The Future is Now: The Case For Wearable RoboticsAuthor : Karen Jones and Dominic FlanneryMedical Malpractice
For paraplegics with a spinal cord injury the opportunity to stand on their own feet and look another person eye to eye has previously been little more than a dream. However, wearable robotics is making this dream a reality for some, and in the process, changing the traditional rehabilitation landscape of the insurance industry.
Wearable robotics, also referred to as exoskeletons, comprise of physical hardware controlled by the wearer to assist with human motion. For some paraplegics, they can be used as a therapeutic tool and to assist with mobility, by supporting and assisting the lower body to perform movements that comprise standing and walking.
Demand Drives Global Growth and Technological Advancement
Industry reports forecast the global total market for wearable robotics will surge over the next decade creating a multibillion dollar market. There are a combination of factors driving this growth including; investment in research and clinical trials, particularly in the USA, Asia and Europe, the development of improved devices resulting in reduced manufacturing costs, and a subsequent push from both the medical profession and the insurance industry to trial the technology as an alternative to other rehabilitation solutions.
While use is not yet commonplace in Australia, there are some signs that we may see this change in the near future. In Melbourne, Austin Health’s Royal Talbot Rehabilitation Centre has participated in an international clinical trial of robot assisted physiotherapy exercises using an independently controlled, robotic mobility device that has demonstrated remarkable results. Further, Melbourne University is set to trial the use of a ‘thought controlled’ device, which will see a computer program decode brain signals to drive the use of a wearable robotic.
Risks and Benefits
Overall, the benefits of wearable robotics are significant. Based on clinical trials to date, users can expect significant physical and psychological benefits including:
- Improved bladder and bowel function.
- Weight loss and reduced body fat percentage.
- Improved glucose testing (and reduced insulin dependence).
- Reduced pain levels
- Better posture while seated.
- Improved sleep quality.
- Reduction of secondary health issues, such as pressure sores.
- Improved psychological wellbeing associated with an experience of freedom and the ability to address people at eye level, as well as the opportunity to return to work
There are currently limitations and concerns about the use of the technology. The devices themselves are heavy, and require considerable time for a user to be strapped in as well as the need for a power source and subsequent issues of battery life. In addition, the technology is only suitable for a limited number of people, due to the bone density and strength requirements required for a person to be able to qualify.
The Insurance Industry Response
Early indications would suggest wearable robotics will feature as an alternative to current therapy options in insurance policy development and claims resolution. .
In the United Kingdom, RSA Insurance Group is currently trialling the provision of wearable robotics in rehabilitation for some claimants. Meanwhile, another provider in Japan has teamed up with AIG Japan Holdings KK (a USA affiliated insurer) and Daido Life Insurance Co to offer policies that will cover the use of wearable robotics in rehabilitation, work and medical settings.
In Australia, the National Disability Insurance Scheme (NDIS) recently approved one paraplegic for training with a wearable robotic, which he hopes will allow him to walk to receive his undergraduate degree later this year. Given the NDIS was established by the Government to provide all Australians under the age of 65 with the reasonable and necessary support to enjoy everyday life; this speaks volumes to the potential this technology may offer to those with spinal cord injuries.
Notably, if the trial proves successful, it may become a contributing factor for private insurers to determine whether to approve the supply of the technology to claimants.
The Question of Cost
For insurers, the key determinative will of course be the question of cost. Each wearable robotic costs in the vicinity of $100,000 and will require maintenance and repair over the life of the device, even before rehabilitation and training costs are factored in. Compared with motorised wheelchairs, costing as little as $4,000, this initial outlay may be prohibitive.
It will be important for insurers to assess not just the cost of the technology but also the long term benefits of wearable robotics in each case. However, current indications would suggest the total claims costs may in fact halve, with users returning to work much sooner. For example, in a recent case in the USA, a surgeon who suffered a spinal cord injury and was confined to a wheelchair at work for 11 hours each day, was approved coverage by his insurer (after an appeal process) for a wearable robotic which allowed him to stand up and ambulate both at work and home. The wearable robotic was reluctantly approved by the health fund, at a cost of about US$80,000 after an independent medical review panel found that the available peer-reviewed medical literature was supportive of the device offering a real benefit to the surgeon. Notably, the panel rejected that the wearable robotic was an experimental technology.
Last year a Social Welfare Court in Germany made a similar finding to provide a wearable robotic to a paraplegic approximately ten years after he had suffered a spinal cord injury. In reaching their decision, the Court outlined the technology was not comparable to a wheelchair, as it allows a user to walk again, and should not be denied given that a wheelchair, which would still be necessary, does not compensate for the malfunction of the body completely, which the wearable robotic is able to do.
In Australia, the estimated lifelong cost of a paraplegic person is $5 million. Of this sum, about $2.6 million relates to out of pocket expenses and economic loss. With this backdrop, while the upfront cost of a wearable robotic might seem large to an insurer, in circumstances where a person is able to return to the workforce and has significantly reduced secondary health issues, leaving to one side the quality of life arguments, the technology will likely pay for itself over the lifetime of a recipient.
Transforming Lives, Improving Humanity
By any objective measure, wearable robotics are set to transform the lives of paraplegics, providing hope, ongoing rehabilitation and a means to interact face to face with their peers as well as immeasurable psychological benefits.
In the process, this incredible technology is set to revolutionise the medical and insurance industries.
As costs are anticipated to decrease as demand increases, we expect insurers will need to embrace the possibility of wearable robotics in specific cases, to best maximise on the long tail costs savings.
 Summary of Presentation RAPPER II, 93rd Annual Meeting of the American Congress of Rehabilitation Medicine, Chicago Illinois, 3rd November 2016, http://www.rexbionics.com/wp-content/uploads/2016/12/ACRM-Slide-Handout-Summary.pdf
 ReWalk Robotics Exoskeleton Deemed Medically Necessary by Independent Medical Review Organization http://rewalk.com/rewalk-robotics-exoskeleton-deemed-medically-necessary-by-independent-medical-review-organization/
 The economic cost of spinal cord injury and traumatic brain injury in Australia; Report by Access Economics Pty Limited for the Victorian Neurotrauma Initiative, June 2009; https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwi93MiOyNLSAhWLgrwKHYqMDrUQFgggMAA&url=https%3A%2F%2Fwww.tac.vic.gov.au%2Fabout-the-tac%2Four-organisation%2Fresearch%2Ftac-neurotrauma-research%2Fvni%2Fthe20economic20cost20of20spinal20cord20injury20and20traumatic20brain20injury20in20australia.pdf&usg=AFQjCNEylUIo7ESej_hn2BcchgYcSxYDLQ