Imagine if there was a way to walk again after being paralyzed. Not walk again attached to some external supporting device, but actually walk by yourself on your own two legs. Now it’s possible. Brooks Rehabilitation in Florida has been helping people with lower body paralysis learn to walk again with the help of a new robotic exoskeleton, the Hybrid Assistive Limb (HAL), designed by the Japanese company Cyberdyne.

HAL detects the movements of specific muscles patients are trying to move and gives them a boost, according to IEEE Spectrum. Other assistive exoskeletons don’t detect a person’s intentions – they just automatically walk users forward as they shift their weight.

“The difference is, we’re not just putting people through the motions, we’re strengthening a neurological command.” – Morace

In the beginning of 2018, the U.S. Food and Drug Administration approved HAL for use by clinics and medical centers in rehabilitating patients with spinal cord injuries. That same year the exoskeleton helped 18 people in it’s first ever program. It turned out to be such a success that in 2019 five more yet-unannounced hospitals will begin using HAL as well.

According to Cyberdyne:

“This process provides positive feedback to the patient’s brain that the intended motion was completed, which strengthens the signal pathway between the brain and the muscles, and ultimately helps patients learn to carry out the movements on their own, independent of HAL. They will not have to continue to wear the exoskeleton in order to get around.”

 

How The treatment for functional regeneration with HAL works:

  • What goes on when a person intends to move their body is, first nerve signals are transmitted from the brain to muscles via motor neurons; then, a musculoskeletal system such as a joint moves. At that moment, subtle “bio-electric signals [BES]” that reflect the person’s intention to “move” leaks out onto the human skin.
  • So these electrodes(BES) that have leaked out on the back of their legs are picked up by HAL. It reads the signal and determines where that person’s brain is trying to tell their legs to go, then sends the directions to a power unit that is able to assist the joint’s movement in harmony with the person.
  • The Technology is only helping the person’s legs do what their brain wants them to do. Since the person and not the exoskeleton is guiding the movement, the user’s brain is able to learn how it feels to take a step. Therefore, as long as a few neural signals can make it past their injuries and reach their legs, this feedback system of the exoskeleton can help people eventually learn to walk around without help from HAL.

On Cyberdyne’s website they tell the stories of people who have gone through their program. Here’s one of them so you can get a feel for and understanding of the wonders this technology is doing in peoples lives:

Danny Bal was riding his brand new motorcycle to work from his home in Ocala, Fla., two years ago when the driver of an oncoming car fell asleep and plowed into Bal’s electric-blue bike.

After the accident, which crushed three of Bal’s thoracic vertebrae and shredded a spinal nerve, Bal adjusted to life in a wheelchair. He added a motorized lift to his beloved F-250 truck, explored local trails with a hand-powered bike, and joined a therapeutic horseback riding program.

Now, one of Bal’s daughters is about to get married, and 57-year-old Bal wants to walk in her ceremony. So on a recent Friday morning in December at Brooks Rehabilitation in Jacksonville, Fla., Bal was back on his feet, taking slow but steady steps as his granddaughter cheered from the sidelines.

It’s a grueling treatment regimen, often leaving patients feeling exhausted and sore. And the standard 60-session program costs $24,000 and is not covered by insurance; Bal asked his mother for part of his inheritance in order to pay for it.

For Bal’s recent session in Jacksonville, he wore a harness that kept him balanced over one of two treadmill tracks specially installed for use with HAL. As he thought about taking a step, his brain sent the necessary instructions to his leg muscles. But because of his injured spine, few signals made it through, and those that did were too weak to make his legs move, or to move with the swiftness and force of a normal step.

That’s where HAL came in. Nine electrodes stuck to each of Bal’s legs detected these faint signals and relayed them to the exoskeleton fitted to Bal’s legs. The exoskeleton’s control system read these signals to decipher Bal’s intent. Then, the exoskeleton assisted Bal in carrying out the movement he wished to make. HAL did not complete any movements for Bal. Instead, once Bal had initiated a movement with his brain, HAL simply helped his muscles carry it out properly.

 

A typical program consists of sixty 90-minute sessions. They are conducted five days a week for 12 weeks. Although it has been the case that some patients complete their treatment in fewer sessions. During a session patients can monitor their progress on a screen which they have found to be very useful. It helps the patient gauge which muscles are involved in a movement, and how their ability to generate those signals is improving over time.

There are other reported benefits too, apart from assistance with walking on their own again or with a walker. These benefits include greater endurance, better posture, more control of bladder and bowel functions, and improvements to their respiratory system and/or cardiovascular health (such as lower blood pressure).

So far, patients from Brooks Florida clinic have been the only ones in the United States with access to Cyberdyne’s HAL exoskeleton but this year such will not be the case. Part of their plans to help Cyberdyne bring HAL to five more hospitals across the country includes hosting and training visiting staff from those hospitals at their Jacksonville facility.

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