Technology driving rehabilitation devices of the future

Technology driving rehabilitation devices of the future
ABLE Human Motion’s Co-Founder and CEO shares how the company has grown from humble beginnings to offering leading life-changing technology

Despite a plethora of discoveries and breakthroughs advancing developments in healthcare, it’s safe to say that thanks to advancements in technology, possibilities have evolved exponentially, with endless possibilities as to where it will go next. One of those things is wearable technology. 

But this is wearable technology like you’ve never seen it before.

Cue ABLE Human Motion’s Exoskeleton, a new generation of exoskeletons to enable mobility for all.

Robotic exoskeletons - wearable structures that support and assist movement, or augment the capabilities of the human body - are by no means new, but the pioneering technology behind ABLE’s incarnation propel it into the future and shape it into an enabling device leaps and bounds ahead of the rest.

Alfons Carnicero is ABLE’s Co-Founder and CEO. An industrial engineer by trade, he has a keen passion for applying physics and engineering into the wider world, such as aiding professional athletes in improving their performance. It was when his father suffered a devastating stroke resulting in the loss of half of his mobility, while Carnicero was finishing his baccalaureate in Industrial Engineering, that inspired him to apply his technical talent to healthcare.

“When my father had his stroke, it completely changed my focus,” Carnicero shares. “He was not able to talk or write.”

Although fortunately Carnicero’s father recovered, closely watching his rehabilitation opened his eyes in an impactful way. “From then, I decided to devote my career to the biomedical field and to create technology for a purpose, technology that can improve people's lives.”

ABLE: Using technology to power independence 

After subsequently completing a Master’s in Biomedical Engineering, Carnicero pursued his dream. Working in neurorehabilitation hospital Institut Guttmann on the outskirts of Barcelona - the International Reference Center for rehabilitation of injuries of neurological origin - Carnicero was exposed to the available technologies aiding stroke and spinal cord injury patients in their recovery, but also downfalls in equipment that meant patients’ needs were not best being met.

“There was a clear opportunity to innovate in this field,” he recalls. “I then went to Hamburg, Germany, working with a company making medical devices and joint implants to learn how a real medical device company actually works.” 

From there he met a professor at the Polytechnic University of Catalonia conducting research with other Spanish universities on building a powered orthosis, or mechanical braces with a motor attached. 

“I saw that project and I fell in love. Together we decided to request a grant to see if there could be a market for such a project.” Carnicero then obtained bank-backed funding to undertake market research to see how well existing solutions were working and how they could best fulfil their needs. “From there, we saw a clear opportunity to create a company,” he reflects.

Needing someone to lead the ABLE Exoskeleton - which Carnicero likens to robotic trousers - from wire-riddled prototype to slick commercial product for patients, he then convinced fellow Co-Founder and university mate Alex García to join what he says has been a “crazy adventure”, which has seen the company grow to a team of 18 which has built several prototypes which have been tested on 200 stroke and multiple sclerosis patients.

“And now, after all these tests and clinical trials in reference hospitals all around Europe, we are starting to commercialise the product. We are waiting for the final approval from the notified board from the European Commission to start selling the product at the end of this year for hospitals and clinics.”

What makes the ABLE Exoskeleton so revolutionary is the qualities it boasts thanks to its technology. It’s billed as the world’s lightest adjustable, hip-knee powered exoskeleton on the European market for rehabilitation and incorporates the latest technologies in robotics, electric motors, power electronics, manufacturing and wireless connectivity to maximise patient autonomy and promote the neurorehabilitation process.

ABLE Human Motion has been recognised as the Best European Robotics Startup and Innovator Under 35 by MIT Technology Review, and secured the top spot in the Toyota Startup Awards Mobility for AI competition. 

“This has been very important for us. Having this recognition helps us gain awareness, get more people involved, and in turn results in more investors, patients and opportunities to get to know clinics.”

How the ABLE Exoskeleton works

He continues: “You put the device on, which has motors that mimic the function of leg muscles, so it is able to help a patient stand up and go through motions of moving. The whole device is full of sensors that are constantly measuring. The goal of those sensors is to decide when you want to make an action. For example, if you want to make a step, then the sensors measure a certain orientations and velocities so it can decide when is the right instance to initiate those motors. 

“The brain of the system is made up of several electronic boards inside the exoskeleton that command and read the sensor information to then send those signals to the motors to move accordingly.”

Likening the technology to an electric vehicle, the ABLE Exoskeleton is powered by lithium batteries inside the exoskeleton which can be taken out and charged. 

“Although we have not invented the exoskeleton, what we saw when we started the project is that there were a few out there being used, but there were three main problems. The first was the weight. Current devices weigh around 30kg. Imagine if you need to move such a device from one site of a clinic, for example, to another. It also makes it difficult to manoeuvre. 

“Secondly is the time to set up. Rehabilitation sessions are usually 45 minutes to an hour, so you need to make the most of that time standing and walking. Most devices out there on the market take more than 15 to 18 minutes to set up to put on a patient, some even take half an hour. So imagine if you take half the session just putting the device on your body. 

“Finally, and also very important, is the accessibility with the price. Current devices, all of them are above €100,000 (US$105,000), and the gold standard costs around €150,000 (US$158,000). This makes them only a real possibility for large clinics or other private clinics. The result is that most patients are not able to benefit from this therapy in their daily life.”

With this in mind, ABLE designed their version of the exoskeleton. Following seven prototypes, their current device weighs just 17kg, half the weight of its competitors. Its set-up time can be executed in seven minutes, with one of its experienced patients Ricard - who demonstrated the technology at MWC23 in Barcelona in March - able to put it on completely independently in around 120 seconds.

“The price is super important because we don't only want this device to be in the top hospitals. We want it in every city so any patient has access. We have been able to reduce the price to half that of our competitors.”

The human impact

Highlighting the negative consequences of immobility to patients, Carnicero shares his endless pride in seeing what positivity his technology brings to people.

“It’s about the psychological impact,” he explains. “We were in the north of Spain testing the exoskeleton and a guy came in with his wife. She was almost crying when she saw her husband standing up again and towering over her. He exclaimed that it was movement he could do, movement he remembers from before his injury. It’s amazing to get him to this level thanks to technology.”

Carnicero continues to explain how, when patients are sent home from hospital, they are encouraged to get up every day. The question though is, how?

“Standing frames help you to stand, but you cannot move around. Leaving a wheelchair for amounts of time has many health benefits for cardiovascular and digestive issues. We have patients that have reported improvements in pain. There are studies out there that demonstrate that using high intensity repetitions with robotics allows for faster rehabilitation. 

But this is just the beginning. Our mission is to democratise the technology. So we are working on a next generation device to also allow them to use it every day outside the clinic also.

‘Open innovation’ behind ABLE Exoskeleton’s success

“What I have learned the most is that it's not only about technology. You need to involve many other parties around you,” Carnicero exclaims. “You need to have the intellectual property, patents, clinical trials, clinical partners and patients involved in your project. That's been my biggest learning. You cannot be inside your cave developing the technology for three years and then go out. It needs to be an open innovation.”

Next year, the ABLE team will fundraise once more once their focus moves away from bringing the ABLE Exoskeleton to market and generating the first lifesaving sales to clinics. In the future, there is hope the brand can make more personalised devices to be worn in day-to-day life which will be further reduced in weight - around 12kgs - for a cost of €30,000 (US$31,500) by 2026.

“We have also partnered with several universities and companies across Europe with a goal of implanting an electrical stimulator in the spine to connect bidirectionally with the exoskeleton. For example, when your foot touches the ground, the sensors of the exoskeleton will detect the contact and will send the signal to the stimulator so a patient can actually feel the sensation. 

“This is the future.”

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