I, iBot

Dean Kamen invented what he calls “the world’s most sophisticated robot” to transport people with mobility impairments places they never thought they could go.

By Lori A. Wood

A wonder of modern technology, the Independence® iBOT® 4000 Mobility System, allows people with disabilities to go places that they may have never imagined. “It took some of the smartest engineers in the world about ten years to make that happen,” says Dean Kamen, founder and president of DEKA Research and Development in Manchester, New Hampshire.

“I spent my whole life building medical equipment,” Kamen says. This equipment included wearable infusion pumps for diabetics and the first practical home dialysis machine. “Almost every product we work on is dedicated to making better ways to deliver health care and health products to people. In the early eighties, we decided that the disabled community didn’t get much attention. Drugs were screaming ahead, as was surgery with robotics and lasers, but the wheelchair looked sort of like the wheelchair of two hundred years ago. It wouldn’t go up curbs or stairs. It never let people get to eye-level, or give them the eye-level dignity of talking to people.”

Recognizing its many limitations, Kamen sought to improve the wheelchair. “It turned out to be a really stupid idea,” he says. “Defining the problem of improving the wheelchair is why we were doomed to fail. We spent a couple of years trying to make wheelchairs that would climb curbs or stairs.” They found that technology permitted them to do any one of those things, but the resulting products often had excessively wide bases or unsightly outriggers. “Everything we built was an improvement in some function, but it would be so impractical,” Kamen remembers. “It would eliminate so many other advantages.”

Eureka Moment

After slipping in the shower one day, it occurred to Kamen that a sense of balance was a key element that engineers had been missing in the wheelchair’s development. “I said, ‘We’ve been trying to solve the wrong problem.’ When somebody can’t walk around anymore, the big thing that you’ve got to give them back is their balance. Making vehicles that can move is no big deal. Making something that can stand up and balance a human-that’s a hard thing.”

Since the human body uses the inner ear for balance, engineers added gyroscopes to the iBOT® Mobility System, to mechanically compensate for any lack of balance that users with disabilities might experience. A person’s brain, eyes, inner ears, and muscles are replaced with gyroscopes, accelerometers, computers, and motors. “We made a device that literally balances itself and moves around the room by leaning, falling, and catching itself, just the way a human does,” Kamen explains.

The Segway®, which Kamen also helped to develop, also uses balancing technology, but it has no seat or second set of wheels to climb stairs and curbs. The iBOT’s second set of wheels is perpendicular to the ground and positioned over the first set. The first set of wheels rests against the vertical section of the first stair, is rotated by the cluster, and the second set of wheels rolls forward until it sits on the stair. The first wheels rotate up, and go—one over another—up the stairs.

Modes of Wheeling

“Stair Mode” is one of the iBOT’s four functions. “Standard Mode” enables it to function as a standard wheelchair, to prevent a user from being stranded should the device malfunction. “Enhanced Mode” is similar to Standard, except all four rotating wheels are on the ground, permitting four-wheel drive capabilities, which help to keep the seat level with the ground. “Balance Mode” allows a user to stand.

“The iBOT is so humanoid,” Kamen says. “When you sit in one for the first time, you feel like you’re still on your own feet. You don’t feel like you’re in a wheelchair. When we see a disabled person get it, they smile. They’re up and they’re free. With all the available functions, they can look people in the eye, go across sand or grass, up curbs and stairs. It’s amazing.”

Unfortunately, it can be expensive, as well: Each unit costs approximately $26,000. “Believe it or not, that is not dramatically more than a very high-end, sophisticated power chair would cost,” Kamen says. “Obviously, it does much more. It’s the world’s most sophisticated autonomous robot.”

In Kamen’s view, the iBOT’s benefits to users justify the expense. “You don’t need elevators . . . It can easily walk itself into a van; you don’t need all sorts of equipment. I wish I could say they were cheaper now, but at that price, considering what you get and how long it runs, complete with every feature and the best batteries, it’s pretty good. It gives you freedom. All you have to do is try it, and you fall in love with it.” Johnson & Johnson, the world’s largest, and one of the most prestigious, medical companies, has partnered with DEKA to give people that chance.

“When you have a partner and provider like Johnson and Johnson, you get a pretty exceptional package of service,” praises Kamen. “It gives you confidence.”

How To Afford an iBot

Last summer, despite pressure from Johnson and Johnson and some 70 nonprofit groups, including United Spinal Association, to give iBot special status that would make it more affordable for more people, the Center for Medicare and Medicaid Services (CMS) ruled to keep classifying it as a standard power chair. This means that under the current rules, Medicare would cover just $5,300. Johnson and Johnson and the nonprofits are challenging this decision. In the meantime, Kamen says that private insurance companies have played an important role in reassessing the medical necessity of iBot. “From what we’ve seen so far, all the insurance companies that look at this realize how well it’s made, how long it’s going to last, and the problems that it solves for their clients. In almost every case, we believe that they paid some or all of the costs of getting one. People have to make their case, but when insurance companies see a real person that really needs this, generally, they do the right thing. We’re very happy about this.”

“We have our own case management entity,” says Gregg Howard, vice president of Sales and Reimbursement at Johnson and Johnson. On behalf of the patient or consumer, Howard’s staff work with the insurance companies’ case managers, and also gather letters of medical necessity from doctors and therapists, to convince insurers of the necessity of the iBOT. The iBot is a Class Three medical device, which means that you need a doctor’s prescription to get it. The patient is then referred to a clinic for an assessment with independent physical and occupational therapists. “We have trained [the therapists], so that they’re experts in understanding the device,” Howard explains. “The patient has an hour and a half to two-hour session with a therapist, who determines whether the device is safe and efficacious for them. Once that’s determined and somebody elects to purchase an iBOT, they go through a training program that averages in length from five to ten hours, administered by an independent physical or occupational therapist. It basically trains them in all facets of the device, making certain that by the time they’re trained, they’re safe and understand how to operate the device in all different functions.”

The costs of these sessions vary by clinic. “Oftentimes, the clinics can submit that therapy to thirdparty payers for reimbursement,” states Howard. “For me, it’s a thrill to get somebody an iBOT. All the consumers that I’ve met with that are now riding in iBOTs are very happy with the device. In many cases, it’s been lifechanging.

It’s a great feeling to know that you’re helping somebody to be able to better participate in all of life’s activities.”

If it’s the journey, rather than the destination, that matters most as we move through life, people with disabilities have been given an opportunity to experience it in a whole new way, and the iBOT® Mobility System enables them to see just how far they’ve come.

For more information about the Independence iBot 4000 Mobility System, visit www.ibotnow.com, or call the Independence Technology Customer Zone toll free at 1-866-813-0761 to see if test drives are currently being scheduled in your area.

Lori A. Wood is a regular contributor to Action.