Assistive Technology for Various Levels of Paralysis

Bobby Miller

There are various levels of paralysis depending on how much body control an individual has lost. Paraplegics have lost use of their legs, quadriplegics have lost use of everything below the neck, and locked-in people have lost use of every external body part except the eyes. A growing amount of incredible technology has allowed these individuals to perform tasks they never thought were possible.

Paraplegic Aids: ReWalk and Esko

Although people with paraplegia have long been able to move around in wheelchairs, technology now offers different options.

One option is the ReWalk, a robotic exoskeleton that fits on the body to allow leg movement. “Paraplegics will be able to stand, walk, even climb stairs,” according to AMS Vans, a blog devoted to disability news. “Users walk with the help of crutches, and movement is controlled by shifts in the center of gravity and upper-body movements.”

The lightweight suit has braces featuring motors at the joints to allow for movement. The product’s website adds that it comes with a computerized watch featuring buttons that activate special functions.

Nvate Assistive Technology Brain-Machine Interfaces Camera Mouse Esko Paralysis Paraplegic Aids Quadriplegic Aids ReWalk robotic arm Tongue Drive System


Launched in 2012, the company Argo believes the ReWalk has a number of benefits. A person can walk upright to make easy eye contact, access areas without ramps, and reach objects in high places. Since the user can now move their legs, they can perform a wider variety of exercises than wheelchair-bound individuals can, as its website reported. Walking affects bone density, decreases body fat, improves cardiorespiratory fitness, and allows for smoother bladder and bowel functions.

The ReWalk system does have limitations, though. Only people weighing below 220 pounds can wear it, which certainly isn’t good news considering one third of the U.S. population is obese. Also, the personal version of ReWalk is currently unavailable in the United States; it can only be found at rehabilitation hospitals. Jay Courant, a worldwide training director for Argo, said in an email that even if they can manage to provide one for personal use, it will cost about $75,000.

A similar device is the Esko, which advertises as “a gait training exoskeleton intended for medically supervised use by individuals with various levels of paralysis or hemiparesis due to neurological conditions such as stroke, spinal cord injury or disease, traumatic brain injury and more.”

By donning it in just five minutes, a paraplegic individual can walk again. It allows for walking speeds up to one mile per hour. It is currently available in the United States, Europe, and South Africa for $100,000 and “unlikely to be covered by insurance,” according to USA Today.

Quadriplegic Aids

EHow defines quadriplegia as “paralysis or a lack of an ability to use all four limbs—arms and legs—also known as tetraplegia” in Europe. This may affect a surprising number of people. Yahoo claims that “high-level spinal cord injuries, one of the major causes of paralysis, currently afflict about 250,000 people in the United States.” According to, that is roughly the population of Orlando, Fla.

Since quadriplegics do not have any control of their body below their necks, they can’t use their arms and hands to move a wheelchair, write, flip through a book, or use a computer. Fortunately, technology exists to help those with quadriplegia.

Tongue Drive System

Dr. Maysam Ghovanloo of Georgia Tech developed what he calls the Tongue Drive System. True to its name, it allows individuals to drive a wheelchair using nothing but their tongue, as Georgia Tech’s YouTube videos explained. The idea came to him because there is a high-level connection between the brain and tongue, meaning that most people with severe spinal cord injuries can still move it.

To use the system, a magnetic adhesive is attached to the tongue, though a magnet can be pierced or implanted for permanent use. Next, the user puts on what looks like a communication headset with two microphones. But the tips of each end aren’t microphones: they’re sensors.

Nvate Assistive Technology Brain-Machine Interfaces Camera Mouse Esko Paralysis Paraplegic Aids Quadriplegic Aids ReWalk robotic arm Tongue Drive System


To turn the wheelchair left or right, the user simply moves their tongue left or right at the bottom of their mouth. To go forward or backward, they put their tongue at the top of their mouth. There’s also a handy command available for when users want to shut off the Tongue Drive so they can talk or eat.

Although this technology has largely been applied to wheelchair movement, it can also be used to control a computer cursor. Coupled with an on-screen keyboard, one could browse and type as if using a mouse and standard keyboard. According to Ghovanloo, if you can control a computer, then you can control anything that can be controlled by a computer. This, of course, opens up a wide array of possibilities for quadriplegic individuals.

Testing has shown promising results. People using the Tongue Drive System can learn to navigate with their wheelchair and play specialized computer games within just 30 minutes. In 2013, Ghovanloo showed that able-bodied people can use it equally well. He also hopes to mount the magnet receptors in people’s gums rather than a headset so that it will be more discreet. However, he has told Yahoo that “a commercial version is still years away.”

He went on to mention that people’s performance with the Tongue Drive System is about three times better than the traditional sip and puff system—even for people who have long depended on it. Often given to quadriplegic individuals, the sip and puff system basically mounts a straw right within range of the mouth. It can detect the difference between hard and soft breathing. A hard sip, for example, may push the wheelchair forward, and a soft sip may push it back. A hard puff may turn left, and a soft puff may turn right; it depends on the user’s preference.

Since the traditional sip and puff system is difficult to use, limited, and often inaccurate, technologies such as the Tongue Drive are exciting developments for paralyzed individuals.

Camera Mouse

Quadriplegics also have the option of using Camera Mouse, a program free of financial costs, advertisements, and gimmicks. Simply put, users control the mouse pointer on a screen just by moving their head. To use it, all the user needs is a computer that run on Windows XP or higher, as well as a webcam. For people without a Windows OS, there is a similar program called Head Mouse Extreme by Origin Instruments, but it sells for $1,225.

Professors James Gips and Margrit Betke of Boston College came up with the idea for Camera Mouse back in 2000 and made the program available in June 2007. Since then, it has been downloaded nearly 2 million times. According to the aptly-named, it allows computer access for “people with Cerebral Palsy, Spinal Muscular Atrophy, ALS, Multiple Sclerosis, Traumatic Brain Injury, [and] various neurological disorders.” There are even some individuals with repetitive stress injury that enjoy the hands-free technology.

Nvate Assistive Technology Brain-Machine Interfaces Camera Mouse Esko Paralysis Paraplegic Aids Quadriplegic Aids ReWalk robotic arm Tongue Drive System


The camera follows a point on the user’s face, and it moves the cursor when they move their head. “Dwell time” allows the user to hold the cursor at a certain point for a second or two to click. Although double-clicking is possible, one setting’s option allows users to open Windows icons with just one click. For typing, people can use an on-screen keyboard such as the Midas Touch Keyboard, also provided for free by Boston College. The time involved for clicking does not make Camera Mouse optimal for fast-paced games, but playing traditional board games like checkers or chess online is entirely possible. Armed with this special type of mouse and keyboard, quadriplegic users can perform many of the same computer tasks as able-bodied people.

Voice Commands

It should also be pointed out, though, that voice commands commonly found on electronic devices can allow quadriplegics to use electronics too—without the neck pain. I tried using Window’s Speech Recognition for hours and still found correcting its many errors to be a slower option than normal typing, so its usefulness may depend on the user.

But as explained, there are more nuanced dictation devices available. The Dragon program is $75 for computers and free for smartphones. Also, the Tecla Shield DOS connects a user’s wheelchair to a smart phone or tablet for full control through voice commands. It costs $299. Needless to say, the Tongue Drive and Camera Mouse would be better options for people with speech impairments.

Brain-Machine Interfaces

Many paralyzed individuals still have their inactive limbs. For such people, as reported in 2010, “wearable robots” are in development. Under the lead of Nicholas Hatsopoulos, professor of neuroscience at the University of Chicago, research is being conducted on material that covers limbs and allows them to be moved just by thinking about it.

Nvate Assistive Technology Brain-Machine Interfaces Camera Mouse Esko Paralysis Paraplegic Aids Quadriplegic Aids ReWalk robotic arm Tongue Drive System


For example, we could put a robotic sleeve over someone’s arm, connect the sleeve and their brainwaves to the right electronics, and let them move said limb. When this happens, many people will experience the “feel” of this themselves, since many patients have “partial sensory feedback,” according to Hatsopoulos. These sleeves tend to allow 40 percent faster and more accurate movement than separate robotic limbs. And they’re so easy to use that a trained monkey could do it, literally. That’s how the wearable limbs have been tested. So far, this exciting technology has not been distributed publicly. also reported that separate robotic limbs show promise. In 2012, researchers Andrew Schwartz and Elizabeth Tyler-Kabara of the University of Pittsburgh created a very accurate mind-controlled robotic arm. “The scientists developed microelectrode arrays that connect brain cells to electronic circuitry,” the website explained. After using brain scans to figure out where to put the electronic grids in the test patient’s brain, “They implanted the devices into [the patient’s] left motor cortex, the part of the brain that controls movement of the right arm and hand.”

Nvate Assistive Technology Brain-Machine Interfaces Camera Mouse Esko Paralysis Paraplegic Aids Quadriplegic Aids ReWalk robotic arm Tongue Drive System


Although the robotic arm is slow, it is accurate 91.6 percent of the time thanks to its advanced joint and wrist movements. The patient could perform tasks such as handling an egg, stacking cups, and pouring one, half-full glass into a measuring cup. Most importantly, the patient could eat a piece of chocolate all by themselves for the first time in years. All they had to do was imagine that they were moving their own arm. This takes weeks of training, and the FDA allows only 20 months of testing per patient. These studies could end up revolutionizing people’s lives.

Researcher Jennifer Collinger, also hailing from the University of Pittsburgh, speculates that “it might even be possible to combine brain control with a device that directly stimulates muscles to restore movement of the individual’s own limb.”

There are further ways that technology helps those with paralysis. Part two of this article explores technology that helps people who are locked-in, or people who are able to only move their eyes. Check out the February issue of Nvate for the second installment.

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