern Bhugra

“If you look at revenue in 2015, it’s about $25 million, but if you project it out to 2025, we’re hitting almost $2 billion,” Bhugra, said. “That’s a massive rise in terms of this industry and the expectations that we have. In addition, if you look at the number of devices sold, we’re looking at a figure north of 100,000 units, so there are significant expectations going forward.”

Meanwhile, prices for exoskeletons are projected to decrease by more than 50% during the next decade, as costs come down and reimbursement improves, he added.

According to Bhugra, NeuroLutions is developing an upper extremity robotic rehabilitation device based on a brain-controlled interface, which will leverage contralesional brain waves.

A 13-week, at-home study recently published in Stroke showed statistically significant results for improved hand function, he said.

“The company is still in the development stages, so it isn’t on the market yet,” Bhugra told attendees during the session. “However, we’re far along down the path.”

Challenges ahead

Although it is “easy to get excited about the headlines,” several challenges loom large in the specialty of exoskeletons, according to Jasinski.

Larry Jasinski, MBA
Larry Jasinski

“It’s easy to get excited at an industry level, as well as on a personal level, as you focus on a patient who may be able to walk again because of this technology, but the pathway to the $1.8 billion that is forecast is going to take a lot, and I think some people underestimate that,” he said. “What it takes to finish the design, to get it finished, to finish the clinical trials, to get FDA clearance, to get the appropriate infrastructure in place — those are the challenges we face, because we don’t have a lot of that infrastructure and support right now.”

In addition, he said exoskeleton designers are continuously forced to plead their cases before the “outrageous objections” of insurers as to the benefits of the new technologies they are developing.

“As a new technology, most of our insurers give us outrageous objections at the beginning,” Jasinski said. “We’re winning 82% of the cases, but it takes evidence.”

According to Jasinski, Rewalk’s robotic assistance devices for patients with spinal cord injuries are in the market for both institutional and personal use.

“There are more than 400 ReWalk systems in use worldwide and in 2015, the U.S. Department of Veterans Affairs issued a national coverage policy for the procurement of exoskeleton systems for all qualifying users,” Jasinski told O&P News.

The company is developing a soft exosuit for stroke rehabilitation, with a commercial build underway and clinical trials scheduled for the fourth quarter of 2017, Jasinski said.

‘Prosthetic’ approach to exoskeletons

Despite the many challenges, Naft said the current state of the profession, as well as the future of new technology, remains exciting and rewarding.

Jonathan Naft, CPO
Jonathan Naft

“In my 27 years of developing new products in the O&P industry, I would say this is for sure the most exciting time,” Naft said. “It is also the most fun and most rewarding experiences that I have had.”

Myomo’s MyoPro Motion G is an orthotic device that provides elbow flexion/extension and grasping function, enabling paralyzed individuals to perform essential daily functions, Naft said. When developing the device, he and his team set out to build the “myoelectric equivalent of a prosthetic arm,” which would then fit over a patient’s weak and deformed arm to provide support and function for those that could otherwise not use their arm.

“If one is missing their arm as an amputee, isn’t that the same hardship that one has when they have an arm but can’t use it?” Naft said. “On the prosthetic side, you get a myoelectric prosthesis to regain function, and what we set out to do is exactly the same.”

Lighting the way

Herr discussed recent advances in optogenetics, in which biologists use light to control cells in living tissue. According to Herr, this is accomplished by taking a DNA strand from a species of single-celled algae and, using a safe virus, target a neural cell. Then, when they shine a light on the neural cell, a light-sensitive protein activates the cell electrically.

Hugh Herr, PhD
Hugh Herr

According to Herr, the FDA has already approved the use of optogenetics in the treatment of blindness. He expects additional applications to be approved in the coming decade.

“By shining light on the skin, there’s enough light to get to the nerve that can control the muscle — and the control is exquisite,” he said. “To summarize, I think in the distant future, in addition to motorized exoskeletons and synthetic motors, we’re going to have regenerative medicine. We’re going to have exoskeletons, but we’re going to use the person’s own tissues with synthetic sensors to exploit the person’s own muscles.” – by Jason Laday

Disclosures: Bhugra reports he is the CEO of NeuroLutions, cofounder of Tibion and founder of Leonis; Herr reports he is the founder of Bionx; Jasinski reports he is the CEO of Rewalk Robotics; and Naft reports he is general manager of Myomo.

LAS VEGAS — Sales of robotic exoskeletons are expected to reach an estimated $1.8 billion, with more than 100,000 units sold by 2025, signaling high expectations for the specialty in the coming years, according to Kern Bhugra, MSEE, CEO of NeuroLutions.

Bhugra, who is also cofounder of Tibion and founder of Leonis, made his comments during a panel at the American Orthotic & Prosthetic Association World Congress, along with Hugh Herr, PhD, director of biomechanics at the MIT Media Lab and founder of Bionx; Larry Jasinski, MBA, CEO of Rewalk Robotics; and Jonathan Naft, CPO, vice president and general manager of Myomo.

Kern Bhugra, MSEE
Kern Bhugra

“If you look at revenue in 2015, it’s about $25 million, but if you project it out to 2025, we’re hitting almost $2 billion,” Bhugra, said. “That’s a massive rise in terms of this industry and the expectations that we have. In addition, if you look at the number of devices sold, we’re looking at a figure north of 100,000 units, so there are significant expectations going forward.”

Meanwhile, prices for exoskeletons are projected to decrease by more than 50% during the next decade, as costs come down and reimbursement improves, he added.

According to Bhugra, NeuroLutions is developing an upper extremity robotic rehabilitation device based on a brain-controlled interface, which will leverage contralesional brain waves.

A 13-week, at-home study recently published in Stroke showed statistically significant results for improved hand function, he said.

“The company is still in the development stages, so it isn’t on the market yet,” Bhugra told attendees during the session. “However, we’re far along down the path.”

Challenges ahead

Although it is “easy to get excited about the headlines,” several challenges loom large in the specialty of exoskeletons, according to Jasinski.

Larry Jasinski, MBA
Larry Jasinski

“It’s easy to get excited at an industry level, as well as on a personal level, as you focus on a patient who may be able to walk again because of this technology, but the pathway to the $1.8 billion that is forecast is going to take a lot, and I think some people underestimate that,” he said. “What it takes to finish the design, to get it finished, to finish the clinical trials, to get FDA clearance, to get the appropriate infrastructure in place — those are the challenges we face, because we don’t have a lot of that infrastructure and support right now.”

In addition, he said exoskeleton designers are continuously forced to plead their cases before the “outrageous objections” of insurers as to the benefits of the new technologies they are developing.

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“As a new technology, most of our insurers give us outrageous objections at the beginning,” Jasinski said. “We’re winning 82% of the cases, but it takes evidence.”

According to Jasinski, Rewalk’s robotic assistance devices for patients with spinal cord injuries are in the market for both institutional and personal use.

“There are more than 400 ReWalk systems in use worldwide and in 2015, the U.S. Department of Veterans Affairs issued a national coverage policy for the procurement of exoskeleton systems for all qualifying users,” Jasinski told O&P News.

The company is developing a soft exosuit for stroke rehabilitation, with a commercial build underway and clinical trials scheduled for the fourth quarter of 2017, Jasinski said.

‘Prosthetic’ approach to exoskeletons

Despite the many challenges, Naft said the current state of the profession, as well as the future of new technology, remains exciting and rewarding.

Jonathan Naft, CPO
Jonathan Naft

“In my 27 years of developing new products in the O&P industry, I would say this is for sure the most exciting time,” Naft said. “It is also the most fun and most rewarding experiences that I have had.”

Myomo’s MyoPro Motion G is an orthotic device that provides elbow flexion/extension and grasping function, enabling paralyzed individuals to perform essential daily functions, Naft said. When developing the device, he and his team set out to build the “myoelectric equivalent of a prosthetic arm,” which would then fit over a patient’s weak and deformed arm to provide support and function for those that could otherwise not use their arm.

“If one is missing their arm as an amputee, isn’t that the same hardship that one has when they have an arm but can’t use it?” Naft said. “On the prosthetic side, you get a myoelectric prosthesis to regain function, and what we set out to do is exactly the same.”

Lighting the way

Herr discussed recent advances in optogenetics, in which biologists use light to control cells in living tissue. According to Herr, this is accomplished by taking a DNA strand from a species of single-celled algae and, using a safe virus, target a neural cell. Then, when they shine a light on the neural cell, a light-sensitive protein activates the cell electrically.

Hugh Herr, PhD
Hugh Herr

According to Herr, the FDA has already approved the use of optogenetics in the treatment of blindness. He expects additional applications to be approved in the coming decade.

“By shining light on the skin, there’s enough light to get to the nerve that can control the muscle — and the control is exquisite,” he said. “To summarize, I think in the distant future, in addition to motorized exoskeletons and synthetic motors, we’re going to have regenerative medicine. We’re going to have exoskeletons, but we’re going to use the person’s own tissues with synthetic sensors to exploit the person’s own muscles.” – by Jason Laday

Disclosures: Bhugra reports he is the CEO of NeuroLutions, cofounder of Tibion and founder of Leonis; Herr reports he is the founder of Bionx; Jasinski reports he is the CEO of Rewalk Robotics; and Naft reports he is general manager of Myomo.

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