High-tech humans: Robotic exoskeleton helps patients learn to walk again
David Evans moved slowly and deliberately down a hallway at the OhioHealth Rehabilitation Hospital, getting help not just from physical therapists but also from a new robotic device designed to give him the support and assistance needed to take step after step after step.
The February session marked just the second time Evans had walked since the November morning he awoke unable to move his legs.
But the possibility that he might never again walk on his own hadn’t even crossed his mind.
“They asked me what my goal was when I left here, and I said ‘to regain the use of my legs.’ So it’s gonna happen,” Evans said as he sat in a wheelchair after the exoskeleton was removed. “This machine has helped me.”
Evans had taken more than 300 steps with the help of the Ekso Bionics EksoGT, an intuitive, robotic exoskeleton that senses where users need assistance to move their legs. Therapists say the device will allow patients to improve more quickly after spinal cord injuries or stroke.
“It was great for me. It gave me a different sensation from what I’ve been through thus far, and it’s given me the added confidence that I can get the strength back in my legs,” said Evans, a 60-year-old Downtown resident whose paralysis was caused by a benign mass on his spine.
The device features leg braces and a thick back harness held on by a wide Velcro strap. Four motors — two in the hips and two in the knees — power the robot, and dozens of sensors determine each patient’s unique capabilities.
Therapists at the Rehabilitation Hospital in Victorian Village have been using the exoskeleton since July, after four staff members received seven days of training. OhioHealth is the only local hospital currently using the technology.
“It adapts to what the patient’s doing performance-wise, and it only provides the assistance where the patient needs it,” said Erin Rogers, a physical therapist who leads the EksoGT team at OhioHealth. “It’s amazing. It excites me every time.”
It typically requires four health-care workers to support and move a patient regaining the ability to walk, Rogers said, and therapists’ physical fatigue would limit the amount of steps a patient could take. With the robot, just one or two therapists are needed to help a patient, allowing the patient to cover far more ground per session.
The exoskeleton also more effectively coaches patients to walk with a normal pattern, preventing them from compensating for weaknesses and falling into bad habits, Evans said.
A hand-held controller gives therapists feedback on how much work patients are doing on their own, with data collected by Ekso Bionics to help guide treatment plans.
Over the past three years, there’s been an explosion in the interest of exoskeletons, said Tom Looby, president and chief executive of the Richmond, California-based Ekso Bionics.
He said the company is focused on getting the robots into rehabilitation clinics. So far, there are about 225 deployed across the United States and Europe. Once that is accomplished, the company hopes to deploy robots of varying support levels into homes and the community.
That would involve making devices that are safer to use on varied walking surfaces, without a therapist’s help, and making them more affordable. The current list price of the EksoGT is about $160,000.
Affording more people the ability to walk reduces the number of patients who must return to clinics and avoids complications of prolonged wheelchair use, such as bowel and bladder problems, pressure sores, a loss of bone density and depression, Looby said. The robot also allows patients to get out of bed sooner and more safely and increases their endurance, distance covered and motor function.
“Walking is very important,” he said. “We take it for granted, but it really is the core for how patients with spinal cord injuries and stroke improve.”
Evans said he had been having pain in his back when he awoke on Nov. 27 unable to use his legs. He spent a few blurred days in the intensive care unit at OhioHealth Grant Medical Center, eventually having surgery to remove the mass on his spine and have two rods inserted. He was moved to the Rehabilitation Hospital in late January.
Along with the exoskeleton work, he practiced tai chi, played volleyball and basketball, stretched, lifted weights and used parallel bars and a tilt table while in rehab. The Ekso therapy was covered by insurance as part of the rehabilitation he received during the hospital stay.
He said his second Ekso session was more productive than the first, giving him the sensation of walking on his own and getting him closer to his exit goal. He was able to move forward and turn with the guidance of therapists and the help of a walker.
As he began, Rogers told him she would trigger his first step, leaving consecutive steps up to him. She encouraged him to keep his shoulders back and lead with his hips.
“Yes. Good. This is looking beautiful,” she told him, noting when the readings on the machine’s hand-held controller indicated that he was picking up more of the workload.
After about 20 minutes of walking, Evans sat, remarking that “I actually felt movement on my own.”
The EksoGT accommodates patients ranging in height from 5 feet to 6-foot-3 and weighing up to 220 pounds.
Some patients struggle with anxiety over being strapped into the device or needing a robot to be able to walk, Rogers said. And its use is limited to patients who can communicate with therapists.
But more often than not, patients remark on how the exoskeleton allows them to do so much more than traditional therapy and gives them a sense of normalcy, Rogers said. At times, it can re-engage patients who have been shut down and reluctant to participate in traditional walk therapy.
“It can be motivational,” she said. “When we put them in Ekso, they all of a sudden have a little more hope.”
— JoAnne Viviano writes about health and medicine for The Columbus (Ohio) Dispatch. Email her at firstname.lastname@example.org or follow her on Twitter at @JoAnneViviano.