The first step came with a mechanized whir.
Mike Parsons moved his left foot forward, guided by a robotic frame attached to his legs and torso. Composing himself, focusing straight ahead and relying on the help of two physical therapy nurses, he shifted his weight and stepped with his right foot.
After suffering a stroke in January, Parsons had all but lost the use of the left side of his body. Now, with the help of a newly-developed medical device, he was ready to challenge his previous record for consecutive steps.
“My record is 209 (steps), and I’m going to beat it,” he said. “I’m determined.”
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With the help of a robotic exoskeleton, stroke patients such as Parsons are able to strengthen their bodies and heal more quickly, walking sooner than ever before. The Ekso robotic exoskeleton is a device worn like a brace that provides support and helps regain mobility. The software in the bionic frame can be adjusted to focus on either side of the body, which is ideal for stroke patients.
And as a patient gets stronger, the walking program can be adapted to make rehabilitation more challenging.
“It’s a game-changer,” said Dr. Sachin Mehta, medical director of rehabilitation at Franciscan Health Indianapolis. “As a rehab doctor, my whole specialty is making sure people can function as independently as possible. Any kind of injury, in this case a stroke, we want to see people getting up and moving as quickly as possible.”
“We’re able to implement this as a tool in the overall rehab process. You can see, their outcomes show that they’re improving very quickly.”
The Ekso has been in use helping people with spinal cord injuries for many years. But only in the past year was it approved by the Food and Drug Administration to be used for stroke victims.
The device consists of a support for the patient’s back and lower torso, with a strap fit snugly across the chest. The leg supports are strapped on at the thigh, calf and foot.
When it is turned on, the Ekso assists in weight shifting and moving the leg forward, to help reform the patient’s natural gait.
“When you have a stroke, one side of the body can be normal strength while the other side is weakened,” Mehta said. “It can sense when your heel hits the ground, and provide that muscle movement on the weaker side for the patient.”
Parsons, a Morgantown resident, suffered a stroke Jan. 13. The 57-year-old was home by himself when he felt the left side of his body go numb.
He managed to get to the phone to call 911. Doctors described it as a massive stroke, completely paralyzing half of his body and slurring his speech.
His diagnosis made him an ideal candidate for the Ekso, Mehta said.
In traditional therapy for stroke patients such as Parsons, movement such as this wouldn’t be possible for months, Mehta said. Their focus at this point would be helping him use a wheelchair, getting in and out as well as maneuvering it.
Now, from the first day of rehabilitation, he’s up walking in some capacity.
“We’re able to get them up on day one, get them started on this rehab and working on walking with a better pattern,” Mehta said. “Traditionally, the therapist has to do a lot of the work for the patient, strengthening the legs and arms until they’re strong enough over six, eight weeks, even three months, until they’re strong enough to take steps. We don’t have to wait for that anymore.”
Franciscan Health Lafayette Central was the first hospital in the state to use the system, and Franciscan Health Indianapolis purchased their own unit in late 2016.
Physical therapy nurses did extensive training to learn how to use the device in November, before the hospital started using it with patients. They’ll do another round of training in April to further hone how it’s used, said Amy Horter, therapy manager at Franciscan Health Indianapolis.
The first patients started on the Ekso in December. So far, 10 people have been helped by it.
The device is intended for stroke patients who have weakness in one side of the body. They have to be between 5 feet, 2 inches and 6 feet, 2 inches tall, and weigh less than 220 pounds.
At the same time, patients also have to have the right attitude to want to work and get better. Parsons excels in that area, Horter said.
“Mike is our comic relief in the unit,” Horter said.
Dressed in an Indiana University hat, shirt and pants, Parsons joked with his nurses and teased them about college basketball and going to Purdue. Nurses Sandy Lim and and Leah Bush gave it right back.
But when it was time to get up and start walking, all three were focused. Lim and Bush carefully supported Parsons’ body from either side, helping correct his stance when he favored one side too much and preparing him for the next step.
Halfway down the rehabilitation department hallway, they stopped and had Parsons rest in a chair. They made him catch his breath, even as he wanted to push on.
“No, let’s go,” he said, pointing down the hallway.
The device weighs 23 pounds, so when patients first strap it on, it can be deceptively burdensome. But that only helps strengthen the body.
“The first day, it was a little heavy, because I wasn’t used to it. After that, it’s gotten lighter,” Parsons said. “It works good.”
From its computerized control panel, the Ekso will count how many steps a patients takes, how long they worked and where improvements can be made.
That data can be analyzed to better suit each person’s rehabilitation plan, Horter said.
Though data is still being compiled, the use of the Ekso has been shown to reduce falling, improve balance and increase confidence, Mehta said.
During his first session, Parsons took 116 steps with the Ekso. The second time, he increased it to 151, then to 209.
Weeks of therapy have helped him regain much of his ability to speak and the use of his hands. Training his body to move properly, with a normal walking motion, is the next step.
“He’s a gadget guy, so he’s loving this whole thing,” said Paige Parsons, his daughter-in-law.