Following a Spinal Cord Injury (SCI), the paramount question in the minds of most patients and their loved ones is, “Will I be able to walk again?” Though there is no simple answer to this question, with advances in medical research, new techniques in rehabilitation, including the advent of wearable exoskeletal robotic systems, the hope is that a SCI is no longer always synonymous with the inability to walk.
The annual incidence of SCI is approximately 12,000 new cases each year. Currently, there are approximately 273,000 people in the United States living with SCI—80 percent are male with the average of 42 years of age at the time of injury. The most common cause of SCI is motor vehicle accidents (36%), followed by falls (28%), acts of violence (14%) and sports (9.2%). The most frequent neurologic category of SCI is incomplete tetraplegia (41%), followed by incomplete paraplegia (19%), complete paraplegia (18%), and complete tetraplegia (12%).
Following a SCI, functional recovery mostly takes place within the first three months of injury and can continue as far as one year following injury, with some people continuing to show improvements in function beyond one year.
Yet, despite functional achievements obtained with interdisciplinary rehabilitation therapy, the unfortunate part is that the vast majority of persons with SCI are left with significant disability—including the inability to walk. In one study, approximately 59 percent of those with SCI were unable to ambulate at one year following injury.
SCI can severely hinder a person’s daily function—and although there are compensatory methods to restore mobility, the mainstay for locomotion remains the wheelchair. The good news is that great improvements in design and construction have been made to wheelchairs in the last 40 to 50 years. Additionally, numerous designs of knee-ankle-foot orthosis and reciprocal gait orthosis have been introduced.
But none of these innovations and technologies has made it possible for people with complete paraplegia or tetraplegia to ambulate independently for any significant distances, since the use of such devices is often physically exhausting for the person.
But the SCI community is on the cusp of an exciting breakthrough: the advent of wearable robotic systems. Exoskeletons, such as Ekso, ReWalk, Indego, HALT and Rex, can potentially provide support and assistance to paretic limbs in functional tasks, thereby giving users the ability to walk.
Last summer, the US Food and Drug Administration announced that it will allow the marketing of the first wearable, motorized device that helps people walk. Currently, the use of all exoskeletons is limited to the research environment. Burke Medical Research Institute’s Restorative Neurology Clinic is currently testing the use of the exoskeletal robotic system. In addition, the clinic is conducting research utilizing non-invasive brain stimulation in conjunction with robotics therapy. The researchers are working with patients with neurological disease causing upper body immobility and paralysis caused by stroke, spinal cord injury and traumatic brain injury.
Exoskeletons can be rather bulky and heavy—and require at least one therapist to control the device— so years of research is still needed to sufficiently test the efficacy and safety of such products before they’re ready for regular use by persons with SCI. Radical advancement in technology is also needed to make the devices commercially available.
But with that being said, the field of wearable robotics as a gait aid is undeniably an exciting development in the field of SCI showing genuine promise. Plus, similar technology may also be used in ambulation assistance with disability stemming from pathologies other than SCI, such as stroke, traumatic brain injury, MS, and cerebral palsy. At Burke, we are proud to be a leader in spinal cord injury rehabilitation. Whether it’s by utilizing the latest technology in our inpatient programs, like the Zero G lite machine, or testing tomorrow’s solutions, such as wearable robotics, Burke will continue to strive to help better the lives of those with spinal cord injuries.
—Vincent Huang, M.D., Director of Burke’s Spinal Cord Injury Rehabilitation Program
Additional reporting by Isaac P. Syrop, M.D., Resident in the Department of Rehabilitation Medicine at New York Presbyterian/Columbia/Cornell
Photo of Brad Berman, who experienced a stroke in 2013, using the exoskeleton.
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 van Middendorp JJ et al. A Clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet. 2011;377:1004-1010.
 Ragnarsson KT. “G. Heiner Sell Distinguished Lecture: American Spinal Injury Association (ASIA) 40th Anniversary: Beginning, Accomplishments and Future Challenges.” Top Spinal Cord Inj Rehabil. 2013;19(3): 153-171.