Out of the clinic.

In June 2014, the US Food and Drug Administration allowed a powered exoskeleton onto the American market for the first time. ReWalk was a motorised frame worn over the legs, cleared for people paralysed by spinal cord injuries between the seventh thoracic and fifth lumbar vertebrae, and meant to be used with a trained caregiver. At the time it retailed for approximately $70,000 in Europe.¹

The ambition already reached beyond the hospital. Christy Foreman, director of the FDA's Office of Device Evaluation, said people "may be able to use these devices to walk again in their homes and in their communities."² Twelve years later, the distance between that sentence and the life of a typical older person at home is still wide. The reasons are partly technical, and partly about who these machines were built for.

A device for the clinic

ReWalk reached the market through the FDA's de novo route, the pathway for new kinds of device with nothing equivalent already on sale.¹ The category it opened now has its own federal regulation, 21 CFR 890.3480. It defines a powered lower extremity exoskeleton as "a prescription device that is composed of an external, powered, motorized orthosis" placed "over a person's paralyzed or weakened limbs for medical purposes", and puts it in Class II, with special controls.³

The wording tells you where these machines were meant to live. Prescription, paralysed or weakened, medical purposes: the first generation was designed around rehabilitation centres and people with severe neurological injury, with therapists to fit the device and train the person wearing it.

What Medicare decided

Paying for one was the other obstacle. In December 2023, Medicare's equipment contractors set out a newly finalised rule: powered exoskeletons that support weak arms or legs "are classified as braces", billed under a new code, K1007, for a powered device spanning both hips, knees, ankles and feet.⁴ On 11 April 2024, the Centers for Medicare & Medicaid Services announced fee schedule amounts for K1007, effective for claims from 1 April 2024.⁵ The trade journal O&P Edge reported the rate as $91,032, within a range of $81,929 to $109,238, paid as a lump sum under the brace benefit.⁶ Ekso Bionics, one of the makers, said in a press release that it would work with clinics to qualify people with spinal cord injuries who could potentially benefit.⁷

It was a real step for a small group of people. It also shows where the category still sits: a prescribed brace, for people with paralysed or weakened legs, priced in tens of thousands of dollars.

The parts got cheaper

Meanwhile, the batteries an exoskeleton needs are now made at enormous scale for phones and electric vehicles. BloombergNEF's annual survey found that the average lithium-ion battery pack cost $115 per kilowatt-hour in 2024, a record low and 20% less than a year earlier.⁸

Consumer exoskeletons have followed. Hypershell, for example, sells powered exoskeletons for hikers: when its X series was reviewed in January 2025, it was listed from $799 in the US, and the entry model weighed 2 kg.⁹ They are made for climbing hills with less effort.

Samsung has tested hip exoskeletons with older adults in clinical studies. In October 2024, shortly before Samsung was expected to unveil its consumer device, Bot Fit, KED Global reported that an analysis of its app showed it was designed "to support walking exercises for fitness enthusiasts", although the market had expected it mainly to assist older users with walking problems.¹⁰

Neither the prescribed brace nor the hiking aid was designed around an 80-year-old who wants to get out of a chair, cross the kitchen and walk to the shops.

What the studies in older adults show

The research in older adults is encouraging, and modest. In one trial, 20 healthy adults with a mean age of 70 were randomised: ten trained with a powered hip exoskeleton and ten walked overground at their own pace. The exoskeleton group trained on a treadmill for four weeks, three one-hour sessions a week. Their metabolic cost of walking fell by 26.6% on average, and was still 20.2% below baseline a month later; the control group showed no significant change. Daily step counts did not change, and the authors called it an initial feasibility study.¹¹

In South Korea, a randomised trial of 60 community-dwelling older adults, 30 in each group, compared 18 supervised exercise sessions over six weeks, with or without a 2.1 kg hip exoskeleton developed at Samsung. The net metabolic cost of walking fell by 24.85% in the exoskeleton group after training, against 10.58% without it; three months later the figures were 22.67% and 5.53%. Walking speed and balance scores also improved more with the device. The authors noted that the sample was small, activity outside the sessions was not monitored, and the results cannot be generalised to all older people.¹²

In a senior living community in Evanston, Illinois, 12 adults over 65 did twelve 30-minute sessions over four to six weeks with a lightweight hip exoskeleton. Their comfortable walking speed rose by 0.18 metres per second on average, their six-minute walk distance rose from 371.2 to 433.7 metres, and, among the ten with usable sensor data, daily sedentary time fell from 610.2 to 497.3 minutes. There was no control group.¹³

Early, and mostly not at home

A 2024 systematic review, framed around the World Health Organization's idea of healthy ageing, found 36 studies of lower limb exoskeletons in people aged 65 and over, including people with stroke, Parkinson's disease and osteoarthritis. The reported outcomes were broadly positive. But on a standard quality checklist, 22% of the studies were rated poor and 56% fair; only 22% were rated good. The authors wrote that a comprehensive assessment of these interventions "within a healthy aging context is lacking."¹⁴

How strong is the evidence?

Methodological quality of 36 studies of lower limb exoskeletons in adults aged 65 and over, Downs and Black scale, % of studies

Poor22%

Fair56%

Good22%

Source: Gavrila Laic et al., Sensors (2024)

The trials share a pattern. They are small and short, and training happens with a therapist present, on a treadmill, in a hospital or in the common room of a care community. None of the studies above tested what happens when an older person wears an exoskeleton alone at home, day after day, for months. That is a different question, and an open one.

Veema works on mobility at home because that is where most of an older person's standing and walking happens. Whether an exoskeleton can help there is a question only studies with older adults, in their own homes, can answer.

These figures describe the need. They are not results or claims about Veema.

Sources

1. MDDI Online (2014): An Exoskeleton First, FDA Clears ReWalk: ReWalk the first FDA-cleared wearable motorised device for paraplegia (27 June 2014 report), de novo pathway, spinal cord injury T7 to L5 with a trained caregiver, approximately $70,000 retail in Europe.
2. MedCity News (2014): FDA clears motorized exoskeleton: Quote from Christy Foreman, director of the FDA Office of Device Evaluation, on walking again at home and in the community.
3. Electronic Code of Federal Regulations, 21 CFR 890.3480: Definition of a powered lower extremity exoskeleton as a prescription device for paralysed or weakened limbs; Class II (special controls).
4. Noridian Medicare JA DME (2023): Powered Lower Extremity Exoskeleton, Correct Coding: Posted 28 December 2023; rule finalised that powered exoskeletons that support weak arms or legs are classified as braces; HCPCS K1007 descriptor (bilateral hip, knee, ankle, foot device, powered).
5. Centers for Medicare & Medicaid Services, MLN Matters MM13658 (2024): DMEPOS Fee Schedule July 2024 Quarterly Update (13 June 2024): on 11 April 2024 CMS announced fee schedule amounts for K1007, effective for dates of service from 1 April 2024. No dollar amount stated in this document.
6. O&P Edge (2024): CMS revises fee schedule to include ReWalk payment rate: 12 April 2024; reported established rate of $91,032, ceiling and floor $109,238 and $81,929; dates of service from 1 April; brace benefit category paid as a lump sum.
7. Ekso Bionics press release via Stock Titan (2024): 12 April 2024; company statement: final payment level $91,031.93 from 1 April 2024; company to work with clinics to qualify individuals with spinal cord injuries who can potentially benefit.
8. BloombergNEF (2024): battery pack price survey: Average lithium-ion pack price $115 per kWh in 2024, a record low, down 20% from 2023.
9. Clarke, Advnture (2025): Hypershell exoskeleton: 22 January 2025; Hypershell X series starts at $799 (US dollars); Go X weighs 2 kg.
10. KED Global (2024): Samsung Bot Fit: 14 October 2024, before the expected end-October unveiling; app analysis showed Bot Fit designed to support walking exercises for fitness enthusiasts; market had expected it to mainly assist elderly users with walking problems.
11. Martini et al., Scientific Reports (2019): 20 healthy older adults (mean age about 70), randomised 10 and 10; four weeks, three one-hour sessions a week; metabolic cost of transport down 26.6% post-training and 20.2% at one-month follow-up in the exoskeleton group, no significant change in controls; step counts did not differ; feasibility study.
12. Lee et al., Scientific Reports (2023): RCT, 60 community-dwelling older adults (30 and 30); 18 sessions over 6 weeks; EX1 hip exoskeleton, 2.1 kg, developed at Samsung Electronics; net metabolic cost reduction 24.85% vs 10.58% post-exercise and 22.67% vs 5.53% at 3 months; limitations: small sample and low statistical power, activity outside sessions not monitored, not generalisable to all older people.
13. Jayaraman et al., Journal of NeuroEngineering and Rehabilitation (2022): 12 adults over 65 in a senior living community in Evanston, Illinois; twelve 30-minute sessions over 4 to 6 weeks; self-selected gait speed +0.18 m/s; 6MWT 371.2 to 433.7 m; sedentary time 610.2 to 497.3 min/day (10 of 12 with data); no control group.
14. Gavrila Laic et al., Sensors (2024): Systematic review of 36 articles (adults 65+, including stroke, Parkinson's disease, osteoarthritis); Downs and Black quality 22.2% poor, 55.5% fair, 22.2% good; comprehensive assessment within a healthy ageing context is lacking.