Exoskeletons for Cerebral Palsy: Current Status and Challenges in Practical Use

Cerebral palsy is the most common disability that develops during childhood, affecting approximately 50 million people worldwide. In addition to difficulties with mobility caused by muscle stiffness, weakness, or abnormal movements, cerebral palsy can also be accompanied by neurological issues such as epilepsy or visual impairments. Traditional physical therapy has included treadmill training, muscle strengthening exercises, and task-specific training such as practicing getting in and out of cars. However, in recent years, wearable devices known as exoskeletons have gained attention as a new therapeutic tool. A recent systematic review published in The Conversation sheds light on the evidence in this field, laying out the road to practical application and the challenges that remain.

Over 50 Years of Research and Development

The development of exoskeletons aimed at assisting walking dates back to the 1960s. Early devices were large, complex machines that took decades to move out of the laboratory. After over 60 years of improvements, today’s exoskeletons are significantly more compact. In Australia, several medical-grade exoskeletons have recently been approved by the Therapeutic Goods Administration. While research in this field has primarily focused on rehabilitation for adults with conditions such as stroke or spinal cord injuries, the application of exoskeletons for children with cerebral palsy is becoming increasingly feasible.

Current Classifications and Advancements

Medical exoskeletons can be broadly categorized into three types. The first type is used in combination with treadmills. A well-known example of this is Lokomat. The second type is the “end-effector” model, which resembles a stationary elliptical training machine; Innowalk is one such device.

The third category consists of overground exoskeletons, such as Atlas 2030, which can move across various terrains. This type allows users to choose their destination freely and interact more with their environment. They also hold the potential to be used as long-term assistive devices in daily life, rather than being confined to rehabilitation rooms. In this way, exoskeletons are evolving from mere rehabilitation tools to devices that can improve overall quality of life.

Insights from the Systematic Review

The recent review aimed to evaluate the effects of wearable overground exoskeleton therapy for cerebral palsy patients across several domains: physical outcomes, functional performance, quality of life, and participation. Participation in this context refers not just to being present during an activity but to being actively and meaningfully engaged.

The review analyzed 21 studies involving a total of 241 cerebral palsy patients with an average age of nine years. The findings suggest promising potential for exoskeleton therapy to enhance mobility and participation. However, the review did not delve into specific improvement rates or statistical significance, emphasizing the need for larger clinical trials in the future.

Developments in Australia’s NDIS

Australia’s National Disability Insurance Scheme (NDIS) advisory committee is currently reviewing various support measures for people with disabilities, including robot-assisted gait training. The results of this evaluation will influence whether the federal agency responsible for managing disability funding approves financial support for exoskeleton therapy. The timing of the review’s publication aligns with these discussions, potentially having a direct impact on policy decisions.

Editorial Perspective

In the short term, this report highlights a critical juncture where public insurance systems like NDIS must decide whether to approve exoskeleton therapies. While research evidence remains limited, if Australia leads the way in early adoption, discussions about insurance coverage could extend to other advanced nations, including Japan. In Japan, rehabilitation devices for cerebral palsy patients have been slow to receive insurance coverage, making international developments a valuable reference.

From a long-term perspective, exoskeletons may shift their role from rehabilitation tools to everyday assistive devices. Advances in lightweight materials and control algorithms make it increasingly plausible for these devices to be used in real-world settings such as homes, schools, and workplaces. However, challenges such as cost, maintenance, and achieving a social consensus on the balance between “support” and “dependency” remain. While exoskeletons are designed to assist human movement, there is a risk that they may be perceived solely as a means to “overcome” disability, rather than as tools to enhance human capability.

As a point of reflection, the editorial team poses the following question: Once exoskeletons are widely adopted, how will society perceive them? For example, when someone wearing an exoskeleton walks through a public space, will they be seen as a “patient undergoing treatment” or as a “citizen with enhanced physical capabilities”? Just as technological advancements are vital, so too is creating a framework for their acceptance. Furthermore, while this review emphasizes the concept of “participation,” it is important to recognize that merely improving walking ability does not necessarily equate to greater happiness for the patient. The time has come to discuss the true meaning of “participation.”

References:

• The Conversation - Exoskeletons for people with cerebral palsy are now a reality – but there’s still much to figure out — Published on June 3, 2026