"Exoskeleton Robots: Iron Man, Black Panther, or Venom?" — BlueRun Ventures

As society has developed a deeper understanding of China's aging population, capital and talent are migrating toward the rehabilitation treatment side of clinical medicine. China's rehabilitation industry has reached a watershed moment. For the exoskeleton robotics industry, early participants have moved from zero to one, building industry knowledge from a blank slate and integrating the supply chain.

ChengTian Technology is China's leading exoskeleton enterprise, having achieved disruptive cost-structure innovation in clinical-grade products through its self-contained, closed-loop technical system. BlueRun Ventures was the sole investor in ChengTian's Series A round, and this February, ChengTian secured another 100 million yuan in Series A+ funding. This article chronicles the rapid development of the exoskeleton robotics market over the past decade, and the coming "golden new decade" of "rehabilitation as a service."

"Ten years ago we thought the endgame for exoskeletons would be like Iron Man, but now we want to make exoskeleton robots like Black Panther. And as brain-computer interface technology merges with exoskeleton technology, future exoskeleton robots could become symbiotic with their hosts like Venom."

Using three characters from the Marvel Universe, Dr. Wang Tian, founder of ChengTian Technology, sketched out the developmental vision for exoskeleton robots at different stages. In Wang's view, today's mechanical exoskeleton robots represent just one phase in the evolution. Future exoskeleton robots will be worn like clothing, "using artificial muscle-type materials rather than the compromised approach of motor-driven cables to solve the problem of limited human mobility."

The high degree of interaction between exoskeletons and the human body requires not just advances in materials, but also integration from physical sensors to electromyography and electroencephalography signals.

Currently, ChengTian Technology's UGO series exoskeleton robots for central nervous system disorders (hemiplegia, paraplegia, cerebral palsy, etc.) have obtained NMPA medical device registration certificates. The UGO series uses "intent detection" technology to enable active, passive, and combined active-passive training modes, helping paraplegic and hemiplegic patients with motor rehabilitation caused by central nervous system damage, while also serving as assistive devices enabling non-ambulatory individuals to walk again.

But in Dr. Wang Tian's view, these remain far from the ultimate vision of exoskeletons. The domestic exoskeleton robotics industry has experienced explosive growth over the past decade, completing its first ten-year cycle. After this period of industrial foundation-building, the commercial soil for exoskeleton rehabilitation robots has gradually taken shape in China.

Over the past decade, China's exoskeleton robotics market faced challenges including late technological starts, immature markets, and incomplete industrial support. Now, the industry is approaching an inflection point. With population aging and deepening medical reform, the rapidly developing rehabilitation industry increasingly relies on technological innovation in its supply side, with rehabilitation robots becoming the backbone of rehabilitation services. In the new decade for exoskeletons, how will the industry evolve? VBData interviewed Dr. Wang Tian, founder of ChengTian Technology.

From Zero to One: How China's Exoskeletons Overtook the Curve

Dr. Wang Tian describes China's exoskeleton robotics development over the past decade as explosive growth, completing in ten years the stages of building industry knowledge, commercializing products, and educating the market.

Unlike the development trajectory of the U.S. rehabilitation industry, which began after World War II and reached a watershed in the 1980s with the implementation of DRG-based payment, during which five major rehabilitation groups emerged, with exoskeleton robots achieving commercialization around 2014. China's exoskeleton industry developed almost contemporaneously with its rehabilitation industry. So the greatest changes in the exoskeleton industry over the past decade have been in the external environment.

The most significant change over the past decade has been the macro-environment's evolving understanding of rehabilitation. Society has developed a deeper awareness of China's aging situation. Initially, domestic health insurance tilted toward clinical medicine. Now, with the introduction of medical reform policies such as the two-invoice system for pharmaceuticals, volume-based procurement, and DRG-based payment, capital and talent are being driven toward the rehabilitation treatment side of clinical medicine. China's rehabilitation industry has entered a watershed phase. For the exoskeleton robotics industry, early participants have moved from zero to one, building industry knowledge from a blank slate and integrating the supply chain.

Ten years ago, exoskeleton robots were novel even to someone like Dr. Wang Tian with extensive robot design experience. After in-depth research, he discovered that making an exoskeleton robot wasn't difficult, but making a good one was.

To make a good exoskeleton robot requires first conducting deep needs research, including the needs of doctors and patients in rehabilitation treatment. Understanding the user comes first; only then can you make a good product. Dr. Wang Tian grew up in a medical school compound with abundant medical resources, so at a very early stage, ChengTian Technology engaged deeply with clinical users, embracing real users.

Making a good exoskeleton robot also requires mastering underlying technology and integrating the supply chain. Since key robot components were once dominated by overseas suppliers, domestic exoskeleton robots designed around foreign supply chains faced not only high costs but limited room for innovation.

Dr. Wang Tian explained: "Suppose you want to make an elegant robot, but foreign manufacturers only supply you with outdated, bulky components. You're forced to design an entire system around those parts, and the final product becomes bloated. The logic of product design should be buying shoes that fit your feet, not growing your feet to fit the shoes they provide. That obviously won't work — you have to integrate the supply chain yourself."

So in its early years, ChengTian Technology focused on grinding away at product and supply chain challenges. Today, ChengTian Technology not only has multiple approved products but also possesses mass production capabilities for exoskeleton robots, with significant results from independently tackling and completing the supporting supply chain.

Dr. Wang Tian offered an example: "Take hip joint components. When walking, people swing their arms, which requires the hip joint to be flat enough not to interfere with arm movement. But typical industrial robot hip joints use cylindrical, barrel-shaped motors that would disrupt normal walking motion." Wang continued, "With our motor-plus-reducer modular system, ChengTian's motor energy density can reach twice the industry standard; the reducer can be integrated into a very compact volume and sustain three times continuous overload. Co-designed and integrated with torque sensors and drivers, this allows full optimization of the entire powertrain's performance. Additionally, the module cost can be brought to less than one-tenth of international competitors."

In its initial years, ChengTian Technology concentrated on building internal capabilities around these two major challenges, laying solid foundations and breaking through the supply chain bottlenecks of exoskeleton robots.

This didn't slow ChengTian's development. Dr. Wang Tian said: "Just as in the martial arts world, true masters never start with forms but with internal cultivation. Once internal cultivation is solid, forms can be quickly mastered. We spent a long time integrating core components, building factories, and solving production processes and personnel training systems. Once we had done this preparatory work and built our internal capabilities, our products entered over 200 hospitals within six months of launch."

China's Exoskeleton Robotics Commercialization Sets Sail

In terms of business models, overseas exoskeleton robots encountered obstacles and took detours in commercialization over the past decade, while domestic exoskeleton robotics companies are just now reaching the commercialization stage.

Looking at ReWalk's development trajectory, its stock price declined consistently after going public, but this doesn't mean the exoskeleton robotics market failed commercially. Essentially, ReWalk's stock performance was influenced by multiple factors.

First, in R&D, ReWalk lacked vitality. Founded in 1998, ReWalk saw little product upgrade or iteration over the past decade, with relatively few R&D personnel.

In terms of product portfolio, ReWalk's products targeted primarily the consumer market, making its commercial potential heavily dependent on insurance reimbursement. Thus, every ReWalk stock price rise accompanied news of its products entering insurance formularies. But gaining inclusion in health insurance typically requires accumulating long-term health economics data to persuade insurers.

Meanwhile, another major difficulty in exoskeleton robotics commercialization in developed countries is that their rehabilitation markets, with ample supply of professional talent, lack sufficient motivation for supply-side transformation.

Unlike overseas markets, China's exoskeleton robotics market holds greater commercialization prospects. Due to China's significant shortage of rehabilitation professionals, rehabilitation service supply depends more heavily on technological products. China has only one rehabilitation therapist per 100,000 people, while most developed countries have 60 therapists per 100,000. This massive talent gap cannot be filled in the short term.

Regarding health insurance reimbursement, domestic payment differs from overseas situations. Domestic health insurance payment is tilting toward rehabilitation, with exoskeleton robots viewed as important products for rehabilitation services. In Beijing, mobile robot-assisted lower limb gait training has been classified as Category A health insurance, priced at 222 yuan per session. In April 2022, the National Health Commission and other departments jointly issued "Opinions on Accelerating the Development of Rehabilitation Medical Work," adding 25 new rehabilitation items including intelligent bodywork training systems and intelligent upper limb feedback training.

Beyond hospital settings, domestic exoskeleton robots are also expanding into home-use scenarios. ChengTian Technology developed the UfU robot for patients with mobility impairments; in home settings, walking-assist robots face fewer restrictions from health insurance reimbursement.

In the domestic market with gradually released rehabilitation demand, as domestic exoskeleton robots increasingly obtain registration certificates, diversified commercialization prospects are gradually opening.

From One to N: The Golden New Decade Arrives

After a decade of development, China's exoskeleton industry has gradually shifted from follower to industry leader. In the new decade for exoskeletons, industry development trends have become clearer.

First, the production and R&D of consumer-facing (C-end) rehabilitation medical devices will be a key trend.

Dr. Wang Tian stated: "Clinical medicine focuses on solving patients' problems at minimum cost; rehabilitation is about restoring function, returning to society, and addressing complications and secondary recurrence — it's an accompanying solution. So its largest application scenario must be in the C-end, patient lifecycle-accompanying healthcare, which gives it consumer attributes."

Second, smart rehabilitation is becoming a trend. Smart rehabilitation forms networks through intelligent means, with digital systems maintaining consistency in technology, data, treatment pathways, and management standards, achieving digitization and standardization of rehabilitation treatment.

In the new decade for exoskeleton robots, ChengTian has introduced its "Rehabilitation as a Service" RaaS model, covering three levels of rehabilitation terminals.

Dr. Wang Tian explained: "Since rehabilitation medicine still lacks an integrated evaluation system and quantitative assessment standards, achieving standardization is difficult. We hope to use robots to provide more standardized rehabilitation services, becoming a tool for doctors' standardized prescriptions. Through digital systems, we can provide standardized services for patients. Only with digital systems can we better connect in-hospital and out-of-hospital rehabilitation scenarios, allowing users to receive personalized rehabilitation services at hospitals, community facilities, and home."

Regarding construction of the digital rehabilitation system, ChengTian Technology has already achieved initial scale. In ChengTian Technology's rehabilitation center digital cockpit, the data center aggregates and stores operational data from exoskeleton robot devices, providing foundation for data analysis and mining, optimizing systems, with professional medical personnel annotating data to build rehabilitation knowledge graphs.

In 2022, ChengTian Technology will also complete its C-end product matrix. Patients can use related products through renting exoskeleton robots or purchasing rehabilitation services. Penetrating home-use scenarios requires building comprehensive service systems and reducing costs, and ChengTian Technology's integrated supply chain enables it to provide more cost-effective products for the C-end.

For exoskeleton robots, five or ten years are merely small milestones in development. Exoskeleton robots should be a century-long technology; as solutions continue maturing, steady growth will inevitably come, ultimately becoming a "new organ" that no one can do without.

Further Reading: BlueRun Ventures Portfolio Wins Nearly 60 Awards from 36Kr, ChinaVenture, Rongzhong, TMTpost, VBData and Others | H1 Highlights

BlueRun Ventures Continues to Double Down: Exoskeleton Leader ChengTian Technology Secures Another 100 Million Yuan in Series A+ Funding | BlueRun Ventures

BlueRun Ventures was established in Silicon Valley in 1998. BlueRun Ventures China was established in 2005 and is a venture capital firm focused on early-stage startups.

Currently, BlueRun Ventures manages multiple USD and RMB dual-currency funds in China, with assets under management exceeding 15 billion yuan, making it one of the largest early-stage funds domestically. Its investment stage focuses on Pre-A and Series A rounds, covering hard technology and innovative interaction, enterprise technology, new consumption, and healthcare. It has cumulatively invested in over 150 startups, including Li Auto, Waterdrop, QingCloud, Guazi.com, Qudian, Songguo Mobility, Ganji.com, Energy Monster, Yuntu Semiconductor, Machenike, CloudSaints Intelligence, Anxin Wangdun, BioMap, and others.

BlueRun Ventures has been ranked first in Zero2IPO's "China's Top 30 Early-Stage Investment Institutions," first in ChinaVenture's "China's Best Early-Stage Venture Capital Institutions TOP30," and among Preqin's Top 10 global venture capital fund managers with consistently high returns.

Additionally, BlueRun Ventures has consecutively received honors from Forbes China, 36Kr, Cyzone, Caixin Media, CBNweekly, Jiemian, and other media institutions, including "China's Best Early-Stage Institution of the Year," "China's Top Venture Capital Institution," "Early-Stage Institution Most Welcomed by Entrepreneurs of the Year," and "Most Influential Early-Stage Institution of the Year."