Technology designed by researchers with Case Western Reserve University (CWRU) and with the Advanced Platform Technology (APT) Center and Functional Electrical Stimulation (FES) Center at the Louis Stokes Cleveland VA Medical Center has shown that FES significantly helped two men with gait impairments walk more effectively. FES helped Robert Bush, 42, who has multiple sclerosis (MS), and Joseph McGlynn, 69, who has a post-stroke gait impairment, walk farther and faster.
Nathan Makowski, PhD, an investigator at the FES Center, said that FES technology has been used primarily for therapy in stroke patients in the past. “This, though, is a more long-term assistive system,” he said.
Bush walks with the help of FES stimulation in a still from a video recording.
Photograph courtesy of CWRU.
“I went in there and I could barely take two steps,” said Bush, who researchers believe is the world’s first patient with MS to test an implanted FES system. His proof-of-feasibility test lasted 90 days. “At the end, I was walking down the hallway. To me, it was monumental.”
McGlynn could walk with a cane, but not easily. With the technology switched on, he covered far more ground and his pace was twice as fast during his 30-week study.
“It’s helped with balance and confidence,” said McGlynn. “I’m confident now that I can walk without stumbling and falling.”
“In both cases, there is a disconnect between the brain and muscles,” said Stephen Selkirk, MD, PhD, a neurologist at the VA’s Spinal Cord Injury Division and assistant professor of neurology at CWRU School of Medicine. “This system replaces the lost connection.”
The system includes implanted electrodes that tie into nerves that control the hip and knee flexors and ankle dorsiflexors. When Bush or McGlynn walks, he pushes a button on an external controller, which sends signals to a pulse generator, which then sends electrical pulses to the electrodes. The pulses stimulate the nerves, which in turn stimulate the muscles in both of Bush’s legs and McGlynn’s left leg.
“Both guys were taking steps the first time we turned the systems on,” said Ron Triolo, PhD, a professor of orthopedics and biomedical engineering at CWRU and executive director of the APT Center. “When Robert Bush took a step, it wasn’t pretty, but we saw the potential.”
Both men gained strength and endurance through repeated use of the systems and fine-tuning by the researchers. Bush went from two steps to consistently walking more than 30 yards during the trial. In that time, he used a walker to help maintain his balance. McGlynn’s gait became noticeably more symmetrical and energetic, the researchers said. His gait without the system was about 19 yards per minute; with the system, it was 47 yards per minute. Training with the system improved McGlynn’s speed to 23 yards per minute when it was turned off, indicating therapeutic benefit. Initially, he could walk 83 yards but improved to 1,550 yards at the faster gait.
The studies, “Improving Walking with an Implanted Neuroprosthesis for Hip, Knee, and Ankle Control After Stroke” and “Feasibility of Restoring Walking in Multiple Sclerosis with Multichannel Implanted Electrical Stimulation” are published in the December 2016 and February 2017 issues of the American Journal of Physical Medicine and Rehabilitation.
Editor’s note: This story was adapted from materials provided by Case Western Reserve University.
To watch a video of Bush walking while using the FES system, visit https://youtu.be/17JYaKkdRYs.
To watch a video of McGlynn walking while using the FES system, visit https://youtu.be/3CYq-FSFQLM.
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