Exoskeleton Report Digital Magazine Issue 8 Jun 25, 2024

JUNE 25, 2024

EXOSKELETON REPORT

ISSUE NO 8

ISSUE 8

INTERVIEW TOM ILLAUER FOUNDER OF ORTHEXO

COVERAGE WEARRACON 23 A+A TRADE FAIR & EXOWORKATHLON

CONTENTS PAGE 3-7 INTERVIEW

Sebastian Orth & Tom Illauer share their journey in starting and running Orthexo as well as their thoughts for the future of exo technology.

PAGE 8-11 EXOWORKATHLON AND WEARRACON EUROPE 2023

Dr. Thomas Sugar, director of WearRA, conveys his take on WearRAcon 23 Europe, the A+A Trade Fair, and an overview of ExoWorkAthlon and its goals.

PAGE 2 | EXOSKELETON REPORT

ISSUE 8 | JUNE 25, 2024

ISSUE 8 PAGE 12-13 INTERSECTION BETWEEN FIRST RESPONDERS AND EXO TECHNOLOGY Exo Games 2024 open to the public GOGOA completes EXO-RESCUE Project

PAGE 14-17 HEADLINE NEWS

PAGE 18-19 EXOSKELETON EVENTS CALENDAR

ISSUE 8| JUNE 25, 2024

EXOSKELETON REPORT | PAGE 3

Interview With SEBASTIAN ORTH Advisor for Orthexo.de

TOM ILLAUER Founder of Orthexo.de Conducted: Jan, 2024 Left: Sebastian Orth; Right: Tom Illauer

1. ExR: How and when did you discover exoskeleton technology?

2. ExR: What personally interests you the most about exo technology?

Tom: I was Chief Marketing Officer at Germany's largest medical supply retailer. Sebastian and I worked there together for 4 years. As a master orthopaedic technician, he was in charge of purchasing for orthopaedics and built up the medical exoskeleton division there.

It was at this company that I had the opportunity to test the Rewalk for the first time. A 33-year-old patient tested the device after a motorcycle accident. We filmed everything with a drone, his family was there and everyone had tears in their eyes. However, the patient was not interested in walking as such, but in being able to see eye-to-eye with his wife again.

Sebastian: It's not about one advantage or one technology, but about looking at the big picture. We have a market-ready technology that would make the entire country barrier-free. We can enable patients to walk again and protect workers from damage to their health.

Exoskeletons can solve both problems.

So it's a technology that can really make a difference in the world.

VISIT ORTHEXO.DE

Sebastian: As an orthopaedic technician, I have carried out patient care and fabricated all types of orthotic fittings.

Basically, every orthosis is a type of exoskeleton. In 2016, we had a paraplegic jockey in a neurological clinic and were able to fit him with an exoskeleton.This result inspired me.

PAGE 4 | EXOSKELETON REPORT

ISSUE 8 | JUNE 25, 2024

3. ExR: Why did you decide to create a brand new company and organization rather that partner and expand upon an existing one?

Tom: After the story with the Rewalk, I pitched to the shareholder that we should make this technology available to more people here. He didn't want to put any resources into it. So I started a blog. After a few months, the first inquiries came in from patients and companies with hundreds of questions. These were not related to studies, but to practical use. I looked for a partner who was much fitter in the subject than I was and found Sebastian. He took over the consultations and the expert position. As we are writing about medical products, there are liability risks in Germany, so we decided to turn it into a limited company. Now you have to imagine that to this day we both work fulltime as managers or CEOs in other large companies, at the same time we have received daily inquiries and so we have invested more time to make the platform better and better, to enable all languages, to build the AI configurator and much more. It was important for us to learn quickly from our customers. To date, we have provided almost 300 free consultations, tested 60 solutions ourselves, are available in 22 countries and 7 languages and work closely with 9 manufacturers.

Orthexo Logo, all images courtesy of Orthexo.de ISSUE 8| JUNE 25, 2024

4. ExR: Do you think military, medical, occupational/industrial, sport exoskeletons are still similar enough that they can be under one umbrella, or should they be branched off. (For example, ExR tries to cover all exo technology, while IISART covers only medical.)

Sebastian: I believe that you should not do this. If we were to relaunch, we would also not display all categories on one website, but on different ones. The term exoskeleton is also too generic and has too much room for interpretation.

Exoskeletons range from improved back orthoses to self-balancing high-tech rehab solutions. This makes it all the more important to separate the classes and develop separate standards, separate associations and separate expectations for each of them. But the most important thing is to talk about it together.

EXOSKELETON REPORT | PAGE 5

5. ExR: What are the two top things that you think are holding back exoskeleton products from seeing an explosive, exponential increase in sales and adoption?

Tom: I will mention 3 points: 1. attention. I have been active as a CMO in companies for 17 years. If there's one thing missing, it's attention. Nobody knows an exoskeleton. This is analogous to the E-Bike. You need a critical mass for the technology to generate organic demand. But for that to happen, everyone has to know someone who uses it.

So it has to be used in an inflationary, decentralized way. We need an Elon Musk effect. If he presents the new Tesla with an exoskeleton, we'll have a market from 0 to 100. Testimonials should play a much bigger role!

2. In my opinion, manufacturers are not where the daily attention is. Most manufacturers have brilliant developers and minds, but no marketers or fill them with marketing people who previously did something completely different. Where does the attention economy take place in our world? On marketplaces like Amazon, on Tik Tok with shorts and on moving images on YouTube. We as a collective are not represented there.

PAGE 6 | EXOSKELETON REPORT

3. more focus on customer groups. Due to the high number of consultations and the fact that we get feedback after every test, we have feedback from over 300 tests from real users. Sometimes this is still shocking. Exoskeletons for the trades do not allow you to wear a tool belt or prevent you from climbing ladders.

Another example: You have to intrinsically motivate people to wear the exoskeleton in the long term. Every 5th person asks us if they can get the exoskeleton with the company logo.

To generate a market for everyone, we should simply all work together much more, book testimonials together, provide material for an exoskeleton Instagram and Tik Tok channel, share customer feedback from tests and swap nonmatching customers.

ISSUE 8 | JUNE 25, 2024

6. ExR: Where do you see the future of AI and exoskeleton technology?

Tom & Sebastian: A cycle is created first.

The hardware collects data and this allows us to develop better hardware. The exoskeletons become more networked with the environment. Wearables could be linked to the exoskeleton. The exoskeleton recognizes the pulse and knows when a break is necessary based on the number of steps. A GPS recognizes that you are in front of a staircase. A lidar sensor recognizes three-dimensional space and warns of tripping hazards. The AI recognizes the light from the forklift and vibrates if you are in danger. The exoskeleton recognizes signs of fatigue based on sweat production. Exoskeletons work hand in hand with tools.

We will also be combining normal clothing with exosuits. Exoskeletons could use AI to recognize rooms and automatically deactivate themselves in the break room or toilet. Emergency call buttons could trigger an alarm in the event of accidents at work and even log them. This would have another advantage: you wouldn't just sell one exoskeleton worn by 5 employees, but one exoskeleton per employee. These are just a few examples where I believe that development can benefit greatly.

ISSUE 8| JUNE 25, 2024

And that is precisely the crux of the matter. At the moment, customer inquiries are still higher than production capacity.

Every manufacturer is currently increasing this and looking for retailers per country. But these three things will change the world. When production costs fall due to AI and more demand, more people will be able to buy exoskeletons.

As a result, more people will pay attention to them, companies will continue to increase production capacity, exoskeletons will become cheaper due to fixed cost degression and so on. We are therefore looking forward to what happens next.

ORTHEXO.DE Founded in 2022, Orthexo.de has quickly established itself as a guide and lead generator for industrial/occupational and medical exoskeletons. It’s ranked highly in over 22 countries and is available in multiple languages. The site features its own AI-configured chatbot that helps compare exoskeleton devices from over 150 producers, including advantages, costs, features, areas of application and much more.

EXOSKELETON REPORT | PAGE 7

Coverage from WearRAcon 2023 And the A+A Trade Show

By Thomas Sugar, Director of WearRA

WearRAcon Europe was held on October 25-26, 2023, in Dusseldorf, Germany, in conjunction with the A+A Trade Fair. A+A was one of the world’s largest trade fairs for Safety, Security, and Health at Work, highlighting that “People Matter.” It is held once every two years, and in 2023, it brought over 65,000 visitors. The final program of the trade fair is available on the A+A website. The Fraunhofer Institute IPA organized the WearRAcon 23 conference, ExoPark, and ExoWorkathlon in cooperation with Stuttgart University and the Wearable Robotics Association (WearRA).

Keynote speakers included Professor Nicola Vitiello, who discussed wearable robotics for human movement, and Dr. Thomas Alexander from the Federal Agency of Occupation Safety, who talked regarding a safe and healthy workplace.

PAGE 8 | EXOSKELETON REPORT

Sessions over the two-day period included Exoskeletons and Exosuits, Assessment and Human Factors, Modeling and Simulation, Exhibitor demonstrations, an End-User Forum, and Use Cases. More than 100 academic researchers, industry experts, and industry producers participated in the conference.

Drs. Tom Sugar and Urs Schneider examined the need to educate consumers, market success stories, and highlight that musculoskeletal injuries continue to be a leading cause of missed workdays. Use cases were described with exoskeleton technology utilized in a Ford Valencia manufacturing plant, heavy maintenance work at a rail maintenance depot, baggage handling at an airport, and lifting large containers at a chemical plant.

ISSUE 8 | JUNE 25, 2024

At the A+A event, an ExoPark was built where more than 15 exhibitors could demonstrate their exoskeletons. Users tested exoskeletons as part of the ExoWorkAthlon. Parcours included overhead construction work, overhead car assembly, logistics task of box handling, and a new parcour for sanding drywall material.

The two-day conference ended on a high note with manufacturers saying that more than 5,000 visitors visited the ExoPark to learn about exoskeleton technology.

Best Poster Prize Veronika Hofmann won the conference’s best poster prize with runner-up Catherine Michaud! Members of the jury (Thomas Sugar, Marisol Barrero, CPE, and Nicola Vitiello). The Cambridge University Press was the prize-sponsor.

Note that you can find a link to the PDF for all of the posters on the agenda website.

Additional Coverage:

Photography courtesy of Thomas Sugar

Video by Messe Düsseldorf via Vimeo ISSUE 8| JUNE 25, 2024

EXOSKELETON REPORT | PAGE 9

What is ExoWorkAthlon Anyways!?

By Thomas Sugar, Director of WearRA

ExoWorkathlon® is a set of work-related tasks (called Parcours) to test the use of industrial exoskeletons. Important features include: Parcours in Box Handling, Car Assembly, Welding, Sack Handling, Installation of Rail Systems, and hanging Drywall.

Professional workers complete a particular Parcour, not untrained students or individuals.

Industrial manufacturers helped develop industry-relevant work tasks.

Performance assessments during the task include subject feedback, quality feedback, EMG feedback, and metabolic cost.

The goal is understanding user feedback, ergonomics, metabolic cost, and production quality.

PAGE 10 | EXOSKELETON REPORT

The goal is not to determine the advantages and disadvantages of a particular exoskeleton but to maintain market neutrality and understand whether a particular type of exoskeleton can be helpful in industry. In particular, ExoWorkathlon® is a very large study collecting data on families of exoskeletons (120+ participants).

Interesting data included: In box handling, the BORG subjective feedback was reduced by 40% when wearing a back exoskeleton. · In car assembly, the BORG subjective feedback was reduced by 33% when wearing a shoulder exoskeleton.

Quality: In the welding task, a certified welding simulator sets a score on the quality of the weld. The quality of the weld improved, and the speed increased by 10.1%.

ISSUE 8 | JUNE 25, 2024

In a body questionnaire survey, the back-supporting exoskeletons reduced the discomfort in the lower back. The discomfort in the neck was lower in the car assembly task, and the discomfort in the forearm was reduced in the welding task.

Contributing partners include: Institute of Industrial Manufacturing and Management, University of Stuttgart Fraunhofer Institute of Manufacturing Engineering and Automation IPA Dr. Hensel-Unger, AUDI AG Israel Benavides, FORD GmbH Dominic Bihl, Hilti AG Mrs Richter, WELDPLUS Mrs Pohlmann, SLV NORD Mr Glitsch, DGUV IFA Mr Wischnieswski, BAUA More information can be found on the ExoWorkAthlon website:

ExoWorkAthlon Additionally, live testing occurred at: 1.

2.

3.

WearRAcon Europe 2021 WearRAcon US 2022 WearRACon Europe 2023

ISSUE 8| JUNE 25, 2024

Related Peer-Reviewed Research: Kopp, V., Holl, M., Schalk, M., Daub, U., Bances, E., García, B., Schalk, I., Siegert, J. & Schneider, U. (2022).

Exoworkathlon: A prospective study approach for the evaluation of industrial exoskeletons. Wearable Technologies, 3, e22. https://doi.org/10.1017/wtc.2022.17 Schalk, M., Schalk, I., Bauernhansl, T., Siegert, J., Esin, A., & Schneider, U. (2022). Influence of exoskeleton use on welding quality during a simulated welding task. Wearable Technologies, 3, e17. https://doi.org/10.1017/wtc.2022.13 Schalk, M., Schalk, I., Holl, M., Kopp, V., Bauernhansl, T., Siegert, J., & Schneider, U. (2022). Exoskelette reduzieren die subjektive Belastung/Effect of exoskeletons used in industry on perceived exertion during standardized work tasks. wt Werkstattstechnik online, 112(09), 607–612. https://doi.org/10.37544/1436-49802022-09-79 Schalk, M., Schalk, I., Bauernhansl, T., Siegert, J., & Schneider, U. (2022).

Influence of Exoskeleton Use on Cardiac Index. Hearts, 3(4), 117–128. https://doi.org/10.3390/hearts3040014

EXOSKELETON REPORT | PAGE 11

OPEN TO THE PUBLIC EXO GAMES 2024

The ASTM Exo Technology Center of Excellence (ET CoE) is excited to welcome you to the second Annual Exo Games event at ASTM Headquarters!

Exo T ech

Team Biomechatronics and Intelligent Robotics Lab - North Carolina State University, USA, link to team page

Exo G ames

Participating Teams

First Respo nders

Registration is free for students, $25, for members, and $40 for non-members.

Team Exo, University of Maryland, USA, team page Team FlexoExo, University of Wisconsin - Madison and Texas A&M University, USA, team page Team Queen’s BioMechatronics, Queen’s University, Canda, Focused on hip & knee movement assist exos Team UCLan, University of Central Lancashire, England, looking to ground external loads Team VEXO, Vrije Universiteit Brussel, Belgium, team page PAGE 12 | EXOSKELETON REPORT

ISSUE 8 | JUNE 25, 2024

Photography courtesy of GOGOA

GOGOA Announces the Completion of the EXO-RESCUE Project The Spanish exoskeleton developer GOGOA has completed the development of a semi-active (or would that be hybrid?) modular exoskeleton designed to assist with rescue services. The project's primary goals were to build and validate a fully operational prototype.

The project was completed with financial support from the European Union and the Centre for the Development of Industrial Technology (CDTI). The devised exoskeleton, named EXO-RESCUE, is meant to support the user during situations that require lifting and transportation of heavy loads, facilitating rescue operations in emergencies like natural disasters and traffic accidents.

The EXO-RESCUE project was a collaboration between Gogoa Mobility Robots (exo technology), IHS Weigling (electronics), and SPSI, the University of Applied Sciences and Arts of Southern Switzerland (controls).

Reportedly, the first concepts were initially digitally rendered in CAD and put through strenuous finite element analysis for durability and fit prior to lab and real-world testing of the assembled prototypes.

Read the full story on the GOGOA website: ISSUE 8| JUNE 25, 2024

EXOSKELETON REPORT | PAGE 13

ReWalk, now LifeWard, celebrates 20 years since its first prototype!

2004: First working prototype 2007: A new prototype appears on the hit US TV show “Glee.”

2011/2012: The ReWalk Exoskeleton is available for commercial sale in Europe and rehabilitation use in the US for patients with SCI. 2014: FDA granted clearance for personal use of the ReWalk Exoskeleton.

2015: The ReWalk 6.0 Personal Exoskeleton launched.

2023: The ReWalk Personal Exoskeleton receives FDA clearance for use on stairs and curbs, expanding access to more real-world environments.

2024: Medicare finalizes reimbursement for the ReWalk Personal Exoskeleton.

There appears to be re-emerging interest in gravity-redistribution exoskeletons in Europe.

These can be entirely passive, quasipassive, or powered systems that aim to take the weight of a backpack or body armor off the shoulders of dismounted infantry (or civilians) and redirect it into the ground. This bypasses the lower back, hip, and knees, reducing the risk of injury for those overburdened with supplies and equipment.

New models have emerged in the public domain (but there are others in development) by: Cyber Human Systems (GOGOA): GUDEX InteSpring: Centaur MAWASHI: UPRISE Newndra: CarryON EXOMED: Enforcer

Link to original post: LinkedIn-ReWalk PAGE 14 | EXOSKELETON REPORT

ISSUE 8 | JUNE 25, 2024

For half a decade, there have been reports that walking-assist exoskeletons help with secondary functions like selfesteem, cardio health, bone mass, and going to the restroom. A new research paper investigates closely the link between gait assist exos and gut health.

Effects of exoskeleton-assisted walking on bowel function in motorcomplete spinal cord injury patients: involvement of the brain–gut axis, a pilot study compares 40 exo users to a control group. The paper validates a noticeable if small, improvement in intestinal function with and an increase in beneficial gut bacteria in the exo user group.

The full paper is free to access: Hu X, Feng J, Lu J, Pang R, Zhang A, Liu J, Gou X, Bai X, Wang J, Chang C, Yin J, Wang Y, Xiao H, Wang Q, Cheng H, Chang Y and Wang W (2024) Effects of exoskeleton-assisted walking on bowel function in motor-complete spinal cord injury patients: involvement of the brain– gut axis, a pilot study. Front. Neurosci.

18:1395671. doi: 10.3389/fnins.2024.1395671

ISSUE 8| JUNE 25, 2024

The Portuguese power glove company NUADA is looking for a fluent English-speaking chief Sales Officer. For more, visit their LinkedIn page.

Effects of using an active hand exoskeleton for drilling tasks: A pilot study The Journal of Safety Research has published a study examining the effects of an active (powered) hand exoskeleton. In particular, the study compared 10 Iron Glove (Bioservo) users vs. a control group. The study strongly indicates that powered exoskeletons are beneficial in reducing peak muscle activation forces in the forearm and would, therefore, lead to safer work. The study also found that the perceived assistance was lower than the measured one.

The paper is published on Science Direct: Abdullahi Ibrahim, Ifeanyi Okpala, Chukwuma Nnaji, Abiola Akanmu, Effects of using an active hand exoskeleton for drilling tasks: A pilot study, Journal of Safety Research, 2024, ISSN 0022-4375, https://doi.org/10.1016/j.jsr.2024.05.004. (https://www.sciencedirect.com/science/article /pii/S0022437524000574)

EXOSKELETON REPORT | PAGE 15

Headlines Simulating Exoskeleton Training Using AI

Have you ever wondered why there are so many back-support exoskeletons and exosuits? Liberty Mutual Insurance has published its updated workplace injury statistics. U.S. businesses spend more than $1 billion per week on workplace injuries, and the leading causes continue to be overexertion, back and shoulder injuries. You can read the entire table for free on their website: link

Researchers from the German Research Center for Artificial Intelligence (DFKI) and the University of Duisburg-Essen (UDE) are working on a stationary exoskeleton that can simulate zero gravity. Rather than using swimming pools and other contraptions, the powered upper-body exoskeleton accounts for the force of gravity while likely leaving all inertial forces intact (as opposed to the Sarcos Guardian prototypes, which accounted for the force of gravity and inertia): Phys.org (link) PAGE 16 | EXOSKELETON REPORT

What if we could use AI to train exoskeleton controllers to understand how we walk and what we are trying to achieve? At the last CYBATHLON Exoskeleton race, users (pilots) spent a disproportionate amount of time switching between operational models (such as stairs, slopes, etc.) manually.

If this process can be replicated, it could be a significant shortcut to the deployment and adoption of powered exoskeletons of all kinds, making them feel more natural and transparent out of the box.

The full paper is published in Nature: Luo, S., Jiang, M., Zhang, S. et al.

Experiment-free exoskeleton assistance via learning in simulation. Nature 630, 353–359 (2024). https://doi.org/10.1038/s41586-02407382-4 ISSUE 8 | JUNE 25, 2024

Headlines & The National Safety Council (NSC) has awarded Wichita State University (Wichita, Kansas) $48,500 to assess the feasibility of utilizing arm support exoskeletons for overhead construction tasks and evaluating the impact on musculoskeletal health. Read the full press release here.

Gogoa Mobility Robots presented its vision for marching, logistics, weapon stabilization, and soldier comfort of the future as part of the ACHILE Project, an initiative backed by the European Defense Fund. The project aims to revolutionize the equipment of European soldiers, including utilizing advanced exoskeletons. A preliminary design review was presented at the June 11 meeting in Munich.

Read the full press release on the Gogoa website.

Photography courtesy of GOGOA

ISSUE 8| JUNE 25, 2024

Based on the success of the Excellent Exo Chat, ASTM International's Exo Technology Center of Excellence has received a grant from the Navy to produce the "Following Seas" Podcast series.

This initiative aims to bridge the gap in student awareness of STEM opportunities within the Navy, providing insights into futuristic science and technology areas such as artificial intelligence, robotics, exoskeletons, and more.

"The Following Seas" will host 24 podcasts annually over the next three years, featuring former Navy civilian and military members who will discuss STEM challenges, the importance of technical standards, and the rewarding careers available in the Navy. The first three episodes are already out: https://www.buzzsprout.com/2355730 EXOSKELETON REPORT | PAGE 17

EXO RELATED EVENT CALENDAR

PAGE 18 | EXOSKELETON REPORT

ISSUE 8 | JUNE 25, 2024

You can learn more about these upcoming events by visiting the ExoskeletonReport.com Events Calendar.

On the website, each event has its own page, you can view past and future events, and change to calendar or list view.

ISSUE 8| JUNE 25, 2024

If you know of any upcoming exo-focused events that are not listed above, let us know: hello@ExoskeletonReport.com

EXOSKELETON REPORT | PAGE 19

©Exoskeleton Report 2024 The Exoskeleton Report (ExR) e-magazine is written and produced by Borislav “Bobby” Marinov and the Exoskeleton Report LLC. Thank you to everyone who purchased this issue and for your support!

As always, I am grateful to Tri Dao, who continues to be the central pillar behind ExR. Visit us at ExoskeletonReport.com

Reach out: We welcome all feedback, comments, suggestions, news submissions, or inquiries regarding advertising or consulting! Contact us using our email: Borislav.Marinov@ExoskeletonReport.com Hello@ExoskeletonReport.com Or by utilizing our contact form at: https://exoskeletonreport.com/contact-us/ Above: About Us... by Rolling Camera via Getty Images

PAGE 20 | EXOSKELETON REPORT

ISSUE 8 | JUNE 25, 2024