The Indego exoskeleton is a powered, wearable robotic device designed to help people with lower-limb paralysis or severe weakness stand up and walk over ground. Developed from research at Vanderbilt University and later commercialized by Parker Hannifin, the Indego has been used in both clinical rehabilitation settings and, to a more limited extent, personal home use for people with spinal cord injuries. What makes the device worth understanding goes beyond the hardware itself: clinical trials have tested its effects on walking speed, bone health, pain, spasticity, and the often-overlooked psychological experience of simply being upright again.
What the Indego Actually Is
The Indego is a lower-limb exoskeleton, meaning it straps onto the legs and hips and provides motorized assistance at the hip and knee joints. It is lighter than several competing devices, weighing roughly 12 kilograms (about 26 pounds), and uses a modular design so the leg segments can be separated from the hip unit. This matters for people in wheelchairs, because the components can be attached while seated rather than requiring a standing transfer into the device. Users typically walk with forearm crutches or a walker for balance while the Indego handles the leg movements.
The device comes in two main configurations. The clinical version, sometimes called the Indego Therapy, is intended for use in rehabilitation facilities under therapist supervision. A personal-use version received FDA clearance for home and community walking. Both versions share the same core hardware, though the clinical model includes features geared toward therapist control and monitoring during gait training sessions.
Walking Outcomes in Spinal Cord Injury
The most studied application of the Indego is helping people with spinal cord injuries walk again as part of a structured rehabilitation program. A multicenter study found that after eight weeks of training, participants reached average indoor and outdoor walking speeds of about 0.37 meters per second. Walking speed improved significantly between the midpoint and final assessments, and walking endurance also increased over the training period.1PubMed Central. Initial Outcomes from a Multicenter Study Utilizing the Indego Powered Exoskeleton in Spinal Cord Injury
To put that speed in context, 0.37 meters per second is slow by able-bodied standards, roughly equivalent to a very leisurely shuffle. Community walking typically requires speeds above 0.8 meters per second to cross streets safely and keep pace with pedestrians. So while the Indego enables upright mobility, it does not currently restore walking at a pace that lets someone move through a busy environment without accommodation. A separate prospective study found that after around 45 sessions, participants reached between 0.28 and 0.60 meters per second and covered between 0.74 and 1.97 kilometers in one hour. That study also noted the effort of walking in the exoskeleton was about 3.3 times the effort required for manual wheelchair propulsion.2PubMed Central. Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity
That effort comparison is worth pausing on. Rolling a manual wheelchair is efficient. Walking in a powered exoskeleton with crutches is not. The energy cost means that for most users, the exoskeleton is not a replacement for a wheelchair as a primary means of getting around. It is a tool for specific purposes: rehabilitation sessions, structured exercise, and the physical and psychological benefits of weight-bearing and upright posture.
Use in Stroke Rehabilitation
Beyond spinal cord injury, powered exoskeletons including the Indego have been tested in post-stroke gait rehabilitation. A study examining muscular activation in subacute stroke patients compared standard physiotherapy alone with standard physiotherapy combined with exoskeleton-assisted overground walking. Both groups improved their functional gait scores. But only the group that trained with the exoskeleton showed a return to rhythmic, controlled muscle activation patterns in the proximal leg muscles, suggesting they were re-learning a more natural walking pattern rather than compensating with abnormal movements.3Frontiers in Neurorobotics. Robotic Exoskeleton Gait Training in Stroke: An Electromyography-Based Evaluation
This distinction matters. After a stroke, people often develop compensatory movement strategies: hiking the hip, swinging the leg outward, locking the knee. These patterns get the person from point A to point B, but they come with long-term costs like joint pain, falls, and increased energy expenditure. If exoskeleton-guided training can steer the nervous system toward more physiological patterns during the critical early recovery window, that could translate into better long-term walking quality. The evidence here is still early-stage, but the muscle activation findings are a stronger signal than functional scales alone, which sometimes cannot distinguish between “walking better” and “compensating more cleverly.”
What Happens to the Body Beyond Walking
One of the less obvious arguments for powered exoskeleton use is what upright, weight-bearing activity does for body systems that deteriorate during prolonged wheelchair use. When someone with a spinal cord injury sits all day, the lack of gravitational loading on the legs leads to bone loss, changes in body composition, and secondary complications. Exoskeleton walking puts mechanical stress back through the legs, and researchers have looked at whether that is enough to make a measurable difference.
A study on adults with chronic spinal cord injury found that exoskeleton-based walking training was associated with improvements in body composition and a 14.5 percent increase in bone mineral density at the tibia. That increase was not statistically significant, meaning the study could not rule out chance as an explanation, but the researchers noted it may still be clinically meaningful given the rapid bone loss that typically occurs after spinal cord injury.4Journal of Rehabilitation Medicine. Effect on body composition and bone mineral density of walking with a robotic exoskeleton in adults with chronic spinal cord injury
Other reported secondary benefits are even less certain. Some clinical trials found that users reported improvements in bladder and bowel function and reductions in chronic pain and spasticity after training with powered exoskeletons, but a review noted that none of these findings constitute conclusive evidence.5Journal of Neural Engineering. Powered exoskeletons for bipedal locomotion after spinal cord injury These are plausible effects: upright posture and trunk movement can influence autonomic function, and weight-bearing activity might reduce spasticity through sensory input to the spinal cord. But “plausible” is not the same as “proven,” and anyone considering an exoskeleton specifically for bowel or bladder management should know the evidence is anecdotal at this point.
The Safety Profile
Any device that takes a person with paralysis from sitting to standing and then walks them forward involves risk. A systematic review with meta-analysis of powered exoskeleton trials found no serious adverse events across the included studies. Falls occurred in about 4.4 percent of cases, and all of those happened while the user was tethered (attached to an overhead support) and using a first-generation exoskeleton, with none resulting in injury. Bone fractures during training occurred at a rate of about 3.4 percent. The reviewers noted that both of these risks have been reduced with newer-generation devices and tighter screening of who is eligible to use them.6PubMed Central. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis
The fracture rate is the one that catches people off guard. Bones that have been unloaded for months or years after a spinal cord injury lose density rapidly, and the mechanical forces of exoskeleton walking, while therapeutic in intent, can exceed what weakened bones can handle. This is why screening protocols now typically include bone density assessments before someone is cleared for exoskeleton training. Skin breakdown at the points where the device contacts the body is another commonly reported issue, particularly around the shins and thighs, though this tends to be minor and manageable with adjustments to padding and fit.
Quality of Life and the Emotional Weight of Standing
You might assume that giving someone the ability to walk again, even slowly and with assistance, would produce a measurable boost in life satisfaction. The data on this are more complicated than the assumption. A study examining quality-of-life outcomes in people with spinal cord injury using a powered exoskeleton found no statistically significant change in overall life satisfaction scores from baseline to the end of the study period. Satisfaction with Life Scale scores moved from about 20.4 to 21.3 on a 35-point scale, a small shift that could easily be noise.7PubMed Central. Examining the Effects of a Powered Exoskeleton on Quality of Life and Secondary Impairments in People Living With Spinal Cord Injury
That finding is worth sitting with. It does not mean the exoskeleton has no psychological value. Standardized life satisfaction scales capture broad, stable self-assessments that may not shift from an intervention used in a controlled clinical setting over a limited period. The researchers themselves suggested that using a powered exoskeleton in one’s own community, rather than a clinic, could lead to greater social integration and, in turn, improved quality of life. A case report on a woman with progressive multiple sclerosis supports this possibility: after exoskeleton training, she showed improved lower-limb strength, increased social outings, and better self-reported well-being, having previously been depressed and reluctant to leave home.8PubMed. Enhancing quality of life in progressive multiple sclerosis with powered robotic exoskeleton
Where the emotional impact shows up most vividly is in qualitative research. A study collecting user experiences found that one of the most commonly described benefits was interacting with other people at eye level. Users described the experience in strikingly personal terms. One participant said standing up with her husband and having him kiss her while she was upright brought tears to his eyes, and that being at the same height while moving through public spaces made her “feel more complete.” Another said that being able to look someone in the eye while talking was “a big deal,” even though the same conversation happens fine from a wheelchair.9PubMed Central. Users with spinal cord injury experience of robotic Locomotor exoskeletons: a qualitative study of the benefits, limitations, and recommendations
These experiences point to something that clinical outcome scales struggle to capture. The value of upright posture is not just physiological. It is social and deeply personal. For someone who has spent years at seated height in a world designed for standing people, the chance to be at eye level with a partner, a child, or a colleague carries weight that a satisfaction survey may not register.
Practical Barriers to Wider Use
Despite the clinical interest and emotional testimonials, powered exoskeletons like the Indego remain far from mainstream. The cost is the most immediate barrier. Personal exoskeletons have historically been priced in the range of roughly $80,000 to over $100,000, putting them out of reach for most individuals without insurance coverage, and insurance coverage for personal exoskeletons remains inconsistent and difficult to obtain in many countries. Even in clinical settings, the cost of the device plus the staffing requirements for safe training limit how many rehabilitation centers offer exoskeleton programs.
The energy cost of walking, as mentioned earlier, is another practical constraint. Walking in the Indego requires substantially more effort than wheelchair propulsion, which means it is not a practical everyday mobility solution for most users. Donning and doffing the device takes time even with the modular design, and users need upper-body strength and stability to manage crutches or a walker. People with higher-level spinal cord injuries or significant upper-limb weakness may not be candidates at all.
Terrain is a further limitation. Current exoskeletons perform best on flat, smooth surfaces. Uneven ground, slopes, curbs, and stairs remain challenging or impossible depending on the device and the user’s level of injury. The gap between walking on a clinic floor and navigating a real neighborhood is substantial, and it is one reason why many users who train with an exoskeleton in rehabilitation still rely on a wheelchair for daily community mobility.
How the Indego Compares to Other Devices
The Indego exists in a field alongside several other powered lower-limb exoskeletons, including the ReWalk, the EksoGT (now EksoNR), and the HAL by Cyberdyne. Each device has its own design philosophy and target population. The Indego’s relative lightness and modular construction are its most frequently cited practical advantages, since a user can attach the device while seated in a wheelchair without needing a standing frame or overhead lift. Some competing devices are heavier or require more complex setup procedures.
All of these devices share the same fundamental limitation: they assist walking but do not restore independent ambulation in the way that, say, a cochlear implant restores functional hearing. The user remains dependent on the hardware, on upper-body balance aids, and on a degree of physical fitness to operate the system. The field is still early enough that head-to-head comparative trials are rare, and most of the published evidence compares exoskeleton training to conventional therapy rather than one exoskeleton brand to another. For clinicians choosing a device, the decision often comes down to the patient’s body size and injury level, the fit and adjustability of the device, institutional familiarity, and what the facility already owns.
Where the Technology Is Heading
Research in powered exoskeletons is moving in several directions simultaneously. One active area is refining the control systems so that the exoskeleton responds more naturally to the user’s intentions, using signals from residual muscle activity, body weight shifts, or even brain-computer interfaces to trigger steps rather than relying entirely on pre-programmed gait patterns. The goal is a more fluid, responsive walking experience that adapts to the user’s pace and environment.
Another line of development focuses on lighter materials and more efficient actuators to reduce weight and extend battery life. Current battery capacity typically supports one to several hours of walking depending on speed and terrain, which is adequate for rehabilitation sessions but limiting for community use. Reducing the energy cost for the user is arguably just as important as extending battery life: if walking in an exoskeleton felt closer to the effort of normal ambulation, the devices would cross from rehabilitation tools into genuine mobility aids.
There is also growing attention to involving people with disabilities directly in the design process. The fit of an exoskeleton is not trivial. People with spinal cord injuries often have reduced muscle mass, atypical limb proportions due to disuse atrophy, and pressure sensitivity in areas where the device contacts the skin. A device designed around able-bodied body dimensions may not fit or may cause discomfort for the people who actually need it. Engaging end users in design decisions, from the shape of the cuffs to the user interface, is increasingly recognized as essential to making these devices work in real life rather than just in a research lab.