Step by Step
It may sound like something from a science fiction movie, but exoskeletons continue to advance and help people with SCI walk.
LaQuantis Morton recalls being a child watching The Bionic Woman and The Six Million Dollar Man.
Morton remembers how much she enjoyed those iconic 1970s television shows that featured catastrophically-injured heroes becoming superhuman with technologically advanced bionic prosthetics. Now Morton feels like she’s joined Jaime Sommers and Steve Austin in a world of high-tech wonders.
“Yes!” Morton exclaims, and makes the familiar mechanical sound effect that told television viewers Sommers and Austin were using their bionic limbs.
Nobody ever gets that bionic sound effect quite right, but Morton’s was a recognizable attempt followed by an infectious laugh.
However, for all of Morton’s excitement, the question is whether exoskeletons such as the ones she used in a research study — and are increasingly used for rehabilitation — are anywhere near ready for helping para- and quadriplegics step out their front doors for work and play.
“I believe in my time, yes they will,” Morton says. “I probably would still need [crutches or a walker] to hold onto.”
Morton is a director at the Paralyzed Veterans of America Florida Chapter. She’s also the chairwoman of the chapter’s research and education committee.
The Army veteran sustained a T-3 complete spinal-cord injury (SCI) in 2009. In 2011, she used an exoskeleton, a rehabilitative suit that mechanically assists walking, for the first time.
Exoskeletons, such as this one from Ekso Bionics, are helping people with spinal-cord injuries walk again and reduce pain.
That first go was with The Good Shepherd Rehabilitation Network in Pennsylvania. The first-generation exoskeleton was called eLegs and were made by Ekso Bionics in Berkeley, Calif.
“They were getting the legs and trying it out,” Morton explains. “I only did it three days.”
But Morton was hooked and soon participated in a six-week 2012 study at the University of Miami’s Miller School of Medicine’s Miami Project to Cure Paralysis in Florida.
“It’s about me walking,” Morton says. “I miss standing. I miss walking. It’s life to me. I love walking.”
To participate in the pilot study, Morton had to get up early and ride a series of trains and buses from Boynton Beach, Fla., to the research facility. Not an easy task even in places where public transportation is well-organized. Doing it in a spread out place such as South Florida is next to impossible. Her reward for all that effort?
“I call it air time,” Morton offers. “I got air time. And I’m moving the legs and weight bearing. To me that was beneficial.”
The Miami Project also used Ekso’s products for its study. Morton says she saw improvements with the exoskeleton even in the short time between uses. Not all of the improvements were computerized or high-tech.
“The technology, they added slippers,” Morton says. “It was something under the feet to help you make the turns better. They were orange things made of rubber put on the bottom. When you turned, it made it easier to turn.”
But that wasn’t all.
“The transition from sitting to standing was a lot better,” Morton adds.
Jochen Kressler, PhD, headed up that exoskeleton pilot study. It included three participants with different injury levels. Two men, one young and the other older, joined 39-year-old Morton.
They each used mechanical exoskeletons three times a week over six weeks as researchers recorded a wide range of data, including information about brainwaves when participants “walked” with the device.
“We did a fairly wide approach with the first study to get an idea of what can be done, what can be achieved with the device,” Kressler says.
Among the benefits of the exoskeletons?
“I think the most beneficial outcome was the pain reduction we saw and the amount of ability [increase] we saw,” Kressler says. “We had a person walk more than a kilometer in less than an hour.”
Additionally, Kressler says the assisted walking appeared to help reduce symptoms of autonomic dysreflexia.
Kressler adds there are a few downsides to the exoskeletons, including users sometimes had muscle spasms that fought against the mechanical legs’ softly whirring motors.
“Definite concerns right now for safety, particularly falling backward,” he says. “There’s really no solution for it I can see yet.”
Wheelchair is Still Faster
Users can’t just slip into the mechanical suits and walk away. They must use walkers or crutches as well.
Kressler says at first assistants must trigger the suit’s movements to walk for the users. Then users move onto hand controls to trigger steps themselves. After getting some practice, users can position their feet to initiate steps.
Kressler says the range of motion is limited. For example, there’s no such thing as stepping sideways in the 50-pound exoskeletons.
Does Kressler think exoskeletons will make the leap from rehabilitation and studies to daily wear?
“As of now, the wheelchair is the faster and safer method to ambulate,” he says. “This will not replace the wheelchair for now.”
It’s a scientific answer aimed at keeping hopes reasonable. However, Kressler admits robotics are becoming rapidly sophisticated. Robotic, self-driving cars are a good example.
Despite the advances in technology, it’s hard for anyone to say just how long it might be before exoskeletons are a part of daily life and helping people with SCI to walk again.
“It’s really hard to tell how long it will take,” Kressler says. “Engineers can do crazy things these days.”
Engineers are indeed doing some fantastic things and competition is getting stiff.
Russ Angold, cofounder and chief technology officer of Ekso Bionics, is one of the people who helped Morton get her air time.
Angold says there’s increasingly fierce and sophisticated innovation and competition among engineers in a growing medical robotics industry to be the person who makes the exoskeleton someone slips into and heads out for work and play.
He says a growing number of engineers are combining advancements in medical, brain and robotic sciences to craft the exoskeleton that’ll be aware of and responsive to its environment, and in communication with the user’s brain.
After that, customized exoskeletons will only have to be as big as an individual requires for improving their function.
“They’re living in an exciting time,” Angold says. “Technology has gotten to a point that someone who was told they’d never walk again — we don’t believe that in our office. We believe they will.”
Angold says the epitome of exoskeletons for engineers is for them to be a part of treatment regimens that help restore natural functions. When unused exoskeletons are sitting in corners, engineers will know they’ve done their jobs, he adds.
It’s difficult to know for sure if any of those goals will happen in Morton’s lifetime, but Angold suggests that technological advancements can move fast.
Angold points to the first generation of mobile telephones. Motorola demonstrated one in 1973. It was a cumbersome object that sat on engineers’ desks for a few years as they imagined what it could become. Even they couldn’t have imagined the Internet in a pocket less than 40 years later.
“It’s only a matter of years before we evolve the [exoskeleton] technology to the level of smartphones,” Angold says.
For more information on the Miami Project to Cure Paralysis, visit miamiproject.miami.edu. For more information on Ekso Bionics, visit eksobionics.com.
Step by Step
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