The system supports and moves the patient’s legs through its combination of motors and sensors. During the early stages of training, the exoskeleton is tethered to the ceiling to prevent a patient from falling. It is eventually untethered.  In addition, two specially trained physical therapists walk with the patient  -- one uses a remote to control each step while the other stands behind the patient and coaches the patient through the learning process. Rittenhouse is one of only six rehabilitation facilities in the country to use this device with patients.

According to Kristin Gustafson, DO, director of Spinal Cord Injury Services at Penn Medicine Rittenhouse, the repetitive motion of taking a step, shifting your weight, and taking another offers potential benefits for patients with long-term immobility. It can decrease the risk of osteoporosis, suppress spasticity (uncontrolled spasms) and improve skin circulation. Even more important, ambulating helps maintain the spinal cord’s central pattern generators -– these are the ‘way stations’ that connect messages from the brain to the muscles. 

Gustafson said, “There’s an improved chance for functional recovery when you maintain the central pattern generators, and weight-bearing, reciprocal ambulation helps maintain these connections.”

Standing more frequently also lowers the incidence of orthostatic hypotension, the sudden decrease in blood pressure that can cause a patient to pass out. And it helps improve the patient’s cardiovascular health as well.  “With each step I have to move one of my crutches and shift my weight to keep my balance,” Webb said. “It’s quite a workout!”

Gustafson also believes that physiologic and kinematic data from using the system will lead to valuable research opportunities for spinal cord and other neuro injuries.

 “We’re very excited,” said Timothy Dillingham, MD, chair of Physical Medicine & Rehabilitation at HUP. “Bioengineering devices have the potential to greatly improve people’s lives. We look forward to the point where these robots will augment wheelchairs for use in the community.”

Photo caption: Dan Webb, who is paralyzed from the waist down, takes steps while wearing the Ekso system, a battery-powered exoskeleton.  Helping him are physical therapists Diane Duda (right) and Elena Newland (behind).