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Ronan Langan discusses his work leading the DCU Exoskeleton Programme, the addition of paediatric care and the goal to become a ‘centre of excellence’ in this field.
A hybrid programme in Dublin City University (DCU) is working to help people with paralysis to walk, while improving research in the fields of robotics and neuro-rehabilitation.
DCU’s Exoskeleton Programme is a physiotherapist-led service that supports people with reduced mobility to walk using wearable robotics technology – an exoskeleton.
The programme has been running for years using a single device and has provided therapeutic walking sessions to more than 150 adults with reduced mobility. The programme has expanded with a second exoskeleton and has ordered a third one designed for children.
Ronan Langan is the clinical lead of the DCU Exoskeleton Programme and has 16 years’ experience in rehabilitating individuals with spinal cord injury and various levels of paralysis. Speaking to SiliconRepublic.com, he said the DCU programme began as a “service provision”.
“That was vital to allow me and other people that were working with the technology to discover its potential and get practical clinical experience using it,” Langan said.
“The last couple of years have seen a shift and an attempt to move towards a more research-driven programme, while hopefully trying to maintain that service provision for the service users that have really, really come to rely and value it.”
Clinical support
The exoskeleton is essentially a wearable robotic device that is designed to support an individual as they stand up and walk. It is able to provide assistance for people who have partial paralysis or who have completely lost the ability to walk.
The single exoskeleton device was used to deliver between 500 to 800 walking sessions a year. The acquisition of a second device means the programme expects to complete more than 1,500 annual sessions by the end of 2023.
Langan said these walking sessions have had various benefits in supporting people who have various degrees of paralysis and has helped some improve the amount of time they spend walking without support.
“We’ve had two people in the last month say ‘I went out of my house and into my car and drove somewhere without my wheelchair for the first time in like 10 years’,” Langan said. “They were confident enough and strong enough on their feet.”
Langan said that there are some people in the programme who are full-time wheelchair users and likely always will be, due to the severity of damage to their spinal cord or for other medical reasons.
However, these users still appear to gain “huge benefits” from the programme, with some coming back roughly once a week to use the exoskeleton. Langan said it can be harder to assess the benefits in terms of “conventional metrics” for these individuals, but there appears to be clear quality of life benefits.
Paediatric care
Previously, the DCU Exoskeleton Programme was only applicable to adults who are at least 150cm in height so that they can fit in the exoskeleton. But the programme has ordered a special, rare exoskeleton that is designed for paediatric care. Langan said this is the only pediatric exoskeleton commercially available in Europe with a CE mark.
“There’s only about 12 or 13 devices in the world and they’re all in clinical settings,” Langan said. “There’s none coming into this research, hybrid clinical setting that we’ve established.
“So it just makes us so primed to be able to help support a load of people while advancing the field, because we’re really developing practical expertise.”
Langan said there is a huge benefit to supporting children with an exoskeleton in this way, as it may be able to reduce the impacts of certain issues such as scoliosis as they grow into adults.
“What we know about scoliosis in kids is that the moment those kids go off their feet and become full-time wheelchair users…scoliosis starts to form and worsen,” Langan said. “We don’t know that if we can even support them with a few walks a week robotically, if we can limit that damaging impact.
“Theoretically, we should be able to, but obviously the intention is then to go and demonstrate and prove that with a really nice, robust clinical trial.”
Research and future goals
Langan said the DCU exoskeletons have a certain “awareness” in their ability to support the user and keep them upright thanks to various sensors, but highlighted that this is a “rudimentary level”. However, this technology is becoming more advanced.
“There’s a couple of devices released in the last couple of years that are getting a little bit more advanced and they’re getting a little bit more awareness of the user intention,” Langan said. “And we’re going to come all the way upstream to, when I think about moving, the robot knows what I’m thinking about.
“Those devices aren’t available yet. But that’s what the road ahead looks like.”
Research has been taking place in other locations around the world to try to help people to walk again, with research being done on concepts such as brain-computer interfaces.
“When the robots are aware of your intention at the moment that you’re aware of it, that’s when it becomes a really dynamic and valuable tool that will be more powerful than a wheelchair,” Langan said.
The DCU programme is currently collaborating with the Insight research centre for data analytics, to process the large amounts of data being collected from sensors on the exoskeletons and the users. The team also plans to publish studies on the results so far in the next 12 to 18 months.
Langan said the goal is to have DCU be known as a “centre of excellence” in this field and to change the way clinicians manage paralysis. He also mentioned potential long-term plans as the technology evolves in the future.
“You don’t get appointed that [title], you earn that through demonstrating a long history of doing it,” Langan said. “So as we keep doing this and we build our expertise, we would hope to be recognised as the kind of the reference point for doing that.”
“There is a future where walking in robotic devices will be commonplace for people as their way of getting around. And we’d like to be in the conversation in that space, supporting people as they learn to do that.”
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