Exoskeleton and Exo-Suit Progression Strategies

In this highlight video Matt Giffhorn, PT, DPT, NCS from the Shirley Ryan Ability Lab answers one of the questions we hear a lot: “How can I maximize the benefits of an Exoskeleton or an Exo-Suit to make sure I continue to progress and challenge my neuro rehab patients?”

Matt talks through a couple of different philosophies that he uses when considering how to adjust the device settings and task intensity to increase the level of challenge for his patients as they progress. He also highlights the importance of setting aside some time within each session to practice walking without assistance from the device, to ensure that patients have time to practice carrying over the skills from the device into their everyday walking to maximize the therapeutic benefit.

This is a highlighted clip from ReWalk’s Topics in NeuroRehabilitation web series. You can watch the full episode here: 

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Once we’ve identified that device that we
want to use,

how would you then apply this framework
throughout that progression of the patient

so that we can, you know,
change the way that we’re using the device

as the patient progresses, whether
it’s the settings or the environment?

What would your recommendations be there?

I think it depends on what feature of the
device you’re really trying to utilize.

So if we’re using a device that is
going to give you assistance, right.

Do you turn the assistance up high and

kind of work your way down,
but maintain the same activity?

That would be one progression.

Or, you keep going.

You try to start somewhere mid-level

with the assistance force and sort
of increase, but also increase how hard

the task is.

I think you could utilize both.

It would sort of depend on where you’re

starting from, I suppose,
with the patient in front of you.

And the devices do have some limits

in terms of what environments
you can use them in.

And so you have to kind of figure out

where that upper limit is
before you start using it.

So, you know, kind of how far – how close

you are to it and where you really
can – how far you can push it.

So I think there’s different
different strategies.

Resistance, I would say,
is pretty, a little bit more

straightforward where you can
start low and kind of build

and then continue
to progress the activity.

If you’re already
at the maximum resistance.

Assistance gets a little bit trickier.


it’s hard to it’s hard to know what’s

either start low and gain assistance,
but also keep the task hard,

or start high and then start
to pull away the assistance.

That being said,
I think we always recommend training

outside of the device
for that carry over too.

so it’s important to make sure that you

have some period of time where you’re
training without assistance

to make sure that you’re
achieving that carry over?

Yeah, and if it’s not a device they’re
going home with, ultimately,

their function outside of the device is
what we’re really trying to capture.

So if you don’t try to carry over what
the device has been guiding them to do

outside of it, I think you’re losing
a really big window of opportunity.

This has been a highlighted clip

from ReWalk’s Topics
in NeuroRehabilitation web series.

To watch the full episode,
please go to the ReWalk Robotics YouTube

page, or visit the link
in the comments below.

See you next time!


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