Saturday, 20 August 2016

Paraplegics Learn to Walk With Technology

Even today, most people would tell you that once someone suffers a spinal cord injury, they won't walk again. Thankfully, the Walk Again Project has proven otherwise, with a new study published in Scientific Reports on the 11th of August. All eight patients, all with injuries over three years old, participating in the trial experienced neurological improvements.

How did they do it? Patients underwent a multi-phase rehabilitation program over 12 months, with total training time reaching 1,958 hours over all eight patients. The first stage took 178.5 hours on average, where they had to make a virtual reality set of legs walk and sleeves on their arms provided sensory feedback. This was repeated for another 30 hours while standing. Participants "passed" these stages when EEG readings could pick up that their brains remembered how to walk. Then the real walking began: first with a robotic exoskeleton and body weight support (BWS) on a treadmill (109 hours); then BWS on the ground (51 hours); then just the exoskeleton and a treadmill (143 hours); and finally just the exoskeleton (70 hours). A total of 581.5 hours.

VR headsets have improved too. Source: Minecraftpsyco
After months of training, sensory and motor improvements were found in all patients. On average, the Zone of Partial Preservation (ZPP), which is the spinal levels retaining some sensory function, improved by 5 levels. Some improvements, such as the ability to sense where their legs were and what they were doing, only began to appear after several months. Clinical improvement of motor function also took months to appear. All patients also improved in the Walking Index (WISCI). One went from a score of 0 to 6; another went from 1 to 5; another three improved from 1 to 6; two went from 6 to 9 and the last patient went from a score of 6 to 12. What does this mean? A score of 0 means no ability to walk; 1 means able to walk with parallel bars, braces and two people for under 10 metres; a score of 6 means the patient can walk a walker, braces and the help of one person for 10 metres; 9 means walking with a walker and braces for 10 metres and a score of 12 means the ability to walk with two crutches and braces. The reductions in improvements that most patients saw after taking a break for 30 days were quickly reversed.

Taking long breaks reversed some of the improvements, but could they ever be permanent? Other research on people learning to read Braille on weekdays showed that their brains' "maps" for the Braille-reading fingers initially grew during the week, but shrunk back to "normal" by Mondays. The "map" sizes on Monday didn't start to keep growth until six months, and then slowly improved over the next four months. In terms of hours of practice, it was 600 hours - two to three hours a day, five days a week for 10 months. This is similar to the paraplegic patients' training time, but walking may take longer to be permanently re-learned. Maybe home-based programs, so people with spinal injuries could train every day, would be best to prevent the setbacks caused by breaks. There are already exoskeletons available for purchase, with variety of products going up and costs going down; however suitability comes down to the individual's needs. In conclusion, there is hope, practical hope, for people suffering from spinal cord injuries, and it's happening now.

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