Category Archives: Exoskeleton Suits

Second Skin “Bio-Suit” for Cerebral Palsy?

Dava Newman is professor of aeronautics and astronautics and engineering systems at the Massachusetts Institute of Technology (MIT).

She has been working to develop a new type of space suit.  Currently space suits are like balloons.  They are filled with pressurized gas to provide the astronaut with both oxygen and also positive pressure to counter the vacuum of space.  The problem is that moving around inside of a pressurized bubble is not easy.

Therefore, Dr. Newman’s team at MIT is working with NASA to develop a new type of mechanical pressure suit they are calling the “Bio-Suit”.   The key advantage for astronauts will be that it will allow much greater mobility.  Much like having a second skin.

However, the “Bio-Suit” may have applications beyond space exploration.  It is also very possible that the “Bio-Suit” could form the foundation for a new type of Exoskeleton.  One that is much less bulky and intrusive then current robotic like designs.  In addition, much like the currently used Adeli Suit, the positive pressure aspect of the suit could help with sensory and stability issues.

Dr. Newman’s own team recognises these potential medial benefits and has been working with doctors at Children’s Hospital in Boston, Harvard’s Wyss Institute, Boston University, and Draper Laboratory to see if the bio-suit can help patients with anoxic brain injuries.  For example, children with cerebral palsy, and even children and adult stroke victims, who typically lose motor skills on one side of their bodies.

Currently they are using the BioSuit and it’s built-in sensors to measure movements of normal children and adults and compare those to injured patients.   As it turns out, when patients suffer a brain injury, its harder to move and often movement attempts are unsuccessful (for example spilling the cup of water, rather then drinking it).  This leads to something that Dr. Ed Taub coined as “learned non-use”.   When you don’t use movements, the brain quickly loses its programing for that movement.  Taub’s studies showed this can happen as quickly as 1 month post accident.

However, Taub’s studies also also showed that movement could be preserved or even recovered through the use of what he called Constraint-Induced Therapy.  Which was basically just forcing the patient to continue to use their movement patterns to avoid losing them.

Therefore, Dr. Newman’s team realizes the next step for the Bio-Suit would be to fit the suit with actuators.  These would turn the Bio-Suit into a powered exoskeleton and would facilitate movement therapy like Dr. Taub has found to be successful and we have written about in the post exoskeleton-suits-for-cerebral-palsy-the-idea .

Here are Dr. Newman’s words: “People with cerebral palsy expend a lot of energy moving and have stiffened muscles; our BioSuit technology and know-how could guide movement and enhance mobility to make it more efficient. And because the brains of newborns are still so plastic, enhancing the natural kicking of infants with potential motor problems from brain damage might actually reshape the motor programs and partly “heal” their brains.”

Dava J. Newman is Professor of Aeronautics and Astronautics and Engineering Systems at the Massachusetts Institute of Technology

Treadmill therapy (exoskeleton assisted) for cerebral palsy

A  study using the Lokomat robotic assisted treadmill was conducted at University of Munich, Germany. The results are very exciting because they are exactly as we would have expected based on the research of BRIGHT.

The study shows that assisted gait training improves Gross Motor Skills in a very short period of time (just three weeks of periodic training).  It also shows that results improve with more intense training.

This strengthens the case of BRIGHT that a fully autonomous exoskeleton that will allow 24×7 training would be the ideal treatment approach for Children with CP.  Children that are more severely impaired would stand the most to gain because current systems like the Lokomat are bulky and require the child to exercise in a controlled environment.  This is demotivatational and impractical and therefore, only when more sophisticated exoskeleton suits which allow the child freedom to interact in a natural setting will the child be motivated to “train” intensively and thus achieve improvement through re-routing of the brain through neuroplasticity.

Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy

Abstract

Objective

Task-specific body-weight-supported treadmill therapy improves walking performance in children with central gait impairment. The aim of the study was to investigate the effect of robotic-assisted treadmill therapy on standing and walking performance in children and adolescents with cerebral palsy and to determine parameters influencing outcome.

Methods

20 Patients (mean age 11.0±5.1, 10 males and 10 females) with cerebral palsy underwent 12 sessions of robotic-assisted treadmill therapy using the driven gait orthosis Lokomat. Outcome measures were the dimensions D (standing) and E (walking) of the Gross Motor Function Measure (GMFM).

Results

Significant improvements in dimension D by 5.9% (±5.2, p=0.001) and dimension E by 5.3% (±5.6, p<0.001) of the GMFM were achieved. Improvements in the GMFM D and E were significantly greater in the mildly affected cohort (GMFCS I and II) compared to the more severely affected cohort (GMFCS III and IV). Improvement of the dimension E but not of D correlated positively with the total distance and time walked during the trial (rs=0.748, p<0.001).

Conclusions

Children and adolescents with bilateral spastic cerebral palsy showed improvements in the functional tasks of standing and walking after a 3-week trial of robotic-assisted treadmill therapy. The severity of motor impairment affects the amount of the achieved improvement.

Keywords: Driven gait orthosis, Body-weight-supported treadmill therapy, Task-specific learning

Abbreviations: DGO, driven gait orthosis, CP, cerebral palsy, GMFM, gross motor function measure, GMFCS, gross motor function classification system, BWSTT, body-weight-supported treadmill therapy

    • Ingo Borggraefe

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany
      • Corresponding Author InformationCorresponding author. Tel.: +49 89 5160 7851; fax: +49 89 5160 7745.

      email address

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    • Jan Simon Schaefer

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

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    • Mirjam Klaiber

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

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    • Edward Dabrowski

      Affiliations

      • Children’s Hospital of Michigan, Division of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Department of Pediatrics, Detroit, MI, USA

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    • Corinne Ammann-Reiffer

      Affiliations

      • Rehabilitation Centre, Affoltern a. Albis, University Children’s Hospital Zurich, Switzerland

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    • Beat Knecht

      Affiliations

      • Rehabilitation Centre, Affoltern a. Albis, University Children’s Hospital Zurich, Switzerland

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    • Steffen Berweck

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

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    • Florian Heinen

      Affiliations

      • Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children’s Hospital, University of Munich, Germany

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Wilmington Robotic Exoskeleton

Here is a video of the Wilmington Robotic Exoskeleton.  The WREX is an orthosis for enhancing movement of the upper extremities in people with neuromuscular disabilities

This unique assistive device aids in activities of daily living for a variety of pathologies such as muscle disease, cerebral palsy, spinal cord injury, multiple sclerosis and amyotrophic lateral sclerosis – which effect upper limbs. It also serves as a cost effective exercise/therapy device for people recovering from stroke and other debilitating injuries.

Exoskeletons – An Interview With Prof. Daniel Ferris

As we have suggested in our article Exoskeleton Suits for Cerebral Palsy – The Idea, Professor Ferris also shares the idea that soon Exoskeletons could be used to help rehabilitate those with Cerebral Palsy.

There is a very good article about the possible use of Exoskeletons for therapeutic purposes at this link http://www.exoskeleton-suit.com/FerrisInterview.html.

The link is an interview with Professor Daniel Ferris who is a world renown expert on the subject of exoskeletons.

Exoskeleton Suits for Cerebral Palsy – The Idea

The Iron Man movies have made Exoskeleton Suits a popular idea.   However, Exoskeleton Suits don’t only have to be for fighting and the military.   With the use of computer assistance, an Exoskeleton Suit can serve the purpose of a physical therapists’ that works 24×7.

Here is my idea:

1.) We know that brain plasticity is possible.

2.) We know that re-training the brain does not come easily (otherwise brain specializations like pattern recognition achieved over of millions of years of evolution could easily be wiped out).  In fact, there is the 10,000 hour rule.  Which says that to master some special skill requires 10,000 hours of dedicated practice.  “Mastering a skill” is just another way of saying the brain has been “re-trained” and has developed new specializations.

3.) There is scientific proof this occurs as MRI’s have been used to look at the brains of concert violinist’s and it is clear that they recruit new areas of the brain, that would not be associated in order to master their skill.

4.) Now look at a typical CP patient who has suffered an anoxic brain injury and damage to the basil ganglia.  The issue for these patients is metering of movement.   They can start their muscles, but have a difficult time to  modulate movement.   The result is compensating strategies of either extension or contraction.  Movements appear uncontrolled.   Ask them to pick up a cup of water and what is likely to happen is the cup of water will end up on the floor.  Because of this, frustration sets in quickly, typical PT and OT therapy becomes a lesson in frustration and defeat.   Before long, therapy time becomes an hour to avoid… hardly the recipe to achieve the 10,000 hour rule to master a skill!!

5.) Enter the Exoskeleton Suit.   If an intelligent Exoskeleton Suit can be built, then therapy can become a 24×7 activity.  With an intelligent design, no longer will a simple movement like grasping a cup be a frustration, it will be a success.  With success, comes confidence and motivation.  The intelligent design will allow the Exoskeleton Suit to provide just enough assistance to ensure successful movement, however, with each passing day, the amount of assistance the suit is providing can be scaled back, ever so slowly, such that the user does not even realize that with each passing day they are doing more and more of the work themselves.

6.) Before long, maybe just weeks, it is my opinion that the patient would have retrained the brain through plasticity and the motion regulating function of the basil ganglia would have been taken over by some other area of the brain.

Looking at all the possible thearpies, the Intelligent Exoskeleton Suit, is the #1 priority for the Bright Foundation.  We believe it can be the key to a full and speedy recovery.

We request that any others interested in this idea to please contact us.