Mechanical engineers in the US have decided to make their exoskeleton design open source, ensuring the assistive technology for people with severe physical disabilities is free to access across the globe.

The Northern Arizona University researchers say OpenExo could help people in resource-limited countries create their own wearable robotic devices and foster innovation in this field.

The modular robotic device with multiple configurations can assist in the rehabilitation and improved mobility of people with physical disabilities, such as spinal cord injuries, stroke-related impairments and cerebral palsy.

Globally, over 2.5 billion people need one or more assistive products. According to The WHO and UNICEF Global report on assistive technology (2022), only three per cent of people in some low-income countries have access to the assistive products they need, in comparison to 90 per cent in some high-income countries.

Zachary Lerner, associate professor of mechanical engineering at Northern Arizona University and head of its Biomechatronics Lab, told SciDev.Net: “We believe, OpenExo, which is available worldwide to everyone – individuals and researchers – will be particularly helpful for people in developing countries to create their own life-changing wearable assistive technology.

“It is designed to be easily expandable, so people can use our existing configurations or create their own, and interface with our modular sub-systems.”

In the past few decades, exoskeletons have gained major traction due to rapid advancements in related technologies.

Exoskeletons and prostheses are both designed to enhance mobility and independence. While prostheses replace missing body parts, such as limbs, an exoskeleton is a wearable mechanical device that focuses on enhancing physical abilities.

OpenExo, published in the journal Science Robotics on 25 June, provides comprehensive instructions, including all aspects of the design process — software, hardware, electronics and control schemes — for building a single or multi-joint exoskeleton.

However, specialists in assistive technology cautioned that the infrastructure to support it may be lacking in many countries.

Louise Puli, UN assistive technology consultant to the World Health Organization and the UN Office for Project Services, said: “The accessibility and modularity of OpenExo marks an exciting step forward in enabling wider participation in wearable robotics research.

“But it’s essential to recognise that ease of fabrication does not guarantee appropriate use, particularly in assistive and rehabilitative settings.”

Effective implementation requires not only technical capability to make the product, says Puli, but also specialist clinical reasoning to guide individual assessment, prescription, and fitting.

“Assistive technology like OpenExo must be supported by a strong assistive technology ecosystem — one that includes person-centred products, enabling policy, trained personnel, and well-functioning provision systems,” added Puli.

“Without this broader system in place, even the most innovative device may struggle to deliver equitable, safe, and meaningful impact for users.”

The process of developing wearable robotic exoskeletons is often complex, expensive, time-consuming and requires a broad set of technical expertise. That is where OpenExo can help potential exoskeleton researchers overcome these barriers, according to Lerner.

“It is really suited to help reduce the cost of prototyping and making one-off devices,” he said.

Finding the equipment to make some of the parts could be a challenge he admitted, but added: “We hope to offer affordable kits that researchers and individuals can purchase.

“The cost of materials and supplies for each actuated joint is around US$1,000.”

Currently, the cost of medical exoskeletons — ranging from around few thousand US dollars to over US$100,000 for more sophisticated devices — remains prohibitive for people in need in low- and middle-income countries.

Ritu Ghosh, director at Mobility India, said exoskeleton interventions were seen as an expensive proposition and not generally considered in poorer countries.

She says such countries are hindered by limited local knowhow, which makes repairs and maintenance of imported exoskeleton devices problematic, and a lack of investment in the sector.

However, “OpenExo can have a significant role to play in the fields of research, physical rehabilitation, armed forces, healthcare and industry,” Ghosh told SciDev.Net.

She emphasised the need for greater collaboration among stakeholders – governments, science and technology institutes, academics, and start-ups – at national and international level to help develop the exoskeleton technology locally and build indigenous sources of manufacturing and testing protocols.

Specialists are hopeful that OpenExo will accelerate the development and testing of new exoskeleton designs and control schemes.

Andrew Jolly, founder of the assistive technology (AT) organisation Technical Alliance for AT & Rehabilitation Oceania, said: “Platforms such as OpenExo have the potential to accelerate product development, reduce costs and increase access across the Asia-Pacific region, which has enormous innovation and manufacturing capacity.

“Furthermore, the region has a strong history in the training and employment of the workforce … who can appropriately provide complex assistive products such as the one described in the study, though a significantly larger workforce is required in many low- and middle-income countries to adequately meet the need,” he added.

He said governments were increasingly acting on the need for assistive technology and rehabilitation, under pressure from civil society organisations, and reframing assistive products as essential devices for an inclusive, resilient society, rather than “nice to have” products.

“Involving people with disabilities in surmounting access challenges is fundamental,” he added.

“Innovators looking to use platforms such as OpenExo would do well to also include persons with disabilities in the innovation and design process, recognising them as experts in their own needs.”

According to a report by ATscale, an assistive technology organisation, for every dollar invested in the provision of four assistive products — hearing aids, prostheses, eyeglasses, and wheelchairs — there is a US$9 return.

Monzurul Alam is founder and convenor of the Open-Source Medical Technology Lab, a collaboration dedicated to advancing medical technology through innovative open-source solutions. He said: “OpenExo has tremendous promise to democratise exoskeleton research and development, particularly for low-resource settings such as low- and middle-income countries.”

This piece was produced by SciDev.Net’s Global desk.