Editor's Note

A Fascinating Debate

There's fascinating news coming out of Vanderbilt University and Shepherd Center these days concerning a new “breakthrough” exoskeleton that can enable people with spinal cord injuries (SCI) to stand and walk.

exoskeleton

The Parker Hannifin exoskeleton as developed by Vanderbilt University and Shepherd Center. Photo courtesy Shepherd Center

We’ll have more details — and an original interview — in our February issue, but for now, the highlights are that the exoskeleton is so lightweight and compact that it can be carried in a backpack; that the light weight makes it possible for the user to walk independently without an attendant’s assistance; that the exoskeleton bears the user’s weight as needed and specified; and that turning while wearing the exoskeleton is achieved by leaning in the direction preferred, much like the Segway.

While most of the excitement understandably revolves around the engineering that makes this machine/human interface possible and successful, I was also intrigued by the fact that Parker Hannifin Corp. has signed a licensing agreement with Vanderbilt, thus paving the way for commercial production of the exoskeleton. Early conversations say the exoskeleton could cost about half as much as the other exoskeletons that currently exist.

And that’s what got me wondering.

Mainstream society has vastly different views of wheelchairs and walking.

Where walking is the ultimate goal, wheelchairs are symbols of failure.

That’s why in our culture, prosthetic limbs — especially prosthetic legs — are generally seen as good, and wheelchairs are generally seen as bad.

This perception has colored the funding landscape as well — perhaps not entirely consciously, but definitely at some level. Walking is considered a triumph; using a wheelchair is second best. Just check out the surprisingly robust collection of YouTube videos showing audiences cheering as young wheelchair users rise from their chairs and walk across the stage to receive their diplomas.

Given the emotions that walking gives us, payors must find it difficult to publicly complain about the admittedly high costs of prosthetic limbs. You can imagine the outcry from an outraged public: “How can you put a price on a person’s legs?!?”

That’s one explanation for why, as seating & mobility reimbursement goes through the funding ringers with alarming frequency, funding for prosthetic limbs remains relatively good. I’m not saying it’s outstanding, or always easy to come by. Just that our society willingly purchases “expensive” prosthetics, but caterwauls about customized wheelchairs that actually cost a lot less. And that’s despite the fact that in many cases, wheelchairs would also be the more functional, independence-enhancing option. Prosthetics aren’t functionally practical for many below-theknee amputees — but as a society, we have a hard time acknowledging that.

So if prosthetics are more expensive, why is funding for them still in relatively good shape? Because it’s tough to argue with walking.

That’s why I’m interested to see how funding sources will react to a commercially available exoskeleton that’s priced in the same ballpark as prosthetic limbs.

“But it’s not a medically necessary product.” (Neither are lower-extremity prosthetics.)

“They’re so expensive.” (You pay comparable rates for prosthetic limbs.)

“They’re not the least costly product that would meet the patient’s medical need.” (Neither are lower-extremity prosthetics, but how can you put a price on walking, right?)

What a fascinating debate this could be.

This article originally appeared in the January 2013 issue of Mobility Management.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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