The term wearables paints a very broad stroke, even for a healthcare canvas. Wearable can be something as simple as a pedometer worn on the pant hip, or a fitness watch, to a highly sophisticated robotic device used to aid in the movement of an impaired patient. Today, we’re going to discuss the latter.
If you’ve ever seen the sci-fi movie Edge of Tomorrow with Tom Cruise, you’ve seen a robotic exoskeleton. Now, you may be thinking it looks pretty cool and the flick was entertaining, but those things are a new cinematic version of what I remember growing up watching RoboCop, right? Well, I hate to break it to you folks, but… “they’re here” (in my best Carol Anne from the Poltergeist movie). Joking aside, these wearable robotic devices have actually been around for many years and have come a very long way.
Exoskeletons started off years ago in the form of something you can all remember as long leg bracing (think young Forrest in Forrest Gump). Wearable robotic devices today are found assisting in upper and lower extremity conditions from brachial plexus to incomplete spinal cord injuries. Typically, we see patients who still have a neurological connection with the peripheral nervous system through the impacted extremity who are the best candidates to “qualify” for these devices (more to come on qualify later on).
A company based in Massachusetts called Myomo (a name derived from a patient’s own words, “my own motion”) has a couple variations of robotic orthotic devices specifically designed to help regain function in upper extremities and is continuing to gain exposure in the marketplace.
In a recent interview with Craig Peters, PT, DPT of ReWalk Robotics, which researches, manufactures and distributes several versions of exoskeletal devices for patients who have diagnoses such as CVA and SCI, he informed me that historically these devices have been used over treadmills, but now many are able to be used over ground and outside of a traditional clinic. So, a large change has happened in the modality of intervention and environment of usage. The truth still remains that the best results in recovery are seen with early ambulatory intervention, high intensity, repetition and with task specific movement. The goal being the best possible recovery and function post-injury.
An interesting emergence from technology enhancements with these therapeutic products is that numerous neurorehabilitation centers across the U.S., such as Brooks Rehabilitation in Jacksonville, Florida, that have a dedicated cybernetic clinic, have witnessed and documented an increase in ambulatory function years post-injury! Yes, years. This to some may seem a miracle, but in reality, we believe it has a lot to do with the neuroplasticity of the brain or the ability of the brain to change and adapt. These cases have not been with complete (ASIAA) SCI, rather other neurological conditions and incomplete spinal cord injuries where a connection is still present.
There is actually quite a bit of research out there showing improved health outcomes from standing and ambulation in the form of bowel and bladder function, increase in bone density, decreased risk of contractures, decreased risk of pressure ulcers as well as psycho-social aspects.
Now, I understand that complications and hospital admissions due to pressure ulcers, a UTI (urinary tract infection), or a bone break are not cheap, and if an opportunity was out there to help prevent these, wouldn’t you consider it? Perhaps even more thought provoking is the monetization of walking. Can you put a price on the ability to walk again? To stand up, look someone in the eye and shake their hand. Pretty powerful stuff.
Earlier I used the term qualify in quotations because to date I am not aware of any insurance policies (commercial, private, CMS [Centers for Medicare & Medicaid Services]) that have coverage criteria defined, such as CMS’ LCDs (Local Coverage Determinations) and if anything, they have non-coverage verbiage built into them. But not in workers compensation, where there are very few state- and payer-specific coverage policies, which opens an opportunity shall the shoe fit.
Currently these devices are coded as K1007 (powered bilateral hip, knee, ankle, foot device all inclusive), or they use a miscellaneous E1399. Which leaves a lot of wiggle room on pricing, but I believe that this may be an ace in your pocket as manufacturers want to get their products on the market (obviously) and typically have the ability to be fairly aggressive on pricing.
The future of these devices is bright, and those in this space are very excited. With the speed of technology advancing, it is expected to see these devices connected through cloud-based applications, which would allow clinicians to track progress, for insurers to look at compliance utilization and even through machine learning the devices themselves could automatically modify (progress) functions and movement from data received.
I believe that with the right patient, need, coverage policy and proper environment, these devices can be beneficial. Your role is to gather all the information available, evaluate the risks and benefits from a medical, financial and efficacy perspective and make the best decision. There is a lot of information out there available to almost anyone and even educational courses for credit! We must continue to challenge the status quo and look for better alternatives out there and these wearables may just be an option. As Buzz Lightyear from Toy Story says, “To Infinity and Beyond”!