For patients with spinal cord injuries, the idea of ever walking again may seem out of reach. But thanks to the Ekso GT, an exoskeleton suit designed by Ekso Bionics, the future of spinal cord and brain injury rehabilitation looks a little brighter.

Dr. Chester Ho of Foothills Medical Centre in Calgary, Alberta, has been conducting a Safety and Feasibility study with the Ekso GT since February 2016. According to Ekso Bionics, the device “promotes early mobility and helps correct posture” as well as assists with patient-personalized gait physiotherapy.

Inject This was given the opportunity to learn more about exoskeleton therapy, as well as the promising outlook of this study, by observing the work of Foothills physiotherapist Kyle McIntosh and patient Kurt Timmons.

During the trial, Kurt first stood with the assistance of Kyle and the Ekso GT. As he walked through the halls of the wing, Kurt’s diagnostics were taken and the suit calibrated to assist with his gait and weight-shifting. During the walk, Inject This interviewed both Kyle and Kurt about the Foothills exoskeleton study.

Q: How does the Ekso GT device work?

Kyle: The basic principle of stepping with the exoskeleton is that it moves when it receives input from the user’s weight shift. So, the person using the exoskeleton is responsible for shifting their weight left and right and shifting their weight forward to meet targets. As soon as they have met their forward and lateral targets, the machine knows that it’s time to take a step. And depending on the degree of completeness of their injury, the user can control the step based on their own volitional input. So, they can initiate a step, and the machine will fill in the gaps where they don’t have the strength to do it.

Q: What sort of tests are being performed in this study?

Kyle: This is a Safety and Feasibility study. We want to know, for people with acute spinal cord injuries, if it’s safe to get them up and walking without orthostatic hypotension (a big drop in blood pressure when you stand up to walk). They should have no issues with pain, excessive fatigue, skin breakdowns, falls or fractures. We also look at some walking measures. We look at the Six Minute Walk Test, which is how far a person can walk in a period of six minutes. We also check gait speed, just to see how fast they can walk. We measure this at the onset of the study, again at Session 13, and at the end of the study at Session 25.

Q: What indicators will help you know if the study is going well?

Kyle: If participants are able to get through their training without frequent breaks, without getting light headed and dizzy, and without getting symptomatic for hypotension, then we could consider it successful. As well there should be no incidences of skin breakdown, falls, increases in pain, those kinds of things.

Q: Can you share any preliminary results?

Kyle: The study so far has been successful. We’re only about midway through our training, so it’s really early to come out with anything definitive. But we certainly have had people who have completed our training, which looks quite promising.

Q: What makes a good candidate for the study?

Kyle: There are a few things you require. First of all, you need to have had a recent spinal cord injury. The study focuses on the use of exoskeleton walking in rehab in the most acute phase of the injury. We are looking at anybody who is within the first 6 months of a spinal cord injury. They have to meet the requirements of the manufacturer, as well. So, specific requirements in terms of body size, your height, your weight, hip width and generally your range of motion and strength.

Q: Kurt, how did you get involved?

Kurt: I saw some posters while I was in the spinal unit on the acute side. Then my parents went to see an exoskeleton presentation, and when I got to this unit, Kyle brought it up to me. I wasn’t a candidate for the study, but he figured we could make a case study out of it.

Kyle: Yeah, Kurt was a really unique example. He wasn’t quite appropriate for the study, but he had enough capability to use the device and was very interested. So were able to use the machine in the treatment of Kurt’s injury and, like he said, write up a case study.

Q: What makes this case study important?

Kyle: It’ll document the use of Ekso by somebody with Kurt’s level of injury, which is a C6 incomplete injury. Really one of the most unique things about it is that Kurt doesn’t have full function of his hands. So we have to make adaptations for Kurt to be able to effectively grip and use the crutches.

Q: Kyle, can you tell us about the Ekso conference you attended in San Francisco?

Kyle: In October I attended a peer user conference in San Francisco. Essentially the Ekso company brought together all the users of their exoskeletons in North America and Europe. We shared information on each facility’s experience with the exoskeleton and shared tips and tricks that each facility has developed. Ekso shared information on the new new software they are releasing as well.

Q: What new developments in Ekso technology have you seen recently?

Kyle: So, there is brand new software that Ekso is releasing called Smart Assist. Basically, it enhances the capabilities of this device. It makes it more tunable and more programmable. It also makes it more broadly applicable; it can be used with spinal cord injury, brain injury, and stroke patients.

Q: Are Ekso suits currently on the market for individual use, or are they strictly for research purposes?

Kyle: There are models that are available to the general public. So some models are designed to be used in rehab-only settings. The Ekso GT, the model we use, is to be used only with a physiotherapist and someone who is certified by Ekso as well. But there are devices available for use in the community that are designed to be used independently, without the aid of anybody assisting. Most of them require the use of gait aids, so you’d have to have crutches or a walker.

Q: Where do you see Ekso focusing in the future?

Kyle: I think the direction Ekso is headed is to have more models that are suitable for use independently and in the community.

This study would not have been possible without the generous contributions from The Calgary Health Trust, Hotchkiss Brain Institute/Cummings School of Medicine, the Alberta Paraplegic Foundation, as well as the dedication of Dr. Chester Ho and physiotherapist Kyle McIntosh.