Month: August 2022

Did you know that spinal cord and brain injuries are the most common cause of paraplegia, with spinal cord injuries affecting more than seventeen thousand people annually in America and brain injuries affecting up to 1.5 million per year? [1] A 2013 study done by Christopher & Dana Reeve Foundation revealed that about 1 in 50 people live with paralysis, nearly 5.4 million people. This is equal to the combined populations of Philadelphia, Los Angeles, and Washington, D.C. [2]

Despite the high number of people who need assistive devices like wheelchairs and walkers to move about and complete daily activities, little has been done to advance innovation in that field. That is, until the last decade when robotic legs (medical exoskeletons) were introduced in rehabilitation and recovery centers. Now, patients with paraplegia aren’t limited to a wheelchair, which may have access and mobility issues. This new innovation has led to the development of external robotic devices which can help enhance recovery through repetitive movement and improved neural plasticity. Additionally, they can serve as mobility support beyond walkers, wheelchairs, and orthoses. [3] 

According to the Exoskeleton Industry 2019 Global Market research report [4], the increased uptake of exoskeletons in the medical industry has encouraged companies to invest more in research and development. 

Are robotic legs the answer to helping people with spinal cord injuries, neurological disorders, and strokes regain independent function and their ability to walk again? In this article, we will break down what robotic legs are, the paraplegic conditions that are supported by robotic legs, the benefits of robotic legs, and where you can get them.

What Are Robotic Legs?

Robotic legs are powered medical exoskeletons that are fastened to the lower back and legs. They usually have motors and sensors attached to the hip and knee joints which coordinate and adjust with each step. Some robotic legs are customized to the wearer’s needs, allowing them to perform various tasks, including driving. To break it down further, a medical exoskeleton is any robotic system that patients with conditions like stroke, multiple sclerosis, brain injuries, and spinal cord injuries can wear to support movement. 

Exoskeletons represent the coming together of man, machine, and work by responding to the user’s movement. They provide motor support to the wearer through patient-initiated movement or based on the setting the physical therapist uses and dependent on the patient’s needs.

Operating an exoskeleton is pretty easy for both you and your patient. The wearer only needs to shift their weight in the direction they want to move. The sensors then pick up the intended movement and offer support. With a powered exoskeleton, the wearer can stand from a sitting position, walk, and may even climb stairs. However, it is essential to note that these activities require training.  

Robotic wearable technology has a wide range of applications and can be used by people with spinal cord injuries, brain injuries, multiple sclerosis, and stroke. According to Conor Walsh, a roboticist at Harvard University, “Robotic technology has recently expanded to benefit stroke patients. More than 70% of people who suffer a stroke never regain their full walking capacity.” At the same time, exoskeletons are not limited to medical uses only. They are also used by industrial workers like construction workers and warehouse workers to support the lifting of heavy loads. In fact, some companies have made it mandatory for workers to use exoskeletons as part of their personal protective equipment. They include: Ford, BMW, Hyundai, Samsung, and Mitsubishi, among others.

Paraplegic Conditions That Are Supported by Exoskeletons

One of the conditions we highlighted that is a common cause of paraplegia is spinal cord injury. When spinal cord injuries happen, they interfere with the communication between the brain and body parts below the injury, leading to paralysis. Exoskeletons can be used to support paralysis caused by spinal cord injuries, including injuries to the cervical, thoracic, and lumbar regions.[5]

To support this assertion, several studies have been conducted to investigate and verify the usefulness of exoskeletons for paraplegic conditions. In a 2018 study concerned with the development and control of a robotic lower limb exoskeleton for patients with paraplegic conditions, healthy subjects tested exoskeletons by performing normal daily activities like walking, standing, and sitting. It was concluded that the exoskeletons had natural gait cycles which support ambulation. [6] In simple terms, it demonstrated the exoskeleton’s ability to aid the rhythmic movement of a stride, which is needed in walking.

Exoskeletons have been shown to have a high impact on people with disabilities who were trying to regain muscle activity in their thighs, hips, and legs. In a clinical trial published in Frontiers in Robotics and AI, it is reported that 62% – 72% of wearers who practiced using exoskeletons in physical therapy could achieve their walking goals within 12 sessions. It also noted that after the 36th session, 80%-84% of the study groups achieved their walking goals. [7]

To demonstrate how useful and practical exoskeletons are in patients’ recovery and daily activities, here are two stories of patients who rely on exoskeletons.

At 22 years old, Julio Caro, a structural steelworker in southern California, took an 18ft fall while working, which would change his life forever. He broke his back in two different places, injured his spine, and was unable to walk after the ordeal.

“I was young, and so I didn’t understand what was happening,” Caro said. “They said, ‘You’re not going to be able to walk again,’ and I thought they were lying.”

“I just wanted to get back on my feet — I was out to prove everybody wrong,” he added. “So when I first heard [about exosuits], I was, like, Robocop. As soon as I saw the machine and I saw it walk, I thought, ‘Oh cool, it does everything for you.’”

After using the exoskeleton for only five sessions in physical therapy, Caro was able to walk again. He says it made a lot of difference having the robotic legs as they allow him to work again and enjoy what we might typically take for granted, like reaching out and touching a leaf.

 “I’m glad this technology is out there, [and] it’s only getting better,” he added.

On Tuesday, December 4th, 2018, Amelia Clark dropped off her three sons at school and went to a hair-coloring class. She had a headache but thought nothing of it. She dismissed it as low blood sugar until the unthinkable happened. She couldn’t stand up.

“I must have passed out because when I woke up, I saw a whole bunch of lights, and the doctor said, ‘Hi. What’s your name? You’ve had a stroke.’”

Clark was hospitalized for a month and a half, unable to walk without any assistance. The first time she took a step after her stroke was when she was introduced to an exoskeleton, EksoNR. In just three months, she was able to walk with a cane and, by August, started driving again.

Benefits of Robotic Legs

1. Robotic Legs Don’t Require Surgery

One great thing about robotic legs for physical therapy patients is that, unlike other treatments, they don’t require invasive surgical procedures. For instance, in epidural stimulation, a device is implanted near the spine, and in stem cell transplants, spinal cord injections are done. Conversely, robotic legs (exoskeletons) are worn on the body, making them an easy way to improve mobility without risk of complications.

2. Robotic Legs Improve Circulation

When you have a spinal cord injury, blood tends to pool in the legs due to lack of movement, reducing the amount of blood flowing to the heart. It can also lead to swelling in the legs. Using exoskeletons can allow your patients to ambulate and move paralyzed areas. This contributes to the circulation of blood which is essential in supporting cellular activity. 

3. Robotic Legs Reduce Muscle Atrophy

Movement is very critical as it helps in strengthening muscles and bones. However, patients with paraplegic conditions may not be able to move around much. This can cause their muscles to reduce in size to conserve energy, hence the need for robotic legs. Though they do not stop muscle atrophy, they help maintain bone and muscle density as they keep the wearer moving and bearing their own weight. 

4. Robotic Legs Boost Confidence

When a patient experiences an injury or condition that affects their lower limbs, the recovery outlook is painted as marginally lower, and this can impact patient confidence. One of the most invaluable benefits of robotic legs is the hope they restore to patients who’ve been told they’ll never be able to walk again. Robotic legs represent an opportunity for them to walk again, which not only helps them become more independent but also more confident. Robotic legs can be used for rehabilitative exercises and help patients with complete SCI regain more mobility than they thought possible. 

5. Robotic Legs Help Manage Spasticity

One of the most common problems that patients with paraplegia face is a painful condition known as spasticity (the contraction of muscles). Robotic legs can help manage spasticity and improve other related conditions like pain and bowel function. When one robotic leg user was asked, she said that tending to her bowels took roughly 20 minutes, which was different from the hour she usually spent without an exoskeleton. [8] 

The Best Robotic Legs for Paraplegic Conditions

There are different types of exoskeletons available in the market for paraplegic conditions that assist physical therapists, additionally, these exoskeletons have been approved for use in communities and medical institutions with supervision. One great example is Ekso Bionics’ EksoNR which is used to rehabilitate people after spinal cord injury, stroke, brain injury, and MS. 

The EksoNR is like a backpack that extends to the legs and supports the torso and lower limbs. It has sensors on the footplates which signal the movements of the wearer. The exoskeleton then creates feedback and offers support to the wearer, depending on the settings. It not only supports ambulation but also helps patients regain muscle activity.

Where Can You Get Robotic Legs?

Robotic legs like the EksoNR and EksoGT are readily available in more than four hundred rehabilitation centers globally. If you’d like to acquire exoskeletons for your facility, you can contact our sales team by clicking here.

Conclusion

Robotic legs are essential for patients with paraplegic conditions. They help support movement, reduce muscle atrophy, and address other related conditions like pain, bowel function, spasticity, and overall quality of life.

Ekso Bionics has been at the forefront of creating the best quality medical exoskeletons for over a decade. Our EksoNR was one of the first FDA-approved medical exoskeletons for rehabilitation, and it continues to be the exoskeleton of choice for rehabilitation clinics. Please review our indications for use to determine eligibility. [9]

References:

1. https://www.cdc.gov/traumaticbraininjury/pubs/tbi_report_to_congress.html#:~:text=Traumatic%20brain%20injury%20(TBI)%20is,people%20are%20hospitalized%20and%20survive. 
2. Paralysis statistics – Reeve Foundation https://www.christopherreeve.org/living-with-paralysis/stats-about-paralysis
3. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095795/
4. Exoskeleton Market Size & Share Report, 2022-2030 https://www.grandviewresearch.com/industry-analysis/exoskeleton-market
5. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095795/
6. Development and control of a robotic lower limb exoskeleton for paraplegic patients https://journals.sagepub.com/doi/abs/10.1177/0954406218761484?journalCode=picb
7. How Exoskeletons Can Help People With Paraplegia Walk Again https://eksobionics.com/how-exoskeletons-can-help-people-with-paraplegia-walk-again/
8. Robotics are helping paralyzed people walk again, but the price tag is huge – The Washington Post https://www.washingtonpost.com/news/morning-mix/wp/2017/06/10/robotics-are-helping-paralyzed-people-walk-again-but-the-price-tag-is-huge/
9. Indications for Use – Ekso Bionics https://eksobionics.com/indications-for-use/

Physical therapy can be intimidating for patients, especially if they don’t have enough information, are afraid, or don’t have any prior experience with therapy. Misinformation and fear can lead to concerns and notions, which, if not addressed, can keep patients from seeking the help they need in order to recover well. It is important for therapists to understand their patients’ concerns to address them and increase patient safety. In this article, we will address the most common concerns patients have about physical therapy and how you, as a physical therapist, can address them to ensure patient safety and comfort.

Common Concerns Patients Have About Physical Therapy

1. Some Patients Are Afraid of Pain

One of the most common misconceptions people may have about physical therapy is that it is painful. However, contrary to popular belief, physical therapy is actually designed to help relieve and manage pain, as you already know. Sometimes it takes explaining to patients the benefits of therapy in pain management and alleviation for them to understand how it works and what they should expect from it. Many people fail to realize that though therapy can be uncomfortable, it is never meant to be painful.

2. Patients May Think Physical Therapy Is Time-Consuming

Time is generally a primary concern for most people. Most patients usually have school, careers, family, and other demands on their time. Therefore, when it comes to scheduling time for physical therapy, it can seem impossible to add one more thing to their already packed schedule. On the other hand, some patients may be concerned that physical therapy will take too long. They do not want to commit weeks and months of their time to attend therapy. When you consider the busy lives we lead and how we try to fit everything into our limited schedule, you can begin to empathize with your patients and understand where they are coming from. A great solution would be creating a rehabilitation schedule that is tailored to your patient’s schedule. It can include at-home exercises and in-office rehabilitation sessions.

3. Patients May Believe Physical Therapy Is Too Expensive

Physical therapy is not familiar to most people. It’s not a program your patient may have undergone before, and people tend to be afraid of the unknown. This can be a barrier for many patients. Additionally, if your patient does not have insurance to cover their costs, paying out of pocket can be too expensive. However, you can work with patients to discuss cost-cutting strategies they can leverage to get the treatment they need. 

4. Some Patients Are Afraid That Physical Therapy Won’t Work

How do you know something is going to work, especially if you have never experienced it before? This is the same thought that may plague patients, as they may not ascertain the effectiveness of attending therapy sessions. This might be less of a concern for patients who have undergone rehabilitation before, but it can be a very real concern for patients who haven’t undergone physical therapy. To curb this, you can share success stories with your patients that qualify the importance of therapy during consultations.

When someone is suffering from mobility issues, it might be easier to convince themselves that rehabilitation won’t work rather than have hope and then get discouraged. Getting over this mental barrier may help some patients open up to physical therapy.

5. Some Patients May Be Afraid of Working With a Physical Therapist

Even though therapists normally try to be friendly and welcoming to everyone, sometimes some patients may feel uncomfortable and even afraid to do physical therapy. This may be due to personal issues like haphephobia (the fear of being touched by strangers) and uncommunicated expectations like the outcome they desire out of physiotherapy. 

6. Patients May Be Afraid of Commitment

Just like going to the gym or starting a new diet, physical therapy comes with a demand for commitment; not many patients feel they can stick it out till the end. This may keep many patients from trying because they already believe they will fail. However, working out therapy plans that work for your patients can help them conceptualize how much will be asked of them within the program. This can help them evaluate their commitment using a tangible measure compared to going at it blindly.

7. Some Patients Are Afraid of Falling

Some patients are concerned about attending therapy because of the fear of falling, clinically referred to as “ptophobia”. According to Tinetti of the Department of Medicine and Public Health at Yale University and Powell of the Department of Epidemiology and Public Health, the fear of falling (FOF) is an ongoing concern about falling that ultimately limits the performance of daily activities.[1] Reduced mobility makes patients insecure about avoiding falls, effectively keeping them out of therapy. 

8. Patients May Be Afraid of Getting Injured

Sometimes patients incur injuries during physical therapy sessions due to falls, among other reasons. This can keep prospective patients from going to therapy as they are afraid that they’ll meet the same fate. Reassuring your patients can go a long way in overcoming this fear. Addressing patient safety is a key concern in ensuring that patients are safe within rehabilitation facilities. This might go a long way in relieving patients’ fears.

In the next section, we’ll discuss patient safety and how physical therapists can ensure they observe patient safety guidelines to ensure their patients get the best care and treatment.

How to Address Patient Concerns as a Therapist

There are a few things you can do to deal with your patient’s concerns, including:

1. Understand Your Patient’s Needs

The most significant step you can take in addressing your patient’s concerns is understanding their needs. A lot of patients have different needs and concerns that can only be met if you are empathetic and understanding enough. Addressing these needs can be the start to relieving any anxiety and worry that a patient has. It can also be the foundation of trust that you need to form with a patient in order to help them through their therapy sessions. 

2. Create a Rapport With Your Patient

This will help them to open up and be more active in therapy sessions. Building a relationship with patients is the fastest way of getting them out of bed. A 2010 study studying the influence of the therapist-patient relationship on treatment outcome in physical rehabilitation said that the connection between a therapist and patient determines the treatment outcome. [1]

3. Communicate and Address Expectations Clearly

Effective communication is a primary facet of successful rehabilitation. Communication is needed to understand your patient’s needs and expected outcome. While communicating with your patients, it’s also important to tailor your communication to your patient’s literacy level when discussing ailments and treatment. Patients value clear and simple explanations about their problems.

Addressing Patient Safety

Patient safety has become an evolving area in the healthcare industry with the increase of adverse events in hospitals. Adverse events are any unintended occurrences within the healthcare system that may lead to a longer hospitalization period, disability, or death. 

According to the Canadian Patient Safety Dictionary, patient safety is “the reduction and mitigation of unsafe acts within the healthcare system, as well as through the use of best practices shown to lead to optimal patient outcomes.” [2] Physical therapists play an important role in mitigating unsafe acts within the system, directly and indirectly. Physical therapists can contribute to a culture of safety by evaluating and implementing safety measures like improving facility layouts, training staff, and being more sensitive to patients’ needs, among others, as discussed below.

Safety issues within physical therapy are not typically big and harmful events. They are normally no-harm events classified as close calls or near misses. In other words, they are events that happen to the patient but do not produce harm. For example, a patient almost falls when they are being moved from a chair. These kinds of events happen as mistakes, and it is important to identify the source of these mishaps and learn from them so as to improve patient safety. [3]

According to a 2004 study by the Canadian Medical Association Journal, some of the adverse events that normally happen in the health care system can be prevented altogether. [4] So, let’s explore some strategies you can implement to mitigate against accidents in your practice and improve patient safety.

How to Increase Patient Safety as a Therapist

You can implement several strategies to alleviate your patient’s concerns. They include: 

1. Identifying Potential Slip and Fall Risks

This is one of the easiest things you can do to increase safety in your facility. Injured patients are vulnerable to falls and slips, so it is extremely important that you ensure slippery areas are shown well. Additionally, you can station staff in risky areas to watch patients during their visit to your practice. Also, never forget to notify patients in case you identify potentially risky areas where they may fall and injure themselves. It is also important to wipe and clean any spills immediately to avoid the risk of a fall. And if your facility has bathing areas, make sure they are always kept dry to avoid injuries. Additionally, you can add non-slip rugs in the bathrooms and grab bars for support. 

2. Improving the Facility Layout

Evaluate your facility to see if patients can easily move from one area to another without straining and injuring themselves. Remember that a good number of patients attending therapy have mobility issues. A great solution to ease patient movement would be having ramps around the facility instead of stairs. You could also place all equipment and furniture out of the way of patients to avoid any falls.

3. Making Signage and Posters Visible 

Having signage and posters all over your facility is great, but they need to be visible and legible. What good is a warning poster if a patient can’t see it or be able to read it? The United States Occupational Safety and Health Administration dictates that all labels, posters, signs, and color codes must be visible enough to warn patients of possible risks. 

4. Labeling Equipment and Providing Instructions of Use

As great as equipment exercise is, it can pose a potential hazard to patients if it does not have any clear instructions for use. Instructions are normally included in any equipment you buy, but in case it is not, make your own and make sure it is visible enough to be seen by the patients using it. 

5. Training Staff 

The best way to increase patient safety and improve healthcare quality is to train staff on the latest and best ways to take care of patients. Additionally, creating a work culture that puts patient safety first can also help address patient concerns like safety. 

Conclusion

Patient concerns are ever-changing and differ from one patient to another. If left unchecked, they can keep potential patients from attending therapy and getting the help they need. When addressed, they can help patients overcome their personal barriers and attend physiotherapy sessions.

When dealing with patients, it is important to remember that you are human, and humans make mistakes. Whenever a mistake is made, the best course of action is to learn from it and make the required changes. It is also important to create a culture and environment that facilitates the identification and reporting of mistakes so that you can improve patient safety. 

References:

1. Fear of Falling | Physical Therapy | Oxford Academic https://academic.oup.com/ptj/article/82/3/264/2837020
2. The Canadian Patient Safety Dictionary https://policycommons.net/artifacts/1212508/the-canadian-patient-safety-dictionary/1765612/
3. Patient Safety and Physiotherapy: What Does it Mean for Your Clinical Practice? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909853/
4. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada https://pubmed.ncbi.nlm.nih.gov/15159366/