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Wednesday, June 8, 2011

You Cannot Kill a Bad Idea: The Exoskeleton Lives

Berkeley Bionics, the California based developer of the the exoskeleton I have railed against is in the news again. In a media release they have announced a partnership with ten of the nations leading rehabilitation centers. Yes, the exoskeleton is going to be used at ten leading centers for rehabilitation. I do not know whether to laugh or cry. I am sure Berkeley Bionics is thrilled--the stock worth will surely go up. The rehabilitation centers, some I admire, get a cool new toy to play with. This will draw newly paralyzed people and the skeptic in me wonders if this too is about profit margin. These ten rehabilitation centers will become the first "eLEGS Centers in the world". If there were audio to this blog you would hear an audible groan.

I am still stunned the exoskeleton gets heaped with such praise. It was one of CNN's top ten innovations, a Wired top ten gadget, and one of TIME's best inventions, all in 2010. The hype and media reception over this device puzzles me. I get the hype coming out of Berkeley Bionics--they are a corporation, a new one at that, trying to make a name for themselves. Thus I can dismiss words from Eythor Bender, CEO who thinks "We are on the verge of a new era of mobility for people with paralysis, using bionic exoskeletons -- first in rehabilitation centers -- and later making them available for home/personal use. We have been fortunate to team up with some of the most respected rehabilitation centers in the world, embarking on this important journey". The journey Bender refers to I would suggest is first and foremost one designed for profit. That profit starts with creating customers in rehabilitation centers too naive to understand the larger implications of the exoskeleton.

I do not blame newly minted paralyzed people with wanting to try out the exoskeleton. In theory it sounds like a good idea. I do not blame rehabilitation centers for trying this new technology out either. I would think there is some possible medical benefit to the exoskeleton, especially for a very young person with a spinal cord injury. And since I am an American, and we Americans love to play the blame game, where does the blame lye in the glorification of the exoskeleton? I place blame blame on American society at large for consistently refusing to perceive wheelchair use as anything less than a tragedy. Terms like "wheelchair bound" are used daily and we as a nation refuse to value people that use a wheelchair. We refuse to make our buildings accessible--courts, schools, stores, stadiums, airports, mass transportation centers, hospitals, universities, etc. I have encountered obstacles at each one of these places--not twenty years ago when the ADA was passed into law but today. What happens when I complain about the lack of access? I am deemed unreasonable, a bitter cripple who wishes he could walk. This line of reasoning makes me crazy. It misses the point so badly it would be laughable if it were no so common place. I am mad because we do not value access--it is not expected or desired. We only provide access because it is the law. That law, civil rights legislation called the ADA is begrudgingly adhered to but no one really cares. If people cared I would not encounter the needless architectural problems I come across daily.

Into the void of not caring about access for people with a disability, by access here I mean equal rights not only terms of architecture but civil rights, we waste valuable and limited resources with dubious inventions like the exoskeleton. This highlights a problem that has plagued the ADA--the notion of a "reasonable accommodation". The people who decide what is reasonable are not people with a disability--they are simply not in positions of power. Into this void steps (pun intended) the exoskeleton. Anyone who can walk thinks walking is the best form of locomotion. They are right it is what the human body was designed to do but I would argue a wheelchair is no less efficient means of motion. I do not know a single content person that uses a wheelchair that dreams or has ambitions of walking again. We simply move on with life. We get jobs, have a career, family,etc. If we have any mutual desire it is for more efficient reliable wheelchairs. Here is where I get upset--imagine if the resources put into the development of the exoskeleton were put into wheelchair technology? What inventions, new designs, different materials could have been developed as a result? I assure you finding a high end wheelchair is no easy task. American manufacturers have no interest in the development of high end wheelchair because insurance will not pay for such wheelchairs. And insurance drives the wheelchair business.

Do not take my extended complaints about the exoskeleton to infer I am anti technology. Nothing could be further from the truth. My point is that all technology has a social element and I cannot overlook the very bad message the exoskeleton sends. Indeed, it makes me mourn for a simple time when people who were paralyzed were told point blank you are paralyzed and will never walk again. Yes, this is a hard reality to accept. However people, once paralyzed, need to maximize the muscles they can move and this is where technology need to be directed. Thus while the exoskeleton makes headlines another technological innovation received scant press. Here I refer to an invention that I think combines technology with an additional cool factor. The New York Times reported about a device that enables a high level quad to steer his or her wheelchair via a tongue piercing. The magnetic stud would allow a person to steer the wheelchair with their tongue thereby negating the need for a sip and puff wheelchair. This is exciting to me--it combines non traditional body modification and technology in a way that truly empowers a person (curiously this story appeared in the Health section of the NYT and not Technology section).

The point I have tried to stress is that technological innovation is designed to meet a perceived social need. There is no need to walk after a paralyzing injury. The only need I have along with all those who are paralyzed and even more generally disabled in in some way is to be valued, our simple presence wanted. This starts with being treated equally--that means equal access to all parts of society. This is very much a minority viewpoint. To consider one's paralyzed body equal requires going against the social grain. I have been doing this for the past thirty two years and hope someday it will no longer be necessary. Inventions like the exoskeleton and the resources used to develop it make me doubt that day will be coming any time soon.


Becs said...

I went to the NY Abilities Expo and the exoskeleton was being pushed very hard.

One manufacturer had a booth just as you walked in. Another had an attractive young teen girl walking around in an exoskeleton on her legs, assisted with crutches. For anyone not a lithe young teen, it looked like a lot of equipment to deal with.

Again, exoskeletons and equipment like that will be more in favor with the DME people because you can't sell civil rights.

Unknown said...

I could see how such a device might have its uses in the rehabilitation context - if it's used to help body/muscle memory with the act of walking/standing, in cases where a spinal cord injury isn't "total". There are a lot of SCIs where people regain function quite quickly.

But that's the extent of that. To assume it could be an acceptable equivalent to *walking* is silly, at best.

Walking is highly overrated anyway...

Anonymous said...

My engineering prof. always says that good engineers solve problems. I can't see what problem is being solved here. No one wants this invention, which is a severe marketing flaw- not checking with your target demographic to find out if they want a product _before_ you develop it. This invention's design flaws are too numerous to list, so I'll just pick on a few. I would NEVER have turned in a project like the exoskeleton for engineering because it's so severely flawed.
In the first place, it's way too heavy. We're dealing with people who have minimal to no muscle strength in specified areas- how are they supposed to carry 50 pounds of gear? It's ridiculous. From an engineer's point of view, (I'll try not to bore everyone) this invention is going in exactly the wrong direction, however, it's not going there (or anywhere else, for that matter) quickly. Talk about going nowhere fast.
Clearly, advanced theoretical physics are a must here. If I had been on this project, _and_ ordered to design an external solution, I would've started with anti-gravity boots (a popular novelty item) and gone on to develop hip-high boots with full support up to the waist and a complete anti-gravity field generator, which would probably be around the waist. Battery technology exists which is sufficient to power the unit but may be worn discreetly around the waist and according to my research on other biomedical devices, it would be smaller than a deck of cards and weigh no more than an obnoxious belt buckle.
Another of the exoskeleton's failings, from a purely engineering point of view, is that it doesn't make it easier for people with disabilities to use the muscle strength or control that they have. Reports describe it as awkward, cumbersome, & difficult to use- all very serious design flaws. From what I've read, it takes 2 other people to help one person use the device. Clearly, a system like this doesn't promote independence & autonomy, which is what a system like this ought to do, or else what's the point of such a thing? In fact, my question, as one engineer to the others who designed this monstrosity is, what's the point of this thing anyway?

emma said...

Well, I took a look at "eLegs" on YouTube. I think Nic's point about uses in rehab are good, although it seems a very cumbersome device for such a thing, aren't there other ways of producing similar results?

The woman who tries the legs speaks of part of her "spirit dying" when she became disabled, which doesn't really help peoples perception of disability!

And of course it wasn't long before military applications were mentioned in the video. Or that it came out of the HULC load carrier (the military application came first?).

People, for better or worse have been interested in using science and technology, not for rehab, but for "human enhancement" for a very long time (turns up in sci-fi books and movies all the time). The belief that if we are somehow physically improved will lead to a happier better life? We all want to be super-heroes? I don't know.

It seems quite sad to me that in general people believe that happiness or quality of life comes from certain physical aspects of ourselves or the possession of "stuff".

This exoskeleton just seems impractical, and even though I'm sure the design will improve, the price won't.

Matthew Smith said...

Here I refer to an invention that I think combines technology with an additional cool factor. The New York Times reported about a device that enables a high level quad to steer his or her wheelchair via a tongue piercing. The magnetic stud would allow a person to steer the wheelchair with their tongue thereby negating the need for a sip and puff wheelchair.

A tongue control for a wheelchair has already been done -- Brooke Ellison uses one, and a friend of mine had one until 2009 or 2010 when it broke down, along with her power chair, coincidentally, and along with the company that made the device, so her next wheelchair had to be a sip-and-puff. The tongue device is a remote control fitted into the roof of the mouth like a dental retainer, and can be used for environmental control (e.g. switching lights and heaters on), and is particularly useful for someone with little or no head movement (such as some C1 quads). All that's needed is for someone to pick up the technology. No piercing required.

Becs said...

This doesn't go with the post, but I thought this was fascinating. I wonder if there could be an application for it regarding wounds like the ones you had: