A study published in the Journal of NeuroEngineering and Rehabilitation has reported positive results from a trial of robotic exosuit-aided rehabilitation of stroke patients. The device, representing the first time an exosuit has been cleared by the US Food and Drug Administration (FDA) for stroke rehabilitation, is aimed to help those with difficulty walking due to severe ankle weakness after suffering a stroke.
Exosuits have become increasingly involved in motility rehabilitation in recent years, and this study by Dr Louis Awad of Spaulding Rehabilitation Hospital, Boston, and colleagues was to assess the reliability and safety of the device.
Developed by ReWalk Robotics Ltd, the ReStore™ exosuit is a soft robotic exosuit that supports the ankle by constantly monitoring foot and ankle movement and assisting in keeping a natural gait. While the device assists the patient, metrics are sent to the physiotherapist conducting the therapy to adjust how much support is needed.
The ReStore™ exosuit is the first exosuit approved for stroke hemiparesis rehabilitation, with both the high level of training required to assist their use and the huge cost involved proving a barrier to entering large-scale applications. Currently used in other rehabilitation therapies, such as the HAL medical exoskeleton, the ReStore™ exosuit arrives at a much lower cost (at around $30,000 compared to the average of around $100,000) but requires more intensive testing to discover how feasible it can be. Exosuit therapies are still in their infancy, with insurance and healthcare providers dubious over whether the technology justifies the cost.
A stroke can cause an array of long-term ailments after the event, with one of the most common being hemiparesis. Characterized by a weakness of one side of the body, hemiparesis can be a huge blow to quality of life. Hemiparesis varies in severity and areas affected and some sufferers may have little difficulty walking, while some may be unable to walk at all without assistance. This exosuit trial focused on people that could walk 1.5 meters (5 feet) unassisted and aimed to improve their speed and gait.
Based on the 44 participants with post-stroke hemiparesis that received the exosuit therapy, the device was able to increase both assisted and unassisted walking speeds after just five days of practice. The device had very few malfunctions during the time and managed to help with both plantarflexion (movement of the foot in which it points away from the leg) and dorsiflexion (pointing of the foot towards the leg).
"We found that the ReStore provided targeted assistance for plantarflexion and dorsiflexion of the paretic ankle, improving the gait pattern," said Dr Nolan, senior research scientist at the Center for Mobility and Rehabilitation Engineering Research at Kessler Foundation in a statement. "This is an important first step toward expanding options for rehabilitative care for the millions of individuals with mobility impairments caused by ischemic and hemorrhagic stroke."
This was an early trial and the authors emphasized they are not attempting to prove how effective the device is just yet. However, the results definitely warrant further study to fully understand if exosuits could impact the massive number of stroke patients struggling to walk.
With stroke being the leading cause of long-term disability in the USA, advances in rehabilitation are ever more necessary – and exosuits may play a vital role.