It may take years for the child-sized Ekso, but one will be a welcomed breakthrough.

Two Oakland doctors pair up with robotics firm Ekso Bionics on a pint-sized exoskeleton for kids.

Idealism isn’t the first qualification people seek in their pediatric rehabilitation doctor, but for parents or caretakers of children with neurological conditions leading to movement disorders, it should be near the top of the list.

At UCSF Benioff Children’s Hospital Oakland, medical doctors Christine Aguilar and Robert Haining are working on a rehabilitation project so futuristic it’s still in development—the development of child-sized human exoskeleton.

Richmond-based Ekso Bionics is a leader in human augmentation with its wearable exoskeleton that allows people with lower extremity impairment to walk. The brace-like assistive robotic device is propelled by a programmable power backpack and, when used with a trained therapist, enables paraplegics to stand, ambulate, and pivot.

In the Bay Area, Alta Bates Summit Medical Center and Palo Alto Veterans Hospital have an Ekso—models are priced at $110,000 and up. But the weight and proportions are suited only to people 5 feet 4 inches and taller. Elsewhere, DuPont Children’s Hospital in Wilmington, Del., has child-proportioned robotic exoskeleton arms made from 3-D printing, and Children’s Healthcare of Atlanta uses an adult model Ekso with taller teenage patients.

“Unfortunately, if you’re small, you can’t use one,” said Aguilar, medical director of the Oakland facility’s rehabilitation medicine program. “That’s why we got involved. We’re re-designing the hip, knee, and ankle to fit children. We’ve been trying to make it lighter.”

At UCSF Benioff Children’s Hospital Oakland, a multidisciplinary team is applying its vision and expertise to transform children’s lives. Among those efforts is Aguilar’ and Haining’s work helping Ekso develop a pediatric prototype of its Ekso GT robotic exoskeleton. The device is being designed for children ages 5 to about 8 years old, who typically range in height from 42 to 50 inches.

A $180,000 National Institutes of Health grant is supporting this effort. If it develops as projected, Ekso and UCSF Benioff Children’s Hospital Oakland will discuss a sequential phase two grant.

“Spina bifida kids are the first group that will go into it,” Haining predicted. “If you can decrease their energy use while walking, you might be able to keep them upright.”

Ekso Bionics marketing manager Heidi Darling said it’s premature to discuss the exploratory prototype. “Casting the project in the wrong light would misinform parents hoping their child might be able to use something soon that does not yet exist,” Darling said.

Darling isn’t being overly cautious. It took the Ekso GT seven years to reach the market. The process that took the Ekso from its 2005 origins at UC Berkeley’s Robotics and Human Engineering Laboratory to the first commercialized robotic exoskeleton available for use in rehabilitative and medical facilities in 2012 was anything but swift.

Even so, conversations about the exploratory Ekso at Children’s are buoyant. “We’re developing something for kids to suit their different biomechanics,” Aguilar said.

Initial concentration is not only on the obvious size and weight reductions but also on the power source. “That pack puts the center of mass behind you, and when you’re little, that pushes you to your arms, and you fall,” Haining said.

Getting in and out of one, worn over clothing but requiring multiple straps and adjustments, can be arduous. Adults with a therapist can spend up to 20 minutes simply putting it on—unreasonable for a child. “We’ve improved getting in and out of it, too. We’ve made the ability to swing the leg out to get the hip in place greater,” Aguilar said.

One thing they’ve not had to consider is whether it will positively impact the lives of their patients. For adults who use the Ekso, standing upright means they regain the ability to look a peer in the eye—a confidence booster. For kids, the benefit might be that they will have a chance to prevent their bodies from being so twisted they will never straighten up, even with an assistive device. “How kids develop and how their contractures develop is different than for adults,” Haining said. “When you’re sitting all the time like kids in wheelchairs are, you take on the form of what you’re in. Kids’ bones are twisted and tendons are shortened.”

Although Aguilar and Haining know that a pediatric Ekso will take years, they remain undeterred by the calendar. “Listen, I’ve had kids who never walked who are now walking,” Aguilar said. “Some of them, the effects of a treatment fades due to multiple changes. Then we try other methods.”

Haining chimed in and said, “That’s why everybody does rehab. Many of our kids, we can’t cure. If we can give them a level of joy, that keeps us coming back.”