There were only winners at the world's first Cybathlon organised by ETH Zurich. The event gave people with disabilities the chance to show how they are better equipped to cope with everyday challenges thanks to state-of-the-art assistive technologies. Around 4600 spectators roared the teams on. This gave researchers new impetus in their development of even better aids.

Successful premiere: Robert Riener, who came up with the idea of the Cybathlon (l.), addresses the media. (Photo: Alessandro Della Bella/ETH Zurich)

Cutting a slice of bread or screwing in a lightbulb - the sell-out crowd were spellbound in the seats of the Swiss Arena in Kloten as people with arm amputations mastered these everyday tasks with the aid of high-tech prostheses.  Each of the pilots was greeted by rapturous applause as they crossed the finishing line of the Cybathlon parcours circuit. "The joy of the pilots and spectators was overwhelming", said Robert Riener, whose brainchild the event is and who organised the event in October 2016.

The professor of Sensory-Motor Systems at ETH Zurich could never have imagined that his idea for the Cybathlon could arouse such great enthusiasm and attract keen interest worldwide. 150 journalists from around the world were accredited to report on the competitions, which brought together 66 teams from 25 countries. Swiss Radio and Television (SRF) and 3Sat broadcast live coverage on a theme day, just like a sports event. This meant that viewers in Germany and Austria were able to watch the Cybathlon too. As Robert Riener said: "It wasn't about going higher or further or faster, it was about coping with everyday life."

The scientist firmly believes that successful developments require dialogue. "As a researcher, you have to sit down with the users, the people with disabilities, right from the word go and seek new solutions together with them." The Cybathlon was the trigger to put these discoveries into practice. Two or three years ago, groups of students at various universities started to develop new projects together with pilots, with a view towards competing in Kloten. And in the expert's assessment, "It is remarkable what has been achieved in that short time."

Climbing stairs in a wheelchair

Students from ETH Zurich and from Zurich University of the Arts built a motorised wheelchair that was able to climb stairs thanks to its innovative caterpillar technology. It came in for praise from Robert Riener, declaring it "a super design". The team looked almost nailed on to secure the gold metal at the Cybathlon. However, the device had to pull out during the race after race-day nerves caused the pilot to make an operating error, and victory went to their rivals from Rapperswil University of Technology. Roared on by the deafening crowd, their pilot Florian Hauser overtook the competitor from Hong Kong on the final stairs.

Walking upright despite being paralysed: Philipp Wipfli advances step by step to task 5 in the exoskeleton race. The motorised “VariLeg” support apparatus was developed by a team of students and doctoral students from ETH Zurich. The prototype is controlled via the handles of the crutches. (Photo: Nicola Pitaro/ETH Zurich)

A second team of students and doctoral students from ETH Zurich developed a robotic exoskeleton for the Cybathlon. Designed with a motorised support apparatus, it is intended to enable people with spinal cord injuries to walk again. In fact, the pilots, who are completely paralysed, were able to negotiate their way around the parcours circuit using their exoskeletons. However, the competition also showed how unwieldy the current devices are; they require a great deal of physical effort by the pilot. "The technology is still not good enough to enable users to do everyday chores better than with a wheelchair," said Robert Riener, who is also working on the development of an exoskeleton with his research group and drew inspiration for new ideas at the Cybathlon. In existing devices, the pilots give commands to call up a saved movement, depending on their position; this movement is then executed statically, and the motion is often cumbersome. As the scientist went on to explain, "part of the running action in exoskeletons could also be performed ballistically, as is the case with knee prostheses, which use momentum to accelerate, not a motor."

Function trousers to help with standing up

His research group is working on a soft exoskeleton which is integrated into garments. It is designed to help patients with partial paralysis who still possess some strength. The scientists explains how this works: "In our scenario there is a person sitting in a wheelchair wearing function trousers, which look a bit fuller than jeans. They enable him to stand up every so often, for instance in a supermarket to get something off one of the higher shelves, or if he has to go up one or two steps to go into the local bakery." This takes new materials that can be flexibly adapted to suit the body, but which are also rigid enough to be able to transfer forces. "We have already had ideas on how to switch materials from soft to rigid quickly," the researcher added.

A prototype in the ETH Laboratory for Sensory-Motor Systems demonstrates how the principle works.  Following a trial phase with able-bodied subjects, initial tests with patients got under way in January 2017. A spin-off company at ETH Zurich is hoping to launch a product onto the market in a few years. The project has financial backing from an investor who suffers from muscle disease himself.

The spectators in the Swiss-Arena are amazed at the commitment shown by the competitors. (Photo: Alessandro Della Bella/ETH Zurich)

For the time being, people with spinal paralysis will have to get by with the sort of robot devices showcased at the Cybathlon. Mark Daniel from the US, who won a silver medal, explained that his exoskeleton weighed 34 kg, "but it supports me and itself. Making eye contact creates trust and makes a huge difference," said the 27-year old who became paralysed following a car crash six years ago. And gold-medal winner André van Rüschen added: "When I am standing up, I am part of the wider group." While Daniel ran with a prototype which was only completed six weeks before the competition, van Rüschen moved with the aid of an exoskeleton which is already on the market and used by hospitals for rehabilitation. The 44-year old German, who has been paralysed since 2002, has also been enjoying better health as he can regularly stand and move again thanks to the exoskeleton. "The ability to do certain things again is priceless."

Cycling as therapy for people with paralysis

Paralysed muscles can also be moved again through functional electrical stimulation. One of the bike races at the Cybathlon brought together pilots with electrodes attached to their skin or implanted. They had to cover a total of 750 metres over five rounds.  "It is remarkable that the pilots were able to cover such a great distance," Robert Riener observed. He is supervising the work of two doctoral students from Bern University of Applied Sciences who are part of the team that won a bronze medal with their pilot, Julien Jouffroy. New types of electrodes and a new activation mechanism enable the pilots to step on the pedal regularly, generating force efficiently. However, it also takes a great deal of training to prevent early muscle fatigue.

59-year old Mark Muhn from Team Cleveland completed the circuit on his recumbent bike in under three minutes. (Photo: Nicola Pitaro/ETH Zurich)

"We had twelve teams on the starting line, including the best in the world," explained the organiser, who was personally involved in attracting pioneers in the field of functional electrical stimulation implants.  After some initial hesitation, Team Cleveland from the US was so enthused by Riener's idea that it organised a qualifying competition that attracted widespread media coverage in the US. It is no wonder that his rivals stood no chance when 59-year old Mark Muhn completed the circuit on his recumbent bike in under three minutes. The American researchers now offer cycling through functional electrical stimulation as therapy.  After all, sporting activity builds up muscles, preserves bone density, improves circulation and, more especially, is fun to do.

So, was the major event a success? Lino Guzzella, President of ETH Zurich, is in no doubt: "ETH professor Robert Riener's visionary idea has developed into an event which resonates globally. We are planning to continue it. ETH Zurich is all about developing solutions which will bring society on in the future."