Overground Wearable Exoskeleton (Robotic Gait Training) at PYONG Rehabilitation Penthouse

The wearable walking-training robot (Overground Wearable Exoskeleton) is a robotic device that helps "support and drive" the hip and knee joints, so that those with a state of muscle weakness or loss of balance are able to train standing and walking safely, particularly in patients with diseases of the nervous system, such as stroke, Parkinson's, those with spinal cord injury, and older people who walk unsteadily. The strong points of walking training with a robot of this kind are increasing the number of steps the patient is able to train, remembering the pattern of support for walking so that each patient is able to walk correctly, reducing the burden on the carer, and creating confidence during the training.

At PYONG Rehabilitation Penthouse Clinic (Gaysorn Tower, Floor 11, near BTS Chit Lom), every step is carried out and supervised by physicians specialising in rehabilitation medicine together with a multidisciplinary team, in order to design a programme specific to the individual safely, with training suited to the real condition of the patient (read the overview of the technology at the page: services/technique-and-technology/overground-wearable-exoskeleton)

What is the walking-training robot?

The wearable Exoskeleton is a robot with a structure for supporting the body attached at the area of the trunk and the legs, using electric motors to drive the hip and knee joints. The robot is controlled by a computer and sensors receiving signals from the movement, in order to help the patient "step" more rhythmically and symmetrically. During the training, crutches/a walker and supporting devices are used as suitable, under the close care of physiotherapists and doctors.

At PYONG Rehabilitation Penthouse we present the most modern model of robotic technology for helping walking training and reinforcing movement (Overground Wearable Exoskeleton for Gait & Mobility Systems), manufactured in Italy, in order to help rehabilitate patients who have severe limitations in movement, particularly patients with cerebrovascular disease or those with a state of hemiplegia. This technology lets patients train walking in a form close to the natural, stimulates the learning of the nervous system, and builds up independence in movement.

Why should you train with the walking-training robot at PYONG Rehabilitation?

The walking-training robot at PYONG Rehabilitation is an Overground Wearable Exoskeleton for Gait & Mobility Systems of the most modern model, manufactured in Italy, meeting the standards of safety supported by the European Union. It uses a structure of material that is strong but light in weight, so that the patient can wear it and move more conveniently. The level of assistance can be adjusted according to the strength of the patient, and it is designed to suit many bodily builds. It can be used very well for training real walking in daily life.

Compared with other walking aids (such as a walker, a cane, or walking-training robots of the treadmill-assisted device kind met generally), the Exoskeleton robot at PYONG Rehabilitation helps stimulate the working of the muscles and the nervous system better, because the patient gets to walk in the "Overground" manner (walking on the real floor, not on a belt), with the result that the brain learns to walk anew in a way closer to the natural.

Besides this, compared with other models of Overground Wearable Exoskeleton for Gait & Mobility Systems, the Exoskeleton robot at PYONG Rehabilitation has a variety of training modes, as many as three modes — Passive, Active-assisted, and Active mode — the level of assistance being adjustable according to the strength and the ability of the patient, and stimulating the working of the brain and the muscles in order to restore walking effectively. It has a system for recording the data of the training within the robot itself, and it is designed to support 8 joints of the patient, making the walking training as close to the natural as possible (compared with other Exoskeleton robots, which usually support only 6 joints).

PYONG Rehabilitation is considered the only rehabilitation clinic in Thailand that has brought walking training with a robot of this most modern model to be a technology that lets patients train walking repeatedly in a correct form and with high intensity, which is an important factor in stimulating the learning of the nervous system (Neuroplasticity) and promoting the recovery of walking. The fact that PYONG Rehabilitation Penthouse has this technology lets us give a programme of rehabilitation that is intensive and highly effective, particularly during the "Golden Period", or the period of 6 months after the symptoms arise, which is the period when the brain is able to recover most quickly.

PYONG Rehabilitation Penthouse Clinic emphasises complete care of diseases of the nervous system, every case beginning from assessment by a rehabilitation physician and planning together with physiotherapists/occupational therapists, speech therapists, clinical psychologists, and dietitians as necessary, and combining walking training with the walking-training robot with other forms of rehabilitation, in order to increase the number of steps and the quality of the training so that it is as close to real life as possible.

The clinic is situated in the heart of the city at Gaysorn Tower, Floor 11 (BTS Chit Lom), convenient to travel to, suited to continuous training and monthly follow-up.

How does the walking-training robot work?

The concept of the working of the walking-training robot is "helping train the patient in the skills necessary for walking, specific to the individual, and training the same skills repeatedly", in order to stimulate the learning of the nervous system (neuroplasticity). The robot helps set the posture of the trunk and the hips so that they are stable, reduces the falling of the body, and governs the correct pattern of stepping, so that the patient gets to train a greater number of steps in a limited time, together with receiving the data of the patient's movement in real time.

The steps of the service (Step-by-Step):

1. Assessment by a rehabilitation physician, examining readiness: height and weight, range of movement, stiff joints, the state of the heart, the lungs, the skin, and the bones
2. Fitting the device and testing the system (calibration)
3. Preparing the readiness of the robot
4. Putting on the Exoskeleton and beginning to walk on the floor (overground), with a therapist supervising and using suitable supporting devices
5. Adjusting the force and the speed, as well as increasing the number of rounds of walking/the distance/the incline according to the response of the patient
6. Easing the speed and the force of the training, summarising the result and the plan for further training at home

The feeling during it: one will feel that the legs are "supported and pushed to step" regularly. There are straps holding firmly, and the points of pressure will be checked regularly. If there are symptoms of fatigue or muscle tightness, a break will be taken and the programme adjusted at once (the mode of walking support used depends on the symptoms of the patient) (FDA Access Data (opens in a new tab))

The symptoms/states suited to the walking-training robot

• Patients with cerebrovascular disease (Stroke) who have a state of hemiplegia or weakness of the leg
• Patients with spinal cord injury (Spinal Cord Injury) who still have the potential for recovery of walking
• Patients with multiple sclerosis (Multiple Sclerosis – MS) who have a problem of walking
• Patients with Parkinson's disease (Parkinson's Disease) who have a problem of balance and of initiating movement
• Patients with traumatic brain injury (Traumatic Brain Injury – TBI)
• Those who have a state of muscle weakness from other causes that has a bearing on walking
• Suited to those who want intensive walking training with the goal of restoring walking as much as possible

The academic evidence concerning the walking-training robot

A Meta Analysis of the year 2024 found that walking training with a robot of the walking-on-the-floor kind (overground) helps increase "the speed of walking" in stroke patients, compared with standard physiotherapy, but it must be paired with other programmes of therapy for the most effective outcome (PMC (opens in a new tab)). Besides this, research in the years 2023–2024 also concludes that exoskeleton-assisted training has a tendency to help in the area of the function of walking for patients facing symptoms after a state of stroke, the plan of treatment with suitable intensity and number of sessions having a significant bearing on the outcome (PMC (opens in a new tab), Frontiers (opens in a new tab))

For those with spinal cord injury, much research confirms that the overground exoskeleton helps develop the skills of standing and walking of patients in the real environment, under suitable screening and care (BioMed Central (opens in a new tab)). In Parkinson's, new research data indicates that high-intensity exercise with an exoskeleton may play a part in developing the memory of the method of walking and the overall skills of walking of patients (Nature (opens in a new tab))

How often should one train with the walking-training robot?

The suitable frequency stated in the research is about 2–3 times a week, continuously for at least 4–8 weeks or longer, depending on the plan of treatment, each session setting a goal for the number of steps, the distance, or the time of walking sufficient for each individual patient, and adjusting the level of the supporting force according to the progress of the patient. That said, "the dose of the training" (frequency × duration × number of steps) is an important variable for the outcome, and training with the walking-training robot should be used together with training balance, building up strength, and other walking programmes as a supplement, so that the greatest effectiveness occurs. The physician specialising in rehabilitation medicine will be the one who determines the suitable frequency for each individual, according to the medical limitations, the capacity, and the goals of the patient and the family (PMC (opens in a new tab))

The outcome expected

In the short term (the first session–the first week): most patients report that they feel more confident in standing and beginning to step, and feel that the body is beginning to have a more regular pattern of stepping, and that the number of steps trained per session can be increased when the supporting system is set suitably.

In the long term (4–6 weeks onwards): most patients report that they feel the body has received an improvement in the ability to walk — the speed, the distance, the stability, the pattern, and the confidence in walking — and feel that they can reduce their dependence on walking aids or on a carer.

Contraindications and precautions in carrying out the procedure

Before beginning the treatment, every patient will receive the taking of a history and a physical examination by a doctor, in order to screen for safety. The precautions met often are

• The height/weight must be within the range the device supports (differing according to each model)
• Severe osteoporosis, a fracture that has not yet knitted, incomplete skin in the area of the straps
• Severely stiff/fixed joints, with range of movement insufficient for the pattern of stepping
• Very severe muscle spasticity (for example MAS > 3)
• Blood pressure that cannot be controlled, an unstable state of the heart/lungs, dizziness from a drop in pressure, being unable to stand
• An acute state of a clot blocking a vein (DVT) or other contraindications to bearing weight
• The person receiving the treatment must have sufficient strength of the arms/shoulders to use crutches or a walker (in some protocols)
  The guidance from the manufacturer and from clinical research gives information in the same direction, that when the screening is good and the training is by a team that has been through the training, the use of the walking-training robot is highly safe (eksobionics.com (opens in a new tab), BlueShieldCA (opens in a new tab), PMC (opens in a new tab))

The cost

The service fee for the walking-training robot starts at about 6,000–9,000 baht per session (THB), depending on the package or the intensive programme of rehabilitation of the clinic that the person receiving the service chooses. That said, each case must receive assessment by the team of doctors and experts first, in order to screen for safety, set the goals of the treatment, and design a suitable plan of treatment.

Frequently asked questions (FAQ)

1) Who is suited to the walking-training robot?

Stroke patients, Parkinson's patients, those with incomplete spinal cord injury, older people who walk unsteadily, or those who want to increase the number of steps safely. That said, it depends on assessment by a doctor.

2) How many sessions must be trained for a result to be seen?

In general 2–3 times a week, continuously for 4–8 weeks, together with other supplementary programmes. The doctor will adjust it according to the goals and the real ability of the patient (PMC (opens in a new tab))

3) Is it safe?

When the contraindications are screened and the training is by a team that has been through the training, undesirable events are not met often. We check the skin, the blood pressure, and the symptoms of fatigue every time during the training (PMC (opens in a new tab))

4) What height/weight must one have?

Each model supports a different range, mostly around a height of ~160–190 cm and a weight of ≤100 kg. The team will always measure and try the fitting before beginning (BlueShieldCA (opens in a new tab))

5) How does it differ from the robotic treadmill (treadmill-based)?

The overground system helps train walking "on the real floor", adjusting the conditions to be closer to daily life, suited to transferring the skill to real use, while the robotic treadmill emphasises controlling the rhythm repeatedly and continuously.

Choosing a place for treating pain and diseases of the brain from a clinic cared for by a team of specialist physicians with expertise, such as PYONG Rehabilitation Clinic and PYONG Rehabilitation Penthouse, will help the patient receive care that is effective and safe, with modern technology, letting the patient have the chance to recover and return to a better quality of life quickly.