Robotics help paralyzed walk again, but cost is proving a major barrier

Ashley Barnes was 35 years old when doctors told her she would never walk again.

A botched spinal procedure in 2014 paralyzed her from the waist down. The Tyler, Texas, resident had been an avid runner, clocking six miles daily when not home with her then-9-year-old autistic son, whom she raised alone. Life in a wheelchair was not an option.

"I needed to be the best mom I could be," Barnes said. "I needed to be up and moving."

So she threw herself into physical therapy, convinced she would one day run again. Soon she realized that wasn't a reality.

Although she wore a brave face, "I would save my moments of crying for my room," she said.

About a year later, hope resurfaced when she learned of the ReWalk system, a batterypowered robotic exoskeleton that attaches to the legs and lower back. It contains motors at the knee and hip joints and sensors to help it adjust with each footfall. While wearing the device and holding two forearm crutches, someone with complete lower-limb paralysis can walk.

Rehabilitation centers often employ such devices in physical therapy, which is how Barnes first encountered one at the Baylor Tom Landry Center, a rehab clinic in Dallas. After seven months without being able to stand, she did. Then she took a step as she began to learn how to walk again.

In 2014, the ReWalk system became the first personal robotic exoskeleton approved by the Food and Drug Administration. The following year, the Department of Veterans Affairs agreed to cover the exoskeletons for qualifying vets.

Meanwhile, several companies began touting similar devices. For example, Ekso makes units used to rehabilitate people after spinal cord injury or stroke.

Health insurers, however, generally don't cover the expensive equipment.

After working with the ReWalk system at her rehab center, Barnes, who uses a wheelchair at home to get around, decided she wanted one of her own. But Tricare, her insurer, denied the request.

In a statement, Tricare said it "does not cover these devices for use on a personal basis due to concerns with their safety and efficacy. This is particularly important due to the vulnerability of paralyzed users in the event of a fall."

Two years and countless no's later, Barnes still doesn't have one because, according to Tricare, it isn't "medically necessary." Barnes strongly disagrees. "This is medically necessary," she said. If she had one of the devices, "I'd be able to go to the bathroom. I would be able to walk around, exercise in it. I would love to be able to stand up and cook things in my microwave or on my stove."

She paused before adding, "I would no longer have to look up at my son."

The ReWalk Personal 6.0 System costs, on average, $81,000. Ottobock's C-Brace is priced at $75,000. For the Indego Personal, which received FDA approval last year, it is $98,000.

About 28 percent of the more than 5.2 million Americans living with paralysis survive on an annual household income of less than $15,000, according to the Christopher and Dana Reeve Foundation. The basic expenses of living with paraplegia are, on average, $519,520 in the first year and $68,821 each subsequent year, according to the National Spinal Cord Injury Statistical Center. Furthermore, only 34.3 percent of people are employed 20 years after a paralysis-causing injury.

To date, ReWalk has sold only 118 personal devices in the United States.

Some people do get devices covered by insurance, but it can be an onerous process, as evidenced by Mark Delamere Jr. The Boston native, 19, was paralyzed in a car accident in 2013, on the third day of his freshman year of high school.

Like Barnes, he thought he would never walk again. Like Barnes, with the help of a robotic exoskeleton, he did. Unlike Barnes, though, he has an exoskeleton at home.

But for two of his teenage years, he sat in a wheelchair while his family filed claims and appealed denials.

"They don't really classify these things with the purpose of you getting better, because they think the injury is never going to change," his father, Mark Sr., said.