A step in the right direction Functional and Applied Biomechanics Section, Rehabilitation Medicine Dept, National Institutes of Health Clinical Center

If you are a child with the most common childhood physical disability, cerebral palsy, there is only a 50 per cent chance that you will still be able to walk as an adult. Robotic exoskeletons may just be about to change that.

Some clinics already have bulky robotic devices that support children with cerebral palsy so they can practise walking. But these are usually attached to a ceiling pulley system and so cannot be used at home.

The new device, developed at the National Institutes of Health in Maryland, is completely mobile. Sensors on the exoskeleton legs monitor each step, which is then processed by a computer housed in a backpack. At just the right moment, the exoskeleton’s actuators fire to give a muscular boost, improving posture and easing the strain.


Cerebral palsy is caused by damage to or abnormalities in the developing brain, which lead to movement difficulties. Though many children with cerebral palsy are able to walk, the condition often causes crouch gait, or overbending of the knees. This walking technique requires more strength and energy than would otherwise be necessary. As children grow up and become heavier, their muscles cannot keep up, sometimes leading to complete loss of their ability to walk.

Early intervention

“If we can change crouch gait at a young age, we can maintain mobility into adulthood. Using the exoskeleton will only be temporary. We want them to be able to walk without it,” says Thomas Bulea at the National Institutes of Health.

Seven children and young adults with cerebral palsy, ranging from 5 to 19 in age, used the device successfully, with none of them falling while using it. After six training sessions, all but one of those taking part saw improvements in their walking that were as good as or better than would be expected if they had had the corrective surgery that is often required. This can range from tendon lengthening to bone fusion.

“There are so many children around the world who can be affected by technology like this,” says Sunil Agrawal at Columbia University in New York. He also works on exoskeletons for cerebral palsy and created a lightweight model that uses cables to pull on the legs at the right moments. There are pros and cons with each style, he says. “I’m convinced that one needs to do long-term studies to really find the best approach.”

However, one thing is clear: being able to use an in-home exoskeleton without support from therapists for 1 hour a day over the course of a year could give more children access to the sort of physical therapy that could keep them walking in later life.

Journal reference: Science Translational Medicine, DOI: 10.1126/scitranslmed.aam9145