I Can Walk Project
The Physical Medicine and Rehabilitation Division (PM&R) at Barrow Neurological Institute at Phoenix Children’s Hospital is dedicated to maximizing the functional recovery of children with neurological disorders. The primary goals are to reintegrate children back into school system and community as quickly as possible.
Ewa Brandys, MD, division chief of PM&R, received funding from the Leadership Circle to purchase the RTI 600, a robotic walking device with functional electric stimulation manufactured by Restorative Therapies, Inc. Many children with neurological disorders lose their ability to walk due to severe muscle weakness and impaired motor control, resulting in a sedentary lifestyle.
This sophisticated, cutting-edge equipment presents the opportunity for children to reach their highest recovery potential in a shorter period of time and fulfill their dreams of walking. The device can be used on children as young as 3 years of age.
Many robotic devices for gait training are commercially available and cleared by the FDA. They improve the efficacy of therapies and patient satisfaction. In 2011, the RTI 600 was cleared by the FDA and is the first to combine a robotic motorized device with computerized functional electrical stimulation (FES).
RTI 600 consists of motorized footplates and can provide vibration and perturbation during standing. The patient is secured in a harness on the electrically powered lift. This allows support for an adjustable amount of body weight and is called partial body weight supported stepping or standing.
The machine’s SAGE smart functional electric stimulation system can power 10 muscle groups to produce walking movements by true muscle contractions. Electric current is delivered to muscles through adhesive electrodes in sequential pattern and uses the child’s own muscles’ activation to enable standing and walking exercise. FES has been studied in children and adults and has shown reverse muscle atrophy, improved circulation, increased range of motion, and reduced muscle spasms.
Many neurological disorders including stroke; cerebral palsy; brain injury; tumor; spinal cord injury; transverse myelitis; spina bifida; and multiple sclerosis have devastating effects on a child’s mobility. The consequences of a sedentary lifestyle in children can be significant, not only affecting quality of life and self-esteem, but their overall health. Children who cannot walk or exercise frequently experience life-long complications such as muscle atrophy; joint deformities; brittle bones leading to fractures; poor cardiovascular endurance; obesity; premature cardiac disease; skin breaks; and diabetes. Restoration of function and neurological recovery occurs through neural plasticity, which can help children avoid these unfortunate consequences and live active lives.
Neural plasticity is activity dependent and occurs when a person is practicing the specific skills that need to be restored. Intense and frequent repetition of the activity is needed so motor learning can occur and strength is restored. Achieving this level of intensity is rarely possible with traditional rehabilitation approach. Traditional gait training requires prolonged time and assistance of one to three therapists per patient. These traditional therapy sessions usually can only accomplish between 10 and 200 steps and require significant physical effort of the treating therapists and patients. Gait patterns of these children are usually abnormal due to weakness and impaired coordination, so the motor learning of walking is not optimal.
Based on scientific evidence, more intensive and frequent practice produces better outcomes than traditional therapies. This high level of exercise intensity is achieved with use of sophisticated robotic equipment designed to replicate and support natural functional movements and allows patients to practice hundreds of steps during a single therapy session. Using mechanical devices also prevents physical exhaustion and injuries in therapists. Robotic devices provide motor precision of functional training and stimulate robust positive neuroplasticity.