Comparing the Indego exoskeleton and the Tek RMD

As we noted in a recent article, we are sometimes asked, “You work with both the Indego Exoskeleton and the Tek RMD - which is better?”

This is really like trying to compare oranges and apples. It very much depends on the functional ability and aspirations of the individual client. Whilst both can potentially allow someone with lower limb paralysis to stand and move, both products have very different features and benefits. Both are outstanding products but their true value can only be judged in relation to individual goals and priorities.

We have posted other articles and content on each of these products so we wont repeat all the various strengths and limitations of each product here. Instead we will point to aspects that might not be obvious.

Considering whether a product is suitable and potentially beneficial in a particular case always starts with reviewing personal safety. Will this individial be able to use the product safely? This takes some careful consideration as it is not always obvious.

Both products have what are called indications - (which point to characteristics that the person must have to use the product successfully) and contraindications that represent barriers to use.

The Indego and the Tek RMD can only be used, for example, with persons who fit within the product’s criteria for safe use. In addition to things to do with personal stature, both product designs impose limitations on who will be able to use it. The Indego for example has contraindications to do with needing

“sufficient upper body strength to balance and advance with forearm crutches, front-wheeled walker or platform walker”.

Meanwhile the Tek RMD cannot be used when a potential user has a

“Lack of upper body/trunk control ability. The user should be able to stabilise him/herself in a standing position without using the arms to hold position.”

To identify whether a product can be used requires a skilled assessment that involves a number of stages. This should not focus on the product so much as the ability of the individual.

Of course it means reviewing whether the individual has any obvious barriers to product use because of the presence of contraindications. Even this can be difficult, as sometimes contraindications are relative rather than absolute.

For example, someone might present with a knee contracture or severe spasm which initially would rule them out from using either product. But after a period of therapy these problems might be removed.

On the other hand, some conditions such as MS might create an upper limb, grip and trunk control weakness issue that would not realistically be remedied by a period of therapy. This would then represent an absolute contraindication to using a Tek RMD for example.

At Anatomical Concepts (UK) we always try to disconnect assessment of a client from the sales process.

We think this is ethically correct - we never want to sell a product to someone who cannot benefit from it. This means that engaging with us might start by our requesting that we assess the status of a person via an intial screening to rule out contraindications before looking at a practical, clinical assessment or demonstration.

Clients sometimes think that they can “just try a product” and understand whether it is right for them. This can be a challenge due to the “training or learning effect” required with complex products. For example, before even a physically suitable individual can use the Indego in fluent walking they need to learn basic skills - literally step by step. Our clients who have gone on to purchase the Indego have probably spent a few hours learning to stand, balance and move at the start.

Those who purchase the Indego will spend some 40 hours training to take their product home and work with some independence. Those clients with potential learn that the Indego can also be used not just as an assistive device but a restorative one - where there is some potential for functional recovery the Indego can help but it takes time and effort.

The challenge with “just trying” the Tek RMD is that for a good demonstration it needs to be setup perfectly for the client’s stature. We cant adjust the TeK RMD in a minute or two and it takes time based on a prior assessment. We also need clients to understand that to use the Tek RMD in their lives they have to make some adjustments to their home environment. No product is perfect. Whilst the Tek RMD is definitely an assistive product this does not mean that it has no therapeutic value. Beyond the well established benefits of standing in terms of bowel and bladder function, muscluloskeletal function and even emotional well being there are other subtle benefits that are not perhaps obvious initially. Standing in the Tek RMD provides a challenge to the core muscles of the body so that clients often find that over time their postural control improves and they are able to do much more with their arms; the level of trunk support they need can reduce and transfers become easier.

The bottom line is each complex product needs careful assessment. Although both can get someone moving there is a world of difference in their approaches.