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With device’s aid, the paralyzed take steps anew

Rehabilitation facilities test robotic exoskeleton

A crew of physical therapists and a team from Berkeley Bionics worked with David Leone to test new technology that will help him take steps. A crew of physical therapists and a team from Berkeley Bionics worked with David Leone to test new technology that will help him take steps. (Joanne Rathe/Globe Staff)
By Carolyn Y. Johnson
Globe Staff / September 15, 2011

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David Leone left behind his familiar wheelchair, shifting himself onto a chair where a robotic external skeleton fitted to his 5-foot-11-inch frame sat waiting. Half a dozen people scurried around him, cinching Velcro straps tight around his legs and torso. He grabbed the handles of a walker, leaned forward, and hoisted himself to his feet.

Seven years after he last walked, Leone - paralyzed from the waist down - lifted his right foot and took a step, with the robotic technology moving his limbs.

The 37-year-old from Millis kept on going, racking up 284 steps in a 42-minute session this week at Spaulding Rehabilitation Hospital in Boston.

“It’s a steep learning curve,’’ he said afterward. “It felt a little awkward at first. But there were a couple of times where it just felt . . . normal.’’

Leone, paralyzed since he fell backward off a ladder in 2004, is among the first people with spinal cord injuries to try out eLEGS. The robotic technology, developed by a California company called Berkeley Bionics, is undergoing investigational studies at Spaulding and nine other rehabilitation centers.

The device is completely external, initially with steps triggered by pushing a button on a remote control. That spurs the device’s computer to coordinate the complicated choreography of a step, utilizing motors and sensors at the knees and hips. The machine does all the work, but it’s up to the patient to learn again how to walk, how to lean forward into the opposite foot, how to move with confidence when there is no feedback from the lower half of your body.

Spaulding is piloting the technology on six patients this week, with plans to begin using the device next year, after a version becomes available for use at hospitals and rehab centers.

“Traditionally, there was not very much’’ to offer patients with spinal cord injuries, said Dr. Ross Zafonte, vice president of research, education, and medical affairs at Spaulding. “Now, we’re talking about a real mechanism, an exoskeleton mechanism, for getting people to walk.’’

Researchers looking for ways to help people with spinal cord injuries are moving forward on multiple fronts, ranging from biological approaches aimed at regenerating injured tissue, to protective approaches that minimize the damage in the immediate aftermath of an injury, to engineering approaches that use robotics or implanted technology to restore mobility. The research, however, is still at an early stage in many of these areas.

The eLEGS device will initially be used only at hospitals, although the company plans to make it available for home and personal use. Company officials would not say how much it would eventually cost. But it ultimately may work best in combination with other technologies.

If biological therapies are successful in restoring injured tissue, for example, patients would need rehabilitation devices that help retrain them how to use their muscles and bodies.

“It’s not only important for getting the best mobility and function out of a person in their current state, but also as we develop stem cell therapies or regeneration drug therapies or even neuroprotection therapies, you will want to add a rehabilitation component onto it, to maximize the end result,’’ said Kim Anderson-Erisman, education director of the Miami Project to Cure Paralysis, a research group at the University of Miami Miller School of Medicine focused on spinal cord and brain injury.

Researchers and clinicians are getting to a point, Anderson-Erisman said, where different biotechnologies are beginning to be tested in patients, a necessary step to understanding what sorts of interventions work and are practical. It is an exciting time, she said, noting that next week, the Miami Project plans to apply to federal regulators to begin clinical trials of a cell-based therapy for spinal cord injury.

But even as work continues on the ultimate goal of cures for paralysis, the fast-paced world of robotics has begun to attract considerable attention, and the interest of patients who hope to play a role in bringing the technology forward.

“I don’t pay too much attention to claims of ‘cures,’ ’’ Leone said.

While he would love to be able to walk again, Leone said, he has concentrated on living his life. He thought the eLEGS technology had more immediate promise, so he was interested in trying it out, not knowing what to expect.

After he took his first step, Leone looked down at his feet, pursing his lips as he tried to get used to the feeling of being upright and searching for a way to be aware of his lower body. He asked if he could have a mirror, to help understand whether he was leaning and how to balance. He began to look up as he got used to the rhythm: moving the walker, leaning forward, stepping.

The first time he sat back down in his wheelchair, he said, it felt a bit unnatural, almost foreign.

The next day, he said, he cast aside the walker and began to move more naturally, with crutches.

Leone has talked with his family about the possibilty of walking again. His grandmother, in particular, is convinced that he will be up on his feet one day. But he has also built a joyful, normal life after the accident, and he approaches new therapies with determination and pragmatism, not desperation or unrealistic hopes.

His wife, Michele, was 4 1/2 months pregnant when he was injured, and their son, Ryan, was born shortly after Leone got out of the hospital. Father and son grew up together, in a way, Leone learning how to do routine tasks again, while his son learned to walk by pushing his father’s wheelchair around.

“He’s only said once, ‘Daddy, I wish you weren’t in a wheelchair,’ and when he said that my heart just absolutely broke,’’ Leone said.

“I asked him, ‘Why?’ ’’ Leone said. “He looked at me, and he said, ‘You’re not that good at hide and seek.’ “I said, OK, if that’s the worst you’ve got, I can live with that for now.’’

Carolyn Y. Johnson can be reached at cjohnson@globe.com. Follow her on Twitter @globecarolynyj.