Many users of the iBOT say that “standing” in balance mode is more important to them than the ability to climb stairs.

Many users of the iBOT say that “standing” in balance mode is more important to them than the ability to climb stairs. Photo by Matthew Lomanno Photography

The original iBOT holds the rare distinction of being both a huge failure and a revolutionary industry changer. When inventor Dean Kamen pulled back the curtain on his groundbreaking wheelchair design on national television in 1999, viewers marveled at the chair’s ability to “stand” and balance on two wheels, tackle snow, sand and other tricky terrain — and most notably, to climb and descend stairs. Kamen had set out to create a personal mobility device that would make the world more accessible for wheelchair users, and technology-wise he succeeded. The iBOT was decades ahead of its time and introduced ideas that shifted the paradigm of what a power wheelchair could do, ultimately resulting in cooler products for wheelchair users.

At the same time, even with all the buzz, from a business standpoint the iBOT bombed. Despite a reported investment north of $100 million by Johnson & Johnson, only 500 iBOTs were purchased over seven years. Compare that to the approximately 20,000 power chairs sold annually by industry leader Permobil.

Johnson & Johnson’s decision to discontinue the iBOT in 2009 was far from surprising but left behind a passionate base of users and industry watchers to ponder what could have been if the iBOT had found more robust sales.

Those ponderings came back to the fore in May 2016 when a Toyota press release announced that Kamen was working on a second generation iBOT. The buzz from the release and a subsequent story in New Mobility simmered down over the last three years, as few updates beyond a quick glimpse in some TV spots have emerged. But that’s about to change. The new iBOTs are poised to roll off manufacturing lines by this fall, bringing with them the promise of another leap forward in technology and questions about what was learned from the original run.

The Original  iBOT’s Legacy and What It Means for the New iBOT

Looking back, you might say the first iBOT was 20 years ahead of its time — a futuristic chair that unlocked a whole new world of possibilities for its many users.

Derek O’Brien and Ashley Lizzari compare notes on the new iBOT’s balance mode

Derek O’Brien and Ashley Lizzari compare notes on the new iBOT’s balance mode. Photo by Matthew Lomanno Photography

“The iBOT transformed power wheelchairs,” says Rory Cooper, founder and director of the Human Engineering Research Laboratories at the University of Pittsburgh. “Because of its capabilities, other manufacturers had to advance their products, which led to power chairs with seat raising capabilities like the Permobil F5 and Quantum ‘Eye Level’ and so on. And it had a cool factor.” The iBOT paved the way for other personal mobility devices, including seated Segways like the Omeo (OGO) as well as four-wheel-drive personal mobility devices like the WHILL. Furthermore, it is still the only power chair that can do all of that and climb stairs.

It is unlikely the iBOT would have made it to the consumer market as an FDA approved medical device without the dedication and financial resources of a huge company that believed in Kamen’s mission. Enter Johnson & Johnson, which in 1994 signed with Kamen’s DEKA Research & Development to develop, manufacture and sell the iBOT. Johnson & Johnson spent $50 million and nine years on research and development, including clinical trials, to bring the iBOT to market. A big part of this initial success was the iBOT gaining FDA approval as a medical device, albeit labeled Class III — the strictest classification. This classification meant no modifications could be made, including to seating and controllers. J&J reportedly spent another $50 million during the iBOT’s commercial run.

But the combination of a steep price tag — $28,000, eventually lowered to $25,000 — and minimal insurance coverage, thanks in part to the Class III label, stunted the chair’s sales. In the end, Johnson & Johnson could no longer justify continuing the project because of the growing financial commitment and support needed. It discontinued the iBOT in 2009 but continued servicing it through 2013.

Despite only 500 units being sold, the original fleet of iBOTs proved its durability and viability, delivering over 10 million hours of operation time. Luke Merrow, the CEO of Mobius Mobility, the company that will be manufacturing, marketing and selling the new iBOT, says there are around 100 iBOTs still out there functioning 10 years after the last one was delivered. “The original iBOT gave us validation that a multi-modal mobility device — two-wheel-drive, four-wheel-drive, dynamic-standing, stair-climbing — really makes a difference in people’s independence, and it’s clear the device hit the sweet spot of functionality, independence and access,” he says.

Learning From the Past

When Kamen declared his intention to bring back an updated version of the iBOT, Johnson & Johnson was supportive, telling him it wanted the chair to succeed for wheelchair users, and handing him the “keys to the kingdom” to make it happen. When I interviewed Kamen in 2016, he was excited and optimistic about the timeline for the iBOT to receive FDA clearance as a Class II device. Nearly three years later, it looks like he was a bit too optimistic. However, Merrow puts the delay in context. “The sophistication of this product is massive, and getting clearance was a huge undertaking,” he says. “It took us until mid-2017 to prepare the documentation for the FDA, which consisted of 2,619 pages, in the form of 82 documents, submitted in nine binders. And we received FDA clearance in March 2018.”

Getting the FDA to lower the new iBOT to a Class II device was a critical win, and Merrow and Kamen hope the new classification will make it easier for the chair to catch on. As a Class III device, nothing could be changed on the design of the original iBOT, so it could not accommodate complex seating or alternative controls like switches or sip-and-puff. As a Class II device, the new iBOT can be used as a power base, meaning it can accept different seating systems and different controllers. Mobius plans on adding these options as soon as possible, says Merrow. How long this will take has a lot to do with sales volume — more sales mean more money is available to spend on R&D for seating and specialty controls.

For consumers concerned whether Mobius will stay in business long enough to keep producing and supporting the new iBOTs, Merrow responded that the company’s business model is to do the exact opposite of what Johnson & Johnson did. Instead of an expensive, nationwide sales organization, Mobius is starting out lean and responsive so that even without reimbursement coverage, the company will be self-sustaining on very low sales volume, yet scalable to be able to handle larger volumes as sales increase. The business plan is designed to produce iBOTs for the long haul, whether sales are robust or tepid.

Unfortunately for would-be-users, the new iBOT still carries an initial MSRP of $30,000, a price Kamen had hoped would be considerably less. “We are keeping our costs extremely low,” says Merrow, “but this is the price we need to charge at this point in order for the company to be sustainable. Our goal is to bring the costs down, but how long this will take is an unknown.” He adds, “Dean wants this machine to be as affordable as possible. He remains personally involved and deeply committed to advancing the iBOT technology and making it available to those who can benefit from it.”

Cooper says that because much of the new iBOT is robotic and many of the new and advanced parts are in high demand, its manufacturing has proved to be significantly more expensive than anticipated. He believes $30,000 is a reasonable price for the iBOT, with a caveat. “This is on the high end for wheelchairs, which is going to be a challenge. Typically, $30,000 is only covered [by insurance] for complex seating needs, alternative controls and possibly a ventilator.”

Although the FDA’s changing the iBOT to a Class II device is helpful for reimbursement purposes, getting Centers for Medicare and Medicaid Services coverage is a slow process, takes a lot of work and can be frustrating, especially with Medicare’s “for indoor use only” rule on mobility devices. “Unfortunately, Medicare doesn’t have a category for a chair that makes a user’s house more accessible by enabling them to reach high cabinets and use stairs, and lasts twice as long as conventional power chairs,” says Merrow. To that end Mobius is also working to help pass federal legislation — H.R. 2408: Create a Separate Benefit Category for CRT and H.R. 2293: Protecting Access to Wheelchairs Act.

Mobius and Kamen have been meeting with the powers-that-be at CMS, as well as private insurance companies, to educate them about the chair’s potential and to secure coverage for it.

“Although we are diligently working on getting the iBOT covered under insurance, we aren’t waiting around for it,” says Merrow. “As we’ve seen from other products like the [recently discontinued] WHILL Model M, there is no guarantee your product will get a reimbursement code that will work for people who need it. Our goal is to get the iBOT to as many people as possible.” In addition to continually working to get funding for the iBOT, Mobius is looking for ways to bring the price down, while keeping the company sustainable.

The Rollout

At first, iBOTs will only be available at the Mobius facility in Manchester, New Hampshire, and restricted to five new customers per week. Mobius has a training manual and fitting “template” and wants to ensure that every iBOT user gets the same high level of training.

“This isn’t a simple ‘fit the chair, here is the joystick, let’s go’ training. It is two days of learning and practice to make sure you are completely dialed in on all aspects of your iBOT. Like any other device, say a car, it is extremely safe when used properly, but it can get you into a lot of trouble if it isn’t used properly,” says Merrow.

Sports agent Alan Brown, pictured with Shaquille O’Neal, was one of the few people to get insurance to cover the original iBOT.

Sports agent Alan Brown, pictured with Shaquille O’Neal, was one of the few people to get insurance to cover the original iBOT.

When first-time iBOT users arrive at Mobius, they’ll spend two days for fitting and training. First, they will tackle the Mobius indoor test track. In four-wheel-drive mode, they’ll take on the demo track’s sand, gravel and rocky areas, as well as curbs and 12-degree grades. Then while navigating in two-wheel “standing mode,” they’ll reach high shelves in a practice kitchen. In stair mode, they’ll practice ascending and descending stairs.

The facility is located next to perfect outdoor practice areas that can be used if the weather is nice. These include curbs, grassy areas, a path next to the river and a local café where they can grab a bite.

Current iBOT users will move through the orientation much more quickly, with a focus on seating adjustment and learning the easier, more intuitive controls.

Over time, Mobius plans to ratchet up its capacity by establishing satellite hubs for distribution and training. “At this point we are open to doing this in-house or with partners — a dealer, rehab center or VA — but it has to be a win for the end user in terms of delivery, training and price. The point of this is to make sure end users receive consistent training and service,” says Merrow. The timeline for how long it will take to ramp up iBOT satellite hubs remains to be seen.

Test Driving the New iBOT

I’ve been looking forward to the roll-out of the new iBOT since I wrote about it for New Mobility in November 2016. When I received an invite for a test drive earlier this year, I promptly booked a trip and traveled to Manchester, New Hampshire, to spend a day at Mobius Mobility’s newly acquired and remodeled headquarters — where the new iBOT will be manufactured and customers will go for fitting and training.

Upon arrival, I was greeted by Mobius Mobility CEO Luke Merrow who led me to the demo track where two new iBOTs were waiting. My first impression was that it looked similar to the original iBOT, but with slimmer, cleaner lines.

I was informed that for the time being the name for the new iBOT is … iBOT. The official product description is iBOT Personal Mobility Device.

Gary Linfoot tested the iBOT’s stair mode on all 700 steps at Colorado’s Red Rocks Amphitheatre.

Gary Linfoot tested the iBOT’s stair mode on all 700 steps at Colorado’s Red Rocks Amphitheatre.

A Fan Favorite

The new specs are eagerly anticipated by many of the original iBOT users. While the chair never achieved the widespread usage Kamen and others envisioned, it inspired deep loyalty in the people fortunate enough to obtain one.

I spoke with three people who are still using their original iBOT and have spent significant time demoing the new machine. Derek O’Brien, 36, in his 14th year as a C6-7 quad, got his iBOT in 2006 with cash from a community fundraiser. Alan Brown, 52, in his 31st year as a C5-6 incomplete quad, has two iBOTs. He got them through Blue Cross Blue Shield insurance, albeit after filing many appeals. Brown helped Kamen get the FDA to classify the new iBOT as a Class II medical device by testifying before the Orthopedic and Rehabilitation Devices Panel of the Medical Devices Advisory committee of the FDA. Gary Linfoot, 50, a former Army helicopter pilot in his 10th year as a T10 para, got his iBOT paid for by a veteran’s organization. He is a consultant for Infinite Hero Foundation, which already has funding to purchase eight new iBOTs for veterans.

The new iBOT base is more streamlined and now accepts different seating systems — at press time customers have seating options from Motion Concepts and TiLite in widths from 16 to 20 inches. The seats are sleeker than the original iBOT’s high-back one-size-fits-all seat. All three iBOT users commented on the cleaner look and improved seating options. “The new model looks like the iBOT was put on a diet. It’s smaller and cleaner looking, and it feels cool, not like you are in a power chair,” says O’Brien.

Merrow informed me that the new iBOT is 50 pounds lighter than the original, meaning the power base is now 168 pounds with batteries. Additionally, all of the electronics have been redesigned and updated. An example of this is the gyroscope systems. They used to be half the size of a shoebox and are now the size of a sugar cube.

The new iBOT retains the same four modes of operation as the original:

1. Standard: Rear drive with front casters.

2. 4-Wheel: Dynamically-stabilized four-wheel-drive, where the seat moves fore and aft, and the drive wheels articulate for ascending/descending grades, curbs and varied terrain.

3. Balance: Allows standing and moving at eye-level on two wheels.

4. Stair: Enables the chair to climb up and down stairs.

The controller has been redesigned to make it intuitive to use. “It’s easy and seamless to go from one function to the other,” says O’Brien.

Testing It Out

I transferred to the iBOT and went through a setup mode that determines the six calibrations needed to maintain proper center of gravity. You must do this before using balance mode but it only takes a few minutes. I was then given a brief tutorial on the different driving modes. I checked out on my power-chair driving skills and — under Merrow’s guidance — started my three-hour test drive.

The author reaches high cabinets in balance mode, referred to by some as “standing mode.”

The author reaches high cabinets in balance mode, referred to by some as “standing mode.”

I immediately went to balance mode. It was everything I thought it would be and more. The first thing I noticed as my head rose to 5 feet 10 inches is, “Wow, I’m up really high!” Because the iBOT dynamically balances on two wheels, the resulting sensation is different than being in a standing frame, chair, or elevated seat. It is much closer to how I remember standing, a feeling I hadn’t experienced in the 34 years since my injury.

As an athlete, in my pre-SCI days, I was aware of the amazing, subtle, instant mind/spinal-cord/muscle coordination it takes to stand and balance on size 8 feet. Thinking that all of this is being done by coordination of gyroscopes, microprocessors and motors is really cool. Like standing on feet, if you lean forward or backward in the iBOT, it stays upright by adjusting with proportional movements. If somebody pushes you it adjusts the same way a standing person would — by taking a step forward or back. Although driving the iBOT quickly became intuitive, the wow factor remained during the entire test drive.

While in balance mode I conversed with several people at Mobius and noticed how much more conversation I catch at standing height. Thoughts of once again being eye-level with people at crowded parties rather than staring at their butts quickly came to mind, as did thoughts of being able to see at a concert when everybody in front of me is standing. As the conversation continued, everybody sat down except me. Balance mode felt so good I stayed there. I was the person standing, looking down on people sitting.

Still in balance mode, I wheeled into the employee kitchen. Cabinets that would ordinarily have been hard to reach or out of reach were easily accessible, and reaching them didn’t cause any shoulder strain. I found myself daydreaming of accessing the upper shelves in my house and at grocery stores.

O’Brien, Brown and Linfoot agreed that balance mode is their favorite feature. They backed up my feelings about being at eye level and how talking face-to-face gives a feeling of more respect. “Standing mode has a cool factor, it has changed my life,” says Brown, who doesn’t have the hand function to be able to climb stairs independently in the iBOT. He also found standing mode was helpful when he was working with clients as a sports agent and as a father. “I’m the cool dad,” he says, “especially when I’m playing basketball in standing mode.”

For O’Brien, who also doesn’t have the hand function to do stairs, balance mode highlights have been “walking” down a crowded main street at Disneyworld, being best man at his brother’s wedding, standing next to him during the ceremony, rising to give the best man speech, and dancing the night away at the reception.

Beyond the Easily Accessed

After an impressive run through an indoor demo track that included going up and down a 12-degree grade and curbs, I was ready for the stairs. In order to signal the chair to climb, I set it on stair mode, then leaned back and pulled on the stair railing. If there is no railing, or if a person doesn’t have enough function, an assistant can provide the needed support. Descending stairs requires pulling forward. My first descent, as I faced forward at the top of a flight of stairs in a power chair and pulled forward, took some of getting used to, but was smooth and controlled.

For Linfoot, the ability to go up and down stairs is huge. “At home if I want to go up or down the stairs, the iBOT takes me,” he says. When he was demoing the iBOT in Denver he put it to the test by climbing and then descending all 700 stairs at the famous Red Rocks outdoor stadium. “It was easy, no problem.”

Mobius Mobility is counting on positive user reviews to help make the new iBOT a success.

Mobius Mobility is counting on positive user reviews to help make the new iBOT a success.

For the next part of the tour, I joined Merrow on a quarter-mile walk from Mobius’s office to the manufacturing building. It felt cool “walking” in balance mode and conversing with Merrow as we strolled down the hall. Once outside, I went into 4-wheel mode to traverse the bumpy pavement, snow and ice. When we came to a high curb and a 40-foot wide, snow-covered, hilly median, Merrow continued across and I instinctively turned to wheel 30-yards around it. Merrow casually said, “Where are you going?” It took me a second before realizing, “I’m in an iBOT!” Sure enough it smoothly climbed the curb, powered though the snow, and gracefully descended the curb on the other side.

All three iBOT users raved about the game-changing impact 4-wheel mode had for them. “4-wheel mode is especially useful during snowy winter months,” says O’Brien. “Also, I live in an older city, and it’s great being able to cross streets with no curb cuts and enter businesses and buildings with a big step or thresholds without having to think about it.” Brown finds the same benefits in terms of curbs, and adds wheeling over torn up concrete to the list, but his favorite part of 4-wheel mode is effortlessly cruising across sandy beaches. For Linfoot, the mode means being able to let his dogs off leash and run with them off-road in the hills around his house.

Brown and Linfoot credit long-term use of the iBOT with keeping their shoulders healthy. “With my iBOT, I’ve been able to get out of my manual chair and give my shoulders a chance to rest and heal,” says Brown. Linfoot tore a biceps tendon because of overuse and was able to use the iBOT to rest it and let it fully heal, which took almost a year. Like many iBOT owners, Brown, Linfoot and O’Brien say they are grateful that the chair has been brought back to life and are anxiously waiting to place an order for one.

Our final stop of the day was lunch at a local restaurant. The only tables available were tall ones set up for bar stools. Another chance to use balance mode got me excited. I pulled up to the table and found myself looking down at diners sitting at conventional-height tables while I enjoyed my meal. By the time my demo was over, I was hooked. I started pondering ways to come up with the purchase price. Four months later, I am still pondering.

Hungry and Hopeful

A big part of lowering the price of the iBOT involves economies of scale, where reaching a certain sales number can help bring down the overall costs thanks to the ability to buy and build in bulk.

The iBOT may have received a huge boon in this regard in February. That’s when FedEx announced a collaboration with Kamen and DEKA to produce an autonomous delivery machine called SameDay Bot that uses an iBOT power base equipped with sensing technology for its deliveries. According to an article in Techcrunch.com, FedEx will be working with AutoZone, Lowe’s, Pizza Hut, Target and Walgreens for SameDay Bot delivery to nearby customers [see resources]. Initial testing is expected to start this summer. The article states that the SameDay Bot will complement FedEx SameDay service, which operates in 1,900 cities.

FedEx iBOT delivery

If this takes off, FedEx will be ordering a substantial number of iBOT bases. Kamen is quoted in the article saying, “By leveraging this base in an additional application, we hope that the iBOT will become even more accessible to those who need it for their own mobility.” Translation:  The key to significantly lowering the price of the iBOT may come from delivery of auto parts, medications and pizza.

Additional Factoids:

• Seat-to-floor height: Standard, 18.7 inches, 4-Wheel mode, 25.4-30.4 inches, balance mode: 30.5-35.8 inches.
• Driving range on four batteries is 17.4 miles and can be extended with an optional six battery set.
• Power base: Width, 25 inches, length, 32 inches
• Max speed: Standard mode, 6.7 mph, 4-Wheel mode 5.2 mph, balance mode, 3.4 mph.

Resources
• Alan Brown testifying before the FDA committee, youtube.com/watch?v=ZGE5Q_hZtoI
• FedEx Delivery Bot Commercial, youtube.com/watch?v=N0rt_HB7vd4
• FedEx’s new autonomous delivery bot has iBOT wheelchair DNA, https://techcrunch.com/2019/02/27/fedexs-new-autonomous-delivery-bot-has-ibot%20dna/
• Infinite Hero Foundation, 949/829-6446; infinitehero.org
• Mobius Mobility, 603/206-0550; mobiusmobility.com
• Omeo Evolution 1, omeotechnology.com
• Toyota Press Release, pressroom.toyota.com/releases/toyota-deka-research-partnership-may21.htm
• “The iBOT Returns: Lighter, Leaner and Covered by Insurance?” newmobility.com/2016/11/ibot-returns