New technology has advanced passive bracing to exoskeletons which are wearable robotic devices that have powered joints and extensive software programming to enable synchronized, functional and safe movement. In addition, the weight of the device can be borne by the exoskeleton and not the patient. While the gait speeds are still relatively slow due to safety issues (to minimize loss of balance and potential falls), the major advance is the reduction of energy that is required to utilize these devices to walk. Patients with primarily thoracic injuries have utilized these devices. With the price continuing to drop for these technologies, this will provide opportunity to evaluate their long-term use as more people acquire them for home use. Furthermore, newer versions are accommodating the ability to sit or wheel a wheelchair while wearing the device, increasing utility in a clinical setting (assisting with rehabilitation goals).
Studies ranging from level 1b to level 4 evidence show that PGOs can enable safe walking and reduce energy expenditure compared to passive bracing in patients with thoracic injuries, or those with adequate triceps functioning.