‘Right foot first’: wheelchair users test exoskeletons – 12/18/2023 – Balance and Health

When she woke up in the hospital bed, after a 17-hour surgery, Helena Torres Souza, 70, only moved her eyes. It was December 2018, and two months earlier, she was well and participating in road races. A brain tumor compromised the former physical education teacher’s motor neurons, affected the mobility of her limbs and changed her story.

The turnaround in the life of Levi Silva Castro, 25, was also quick. It happened at the speed of the bus that hit his motorcycle in February 2022, when he was returning home from college — he was studying a degree in Geosciences at USP —, in the east zone of São Paulo. The student was thrown, hit the guardrail and injured the C3 and C4 vertebrae, at the level of the neck.

But it wasn’t the past that the two were thinking about as they watched, from their wheelchairs, the tests with a new exoskeleton at the Vila Mariana unit of the Lucy Montoro Rehabilitation Network. There, through the glass wall and without blinking their eyes, they were looking into the future.

The meeting took place last Thursday (14), when teams from Sheet and Fantástico, from TV Globo, were able to accompany the first patients to use new generation exoskeletons recently arrived from abroad.

There are two new models: the Atalante The arrival of a Chinese model is also under negotiation.

“Bringing them all so we can try out which is the best option for each type of functional limitation is our first desire. Then, knowing all these exoskeletons, we want to identify a model that is flexible, serves a large number of people with functional limitations and that can be built in Brazilian territory”, says Linamara Rizzo Battistella, president of the Board of Directors of the Institute of Physical Medicine and Rehabilitation at USP and former state secretary for the Rights of Persons with Disabilities.

The desire for national equipment relies on the efforts of many professionals and the expertise of years of working with the Lokomat, a previous generation exoskeleton, but depends mainly on patient feedback and results.

“First the right foot”, advises the physiotherapist who monitors the test with the Atalante and works on configuring the equipment for each user. With the help of two professionals and the machine, Helena stands up and takes her first steps. After a few minutes of training, she walks towards her husband and the two hug — standing up.

“You feel like you’re walking, it doesn’t feel like a machine is helping you,” says Helena after the exercise. “It’s a feeling of well-being, I don’t even know how to explain it.”

After that, it’s Levi’s turn to test the ExoAtlet. The device is configured with your measurements and the first steps are taken with the support of a walker. This is then replaced by crutches.

Unlike the Atalante, which has a higher trunk support, movement sensor in the neck and 12 motors, the ExoAtlet is lower, its sensors are located in the knees and hips and there are four motors, compares physiotherapist Rafael Francisco Vieira de Melo. “In the South Korean exoskeleton, the patient needs to have strength in the upper limbs,” he adds.

In both cases, movements are monitored by tablets. The screen allows you to configure the action —getting up, walking or rotating, for example— and shows patient data in real time. In Levi’s case, his heartbeat reached 120 per minute and, at the end, involuntary muscle contractions (spasms) and sweating showed the effort.

“For me, it is so big and so important to live these experiences. I don’t walk and standing up is something that is important. It is important for my rehabilitation and for my body”, he assesses.

There are several benefits, explains André Sugawara, physiatrist at the Lucy Montoro Rehabilitation Network. In Lokomat, the patient has their body suspended while walking on a treadmill and the weight is partially released onto the ground. In new generation machines, there is no suspension mechanism, so the weight is completely unloaded on the floor, the patient walks more freely through the space and can exercise new movements, such as sitting and standing, turning and walking backwards.

“Technology does not cure spinal cord injury, stroke or cerebral palsy, unfortunately. But we have other things to celebrate with this equipment. They help reduce osteoporosis, improve intestinal and urinary problems, including movement, cardiovascular conditioning, and improve well-being”, says the doctor.

Furthermore, despite appearing to be exclusively motor therapies, they activate neurological pathways to carry out movements. “The brain has to think about the movement you are going to make, so the brain gets more tired than the legs”, confirms Helena. After the test, she dreams that one day it will be possible to take the equipment home.

Levi is more cautious. He highlights that this is an increase in the rehabilitation process and the desire is to see the teams and devices spread to other units of the SUS (Unified Health System), reaching the outskirts, to the hospital in the east zone where he heard violence such as “get up and walk” and “stop free”. “My pain wasn’t validated,” he recalls.

“I knew that the Lucy Montoro Network existed, fully equipped. And it was so far away because I was there in bed, there in São Mateus. And I knew that I needed it. Today I’m here, I do rehabilitation with several professionals, just How many other Levis aren’t waiting in line? How many other Levis don’t have access to this?” asks the boy, a member of Uneafro Brasil and the Movimento Black Lives with Disabilities Matter. “I’m not here alone and I don’t want to be the last. I think it has to be for everyone and it’s very important to be within the SUS.”

Linamara also dreams. With the help of professors Arturo Forner Cordero and Adriano Siqueira, from the Polytechnic School and the São Carlos School of Engineering, both at USP, the aim is to create and make the national exoskeleton available as soon as possible.

In ten years? Her eyes fill with water, contrasting the response of the heart and the one that reason expresses with words. “Technology has to be cheap, so everyone can enjoy it”, argues the researcher. In this period of time, she imagines access, ease of pricing, security and certainly financing for the health system.