Exoskeletons, or exosuits as they are also known, are rapidly emerging as a technology not only to improve people’s work, but to change lives.

With applications split across healthcare, heavy industry and the military, exoskeletons have already proved their worth for a variety of uses, and are likely to become more commonplace as the technology drops in price.

Many of us have watched demonstrations of the technology in awe, with videos showing exoskeleton-clad people stand up from wheelchairs, lift heavy objects without effort and nonchalantly operate machinery that would cause a non-suited person to rapidly break out in a sweat.

But for those of us not hauling heavy objects, engaging in military operations or afflicted with physical disability, there are currently few reasons why we would find ourselves exosuited.

However, with the age of augmentation upon us, it could be just a matter of time.

The power to walk

Providing the severely disabled with the ability to walk is undoubtedly the headline benefit of exoskeletons, and has been the subject of much media attention and investment over the past few years. Although by no means universally available, the technology is seeing rapid development, with a handful of companies around the world already selling working exosuits.

Among these is ReWalk, the only exoskeleton currently to hold clearance for home use by the US Food and Drug Administration (FDA), the regulatory body responsible for assessing the safety and reliability of pharmaceuticals and medical devices.

However, the commercial success of the robotic exoskeleton relies not only on the technology, but on whether health insurers and others are willing to cover its cost. ReWalk is doing considerable work to encourage coverage by insurers, and has already had success with a number of organisations in the US and Germany, but it is still early days.

In an interview with The Street, ReWalk CEO Larry Jasinski said that getting support from insurers was key to the company’s success.

“I think it’s going to grow on a month-by-month basis, but it’ll be case by case for probably two to three years,” he said. “If you look at some other sizable companies in their early days, this is not an unreasonable strategy to build a sizable business in the hundreds of millions of dollars. It just takes time to get a national decision.”

However, ReWalk is by no means the only company taking on the exoskeleton market. Its main competitor, Ekso Bionics, is also set to receive FDA approval for its Ekso assisted walking device following an amended submission in December. The company has also secured a number of lucrative contracts with DARPA and the US military, meaning it is less reliant on insurance backing to grow its business.

There is also Indego, a powered lower limb suit developed by Parker Hannifin that is set for commercialisation in the US and Europe later this year, and Japanese firm Cyberdyne’s HAL.

Short for Hybrid Assistive Limb, HAL was the first assistive exosuit to receive global safety certification, and is already licensed for medical use in Europe.

Which company ultimately dominates the market remains to be seen, but it seems likely that the eventual winner will be crowned such not necessarily because they have the best technology, but because they succeed in commercialising their exosuit the most effectively.

Treatment incorporated

Inevitably, the current state of exoskeleton technology will be bettered, and one of the ways this could be achieved is through the incorporation of treatment.

This very concept is currently being explored by Cyberdyne, which recently announced that it had invested ¥1.4bn ($11.5m / /£7.6m) in a project known as Cyfuse to create a version of HAL that merges the exosuit with regenerative medicine. The technology will be designed for patients with severe spinal cord injury, and will involve using Cyfuse tissue regeneration technology to rebuild the damaged spine while the patient wears HAL.

The technology will use Cyfuse tissue regeneration technology to rebuild the damaged spine while the patient wears HAL

Exactly how this will work is still under wraps, but Cyfuse has released information about its current regeneration technology that gives some idea of how it might be incorporated into HAL.

“This technology uses a fine needle array to skewer cellular aggregates (0.5mm diameter), which are then stacked three-dimensionally. Once the cellular aggregates are fused together, the needles are removed, resulting in elastic tissue based on the original cells and the collagen within,” Cyfuse said in a press release.

To achieve this goal, Cyfuse is also using 3D bioprinting technology, leaving us wondering if the HAL exosuit could even be augmented to include a 3D printer.

“The Regenova bio 3D printer can automatically create a 3D cellular structure by inputting 3D data and cellular aggregate material,” said Cyfuse. “The resulting cellular structure spends several days or weeks maturing in a customized bioreactor, and comes to express its target strength and function.”

Material improvements

As well as advances in capabilities, we could also see the development of lighter, more inconspicuous assistive clothing.

A UK-based research project for the development of soft robotic clothing may be the key to moving the technology beyond the rigid suits we know today. The research, which started this month and is expected to run for the next three years, is tasked with developing clothes with characteristics similar to exoskeletons, but without the hard frames that are characteristic of the devices.

“Soft robotic clothing is completely different from conventional exoskeletons that are made from rigid materials, such as metals and hard plastics, and driven by motors and gearboxes,” said Dr Jonathan Rossiter, study lead researcher and reader in robotics at the University of Bristol’s Faculty of Engineering. “In contrast to these slow, uncomfortable, expensive and cumbersome devices, our smart clothing will interact more naturally and effectively with the wearer. They’ll become more of a ‘second skin’.”

Because of this difference in comfort, the envisioned clothing would be able to be worn every day, making it a viable option for those with less severe disabilities.

“Soft robotic clothing is compliant, comfortable and feels natural – like any normal clothing. It moves with the body so that it is unobtrusive when its assist and power is not needed,” added Rossiter.

“It uses body and environmental sensors to determine when the wearer needs some assistance, for example when walking up stairs or when they are a bit wobbly on their feet. It then automatically reacts to assist the wearer by employing artificial muscles built into the fabric to give extra mobility, strength and stability. These artificial muscles are made from smart materials that expand, contract or bend when electrically stimulated, much like biological muscles.”

As a result, Rossiter believes this clothing could have considerable potential for the elderly as well as the disabled. Robotic trousers really could become a perk of old age.

“It is important that we can maintain independence and dignity for people with disabilities and for the aging population,” he said. “We expect these kinds of wearable technologies to be a natural and unobtrusive part of our daily lives, as easy to put on as a normal pair of trousers.”

Military might

If you are healthy and want to use powered exoskeletons on a regular basis, however, joining the military may currently be your best bet.

Since it announced its Future Soldier 2030 initiative back in 2009, the US Army has been investing heavily in exoskeleton technology and has showed off a number of prototypes along the way. Among these is the Tactical Assault Light Operator Suit, or TALOS, which has been publicly in development since 2013.

The suit, which is planned for combat use from 2018, will combine full-body protection from ballistics, beyond-human strength and an array of sensors to monitor the wearer’s health and body position. It will also provide real-time battle information and communications, and will be lighter than current versions so that it can be worn for long periods.

“The intent is to have this fully integrated system so you can provide the most capability at the lowest impact to the soldier,” said TALOS project manager Michael Fieldson. “We think there is some efficiency to be gained if all the equipment is fully integrated as opposed to different components that are simply assembled on the human.”

If we do TALOS right, it will be a huge competitive advantage over our enemies

There are even plans to incorporate oxygen administration or emergency wound care, although it remains to be seen whether these features will make it onto the first combat-ready versions.

Admiral William H McRaven, commander of the US Special Operations Command outlined TALOS’ benefits for the US Army during a symposium keynote in 2014. “If we do TALOS right, it will be a huge competitive advantage over our enemies and we give warriors the protection they need in a very demanding environment,” he said.

However, work from DARPA may produce an alternative exoskeleton that is more suitable for some forms of combat. The agency recently awarded Harvard’s Wyss Institute $2.9m (£1.8m) to develop a soft robotic exosuit that appears to have more in common with Dr Rossiter’s soft robotic clothing than TALOS.

In a video released by the institute, Conor Walsh, Harvard assistant professor of mechanical and biomedical engineering and Wyss Institute core faculty member, described the design team’s approach.

“At Harvard we are studying the biomechanics and physiology of human walking, trying to understand what makes that such an efficient process. We then apply this knowledge to the design of software of robots that act in parallel with the body’s muscles and tendons and mimic their function,” he said.

The interest in powered exoskeletons for military use isn’t just in the US, either. Several other forces have been working on their own designs, including the Chinese military, which unveiled its most ambitious version in November. While warfare may be moving into increasingly digital territory, it seems exoskeletons are ensuring ground troops will remain a key part of warfare in the years to come.

Moving forward

Exosuits are clearly promising for both healthcare and the military, but their industry applications could prove to be the most lucrative for their manufacturers.

Numerous companies have begun developing industry-targeted products, such as Panasonic and General Motors, although full-scale commercialisation is largely still in progress. In theory exoskeletons could be hugely beneficial to industries where safety is a concern or heavy lifting is required, but in reality the technology hasn’t seen major adoption for these purposes yet.

However, that could soon change. Some pilot projects are underway, such as a BMW trial at its Munich plant that involves supplying workers with 3D printed support gloves to aid car fitting, and there is considerable investment being ploughed into the industry.

The challenge will be to find applications where the benefits produced by the suit cannot be achieved through cheaper means, and, eventually, the reduction in manufacturing costs to make such suits an achievable purchase for small businesses.

When that happens, we are likely to see the emergence of consumer applications. Exosuit technology could find its way to us in the form of powered wearables for DIY and childcare, or even form the basis of new sports or modes of transportation. The technology will take some time to develop to this stage, but with so much investment being poured into exoskeletons, it’s only a matter of time.