Robotics helping people walk again — at a hefty price

Updated June 12, 2017 - 4:08 am

Ashley Barnes was 35 years old when doctors told her she would never walk again.

A botched spinal procedure in 2014 paralyzed her from the waist down. The Tyler, Texas, resident had been an avid runner, clocking six miles daily when not home with her then-9-year-old autistic son, whom she raised alone. Life in a wheelchair was not an option.

“I needed to be the best mom I could be,” Barnes said. “I needed to be up and moving.”

So she threw herself into physical therapy, convinced she would one day run again. Soon she realized that wasn’t a reality.

Although she wore a brave face, “I would save my moments of crying for my room,” she said.

About a year later, hope resurfaced when she learned of the ReWalk system, a battery-powered robotic exoskeleton that attaches to the legs and lower back. It contains motors at the knee and hip joints and sensors to help it adjust with each footfall. While wearing the device and holding two forearm crutches, someone with complete lower-limb paralysis can walk.

Rehabilitation centers often employ such devices in physical therapy, which is how Barnes first encountered one at the Baylor Tom Landry Center, a rehab clinic in Dallas. After seven months without being able to stand, she did. Then she took a step as she began to learn how to walk again.

In 2014, the ReWalk system became the first personal robotic exoskeleton approved by the Food and Drug Administration. The following year, the Department of Veterans Affairs agreed to cover the exoskeletons for qualifying vets. Meanwhile, several companies began touting similar devices. For example, Ekso makes units used to rehabilitate people after spinal cord injury or stroke.

Health insurers, however, generally don’t cover the expensive equipment.

After working with the ReWalk system at her rehab center, Barnes, who uses a wheelchair at home to get around, decided she wanted one of her own. But Tricare, her insurer, denied the request.

In a statement, Tricare said it “does not cover these devices for use on a personal basis due to concerns with their safety and efficacy. This is particularly important due to the vulnerability of paralyzed users in the event of a fall.”

Two years and countless no’s later, Barnes still doesn’t have one because, according to Tricare, it isn’t “medically necessary.”

Barnes strongly disagrees.

“This is medically necessary,” she said. If she had one of the devices, “I’d be able to go to the bathroom. I would be able to walk around, exercise in it. I would love to be able to stand up and cook things in my microwave or on my stove.”

She paused before adding, “I would no longer have to look up at my son.”

The ReWalk Personal 6.0 System costs, on average, $81,000. Ottobock’s C-Brace is priced at $75,000. For the Indego Personal, which received FDA approval last year, it is $98,000.

About 28 percent of the more than 5.2 million Americans living with paralysis survive on an annual household income of less than $15,000, according to the Christopher and Dana Reeve Foundation. The basic expenses of living with paraplegia are, on average, $519,520 in the first year and $68,821 each subsequent year, according to the National Spinal Cord Injury Statistical Center. Furthermore, only 34.3 percent of people are employed 20 years after a paralysis-causing injury.

To date, ReWalk has sold only 118 personal devices in the United States.

Some people do get devices covered by insurance, but it can be an onerous process, as evidenced by Mark Delamere Jr. The Boston native, 19, was paralyzed in a car accident in 2013, on the third day of his freshman year of high school.

Like Barnes, he thought he would never walk again. Like Barnes, with the help of a robotic exoskeleton, he did. Unlike Barnes, though, he has an exoskeleton at home.

But for two of his teenage years, he sat in a wheelchair while his family filed claims and appealed denials.

“They don’t really classify these things with the purpose of you getting better, because they think the injury is never going to change,” his father, Mark Sr., said.

Eventually, though, Mark Jr. got approved by his insurance company and received the ReWalk, which he uses for at-home therapy and just to “walk around the house and the neighborhood, up and down the street.” Asked to describe the feeling, he was at a loss for words.

“It’s kind of crazy,” he said. “It just feels kind of — I don’t really know. It feels so different.”

But his story is rare. “People are paying out of pocket or fundraising” for exoskeletons, said Dan Kara, research director for robotics at ABI Research, a technology analysis and consultant company.

The price of the devices exceeds their value in the eyes of insurers, which “want to be able to prove they actually improve quality of life and utility,” said Howard Forman, a Yale professor of diagnostic radiology and public health. “Utility” means that an exoskeleton would provide a medical benefit beyond simply helping people move around and complete daily tasks.

Virginia Tech researchers found that these devices, by getting otherwise immobilized people to move around, can help them manage spasticity — a continuous contraction of muscles, which can be quite painful – and improve bowel function. Barnes said when she was training with the exoskeleton, tending to her bowels took about 20 minutes each day, not the customary hour.

One major concern is how relatively untested the technology is outside the controlled environment of a rehabilitation facility. Indeed, they don’t always work as planned.

Stacey Kozal, a 42-year-old Ohio resident, was paralyzed from the waist down after what she said was a devastating flare-up of lupus. For more than a year, she fought with her insurance provider, Anthem, in hopes of obtaining Ottobock C-Braces. These devices have bendable knee joints equipped with sensors that “measure the current position of the joint every .02 seconds,” according to Ottobock’s website. A built-in microprocessor adjusts ankle pressure while a hydraulic system moves the knee to help the user place her foot down in the right place.

Eventually, Anthem agreed to cover a C-Brace for each leg, which Kozal used to hike the Appalachian Trail, where limitations revealed themselves. The battery required constant recharging. Rain was problematic because the C-Brace isn’t waterproof.

While she plans to wear her C-Braces around the house, she’s now hiking the Pacific Crest Trail using old-fashioned braces that lock her legs in place. She uses her core, hips and upper body to swing her legs forward, and she keeps her balance with the aid of forearm crutches. C-Braces are heavier than traditional devices, so when their batteries died on the Appalachian Trail, they made it more difficult for her to move around.

Another major issue for insurers, though, is the price. But Forman said, “Though these technologies are incredibly expensive now, we have all kinds of evidence that eventually … they can become affordable to anyone.”

Indeed, some entrepreneurs are working on cheaper solutions. Silicon Valley start-up SuitX created a lightweight model called the Phoenix. While most exoskeletons have motors powering each joint, the Phoenix simply uses two hip motors. Even so, if approved by the FDA, the device would cost $40,000, according to SuitX.

“The rehabilitation marketplace is limited by the number of people who have these conditions,” Kara said. The exoskeletons are “basically handcrafted, which is expensive. If you could up the volume, you could lower the price.”

The key would be expanding the user base. One way to do that, he noted, is to sell the devices for purposes other than rehabilitation. Warehouse workers might wear them to assist with lifting heavy loads. Some companies are already testing this idea: Lowe’s, for example, recently outfitted several of employees with exoskeletons as part of a pilot program.

The worldwide market for exoskeletons — $97 million now — is expected to grow to $1.9 billion by 2025, according to ABI Research.

Kara compared the prospects for exoskeletons to the growth of LiDAR, which uses pulsed lasers to record topographic features. For years, researchers used LiDAR to create 3-D maps of the Earth, but it was expensive. However, the rise of self-driving cars, which use the technology to navigate roadways, fostered improvements in the technology. As a result, Kara said, the price of LiDAR systems has begun to fall and is “expected to drop dramatically, from tens of thousands of dollars to hundreds of dollars or less.”

Waiting for exoskeleton prices to drop is tremendously frustrating, Barnes said. “We take so much for granted when we don’t have physical problems,” she said. “Like just being able to reach up and grab something in my laundry cabinet without having to break my neck to get it.”

She isn’t ready to just accept that she — and others who will face these issues — might never get a sense of greater normalcy.

“My biggest reason for standing up tall to them is I want to do it for all those behind me,” she said. “The more it gets approved, the more it can’t get denied.”

ad-high_impact_4
News
Las Vegas shooting survivor has surprise reunion
Oct. 1 mass shooting survivors Taylor Stovall and Parker Gabel meet for the first time since Gabel helped the injured Stovall to an ambulance the night of the shooting. Stovall, then 17, was shot in the arm. They met Friday at the Tropicana.
Hawaii volcano presser
Talmadge Magno of Hawaii Civil Defense gives an update on the Kilauea volcano
Same-Sex Weddings on the Rise in Las Vegas
Allie and Tara Shima finally tied the knot. They've been together for five years and have both been married before. This time, they wanted something simple, quick and cheap, but it still had to feel special. The couple chose Las Vegas. (Madelyn Reese/ Las Vegas Review-Journal)
Courtyard Homeless Resource Center begins building in Las Vegas
Las Vegas Mayor Carolyn Goodman and Ward 3 Councilman Bob Coffin kicked off the demolition of buildings where the Courtyard Homeless Resource Center will be built. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutesfaye
"Yanny" or "Laurel" hearing test has gone viral
'Yanny' or 'Laurel?' This Hearing Test Has Gone Viral This hearing test has gone viral on social media with some hearing "Yanny" while others swear hearing "Laurel." The voice is actually saying "Laurel," but the pitch was changed, causing some to hear "Yanny."
LVMPD Briefs on Year's Sixth Officer-Involved Shooting
Las Vegas police have identified the officer who shot a shovel-wielding woman on Saturday as 23-year-old Ondre Wills.
Police release body camera footage of shovel-wielding woman
Las Vegas police identified the woman they said threatened neighbors with a skillet Saturday night. Officer Ondre Wills, 23, shot at Sommer Richards, 34, multiple times on Big Sur Drive, near Nellis Boulevard and Desert Inn Road. Police responded to the area after receiving reports that the woman was armed with a shovel. Police said the woman chased neighbors and a security guard. Wills got between Richards and the others and repeatedly told her to drop the shovel. The woman instead turned and moved toward a person who was standing nearby before the officer fired shots. Police said she bit another officer as he attempted to render aid. Richards remains in serious but stable condition.
College of Southern Nevada Graduates 2017-18 Class
The College of Southern Nevada's graduation ceremony was held at the Thomas & Mack Center Monday. The 2017-18 class was the institution's largest in history. (Madelyn Reese/ Las Vegas Review-Journal)
Metro looking for suspect in bank robbery.
On Jan. 22, a man robbed a bank in the 8700 block of West Sahara Avenue.
Former Gov. Mike Huckabee at opening of U.S. Embassy in Jerusalem
Former Arkansas Gov. Mike Huckabee, at opening ceremony of U.S. Embassy in Jerusalem, speaks about the violence in Gaza. (Debra J. Saunders/Las Vegas Review-Journal)
Supreme Court strikes down law banning sports betting outside Nevada
The Supreme Court has overturned a federal ban on sports gambling. States other than Nevada will be allowed to provide bookmaking and betting at casinos and race tracks. Justice Samuel Alito said Congress can regulate sports gambling directly, but if it elects not to do so, “each State is free to act on its own.” The vote was 6-3. One research firm estimates that 32 states will likely offer sports betting within five years.
Westcare Clinic Crucial to Las Vegan's Addiction Recovery
Christian Hunt, 21, was sent to Westcare in September after he ended up on drugs and in the hospital. If it weren't for the nonprofit's Community Triage Center, Hunt said he would still be using drugs. Instead, he's been sober for six months, and stopped using methamphetamines seven months ago. (Madelyn Reese/ Las Vegas Review-Journal)
Foundation Provides Full Rides for Clark County Students
Somewhere along the banks of the Ohio River in Owensboro, Kentucky, a group of students from Sin City are pursuing a higher education. Feature on the 38 Clark County students that the Rogers Foundation has given full rides to for Kentucky Wesleyan College. (Madelyn Reese/ Las Vegas Review-Journal)
Flames engulf house in Henderson
Clark County firefighters battled a house fire early Friday morning in Henderson. The house, located near Volunteer Boulevard and Executive Airport Drive, was fully engulfed in flames about 2 a.m. Shifting winds sent massive plumes of smoke across the southern Las Vegas Valley sky. As of 3 a.m. , the cause of the fire was not known and no injuries were reported.
Harvey Weinstein’s Estranged Wife Speaks Out for First Time
Harvey Weinstein’s Estranged Wife Speaks Out for First Time Georgina Chapman was profiled for 'Vogue’s' June issue, speaking on her estranged husband for the first time since he was accused of sexual assault in October. Georgina Chapman, to Vogue Georgina Chapman, to Vogue Chapman, who has two children with Weinstein, also said she has been seeing a therapist and that has helped her move forward. Georgina Chapman, to Vogue Georgina Chapman, to Vogue Read the full profile on Chapman in Vogue’s June issue or online at Vogue.com.
Bark-Andre Furry the dog is a Vegas Golden Knights hockey fan
The furriest fan of the NHL's Vegas Golden Knights is growing into a social media sensation. Bark-Andre Furry the Jack Russell terrier has thousands of followers on Twitter and Instagram. (K.M. Cannon/Las Vegas Review-Journal)
Suspect Sought In Robbery Attempt
Attorney Gloria Allred on case against Benjamin Sparks
Attorney Gloria Allred is representing the victim in a "sex slave" case against GOP political consultant Benjamin Sparks.
2018 Las Vegas Review-Journal High School Journalism Awards winners
Some winners of the 2018 Las Vegas Review-Journal High School Journalism Awards receive their awards.
Weather Balloon Collects Key Data
Meteorologist Chelsea Kryston discusses the Las Vegas National Weather Service's balloon carrying a radiosonde that collects temperature, humidity and pressure readings.
'Avengers: Infinity War' to Cross $1 Billion Mark
'Avengers: Infinity War' to Cross $1 Billion Mark And it will have done so faster than any other film in history. The Anthony and Joe Russo directed film has only been in theaters for eight days since its Apr. 27 release, and it’s already raked in $905.1 million at the worldwide box office, including $338.4 million in North America. It will reach the milestone faster than ‘Star Wars: The Force Awakens,’ which took 12 days to cross over the $1 billion threshold. ‘Infinity War’ is the 34th film to cross $1 billion at the global box office, not accounting for inflation.
Henderson Residents Fighting Their HOA
Sun City Anthem residents Tim Stebbins and Bob Frank were arrested by the Henderson Police Department for filing a false report of a crime after they claimed their HOA was hiding surplus assessments in a secret slush fund. Nearly a decade later, Frank is still trying to clear his name. (Madelyn Reese/ Las Vegas Review-Journal)
UNLV Professor Retiring After 50 Years
Professor Bernard Malamud reflects on his 50 years teaching economics at UNLV and what it's been like watching to school and the city grow.
Donald Trump recognizes Jon Ponder of Hope for Prisoners
Former bank robber Jon Ponder, now CEO of Hope for Prisoners, is recognized by President Donald Trump at the White House Rose Garden. Debra J. Saunders/ Las Vegas Review-Journal
Motorcyclist suffers severe head injury
A crash early Friday morning has left a motorcyclist hospitalized with a serious head injury, according to Las Vegas police. The crash occurred in the southwest valley at Durango Drive and the 215 Beltway, and was reported around 1:30 a.m. Police are investigating and one lane of the eastbound 215 offramp has been shut down.
Woman stabbed in the stomach
Las Vegas police are looking for the suspect who stabbed a woman in the stomach during a street robbery Friday morning in the central valley. The 37-year-old woman walked into the 7-Eleven at 531 E. Sahara Ave., around 1:30 a.m. with a wound to her abdomen, according to police. She was taken to a local hospital and is expected to survive her wound. The stabber remains at-large.
Trump Nominated for Nobel Peace Prize
Trump Nominated for Nobel Peace Prize Eighteen House members sent a letter to the Nobel Committee in Norway, recommending President Donald Trump for the 2019 Nobel Peace Prize. The letter was signed by Rep. Luke Messer and other GOP members, according to the New York Post. Letter to Nobel Committee This week, South Korean President Moon Jae-in said Trump deserved the nomination, as well, for his efforts to rid North Korea of nuclear weapons. Trump is set to meet with North Korean leader Kim Jong-Un soon.
Bodycam video: Las Vegas police breach gunman’s door during Oct. 1 shooting
Las Vegas police released body camera footage that depicts the moment officers breached Oct. 1 gunman Stephen Paddock’s Mandalay Bay suite.
McCaw School of Mines welcomes its 100,000th visitor
The McCaw School of Mines simulated underground mine attraction has been welcoming field trips and other visitors since 1996. On April 30, they welcomed the 100,000th visitor. K.M. Cannon/Las Vegas Review-Journal
Las Vegas Academy learns to Stop the Bleed
Teachers, faculty and staff at Las Vegas Academy and other schools in the Clark County School District are undergoing "Stop the Bleed" training. Participants learn to apply a tourniquet, pack a wound and apply pressure to stop bleeding. K.M. Cannon/Las Vegas Review-Journal
Life
Art Bell’s Top 10 Shows
A selection of radio host Art Bell’s most popular shows.
Calvary Christian Learning Academy, “There was no fair warning.”
Samantha O’Brien, whose three-year-old daughter attended the Calvary Christian Learning Academy daycare, found out Monday night when her daughter’s teacher called about the school closing.
Companies bet their futures on cryptocurrency
Two Las Vegas entrepreneurs talk about finding their niche in blockchain enabled technologies and digital currency.
Solar panels reduce energy bill for CCSD
Wilbur and Theresa Faiss Middle School is one of 42 CCSD schools with solar panel installations, saving approximately $514,000 per year in energy costs.
TOP NEWS
News Headlines
Events
Home Front Page Footer Listing
Circular
You May Like

You May Like