Sophisticated devices add to traditional rehabilitation techniques.
Every year, thousands of people survive strokes (or “brain attacks”), only to become locked in an arduous struggle to regain lost function. With the help of modern rehabilitation techniques, many are able to resume a normal or near-normal lifestyle.
Others are left with substantial deficits that impair their ability to live independently.
For people with difficulty walking after a stroke, exoskeletons hold exciting promise. These robotic, computer-controlled devices provide physical support while helping move patients’ legs back and forth.
“We suspect the repetitions accelerate neurorecovery, but this has not been proven. However, robot-assisted walking has many other benefits that are important to the recovery process,” says Dr. Randie Black-Schaffer, medical director of the stroke program at Spaulding Rehabilitation Hospital and assistant professor of medicine and rehabilitation at Harvard Medical School.
Above: Lokomat is one passive-walking device used to help retrain the brain and muscles to improve walking skills following a stroke.
Photo courtesy of Hocoma.
Right: Designed for home use, Ekso Bionics’ exoskeleton supports leg strength and balance to aid in walking.
Photo courtesy of Ekso Bionics.
Assisting locomotion … and more
Hocoma’s Lokomat is a passive-walking device used at Spaulding. Patients wear a powered exoskeleton strapped to their legs and are placed in a harness that supports their weight while they walk on a treadmill. The movements of the exoskeleton are computer-controlled to simulate a natural stride.
Although a study published in the April 2012 issue of Stroke found that only the most severely impaired patients benefited from passive walking, Spaulding’s experience is different.
“We found that using the Lokomat early in rehabilitation assists with trunk control, upright balance, and step initiation. Giving patients the sensory feedback of a normal gait can help them reproduce it,” says Dr. Black-Schaffer.
In addition, patients often find success motivational.
“Advancing the affected leg often jump-starts recovery. Once patients can reliably and safely advance their weaker leg, they are more willing to practice walking,” she says.
Getting stroke survivors up on their feet also improves circulation, reconditions autonomic reflexes that govern heart rate and blood pressure, and prevents osteoporosis from developing in the affected leg—a key component to preventing hip fractures from falls.
Exercise may help relieve post-stroke fatigue
For reasons that remain unclear, fatigue is common among stroke survivors and may persist for months or years. Multiple causes may be to blame, including brain damage, depression, and poor health or fitness prior to the stroke. As a result, there is no standard approach to treating post-stroke fatigue.
Researchers in the Netherlands recently tested two approaches in 83 stroke survivors who had suffered from fatigue for an average of four years. The patients were randomly assigned to cognitive therapy (an approach to changing mental attitude) or cognitive therapy plus an exercise program that included treadmill walking, strength training, and home exercises.
After 12 weeks, 58% of the participants whose therapy included exercise reported a noticeable improvement in their fatigue, compared with only 24% of the participants who underwent cognitive therapy alone.
Robotics at home
Robotic walkers such as the Lokomat are too costly for most individuals and small rehabilitation centers to purchase, but personal exoskeletons are beginning to improve everyday life for selected stroke patients. One of these is Ekso Bionic’s exoskeleton, a system powered by a battery and computer worn in a backpack and designed to respond to the wearer’s individual weight-bearing pattern.
Tibion’s Bionic Leg is even smaller. This device straps onto the affected leg to provide stability, mobility, and control. Wearing the powered brace enables stroke patients to compensate for lingering weakness in the leg while sitting, standing, walking, and climbing stairs.
“Walking again is a high priority for most stroke patients, and any device that helps them toward this goal is welcomed and eagerly embraced,” says Dr. Black-Schaffer.