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International research on exoskeletons for patients with severe spinal cord injuries

11 December 2019

International research on exoskeletons for patients with severe spinal cord injuries

Written by Miklós Stemler

 

The research team of the Department of Neurosurgery and the Biomedical Engineering Project is conducting an internationally relevant research on exoskeletons, which belong to the forefront of health technology. The aims of the work conducted jointly with the National Institute of Medical Rehabilitation (OORI, Budapest) are the improvement of the living conditions of people with severe spinal cord injuries and the comparative study of the long-term health effects of exoskeletons.

Since the beginning of 2019, two so-called sixth-generation exoskeletons of the ReWalk company have been tested in Pécs by the Department of Neurosurgery and the Biomedical Engineering Project of the 3D Center. Nurses, physiotherapists, engineers, and physicians in the research team are examining the long-term health effects of the equipment that provide mobility experience to severely disabled people.

Self-moving exterior skeletons, known as exoskeletons that improve human endurance, physical strength, and mobility have long been used in the industry and due to the advances in technology, they have appeared in more and more fields in recent years, for example in the field of health as well. The ReWalk devices, representing the forefront of the exoskeleton technology, procured by researchers from Pécs through a European Union tender, can perform up to 10 kilometres a day on flat ground, with proper practice they can be used to climb and descend stairs, and they can work for several hours on a single charge. The equipment also provide the experience of independent locomotion for patients with severe paraplegic spinal cord injury who are no longer able to walk according to the current state of medicine. In addition to the obvious practical advantages, all of this also has a serious health benefit since the vertical posture has a significantly more beneficial effect on the body than sitting in a wheelchair. The UP and the OORI research team thus hope to achieve lasting improvements in the quality of life, even though these high-tech machines are unfortunately not yet available in publicly funded individual care due to their prices, and can primarily be used for training purposes.

- Complications caused by immobilization and wheelchair use can have serious health consequences beyond losing mobility, including bedsores, obesity, muscle atrophy and stiff joints. In the long term, mostly in the case of young people this can lead to early-onset cardiovascular disease, osteoporosis, diabetes, and psychological problems. These are such endemic diseases in connection with which people with severe disabilities are particularly vulnerable. The use of exoskeletons can be crucial at this point, as they can greatly improve the general health of people with spinal cord injuries if they are able to stand and move for a certain amount of time with the help of these devices – says Dr. Luca Tóth, PhD student at the Department of Neurosurgery, one of the leaders of the research.

The aim of the researchers in Pécs is to develop a sustaining therapy that involves working with people with spinal cord injuries over a long, multiannual period to assess how long and how frequent sessions provide lasting health benefits. The importance of the research is increased by the fact that such studies are still in an early stage worldwide.

- It is an extremely new technology, several hundred such devices are currently in use around the world and there is no standard protocol for how often and with what intensity to deal with people with spinal cord injuries. In our research, we apply a very active, five-day-a-week, and one and a half hours a day therapy in cooperation with our kinesitherapist colleagues. Due to its novelty, the follow-up examinations are not really known either, which undoubtedly makes our work more difficult and also exciting.

During the past months, both the research team members and the person with spinal cord injuries using exoskeletons for the first time have undergone intensive training in order to use the machines safely, and as the first significant milestone the subject has been able to use the equipment independently since mid-June.

The Pécs research team has recently been enriched with an important professional partner through OORI, front-runner in the treatment of spinal cord injuries. As part of the joint work, one of the two exoskeletons available is used in Pécs and the other is used in Budapest, so that more patients can be involved in the research. In addition to the examinations with exoskeletons, a so-called biomechanical laboratory is under construction at the Department of Neurosurgery and according to the plans, work can continue in the winter with the help of extended equipment.

- In addition to clinical trials, we also place great emphasis on the equipment and methodological improvements, together with the manufacturing and distribution companies - adds Dr. Péter Maróti, medical-professional manager of the Biomedical Engineering Project. - In the course of our work, we expand the measuring technology possibilities of the existing systems in close cooperation with the UP Faculty of Engineering and Information Technology, but our multidisciplinary research team is also involved in technological developments through a deeper understanding of the devices. All of this is also important for the long-term sustainability of the project since it is possible to establish and strengthen an active professional relationship with market participants and other research and development institutions. We consider it an important first step in this field that we have been awarded the national Center of Excellence title of the ReWalk Company - emphasizes Péter Maróti.