Exoskeletons are generally the stuff of science fiction—the massive rig worn by Sigourney Weaver in the blockbuster Aliens is perhaps the most iconic. But Ekso Bionics is making this technology a reality. The company’s recently FDA-approved product, the EksoGT, is actually far sleeker than its fictional counterpart, and rather than fighting aliens, it’s changing people’s lives and helping them walk again.
When a rehabilitation clinic, like Good Shepherd Rehabilitation in Allentown, Pennsylvania, purchased several Ekso products, the staff was overwhelmed by the response of interested potential patients. “They are attracting patients from a much further distance now—up to fifty miles away,” says Ekso president and CEO Tom Looby. And, though the clinic hadn’t necessarily been considered a thought leader in the industry, it has since become a major center of innovation. “Now, they’re consulting around the country for people who want to do the same thing with our exoskeleton,” he adds. In fact, changing people’s minds in that way—allowing key leaders to see for themselves what Ekso has to offer and how it differs from its competitors—is vital for the company’s evolution.
A Pioneering Spirit
While Ekso Bionics is focused on developing amazing new technology and changing the future of healthcare, the organization is also intricately tied to the past. Its offices in Richmond, California, are located around the corner from the Rosie the Riveter Museum, and the building itself is a national monument.
Tours are routinely led by their offices, and the employees are proud to be working in such a storied environment as they themselves work to change in the world. “We’re at the beginning of this wave,” says Ekso president and CEO Tom Looby. “Our pioneering spirit is meant to help people reach their capabilities.”
Exoskeleton technology has been made viable today thanks to the eleven years Ekso spent developing battery technology that could produce more power than its exoskeletons required to function. Before Ekso, cofounders Homayoon Kazerooni, Russ Angold, and Nathan Harding had been members of the Berkeley Robotics and Human Engineering Laboratory at the University of California. Their first projects for the company, which eventually became Ekso, focused on load carriage solutions, with the goal of giving users the ability to carry hundreds of pounds independently of the operator. “Much of that eleven years had been technology-oriented, doing work for DARPA [Defense Advanced Research Projects Agency] and SOCOM [US Special Operations Command],” Looby explains.
While developing load carriage solutions, however, Ekso envisioned that this technology could change people’s lives in rehabilitation and made plans to leverage its intellectual property in the healthcare sphere.
Healthcare applications for exoskeletons have been theorized and developed for years, but Ekso’s plan involves a key shift: targeting rehabilitation centers rather than individual consumers. Medical devices this advanced can come with large price tags. But this kind of investment can be key to a rehab center that helps many patients rather than just one. Rehab centers can also more easily develop an understanding of the safety profiles of the complex machines, as well as their particular capabilities. Personal-use exoskeletons might still be part of Ekso’s future plans, however. “We will build up the brand and the trust and confidence of healthcare providers and users by focusing on rehab and then deploy new technologies into the home sometime in the future,” Looby says.
Part of that confidence comes from seeing the EksoGT in action: seeing someone who had previously been unable to walk stand up and move almost immediately upon using the device. “I think that we can get a lot of attention because of how visual the moment is,” Looby says. “Family members get it. Certainly, users get it.”
The device is elegantly designed and structured so users can walk with a natural gait. The results are visually stunning. For example, Looby details the story of a young woman who had fallen off a balcony and was told she’d never walk again. Once she started rehabbing with an EksoGT, she was able to defy that prediction. “I get so emotional every time I talk about it, let alone see it,” Looby says. In another key story, he describes how investors were unable to focus on the physical therapist’s presentation because, in the background, a woman who had not walked in forty years got out of her wheelchair and began walking—without ever having used the device before. “Tears were streaming down her face, not a dry eye in any of the investors or from our company,” he adds.
That said, the medical device industry has seen many advancements that were supposed to change the world, only to have them fail to live up to that promise. To that end, Looby understands the potential wariness of even interested healthcare practitioners. “I think it’s a proper wariness to say, ‘All right, how is this one different,’” he says. But the Ekso team is confident that when healthcare professionals get to work with the products, they will see that the differences are
revolutionary.
In turn, that belief will drive the business economically, something on which Looby is keenly focused. He joined Ekso as its chief marketing officer in 2014, bringing a background in strategy and business planning with him. That economic focus, he says, has to be important to the company, no matter how advanced the technology is. “We have to affect economic evidence,” he explains. “We’ve recruited a great leadership team that has had that experience around the globe, commercializing novel medical device technologies. That’s the path we’re on right now: making this technology a standard of care.”
The Future of Preventive Care
Beyond exoskeletons used in rehabilitation centers, Ekso Bionics devices are being used in other settings, such as construction and load carriage, to prevent injury. One of these devices in development is called the EksoZeroG, which is designed to carry the load of a heavy tool and attaches to a fixed mount. In essence, it would allow the weight to be taken away from the user, while still enabling complex work. “Think about somebody who’s drilling holes in a cement ceiling, and they’re going to do that all day,” says Tom Looby, Ekso president and CEO. “If they are using a boring device or a chipping device to take off a chunk of concrete, they can only do it in small pieces because their bodies can only put so much effort into it. With our devices, they can take off larger chunks and move faster, with a reduction in injuries, we think, to their bodies.”
Since much of Ekso’s funding had come from the government, from day one, the organizational plan was flexible to accommodate whatever might come next, without losing sight of its grants. “Vision also has to be funded,” Looby says. “They said, ‘Hey, this interests us,’ and we would study that and develop an expertise. Then, we would try to find commercial applications for that. We said, ‘Let’s focus very sharply on what has to be a breakthrough in the technology versus having it come to us as a byproduct of a grant.’”
Based on that perspective, Looby was able to split his engineers into two major focus areas: healthcare and industrial applications. The healthcare engineers would work on the ongoing development of exoskeletons used for rehab and home mobility, while the industrial applications engineers would work on devices targeted for construction and engineering, for aiding work and preventing potential injury.
To advance its healthcare uses, Ekso has been building relationships with key clinics across the country and creating a network of leaders who can vouch for the devices’ potential. One of the largest clinics in the United States, The Kessler Institute for Rehabilitation in West Orange, New Jersey, even launched a study to track improvement in motor FIM scores in patients who had suffered a stroke, after using an Ekso machine. “We were able to demonstrate in that initial study an improvement with our device that far out-shadowed what standard of care could do in terms of steps taken per session,” Looby explains.
As its own next step, Ekso will look to further commercialize opportunities. Looby stresses that while Ekso commercializes what it has, the company is constantly working behind the scenes to make these devices better suited to various applications. After a rigorous approval process, the FDA appreciated Ekso’s safety profile and efficacy on its EksoGT and allowed the devices to stay on the market while the application went through approval, even as all exoskeletons were reclassified as Class II devices. In the end, Ekso was even granted an expanded label for spinal cord injury, as well as a stroke indication. “Our devices can go very high up on the spine relative to anybody else, and we’re the only company that can market our devices for hemiplegia due to stroke,” Looby says. “That distinction still resides today, and we’re very proud of that.”
On top of the amazing technology and the intelligent business planning, Looby understands the key component to Ekso’s success. “The DNA of Ekso is brilliant people,” he says. “They’re caring. They work very, very hard.” And as the company pushes further into their R&D and commercialization, these intelligent, compassionate people will be working hard to change even more lives and help more people reach capabilities they might have never dreamed possible.
“I think that years down the line, you’re going to be sitting in your office, and you’re going to see somebody walk by, and you might not know that they’re in an exoskeleton,” Looby says. “Maybe it fits under their clothes, and the power management of the batteries last all day or can be quickly interchanged. They’re safe, and the gait mimics how a human being normally walks under their own power. I’ve seen the breakthroughs already occur in our labs. I’m confident that years from now we will be able to fulfill that.”
