Exoskeletons can restore the ability to walk, and enhance quality of life in many other ways too, says Eva Sobonova, head physio at the Royal Buckinghamshire Hospital (RBH).
“They can also reduce pain and improve bowel and bladder function and spasticity. Then there is the huge psychological impact,” she adds.
“Being able to stand up and make eye contact with people, and go outdoors again, are really beneficial psychologically. With one of our devices patients can walk
on uneven ground and up and down slopes, meaning they can venture into our gardens and go out into the wider community. This is highly motivating.”
RBH is the only UK facility with two types of exoskeleton available onsite. The Ekso GTis a wearable robot that helps individuals with lower extremity weakness to stand and walk with a natural, fully weight-bearing gait.
Walking is achieved by the user’s weight shifts or via a button, with motors driving the legs. While this is predominantly a rehabilitation tool used in the hospital, RBH patients also have access to the more compact and portable Indego exoskeletal system. This can be quickly and easily fitted, making it ideal for community settings.
Sobonova says: “The two exoskeletons complement each other. We may use the Ekso to support the patient’s trunk and upper body and improve posture and alignment. As the patient progresses, we may need to improve dynamic movement of the trunk and balance in terms of shifting position, and therefore use the Indego.”
Inpatients at RBH may use the exoskeletons from a few times a week to daily, with outpatients typically having weekly sessions.
“Inpatients use the devices as part of their intensive rehabilitation that also involves a range of other technologies – and disciplines such as occupational therapy, psychology and speech and language therapy.
“The frequency depends on their functional goals. Some might be looking to improve strength, while others might simply use the exoskeletons for the psychological benefits of standing up.”
The intensity of therapy afforded by the exoskeletons is crucial to the successful outcomes they deliver.
“Restoring neural functions depends on repetition. In a centre without exoskeletons it may be possible to give patients bodyweight support over a treadmill but two or three people may be needed to move the legsto recreate the movement of walking. Exoskeletons allow for much more repetition over a prolonged period.”
A recent beneficiary of exoskeleton sessions at RBH is 39-year-old spinal cord injury patient ‘John’ (name changed for anonymity). Sobonova says: “He wasn’t getting any movement in the muscles in his limbs, he had very poor static and dynamic sitting balance and he could barely feel his trunk or his legs.”
An intensive multidisciplinary approach at RBH followed, which included three exoskeleton sessions per week. The assisting power from the device was gradually reduced from 100 to 40 per cent, increasing the muscular input needed to walk.
“He was discharged after six months with his muscle power restored to normal levels.”
In another case, a young spinally injured man used the Indego device to reduce the neuropathic pain and spasms keeping him awake at night. Trials showed that the technology’s ability to completely eradicate his pain, and minimise the spasms, lasted for 12 hours after each session.
“We stress that exoskeletons won’t always get muscles working again but do bring many added benefits. They maintain or improve fitness levels, which impacts on the patient’s mood and has other benefits, including improved bladder and bowel functions. Ultimately, they keep the patient fit in the long-term and give them the best possible chance of recovery.”
The Royal Buckinghamshire Hospital has been specialising in rehabilitation for the past 20 years and remains a destination of choice for patients in the UK and abroad. Its extensive range of services means patients with a wide range of neurological conditions can benefit from our expertise and care. For referrals contact firstname.lastname@example.org. See www.royalbucks.co.uk for more information.