For a child with a neuromuscular disease such as muscular dystrophy, just lifting a spoon or a brush can be difficult. But the Wilmington Robotic Exoskeleton, or WREX for short, gives children with muscle weakness the ability to lift and move their arms in 3-D space.
The WREX, Wilmington Robotic EXoskeleton was conceived, developed, and patented by the Pediatric Engineering Research Laboratory (PERL), in the Center for Orthopedics Research and Development (CORD) at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.
The WREX is a state-of-the-art, light weight exoskeleton with two links and four degrees of motion that approximates normal human anatomy. It incorporates elastic band elevation assists for both the shoulder and elbow to totally eliminate gravity influence on the extremity. The unique design of the shoulder and elbow joints allow for a significant improvement in the available range of motion when compared to other assistive devices.
Developed for people with neuromuscular weakness such as muscle disease, cerebral palsy, spinal cord injury, multiple sclerosis and amyotrophic lateral sclerosis, that effect upper limbs, WREX acts as a functional aid in activities of daily living. It can also serve as a cost effective exercise/therapy device for people recovering from stroke.
The WREX can be attached to most common wheelchairs and mobility seating systems utilizing one of the three Mount Bases provided with the arm (also known as Mount Relocator).
The WREX is assembled as left or right. The size is adjustable to fit most children through adult arms.
- Right or Left WREX Arm with Mount
- The WREX forearm Support of appropriate size to patient
- WREX Product Manual
How to Obtain
Licensed Orthotists: Please register for a user account. Then Contact us to set your user account status so you will be able to view pricing and purchase.
Insurance Reimbursement - HCPCS L-Code: 3999 - MISC
- Print 3 copies this Webpage to take along when you visit your Doctor and Orthotist insteps 2 and 3. (Highlight this center section to be printed, then utilize Print feature in your web browser. Choose the option for "Selection" meaning the area you have highlighted.)
- Visit your Doctor to obtain a short prescription or referral (1 or 2 lines is all that is necessary) to see your local Physical or Occupational Therapist first for an “evaluation" and second to see your local Orthotist. The Therapist and Orthotist will need this prescription or referral from your doctor to bill your insurance on your behalf. Take along a printed copy of this webpage so they know what you are referring to.
- Visit your local Physical or Occupational Therapist. Your therapist will need to write up a justification for why you need and will benefit from the WREX. This additional documentation is typically required for insurance reimbursement under Miscellaneous L-code 3999.
- Visit your local Orthotist (Search for an orthotist near you by Zip code). Take along a printed copy of this webpage so that you know what you are referring to.
- Orthotist faxes (866-672-8919) or e-mails P.O. to Broadened Horizons (sales@BroadenedHorizons.com)
- After your Orthotist receives your completed WREX, they will schedule a second appointment for you to come in for final fitting then send you on your way and bill your insurance on your behalf.
If you are located internationally, are uninsured, or do not have the time or patience to pursue insurance reimbursement, the WREX can be purchased privately and even mounted on wheelchair with the assistance of a friend or family member familiar with basic hand tools. Contact Us to purchase privately and for possible Cash-Equivalent Payment Discounts. Note: It is still best to visit a licensed orthotist or therapist near you to help you with final fitting and maximize use of the WREX for activities of daily living
30 Day Trial Program to mitigate concerns over "Will It Work for Me?"
Many Users and Professionals are concerned if they or their client will be successful with the WREX. The majority of candidates are very successful and the WREX significantly enhances their independence and ability to perform activities of daily living by mitigating the significant forces of gravity the rest of us naturally ignore. Most will improve significantly with practice and use. Active daily use, much like any exercise also helps mitigate the effects of degenerative disorders. However, of course there are some individuals who, even with gravity mitigated still do not have enough strength or range of motion to achieve what they would consider "success".
To accommodate this concern EVERY WREX IS CONSIDERED a 30 DAY TRIAL. If a Licensed Orthotist sends a Purchase Order no payment is due for 30 days (we may require a credit card on file if orthotist does not have credit terms with us)
If the WREX is found to not be appropriate to the end users needs, Contact Us for an RMA and we will e-mail you a Return Shipping Label. We must receive WREX back in like new, resalable condition within 30 Days. The credit card or PO will be credited for the full purchase price minus $250 to cover shipping both ways, restocking, cleaning, and refurbishment.
Academic Papers & Studies
Wilmington robotic exoskeleton: a novel device to maintain arm improvement in muscular disease.
J Pediatr Orthop. 2011 Jul-Aug;31(5):e44-9. doi: 10.1097/BPO.0b013e31821f50b5.
Haumont T, Rahman T, Sample W, M King M, Church C, Henley J, Jayakumar S.
Development of WREX—A Power-assistedArm Orthosis
T. Rahman1, J. Nam2, W. Sample1 and R. Seliktar2
Passive exoskeletons for assisting limb movement - Journal of Rehabilitation Research & Development - VA R&D
Tariq Rahman, PhD;1* Whitney Sample;1 Shanmuga Jayakumar, MD;2 Marilyn Marnie King;3 Jin Yong Wee;4 Rahamim Seliktar, PhD;4 Michael Alexander, MD;5 Mena Scavina, DO;6 Alisa Clark6
WREX: Giving Kids a Lift through Life's Motions
Raising a spoon to eat, using a toothbrush, lifting a hairbrush, raising a hand in class: activities that most of us take for granted can present a difficult challenge for children and adults with arm muscle weakness.
The Wilmington Robotic Exoskeleton (WREX), designed and developed by the Pediatric Engineering Research Laboratory (PERL) in the Center for Orthopedics Research and Development (CORD), Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, allows patients with upper-limb weakness to perform activities of daily living (ADLs), explains Tariq Rahman, PhD, CORD director.
The device benefits patients with neuromuscular conditions including spinal muscular atrophy (SMA), arthrogryposis, stroke, cerebral palsy, and muscular dystrophy. “To date we have seen the most benefit for children with spinal muscular atrophy, as the condition remains fairly non-progressive,” Rahman says. One SMA patient has used the WREX on a daily basis for about six years and now attends Lehigh University, Bethlehem, Pennsylvania. “It is an indispensable part of his life,” Rahman says.
With two links and four degrees of freedom, the WREX approximates human anatomy and uses the energy of optimally placed elastic bands to negate the effects of gravity on arm movements. The device can be attached to the back of a wheelchair or to a back brace for ambulatory users.
The WREX allows full three-dimensional movement, unlike the balanced forearm orthosis (BFO), also called the ball bearing feeder, which had been the standard functional orthosis. Also unlike the BFO, the WREX lies alongside the arm and so does not interfere with doorways and wheelchair armrests, Rahman notes.
Motorized Hybrid Coming
A motorized design, WREX II, is being developed to provide a power assist when more strength is needed. “However, it is being designed as a hybrid of rubber bands and motors to keep it smaller and less expensive,” Rahman explains. Users will control it by applying a small force in the direction they want to move their hands. This force will be sensed by a force sensor, which in turn will signal the motors to move in a certain direction. An analogy would be power steering in a car where human effort is amplified.” He adds, “This technology is similar to that being developed for exoskeletons for soldiers in the battlefield.”
Established in 1936 by philanthropist Alfred I. duPont, Nemours currently supports a number of children’s healthcare facilities in Delaware, Pennsylvania, New Jersey, and Florida (For more information, visit www.nemours.org).