Physical therapist Elizabeth Watson works with Collegeville’s Mark Cassarella and the EksoGT. Photo by Tessa Marie Images.
Life changing,” Mark Cassarella says with a big smile. “There’s no other way to describe it.”
Cassarella is talking about EksoGT, which allows him to do something he hadn’t done in the 30 years since a car accident permanently injured his spinal cord. With the aid of a high-tech robotic exoskeleton, he walks an hour a week, relegated to doing laps around Magee Riverfront Outpatient Rehabilitation Center in South Philadelphia. The 47-year-old is more than happy to make the hour-plus drive from his Collegeville home for the opportunity. “I’d be here every day if I could,” he says.
Bone strength, increased muscle tone, bladder and bowel efficiency, and better skin texture are a few of the improvements Cassarella has seen in the two years he’s been using the EksoGT. But it’s the psychological benefits that are the most dramatic. “I hadn’t walked since I was 16 years old,” he says.
It was to the point where he’d forgotten how to walk. “Mark had to learn how to balance and shift his weight from side to side, which are normal components of mobility that his body hadn’t done in decades,” explains Elizabeth Watson, a Magee physical therapist and the rehab center’s locomotor training clinic supervisor.
When he first started using the EksoGT, Cassarella took about 300 steps in one hour. Now, he takes 1,700 steps every session. “We’re more limited by the Ekso’s batteries than Mark’s ability,” Watson says. “He exhausts the robot.”
Also known as exosuits or bionic suits, exoskeletons are robotically powered systems approved by the FDA in 2012 for physical rehabilitation. Ekso Bionics, ReWalk and SuitX are the leading manufacturers. They power hip and knee motion while computerized sensors control gait. Computers and the rather bulky batteries are stored in backpack-like compartments. The EksoGT’s battery weighs 47 pounds.
The exosuits are used with crutches, canes or walkers. “The walker is easier for me than crutches because I can balance better,” Cassarella says. “I’m not leaning on it, but I am using it as a backup so I don’t fall forward.”
Exosuits are used with people with spinal cord injuries and patients recovering from strokes. They’ve also become valuable in rehabilitating patients with traumatic brain injuries, including military veterans. “It’s about gait training, the bend of the leg and other parts of regaining mobility,” says Watson. “The hope is that we can change—and improve—how patients walk when they aren’t using the machine.”
Main Line Health’s Bryn Mawr Rehab Hospital recently acquired an EksoGT; Einstein Health System’s MossRehab has two ReWalks. Exoskeleteon suits are scarce because they are pricey. The least expensive unit runs $90,000, and the EksoGT is $140,000. Magee had to rely on financial donations to purchase theirs. Nonprofit SoldierStrong donated one EksoGT suit as part of its SoldierSuit program for veterans with lower limb paralysis or TBIs. Magee’s other suits were funded by Independence Blue Cross, which donated $280,000 for two EksoGT units. “Independence Blue Cross believes in the power of technology to advance health care,” says Daniel Hilferty, CEO of IBC. “When you see Magee patients using these amazing bionic suits to overcome trauma and live their best lives, it’s truly inspiring.”
For now, that journey takes Cassarella to South Philadelphia every week. Like many patients, he wishes he could use an exosuit at home, but their cost makes that impossible for most people. Although the EksoGT is life changing, Cassarella emphasizes that robotic mobility is not a cure. “It doesn’t allow me to walk on my own—and unless there’s a medical miracle, nothing will,” says Cassarella.
In fact, the EksoGT is only one part of Cassarella’s 30-year commitment to maintaining his health. He plays wheelchair-based basketball and, in his younger years, participated in wheelchair races. Cassarella exercises regularly at a Collegeville gym, using a simulation bike and resistance bands to increase his upper body strength and cardiovascular ability. Cassarella has a special work desk that allows him to stand for two hours at a time—possibly longer than other executives at Wells Fargo. He travels extensively with his wife, even to locations that aren’t wheelchair accessible.
“Living with a spinal cord injury doesn’t mean not living,” Cassarella says.
* Editor’s note: This story has been updated to reflect Main Line Health’s purchase of an EksoGT.