When Mohan, a 69-year-old retired engineer from Ernakulam, woke up after spine surgery, even the smallest movements felt out of reach. He could not move either leg. Both limbs had lost their strength, and bending his knees on his own was impossible. For weeks, getting from one place to another meant depending entirely on a wheelchair and the hands of the people around him.
Then, one day during his rehabilitation programme, a machine was brought into the ward. It strapped around his lower body, read his movement, and did something no exercise or physiotherapy session had managed on its own: it made his legs move.
“It triggers the walking motion,” Mohan recalls. “It activates something I was not able to do on my own. Slowly, slowly, I was able to move my legs in that position.”
The machine that helped Mohan take his first steps was built not in Germany or the United States. It came from Kochi — built by a startup called Astrek Innovations.
And the story of how it came to exist begins not in a laboratory, but in a family home in northern Kerala, where a young man watched his grandfather — a strong, active man he deeply admired — lose the ability to walk after a surgery that should have gone well.
A surgery that left a nagging question
Robin Kanattu Thomas (30), the founder of Astrek Innovations, grew up in Kannur. His grandfather had been in an accident, undergone surgery, and was, by every clinical measure, healthy enough to walk afterwards. But without access to proper, sustained rehabilitation, he never did.
It took six years of collecting data on how healthy people sit, stand, and walk to train the algorithms behind the device.
“He was completely clinically healthy to walk, but he couldn’t because of a lack of proper rehabilitation,” Robin says.
That gap — between what was medically possible and what actually happened — lodged itself in Robin’s mind.
Robin already understood the world of assistive devices through his NGO work with people with disabilities. He had visited hospitals, spoken to rehabilitation centres, and seen how much recovery depended on the right support at the right time.
But after what happened to his grandfather, those visits began to feel more personal. He started looking at rehabilitation wards with a different question in mind: how many people were losing the chance to walk again simply because the right technology was too expensive or too far away?
To understand this better, Robin, along with Co-Founders Alex M Sunny, Jithin Vidya Ajith and Vishnu Sankar began spending time inside rehabilitation facilities across Kerala. They spoke directly with stroke patients, people recovering from spinal cord injuries, and others living with lower-limb disabilities.
What they found was consistent: the solutions existed, but not here. They remained out of reach for most patients in India.
Robotic exoskeletons for rehabilitation were already being used in countries such as Japan, Israel, Russia and the United States. In India, they were virtually absent, partly because importing them could cost upwards of Rs 1.5 crore to Rs 2 crore per unit and partly because servicing and maintenance support were difficult to sustain.
“You can’t bring engineers for service from different countries every time something goes wrong,” Robin says. “And there was no proper servicing support after sales.”
In 2018, he founded Astrek Innovations to change that.
Inside the making of a Made-in-India exoskeleton
Astrek’s device is a lower-limb exoskeleton designed specifically for rehabilitation. It straps around the user’s legs and hips, uses motors to drive movement, and uses machine learning to support a patient’s gait pattern.
Repeated robotic-assisted walking motions can trigger neuroplasticity, helping the brain form new pathways after injury or stroke.
The team spent six years collecting data on how healthy individuals sit, stand and walk. That information was fed into algorithms that allow the device to anticipate and support movement in a way that feels less mechanical and more natural.
Astrek has also tried to make the device easier and cheaper to build. Its patented modular design works much like Lego bricks, Robin says, where different parts can fit into the larger system without having to be built separately each time.
This helps reduce both manufacturing complexity and cost. While imported exoskeletons can cost around Rs 1 to 1.2 crore, Astrek’s pricing varies depending on the institution and deal specifics, typically ranging from several lakhs to tens of lakhs, depending on customisation and service agreements.
The cost could reduce further as production and sales grow, Robin emphasises.
Most of the devices are also made locally. Including the batteries, almost every component is manufactured in India.
The team has also changed the mechanical design so patients do not have to depend too much on upper-body strength. This makes it easier for elderly users and those with limited arm strength to use the device.
The science of helping patients walk again
For rehabilitation specialists, however, the goal of an exoskeleton is to do more than move a patient’s legs. The real objective is to retrain the nervous system.
“More than just re-training the lower-limbs, it is the neuroplasticity or the training for the brain that we are trying to bring through the exoskeleton,” says Dr Remya Mathew, Consultant in Physical Medicine and Rehabilitation at Rajagiri Hospital.
Unlike traditional callipers, which rely on upper-body strength to move the legs, this exoskeleton works the other way around.
According to her, robotic gait training works by repeatedly exposing the nervous system to the patterns of walking.
“The repetitions of the gait cycle we are providing are bringing those movement patterns back to the brain,” she explains.
In rehabilitation medicine, repeated assisted movements are used to help the brain relearn movement after an injury. This process is called neuroplasticity, where the brain forms new pathways to support recovery.
“With gait retraining and repetitions, new neuronal circuitry connections are building up. The brain is getting a new relearning pattern,” Dr Remya says.
The process extends beyond the brain. Similar adaptations can occur within the spinal cord through networks known as central pattern generators, which help coordinate walking movements.
“When it is done repeatedly, what we are trying is bringing neuroplasticity in the brain. The gait centres are getting a resetting and a retraining,” Dr Remya explains.
The science behind the technology is what gives clinicians hope for conditions ranging from stroke and spinal cord injuries to neurological disorders that affect mobility.
‘This is the support I needed’
Prajeesh, a 40-year-old network engineer from Thrissur, sustained a spinal cord injury in a bike accident in 2011. A compression fracture left him paraplegic.
Years later, he became one of the first people to test an early version of Astrek’s exoskeleton.
His doctor connected him with the startup team.
“We were so happy to know that somebody was doing this and that it was quite near my home,” he says.
The prototype was still in its early stages. It was heavier than ideal and required assistance to wear. Yet the experience itself was unlike anything he had encountered before.
His daily mobility routine depended on callipers, which required him to use upper-body strength to move his legs.
Prajeesh, paralysed by a spinal cord injury in 2011, had relied on callipers for years, which use upper-body strength to move the legs — the exoskeleton works the other way around.
“With callipers, you use your upper body strength to move your legs,” he says. “With the exoskeleton, it is the other way around.”
When he stood inside the machine for the first time, the emotional impact was immediate. “I felt like, yes, this is kind of support I need.”
Prajeesh’s story reflects a broader challenge within India’s rehabilitation ecosystem. Despite returning to professional life, driving independently and adapting his home to his needs, he spent years searching for solutions that were readily available elsewhere but inaccessible in India.
“I was feeling like I was really inventing the wheel where things are already there, but it is not accessible to you,” he says.
Addressing India’s quiet ageing crisis
Astrek is not focused solely on spinal cord injuries.
Kerala is already home to one of India’s oldest populations. In the coming decades, nearly 30% of its residents are expected to be elderly. This means more families may have to deal with a difficult question: what happens when age, illness or injury begins to affect a person’s ability to walk?
Robin’s device targets five broad patient groups: stroke survivors, partial spinal cord injury patients, complete spinal cord injury patients, elderly individuals experiencing mobility decline, and those requiring age-related rehabilitation support.
For stroke patients, the device helps retrain motor pathways through repeated movement.
For patients with complete spinal cord injuries, the device may help in other ways too. It allows them to bear weight on their legs, improves blood circulation, supports balance training, and helps prevent the muscles from weakening further.
As Mohan experienced, even the simple act of repeatedly initiating a walking motion can become a critical part of recovery.
Dr Remya argues that rehabilitation quality can significantly influence long-term outcomes.
Kerala is expected to see nearly 30% of its population become elderly in the coming decades, deepening the need for accessible rehabilitation tech.
“The long-term mobility results can be very different if rehabilitation is done with an ideal robotic trainer or a good exoskeletal gait trainer compared to conventional gait training systems,” she says.
At the same time, she cautions that technology alone cannot replace therapists.
“A preset robot cannot do the same job as a therapist,” she says. “Each day, the patient’s neurological condition changes slightly. A therapist continuously grades and modifies the therapy.”
Future generations of rehabilitation robots, she believes, will need to become more patient-responsive. “The robot should have the AI sense to understand that the patient’s condition is changing and adapt to it.”
Why many patients stop therapy midway
For all the promise of advanced rehabilitation technology, access remains one of India’s biggest challenges.
“Only a very small group of people are receiving an ideal level of comprehensive neurorehabilitation,” says Dr Remya. “The financial aspect is the main problem.”
The disparity becomes even sharper outside major cities.
“Advanced rehabilitation is still concentrated in metropolitan areas. The majority of patients remain in villages and semi-urban areas where access to proper rehabilitation care is very difficult,” she says.
Between 15–20% of Astrek’s manufacturing work is done by people with disabilities themselves, through fabrication partners in Kochi.
Many patients discontinue therapy midway because of cost, travel burdens or lack of facilities. When that happens, progress can quickly reverse.
“If rehabilitation is discontinued midway, there will definitely be deterioration,” she says. “Muscle wasting, contractures and other complications can develop.”
The challenge, therefore, has two parts: building better rehabilitation technologies and ensuring they reach the people who need them most.
From Kerala to Japan and the UAE
Astrek currently operates across nine rehabilitation centres — seven in Kerala and two in Japan, where the device is being used in elderly care settings in Okinawa.
The company has also partnered with the Department of Health in Abu Dhabi for a stroke rehabilitation pilot and signed agreements with paediatric rehabilitation centres in Dubai and Israel.
Back home, Astrek is awaiting certification from the Central Drugs Standard Control Organisation (CDSCO), which will allow commercial manufacturing and sales in India. The company currently operates under a test licence that permits deployment within rehabilitation centres.
There is also a social dimension to the company’s manufacturing model.
Between 15 and 20% of Astrek’s manufacturing work is currently carried out by people with disabilities through fabrication partners in Kochi. Robin hopes to increase that number significantly as production expands.
The work continues
For Prajeesh, the importance of a device like Astrek’s extends beyond its engineering.
“There is a lack of awareness, even among doctors,” he says, reflecting on the conflicting advice he has received over the years.
He believes that better rehabilitation protocols, stronger physiotherapy support systems and greater investment in assistive technology are all necessary for meaningful change.
The exoskeleton is part of that future, not the whole answer.
Mohan, meanwhile, remains focused on a simpler goal.
After months of recovery, therapy and incremental progress, he still wants the same thing he wanted when he first lost the ability to move his legs.
“That is my final aim,” he says. “To walk on my own.”
As for Robin? Well, he could not change what happened to his grandfather. But through Astrek Innovations, he is trying to chase a clear goal: no patient should lose the chance to stand, walk, or recover simply because the right rehabilitation was too expensive, too far away, or never reached them in time.
