Exoskeleton Helps Our Patients with Brain Injuries Walk Again
Exoskeletons are highly efficient and effective therapy devices used in rehabilitation to help individuals regain motor function after experiencing declines in mobility and function following injuries such as a stroke, spinal cord injury, traumatic brain injury, or other trauma.
At Totally Kids Rehabilitation Hospital, our children and young adults utilize the EKSO Bionics exoskeleton (or the EKSO) as part of their therapy program for gait training, which helps improve their motor function and sequencing. These improvements are very important outcomes for patients trying to regain the ability to walk.
The typical patient assigned to the EKSO has experienced a catastrophic event, such as an injury sustained in a car accident, or a condition resulting from a brain injury such as an aneurysm. These patients have lost the ability to walk completely or to a great extent. Although losing the ability to walk is traumatic for any person, it is especially distressing to a kid. That is why we are so grateful and happy to see the EKSO helping many of our kids regain the abilities they had lost.
Have you ever thought about the many precise movements your body has to make, in a timely manner, to take a simple step? They involve a specific interaction in each leg between the ankle, knee, muscles, and tendons all moving at the right time to move that leg forward in a way that maximized motion. All are absolutely necessary movements that most of us take for granted.
Basic Anatomy of a Simple Step
To take a step, your brain signals your legs and hips to work together and initiate a series of synchronized movements that take place subconsciously, automatically, and on cue. For example, each time you begin to take a step, your right hip swings slightly forward while your foot pushes off. Your upper leg then lifts up your knee high enough to allow your lower leg to swing your foot forward.
As the foot swings forward, the entire leg must follow a path, so it can have what is called proper gait. Without proper gait, you would not be able to balance your body, and without balance you would simply not be able to walk. As your leg is lowered to complete the step, the front part of your foot raises enough to allow your heel to hit the floor in a gentle manner. For walking to take place, this process is repeated several times. Each time you go on a walk you repeat this process many times over, with precision and timeliness.
A person recovering from a stroke may find it very difficult or impossible to do any or most of the motions necessary to take a simple step. This is where the EKSO comes into picture with flying colors!
How does the EKSO work?
The EKSO acts as an external skeleton that provides patients with a sturdy frame that can support their weight up to 220 lbs. It is worn with straps that wrap around the shoulders and waist with skeleton support at the hips, knees, and ankles in a way that allows it to guide and assist the body as necessary in a desired gait pattern. The device is 55 lbs. in weight and is self-supporting, therefore patients do not feel the weight on themselves.
The EKSO has 2 motors at the hips and 2 motors at the knees. The ankles are not powered but are adjustable to assist with balancing the device and support of the foot. The EKSO is adjusted to the measurements of each individual and can be customized with spacers and pads.
Patients undergo an evaluation by Kristen Gordon, our Director of Physical Therapy, in which she assesses the range of motion, strength, and tone to determine whether they meet the recommended requirements for use of the device. This evaluation helps Kristen determine how to fit and program the EKSO to accommodate the needs of each patient.
Initially each patient begins in 100% Assistance mode, in which the EKSO does most of the work. This gives them ample time to learn the gait sequence. Their primary role at that stage is to shift their weight side to side and shift forward to hit audible targets and find a balance point. This is really important. Once they find their balance point, they could unload their feet and take a step like we do.
As patients improve, the next step is to use the Adaptive Assist mode. This mode allows patients to perform as much movement as they can. The EKSO senses the patient’s input and assists as needed to complete the cycle. The device will assist less if it senses that the patient is doing more, and it will assist more if it senses the patient is doing less. The EKSO does this to create smooth normal steps.
This allows patients to feel the gait path or trajectory that the device is trying to keep them on. The EKSO assists the patient into a symmetrical gait pattern and allows them to use smooth, repetitive steps. The device provides Kristen feedback numbers which allow her to adjust the software to both, progress the patient and to monitor any progress achieved.
Examples of patients who have benefited from the EKSO
Kerrington
19-year-old Kerrington suffered an anoxic brain injury. As a result, he lost considerable strength in both legs. The EKSO was part of his therapy program. As he used it, the device was able to tell how much effort Kerrington was making on each leg as he took every step.
It then adjusted itself to provide more assistance on the weaker leg, and less assistance on the stronger one. Within a short time, Kerrington’s legs were strengthened and he progressed to the point of being able to walk on his own with some assistance.
The EKSO allows our patients to perform the exercises they need to complete with precision. Using the device allows them to regain abilities that otherwise would not be recovered. We are grateful to have the EKSO Bionics exoskeleton as an integral part of our therapy program.
Precious
12-year-old Precious had a stroke which left her weak and unable to perform activities normal of a child, including walking. After undergoing intense therapy as part of her acute rehabilitation. By the time Precious was discharged she had regained some of her abilities and began to walk with the use of a walker.
Today Precious is receiving outpatient therapy which includes use of the EKSO for neuro-reeducation to assist with improving her gait pattern and sequencing. The device is helping her restore the normal function of nerves and muscles, which improve movement, balance, and coordination among other outcomes.
We continue to be impressed and grateful for the outcomes the EKSO allows our patients to experience. As an integral part of our therapy program, this amazing device is always ready to help kids who have suffered brain injuries, or other types of injuries, be able to walk again!