I consider myself extremely fortunate to have had the opportunity to experience “walking” again. I have not been able to move my legs independently and have been paralyzed from the waist down for the past 22 years due to multiple sclerosis.
Dr. Albert Lo invited me to come up to the West Haven VAMC to try out the Lokomat in February when it was delivered. The 4-hour drive from Philadelphia, Pennsylvania to West Haven, Connecticut had never been so short; the traffic jams along I-95 were inconsequential. My excitement grew exponentially in anticipation. I could not imagine what to expect, only that I was in for a thrill.
It’s a rather tedious procedure initially. The therapists take numerous measurements. Forty-five minutes later, I am finally hooked up and ready to go. But the wait was well worth it. I then move onto the treadmill where my harness is attached. I feel like a marionette suspended over everyone else in the room. “I miss being tall!”
Next, the robot moves in behind me and attaches to my torso, thighs, calves, and feet. I am “locked” in. The computer program is initiated and my legs are put into the “start” position. I now feel like I am back on my high school track team, lining up for the start of the 100-meter hurdles.
The computer program continues, the treadmill starts to roll, and the robot begins moving my legs. I am still suspended above the treadmill, “walking in air.” Dr. Lo gradually lowers me down to approximately 30% weight bearing. I am now “walking” at a speed of 1.0 kilometer per hour (k/hr). Each step is very determined and seems to me to be exaggerated. I ask Dr. Lo to speed it up a bit. We arrive at 2.3 k/hr and this seems much better, almost natural (if I can remember that far back). My upper body and hips actually “dip” with each step as my legs and the robot absorb the impact. Dr. Lo can make all sorts of adjustments and changes through the computer to alter my stride. He tells me he has “moved” my hips backward, but actually my body has not moved. The effect is that I am now “goose-stepping.” Next he “moves” my hips forward and my heels are kicking up behind me. He can also shorten and lengthen my stride.
I look down at my legs and see each knee rise individually; the toes of my feet push off with each step. This is truly extraordinary, awesome, electrifying. It’s difficult to find the words that accurately describe what I’m feeling. “Energized,” “elated,” “euphoric” only scratch the surface. I feel like I’m 5 years old and have finally ridden my bike, without training wheels or mom holding on. I don’t want to stop: Let’s go faster! Maybe I could jog!
The smile on my face is enormous; the grin is ear-to-ear. The computer monitor tells me my gait is perfect. Of course, it is. It’s not me; it’s the Lokomat. After 10 minutes, I feel secure enough to let go of the parallel bars. The grin gets bigger, if that’s possible. Emile Wamsteker is taking pictures throughout this entire adventure. I wonder if he can eliminate the robot and I’ll look like it’s just me walking on a treadmill. Wouldn’t that be something!
But please don’t misunderstand; I have no misconceptions that I will walk independently. My life is complete as it is. Yes, there are some limitations and some doors that are closed, but many, many other doors have opened and the experiences that I have had may not have happened if it weren’t for the disability.
The computer screen now tells me I have traveled 1,200 meters in 25 minutes. I feel okay and Dr. Lo agrees to let me complete 1,600 meters. It takes 35 minutes to travel 1 mile. This is the best mile of my life, so far!
Thank you, Dr. Lo.
Laura Schwanger is Administrator of United Spinal’s Philadelphia Office.
The Lokomat: Revolutionizing Gait Therapy
Conventional ambulation therapy for patients who have suffered strokes, traumatic brain injury and paralysis of the spinal cord has consisted of the patient holding on tightly to a parallel bar while two therapists moved their legs in an unnatural, forced gait. This is exhausting not only for the patient, but for the therapists as well.
Thankfully, ambulation therapy has evolved with the introduction of the Lokomat Robotic Gait Orthosis of Hocoma, the first computer driven system to assist gait-impaired patients with walking movements on a treadmill. Available since 2001, the Lokomat System, designed by Volker Dietz of the Balgrist University in Zurich, took over 10 years of research and engineering to develop. The $250,000 system surrounds a patient’s hips and legs with robotic like braces that allow them to “walk” with a natural gait allowing the therapy to be more efficient for both the patient and therapist.
This automated process incorporates the Hocoma orthosis with a Woodway treadmill (unlike your typical one-piece tread, the tread on the Woodway is made of many individual slats), and a body weight support system, which is adjusted to the patient’s individual proportions. Utilizing the high-quality computercontrolled motors and sensors that are precisely synchronized with the speed of the treadmill to monitor the speed and gait of the user, the exercise will help properly stimulate the neural network in a patient’s leg, which connects to the circuitry in the spinal column.
Dr. Albert Lo, PhD, Director of the Multiple Sclerosis Clinic and Assistant Professor of Neurology at the Yale School of Medicine/VAMC at West Haven, who conducted the session for Schwanger, explained the theory behind the Lokomat. “Walking is an automated function and there is (within the body) circuitry there for automated function-like little children, even before they walk, if their foot makes contact with a surface, this triggers a reflexive stepping motion, though they have no voluntary control,” Lo said.
“With the Lokomat, we exploit that circuitry, stimulating the leg with repetitive motion which reinforces the spinal cord circuitry as well, which may help with walking. With conventional therapy, you don’t have a normal gait, thus you don’t stimulate the legs in a normal way.”
Dr. Lo was at the controls of the Lokomat, the only one in Northeast, the fifth one in a VAMC (Miami, Cleveland, Palo Alto, and Gainesville are the others), as Laura Schwanger enjoyed her third workout on the system. Dr. Lo feels that the Lokomat will complement what his fellow researches are doing just yards away at the PVA-Eastern Paralyzed Veterans Association Center for Neuroscience and Regeneration Research-finding a cure for paralysis. The Lokomat will help get the circuitry in shape, helping maintain the muscle’s elasticity to accept the drug therapy that is coming down the pike.
Dr. Lo hopes to work with patients with multiple sclerosis who still have the ability to walk for short periods of time (20-40 minutes), thus giving them an opportunity to have therapy on a regular basis. Trials for this equipment are needed, but like everything else, they cost money. The equipment is in place at the VA, but there is other equipment (a gaittesting apparatus, which costs $35,000) and a full-time therapist ($55,000/year) needed before the studies can begin.
Laura Schwanger knows that her muscles reap the therapeutic benefits of the workouts. After each session, she gets the sensation of a deep ache. But outweighing that are the physiological benefits, evident in the euphoria she feels a full month after the session.
Donna Fredericksen is Director of Public Affairs.
Research Goes on, Despite Funding Drought
While Laura Schwanger was working with Dr. Lo on the Lokomat, I had the opportunity to spend the day with Drs. Steven Waxman, Jeffery Kocsis, Lakshmi Bangalore and the team of researchers at the Center for Neuroscience and Regeneration Research at Yale University in the building next door.
The Center was founded nearly 15 years ago by a partnership between United Spinal Association (then Eastern Paralyzed Veterans Association) and Paralyzed Veterans of America to study and develop new treatments, and ultimately a cure, for spinal cord injury and related disorders such as multiple sclerosis. Not only does the center receive funding from United Spinal and PVA, but also it receives funding from Yale University, the United States Department of Veterans Affairs (VA), the National Institutes of Health (NIH) (including the National Institute of Neurological Disorders and Stroke [NINDS]), other nonprofit organizations and private sources.
Research conducted at this facility uses stateof- the-art technology and techniques-from cell and molecular biology and optical imaging to electrophysiology and bioinformatics-to study a wide variety of neurological topics from neuropathic pain and neuroprotection to restoration of nerve function.
As both a member of the Government Relations department of United Spinal, who specializes in Biomedical Research policy, and a former molecular biologist, the purpose of my visit was to discuss the federal and state laws and regulations that both hinder and help the cutting-edge work these world-renowned researchers perform. According to everyone that I spoke with, the most pressing obstacle they face is funding.
Whether this funding is coming from VA, NIH, or state sources, all government agencies are facing a budget crunch and are cutting back their research grant awards. In some cases, the agencies are decreasing the amount of money given per grant or giving the same amount of money, but awarding fewer grants.
Since the economy is weak, private funding sources are less plentiful than they once were, which forces researchers to look toward public sources for funding. That combined with the decreasing number of grants, means that important research is going unfunded, and, therefore, is not performed. Finally, in a few instances, at least one agency has awarded grants and subsequently reduced or eliminated the funding for them.
Additionally, the researchers and I discussed several other policy issues that have arisen during the course of their studies: government ownership of patents and regulations concerning international collaborations, to name a few.
My visit with the men and women of the Center proved most fruitful. Not only were the individuals friendly and eager to show off the incredible work they do, their insight into the red tape they must overcome was invaluable. It is now the job of the entire Government Relations department to help change or tweak public policy to help the Center do theirs.
Melissa R. Weiss is a Legislative Analyst.
