Wednesday, March 21, 2018

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Featured Stories

New Robotic Device Allows Wheelchair-Bound Patients to Stand Up and Walk

Written by  Christy Rippel

Taylor Roberts was a 20-year-old college sophomore when her life was changed in the twisted metal of a devastating car crash. Three miles from her family’s home, the Virginia Commonwealth University student was hit by a man who ran a stop sign. He plowed into her car, which flipped before crashing head-on into a telephone pole.

Critically injured, Roberts was airlifted to VCU’s hospital, which began her two-month inpatient stay in Richmond and then Philadelphia to treat broken ribs, a lacerated liver and two spinal fractures.

The diagnosis was grim. “I was told I would never walk again,” says Roberts.

Released from the hospital in Philadelphia to begin outpatient rehabilitation, Roberts returned home to Richmond and began therapy at Sheltering Arms Physical Rehabilitation Center. It was here that Roberts’ determination and grit, along with the assistance of a groundbreaking new device called the Indego, helped her defy doctors’ expectations and take her first steps toward independence.

Indego: How it works to help patients like no device before it

The Indego device allows people with paraplegia, which is paralysis of the legs and lower body from spinal cord injury or disease, like Roberts, to stand and walk without the aid of a walker or crutches. Worn around the waist and legs, Indego helps patients take pressure off of the legs so that they can develop the muscles and skills they need to practice walking at home with leg braces.

“The Indego is basically a robot worn outside the body,” says Amber Walter, a physical therapist with Sheltering Arms Rehabilitation Center who uses the device regularly in patients’ therapy. Walter explains that the five modular pieces of the device can be combined to create different sizes to accommodate different patients. There is a hip piece, two lower leg pieces that go into the patient’s shoes, and two that sit on each thigh and attach to the hip and knee.

Indego immediately stood out from the devices that came before it because of its lightweight design. At 26 pounds, it is half the weight of similar devices — important for injured patients who may have difficulty lifting heavy, bulky items. “Patients can still roll themselves around in their wheelchairs with the device on, because it’s so light,” says Walter.

The Indego also allows patients to walk outdoors and down hallways as it can adjust to inclines and declines, unlike other devices that can only be used on a treadmill or flat surfaces.

“The thing about spinal cord injury is that the person still has intact thinking skills, and walking on a treadmill is just not that interesting over time,” Walter says. “The mental boost this device provides to patients — to be able to go outside — is incredible.”

In addition to the mental lift, the Indego is helping patients progress at a faster rate, says Walter, because it challenges the brain in a new way. “On the scientific side, we know that the brain makes changes through time, repetition and a principle called salience, which is the quality of being noticeable or different, and is harder to achieve. The Indego helps with that,” Walter notes.

The challenge of working with the Indego, which responds to the patient’s movements, helps the brain and body adapt and progress. The Indego mimics natural movement and takes cues from the posture of the patient — when he leans forward, the device helps him stand or walk forward. The patient leans backward to stop or sit. A series of vibrations signal the patient for the next movement, and a mobile control app helps the therapist or patient adjust for step length or step height. The app can also decrease the amount of assistance the device provides as the patient gets stronger.

How Indego Has Changed Lives in Richmond

Sheltering Arms was selected as a clinical trial site for the device, which was FDA approved in April 2016 for spinal cord injury rehabilitation. Sheltering Arms is also able to use the Indego, sometimes also called an exoskeleton, for clinical patients, not just those enrolled in the study.

Developed at Vanderbilt, the device has only been available for the past three years, but there are users in other areas of the country who have purchased their own device for private use to improve quality of life. Walter tells of a patient who uses it to stand and give talks at work, and another who wears it to his child’s sporting events so he can stand up to see the action. While it’s not currently meant as a wheelchair replacement, it can allow a wheelchair-bound patient to do more than before.

In Richmond, it has made all the difference to Taylor Roberts, in recovering from the car crash that nearly took her life. While doctors initially believed she had a complete spinal cord injury, meaning she would never recover any movement in her legs, they later downgraded her condition to an incomplete spinal cord injury — meaning she could recover some movement with therapy. That’s when she got to work at Sheltering Arms.

“Prior to using the Indego, I only had mobility through my legs at my hip. After I used the Indego I was able to lock my knees into extension, which opened up a whole new world of possibilities. It was a keystone in my recovery,” Roberts says.

Roberts progressed so much that she’s moved beyond the Indego, and is in physical therapy three to four times a week, working towards walking on her own. She’s just wrapped up finals at a Richmond-area community college, with her sights set on transferring back to VCU to get her degree. She has taken up rowing, and plans to pursue a passion for writing.

Walter has witnessed firsthand the benefits for patients like Roberts, and says the record for number of steps in a one-hour Indego session at Sheltering Arms is up to 1,300. “When the patient puts on the device and stands up for the first time, there’s always a huge smile,” says Walter, who is excited about how the device can continue to help new patients.

Candidates for Indego Therapy

How does Sheltering Arms determine if someone is a candidate to use Indego? Walter says the center looks for a few basics, such as stable blood pressure, good bone density and a baseline range of motion. Stable blood pressure is important because a sudden drop in pressure could cause the patient to pass out, risking further injury from a fall.

Good bone density is key, and is sometimes an issue for patients who were injured years ago. “If you haven’t been weight bearing for some time, you may have some osteoporosis, and sudden weight bearing could be a fracture risk,” explains Walter.

A decent range of motion is required, so a patient needs to be able to get his hips, knees and ankles relatively straight. Lastly, the skin where the device touches has to be free of wounds or sores.

Indego is used for two different purposes, depending on the patient. For someone with a complete spinal cord injury who is not expected to regain movement in his legs, the device can be an exercise tool, and a way to “walk” with assistance. For patients like Roberts, with an incomplete spinal cord injury, Indego can be a bridge from using a wheelchair to walking with leg braces, other devices or independently.

Indego for Stroke Therapy?

Trials will soon be underway to determine if Indego can be useful in stroke therapy, and Sheltering Arms is participating in these trials along with eight other sites across the country. This is an exciting possibility, as stroke is the leading cause of serious, long-term disability in the United States. Each year, approximately 795,000 people suffer a stroke, so the potential for benefit is huge.

The Indego is a novel device that brings hope to patients — which is what keeps Walter, who has worked as a physical therapist for a decade, engaged in her job.

“Bad things happen, but we have to see the hope in any situation … that anything is possible,” says Walter. “For someone who sits in a wheelchair for most of the day, to change position, to stand, to move — there is so much hope in that.”