- The Washington Times - Friday, August 25, 2017

Researchers and engineers at the National Institutes of Health have developed the first robotic exoskeleton for children with cerebral palsy, in a major step forward for improving the quality of life for those who suffer from the debilitating condition.

Nearly 10,000 children are born with cerebral palsy each year, a devastating and incurable neurological movement disorder that impairs walking and mobility. Conventional treatments focus on physical therapy, drug injections and in some cases surgery.

One of the markers of cerebral palsy is “crouch gait,” where a person walks with a perpetual bend in their knees. This has detrimental effects on the muscles and joints of the body that can result in paralysis for half of the cerebral palsy population.

“Most wearable exoskeletons have been designed for adults with paralysis, with the exoskeleton replacing the lost function of the user’s,” said Thomas Bulea, the principal investigator of the study and staff scientist in the NIH Clinical Center Department of Rehabilitation Medicine. “We sought to create a device that could safely and effectively improve the posture of children with crouch gait while they walked.”

The prototype exoskeleton was tested in seven individuals between the ages of 5 and 19 and researchers observed patients were able to walk with the exoskeleton without the help of other mobility devices aids and even without relying on the robot entirely, building muscle capacity and improving posture.

“The improvements in their walking, along with their preserved muscle activity, make us optimistic that our approach could train a new walking pattern in these children if deployed over an extended time,” Mr. Bulea said. “This study paves the way for the exoskeleton’s use outside the clinic setting, greatly increasing the amount and intensity of gait training, which we believe is key to successful long-term outcomes in this population.”

Scientists aren’t exactly clear why cerebral palsy occurs, other than it results from a traumatic brain injury that takes place in utero or shortly after birth. Diagnosis usually happens within the first few months of life when a child’s motor functions are observed as developing abnormally. Brain imagining can reveal a breakdown in communication of the neural pathways between the two sides of the brain essential in directing physical movement.

The idea for an interventional walking aid for children was first generated about six years ago by Diane Damiano*, the Chief of Functional & Applied Biomechanics Section in the NIH Clinical Center Rehabilitation Medicine Department.

The goal is to design an intervention that strengthens the muscles from the time where children are just learning to walk instead of treating the problem when its already progressed into adulthood.

“This is the most common physical disability and effects [CP patients] throughout their whole life,” Ms. Damiano told The Washington Times Friday. “A lot of these individuals will stop walking in adulthood.”

“We do a lot of things early on that weaken their muscles — cut their tendons, inject them,” she said. “We’re trying to come up with solutions that are win-win. … Training them to stay more upright that will keep them walking longer, that’s our pie-in-the-sky goal.”

With the design knowledge of Mr. Bulea, the project gained momentum about four years ago, Ms. Damiano said.

It took about six years to move from an initial idea to the designing of the prototype. The most recent successful trial proved that children with CP can tolerate the device.

The next step is to make it even lighter, with smaller components independent of a grounded power source that allow patients to practice and train with it in their homes.

Ms. Damiano says the main objective is to ensure the exoskeleton is not controlling the user.

“We’re not controlling the knee joint at all, we’re injecting energy to make [the children] stand upright and they have to keep themselves up there,” she said. “We’ve been against braces for a long time. … Kids get weaker and that’s what we don’t want to happen to them.”

In addition to patients with CP, the device could be used for a variety of mobility disorders, such as muscular dystrophy or spinal chord injuries, Ms. Damiano said.

“We’re really aiming this as a training device,” she said.

* An earlier version of this story misspelled Diane Damiano’s name.

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