Copyright 2019 - Clinical Commissioning Groups Association

There is ample evidence that pinpoints neurological disorders as one of the greatest threats to public health. A study conducted in Europe estimated that the annual economic cost of neurological diseases amounted to € 139 billion in 2004. Stroke is the largest cause of morbidity and long-term disability with an incidence of 1 million cases each year, with an estimated increase of 30% by 2025.  


Gait impairment is a large contributor to long-term disability and ambulatory function for those who suffer from a neurological related disease or disorder. Many patients lose the ability to walk independently. The achievement of ambulation is critical for active participation in everyday activities, preventing social isolation and depression, and enhancing quality of life.  


At present, gait rehabilitation is largely based on labour-intensive and costly physical therapy interventions, which have been shown not restore a normal gait pattern in the majority of cases. 


Research into rehabilitation robotics has grown rapidly and the number of therapeutic robots has expanded dramatically during the last five years. Robotic rehabilitation therapy can deliver repetitive high-dosage, high-intensity and task specific training, making it ideal for those undergoing neuro gait rehabilitation. 


In 2013 a Cochrane review examined 23 randomized controlled studies with total of 999 subjects. The findings highlighted that there was a greater likelihood of attaining independent ambulation in a stroke patient group receiving a combination of RAGT (Robotic Assisted Gait Training) in comparison to conventional gait training alone.


The National Institute for Health and Care Excellence (NICE) produced a Medtech Innovation Briefing (MIB) on the Ekso GT robotic exoskeleton in January 2017.  Ekso Bionics was the first exoskeleton company to be selected for a MIB by NICE.


The MIB highlighted the innovative aspect of Ekso Bionics’ proprietary SmartAssist software, which differentiates the Ekso GT from other available wearable exoskeletons. The briefing noted that the SmartAssist technology allowed physiotherapists to strategically target aspects of a patient’s gait by providing varying amounts of support to each leg, effectively personalizing the treatment for each patient’s specific needs.


The MIB authors conducted a systematic review of existing evidence on multiple patient groups and noted that the results indicated enhancement in walking speed and distance for those who use the Ekso GT as a rehabilitation tool.  The evidence also suggests Ekso GT has positive benefits on lower limb spasticity, bladder and bowel function, and pain management.


British specialist commentators who have used the device noted in the MIB that Ekso GT helps patients with incomplete spinal cord injuries improve mobility more quickly by providing a means for repetitive controlled practice. They also noted that the capability for Ekso’s SmartAssist software to apply different power to each leg might be particularly useful for stroke patients.  


The briefing also highlighted that there were psychological benefits associated with users being able to stand and walk, which in turn could have a positive effect on their overall health.


The evidence suggests that the potential to incorporate and adopt Ekso GT specific gait rehabilitation into clinical practice has a sound rationale for inclusion. Therefore should be considered as an effective tool for the modern day clinician and care facility.



Content provided by Barry Richards, Clinical Director EMEA. For more information please visit


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