Self-balancing robotic suit helps ALS patients practice walking

A self-balancing, hands-free robotic exoskeleton designed for people with severe gait impairment was safe and well tolerated in a small pilot study of amyotrophic lateral sclerosis (ALS) patients who could still walk.

While six weeks of walking practice with the Atalante exoskeleton did not significantly slow declines in walking ability or other clinical measures, participants reported feeling more mobile, standing more upright, and having a greater sense of accomplishment after using the device.

“An intensive, hands-free gait-training program using the self-balancing Atalante exoskeleton is feasible, clinically safe, and highly valued by ambulant people with ALS,” the researchers wrote, while adding that future studies are needed “to test whether it preserves function.”

The study, “Safety, feasibility and preliminary effects of Atalante exoskeleton-assisted gait training in amyotrophic lateral sclerosis: a prospective ABA pilot study,” was published in the Journal of NeuroEngineering and Rehabilitation.

For people living with ALS, a progressive neurodegenerative condition that gradually weakens muscles, walking often becomes slower, more tiring, and less stable over time. As walking becomes more difficult and the risk of falls increases, many people naturally become less active. But reduced physical activity can itself accelerate the loss of mobility, independence, and quality of life, making maintaining mobility for as long as possible an important part of care.

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Conventional walking becomes increasingly difficult as weakness and balance problems worsen, posing a challenge to mobility and independence. Robotic exoskeletons help overcome that challenge by supporting people while they practice walking. However, most exoskeletons require users to rely on crutches or walkers for balance. That limits their usefulness in ALS, in which arm strength also declines over time.

The Atalante exoskeleton, developed by Wandercraft, takes a different approach. It balances itself while providing adjustable levels of robotic assistance to support the user’s weight. This allows people to stand and practice different walking tasks while remaining actively involved in each step.

Previous studies in other neurological disorders suggested this type of hands-free training can be delivered safely, but it had not been tested in people with ALS.

Researchers in France conducted a pilot study (NCT06199284) involving 10 adults. The 18-week study consisted of an initial six weeks of usual care, six weeks of exoskeleton-assisted gait training in addition to usual care, and a six-week follow-up period after the training ended. Assessments were performed every three weeks throughout the study.

The main goal was to determine whether hands-free, exoskeleton-assisted gait training was safe and feasible, while also exploring its effects on walking ability, muscle strength, balance, fatigue, breathing function, quality of life, and disease progression.

Participants, most of whom were men (80%), had a mean age of 55.8 and had been living with ALS for a median of 19.5 months. Seven (70%) relied on some form of walking assistance.

All 10 participants completed the program, with 98% of scheduled training sessions completed. Overall, the exoskeleton was well tolerated, and no serious safety issues occurred during training. Researchers recorded 11 adverse events, but only one — a minor pinch to a participant’s forearm — was considered device-related, and no one stopped training because of side effects.

As the sessions progressed, participants gradually took more steps while requiring shorter rest breaks, even as the level of robotic assistance remained unchanged. Pain levels stayed low throughout the program, while fatigue increased slightly immediately after training, an expected effect of exercise.

When researchers evaluated walking ability, muscle strength, balance, breathing function, fatigue, quality of life, and disease progression, they did not find statistically significant improvements compared with periods of usual care alone. However, several measures followed a pattern suggesting that functional decline may have slowed during the six weeks of exoskeleton training.

“The absence of statistically significant improvements should not be interpreted as absence of effect,” the researchers wrote, noting that the findings likely reflect the combination of ALS’s rapid progression, the small number of participants, and the relatively short study period.

Participants also reported positive experiences with the exoskeleton. Most (80%) said they felt less immobile and had a greater sense of accomplishment after the sessions, while 70% felt their posture had improved. Six participants (60%) also reported improved walking stability, reduced muscle stiffness, and better overall well-being.

“In ALS, where the goal may be as much to preserve function as to improve it, our findings position Atalante as a credible platform to restore safe upright mobility,” the researchers concluded, adding that larger studies are needed to determine whether the technology can help slow mobility loss over time.