Series | Challengers

The man building robotic legs for kids with cerebral palsy 

The medical industry wasn’t moving fast enough. So he built a robot to help his nephew with cerebral palsy walk.

It was personal for Manmeet Maggu. 

When he learned that his nephew, Praneit, had been diagnosed with cerebral palsy, the co-founder and CEO of Trexo Robotics was determined to help him walk.

Not being able to walk around and exercise can lead to a cascade of health problems. And walking not only helps cerebral palsy patients with their mobility and quality of life, but also helps avoid complications like diabetes and heart disease

While some robotic mobility exoskeletons exist, Praneit’s family soon ran up against an unfortunate reality.

“We said, ‘why don’t we buy him some sort of robotic system that can help him walk?’ [We] pretty soon realized that there’s just nothing out there for kids,” Maggu says.

“But everybody wants to see their kids walk.”

Building It Themselves

Since buying something off the rack was not an option, Maggu and his friend Rahul Udasi got to work themselves. 

The former University of Waterloo classmates put their robotics expertise to work, building Praneit a child-sized — and Iron Man inspired — version of the mobility exoskeletons available for adults.

Their mobility exoskeletons are composed of a pair of robotic legs that attach to the frame of a mobility trainer that can be customized to each child’s gait patterns through a tablet interface.

Their first attempt… didn’t work.

“We get him in the device, and pretty soon realize that this is not going to work,” Maggu says. “There’s some issues with the design, it’s just not powerful enough … [we] felt pretty defeated at the time, because he didn’t even move.”

They kept tweaking the device, and the next day had their first success: getting Praneit to walk suspended, his legs moving in the air. 

Since that day, Valeriya Botova has seen her son, Jaroslav, take around 10,000 steps — 10,000 more than he was ever expected to take.

“We realized that this is something that families all over the world are interested in,” Maggu says. “And that’s where we decided to start Trexo Robotics.”

Starting Up

Many devices designed to meet medical needs begin their lives in research labs. Surrounded by scientists and researchers, iteration after iteration of the devices are developed and tested, eventually becoming an optimized device the team is confident can work in real world conditions — and get regulatory approval. 

From there they go on to clinical trials and FDA approval, which can take a considerable amount of time — years or even decades. Manufacturing processes need to be established, doctors and insurance sold on the device. And then, finally, it can go to patients. The end results, although they take time, are polished products with a high level of confidence that they are safe and effective.

But mobility exoskeletons developed this way are only helping so many children at a time — for Maggu, the way to help families was to jump right to being a company. 

When talking to hospitals and clinics about using Trexo’s mobility exoskeletons, Maggu realized they just simply weren’t moving fast enough — and all the while, families are asking for a Trexo for their children.

“We soon realized that the best way to have a maximum impact is by building a profitable business out of this,” Maggu says.

Moving Fast

Trexo built on the previous research into mobility exoskeletons for pediatric and cerebral palsy patients. Combining established work in robotic rehab therapy with advances in electric motors and batteries that have made them more powerful and affordable, they began building Trexos for home use.

While previous robotic exoskeleton companies have faced challenges in getting regulatory approvals and cost, Trexo believes it has taken those hurdles down a couple notches thanks to their IP and market strategy, BetaKit reported.

While Trexo was able to avoid years in research and clinical trials by being a startup rather than an academic lab, it did have to seek out approval from the FDA in the U.S. and from Health Canada. 

To help make that process less onerous — many companies that fall under the FDA’s umbrella, like pharmaceutical companies, actually outsource these kinds of studies to specialists — Trexo markets their mobility exoskeletons as exercise and therapy devices, not medical devices, TechCrunch reported

These devices fall under a different classification and have their own regulatory requirements, dealing primarily with safety.

Working in this set of rules, Trexo was able to prove its mobility exoskeletons safe to sell directly to families.

Trying Trials

With Trexos in people’s homes, clinics and hospitals came around, and they are now putting the devices through clinical trials, according to BetaKit.

That’s crucial, because one of Trexo’s greatest barriers to helping more kids like Praneit walk is cost. Currently, a Trexo for home use can cost $35,000 dollars. 

Insurance could help more families afford the device, but to convince insurance companies to cover it, they will need to show rigorous clinical data on Trexo’s effectiveness and long-term benefits.

The path to helping people — whether it begins in a research lab or Y Combinator — is not a linear one, with both approaches providing their benefits and drawbacks. But for Trexo, their narrow mission made the startup route the fastest — and kids are already taking their assisted steps.

“You know, we spoke to so many people who said ‘this is not a business idea, this is a research project,’” Maggu says; whole research labs are dedicated to solving the complex challenges of the real world. 

“We didn’t really care about that. All we wanted to build was a device that can help kids walk every day at home.”

CORRECTION 3/1/22: The video says, “today, [Ellie’s] walked over 25,000 steps.” At time of filming, Ellia had taken over 250,000 steps, and today is close to 300,000.

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