A different user from the start
The first powered exoskeletons of the 1960s were not designed with older people in mind. Defense projects aimed at strength, and early medical work, such as research in Belgrade, aimed at helping people with paralysis to move. The idea of an exoskeleton for older adults came later and grew out of two overlapping developments: rehabilitation robotics, and concern about aging populations. This article covers the history only and is not medical advice.
Rehabilitation comes first
From the 1990s, clinicians and engineers built robotic training systems for people relearning to walk after stroke or spinal cord injury. One common form combines a treadmill, a harness that carries part of the patient’s weight and motor-driven leg braces that guide the legs through a walking pattern. The Lokomat, introduced by a Swiss company around the start of the 2000s, is a widely known example. Sessions are typically supervised by therapists, and the devices are fixed in a clinic rather than worn around town.
Mobile frames followed. Wearable devices that let a person walk over ground, rather than on a treadmill, were developed in the 2000s and 2010s, and several were first cleared for use in clinics or for people with spinal cord injuries. Many of the design problems that these frames solved, such as detecting the start of a step and keeping the wearer’s balance, carry over directly to devices for older adults.
Why interest turned to aging
Japan, with one of the world’s oldest populations, was an early center of work on assistive robots for older people. Concern about too few caregivers and growing numbers of people with limited mobility encouraged government and company programs. Several firms developed lighter devices, often focused on the hip joint, intended to help an older wearer walk or climb stairs rather than to replace leg function. The Hybrid Assistive Limb from Cyberdyne, developed from research at the University of Tsukuba, is one of the better-known systems. Honda began work on a walking-assist device around the turn of the century that applies a small torque at the hips to support the swing of the legs, and other companies in Asia, Europe and North America produced comparable designs.
The target conditions are varied. Muscle weakness with age, a history of falls, arthritis, stroke recovery and balance problems can all limit walking. A device that adds modest help at the hips or knees might reduce effort, or support longer walks, though how much help it gives depends on the user and the task.
Lighter designs
Rigid exoskeletons are heavy and difficult to put on, which is a barrier for older users who may have limited strength, balance or dexterity. A major trend of the 2010s was therefore toward lighter systems, including soft exosuits that use fabric and cables, and hip-only assist belts. Some designs add a small amount of power to the hip as the leg swings, and some use only springs. Smaller electric motors, better lithium-ion batteries and cheaper sensors made such devices possible.
At the same time, other assistive technology competes for the same role. Walkers, canes, powered wheelchairs and mobility scooters are cheaper, simpler and well tested. Exoskeletons need to show that they offer something these cannot, such as keeping a person on their feet for longer, to justify their cost and complexity.
What the evidence shows
Studies of wearable walking assistance for older adults are generally small and short. Several have reported that users walk with less effort or show better walking speed while wearing a device, but results vary, and improvements while wearing a device do not automatically mean a lasting improvement once it is removed. Researchers are still studying whether training with exoskeletons produces long-term gains, how to avoid dependence and how to prevent falls. Safety is a specific concern, since an older user may have fragile bones, and a fall while wearing a rigid device could cause injury.
Cost and practicality are also obstacles. Many devices have been priced in the range of tens of thousands of dollars and are intended for use in clinics or care settings rather than homes. Lighter products have been aimed at consumers, with limited uptake so far.
Regulation and standards
Medical exoskeletons are generally regulated as medical devices. International standards for personal care robots, including a safety standard published in the 2010s, were developed in part because robots that touch and support people raise different safety questions from factory robots. Rules vary by country and have been revised as the products change.
Where it stands
The history of exoskeletons for older people is thus one of adaptation rather than invention: techniques from rehabilitation, military and industrial research were tuned toward lighter, quieter and more comfortable devices for everyday mobility. Whether they will become common remains uncertain. For now they are best viewed as promising assistive tools whose benefits are still being measured.