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Robotic Exoskeletons Allow Paralyzed Veterans to Exercise, Reduce Sedentary Effects

by U.S. Medicine

October 11, 2012

By Stephen Spotswood

New York  — For veterans suffering from paralysis due to a spinal-cord injury (SCI), the inability to move a significant portion of their body is the obvious, immediate concern. Over the long-term, however, the extreme sedentary lifestyle caused by paralysis can lead to many secondary medical problems that can severely impact not only the quality of but also the length of their lives.

To combat this, VA physicians are experimenting with the use of robotic exoskeletons to provide patients with limited mobility, allowing them to train and exercise and stave off longterm health effects.

Lack of mobility can lead to obesity, coronary heart disease, diabetes, insulin resistance, impairments in bowel and bladder function, weight gain and pressure ulcers. Even a modest amount of movement and exercise can help counteract those co-morbidities but can be difficult to achieve from a wheelchair.

Philanthropist and world-renowned accessibility advocate Rick Hansen looks on as Air Force Lt. Ian J. Brown, a full paraplegic, walks in the ReWalk device at James J. Peters VAMC in The Bronx, NY. Hansen’s foundation is funding spinal cord injury research there.

“Paralysis from SCI causes immediate body changes,” explained Ann Sponge, researcher at the Center of Excellence for Major Consequences of SCI at the James Peters VA Medical Center in the Bronx, during a press briefing on VA’s SCI research. “There are significant losses in lean-tissue mass and bone-mineral density, while fat-tissue mass increases significantly. We have been studying ways to ameliorate, intervene or reverse these and other complications.”

Sponge and her colleagues are experimenting with use of the ReWalk exoskeleton suit developed by Argo Medical Technology and approved for institutional use in January 2011. The device consists of a light brace support suit, with motors at the joints and an array of motion sensors to allow patients limited mobility. Arm crutches are used for stability.

The SCI center has four such suits and has trained seven paralyzed veterans in their use, eventually allowing the patients four to six hours per week of continuous walking. The program begins with a learning phase (12 sessions over four weeks), then progresses to a training phase (18 sessions in six weeks), though the length of the phases will vary, depending on each patient’s learning curve.

During the training phase, patients will learn to sit and stand and develop basic balance using the exoskeleton. Progression to walking will occur as the patients’ skills develop. Those skills also include standing balanced with crutches, balancing with one crutch, ascending and descending stairs, a 10-meter walk in less than two minutes and a 30-meter walk in under six minutes.

“During each session, the 10-meter walk time and the six-minute walk time are assessed,” Spungen explained. “We saw an average increase of 2.4 meters per session.”

The program’s three best exoskeletal-assisted walkers can walk the length of a football field in about six minutes, Spungen said. Two of the patients also improved the ability to control their legs. Those are minor improvements that correlate with gains in leg lean tissue, she noted.

Robotic Exoskeletons Allow Paralyzed Veterans to Exercise, Reduce Sedentary Effects

Patients have demonstrated other improvements, as well. All of the patients showed increases in mobility and strength, and all five of the first five participants were self-reporting improvements in bowel function by the end of 20 sessions.

The patients’ body composition also changed in a positive way. After 25 to 40 sessions, all patients showed reductions in fat tissue in the arms, legs, trunk and total body.

“Exoskeletal-assisted exercises appear to specifically improve body condition below the level of lesion,” Spungen said.

One of the patients, a Marine Corps veteran paralyzed in an automobile accident in 2003, is planning to use the ReWalk exoskeleton to participate in this October’s Marine Corps Marathon in Washington. If he does, he will be the first and only participant to enter the race as a runner, a wheelchair competitor and as a person with an exoskeleton.

The exoskeleton suit study is set to run until April 2014 and is recruiting both men and women age 18 to 65 who have been spinal-cord injured for more than six months, although the list of exclusion criteria is lengthy.

Spungen noted that the ReWalk likely will never replace the wheelchair but can be used to augment patients’ mobility and improve health. The patients in the study, both veterans and nonveterans, are looking forward to the day when they can have the devices in their homes, she said.

“Men and women are not meant to sit in a chair 24/7,” Spungen said. “The detriments from this extreme level of inactivity are multifold. The potential medical benefits from regular upright posturing and walking may be the largest advantage from these upright skeletons for people with paraplegia.”

A study conducted by the Kessler Foundation, a charity focused on improving the lives of disabled individuals, had similar results. The study looked at spinal cord-injured patients trained to use a robotic exoskeleton made by Ekso Bionics . According to Gail Forrest, PhD, Kessler’s assistant director of Human Performance and Engineering Research, data collected from 13 patients indicates improvement in gait and balance over time.

Patients also seemed to have improved metabolic and cardiovascular response following training with the exoskeleton. And some data indicates that there is increased activity in lower leg muscles during Ekso-assisted walking—data that needs to be examined in further research to determine potential health benefits.

The ReWalk Exoskeletal Walking System for Persons With Paraplegia

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