Clinical benefits of exoskeletons

Helena López; why did you decide to become a physiotherapist?

Because I like dealing with people, I like helping, I like healthcare… All these reasons were leading me towards medicine, but, in that case, I would spend little time with the patient. I preferred the contact, to be more involved in their evolution. And what made me decide,
specifically for the field of neurology, was the movie: Regarding Henry, I said: “I want to devote myself to this” (like one of the characters of the movie).

How many years and where did you work?
I worked for more than 10 years in a foundation dedicated to the rehabilitation of people with spinal cord injury and other pathologies of neurological origin.

What role does physical therapy play in the daily life of a person with spinal cord injury?
As a patient with a neurological pathology once told me: “the physiotherapist becomes our best friend” (along with other professionals such as occupational therapists).

At first, we teach the body and the person how to live with the sequelae: how to move, how to perform activities of daily living and. Furthermore, but not less important, we focus on preventing potential secondary complications associated with spinal cord injury, seeking to provide, considering the difficulties, a better quality of life. I believe that when someone has a motor alteration of neurological origin, with greater or lesser frequency, they will always be in the hands of a physiotherapist.

As a patient with a neurological pathology once told me: “the physiotherapist becomes our best friend”

Which are the conventional, or more extended, rehabilitation techniques?
Techniques focused on the stimulation of the preserved musculature, seeking its functionality (movement, balance, coordination, etc.), and improvement or maintenance of basic functions such as cardiorespiratory function. It can be therapeutic exercise, use of medical or sports devices, hydrotherapy, and even new emerging technologies such as exoskeletons or virtual reality.

How can robotic therapies help in the rehabilitation process?
First, they help to perform a specific task, sometimes intensively, which has been shown to enhance neuronal stimulation.

Also, they help to increase patients’ motivation. And, finally, they contribute to decreasing community expenditure, since less personnel is needed and they are also less fatigued and can accompany the patient on the task for a longer period of time.

Who can use an exoskeleton?
Any person who meets the inclusion criteria of the device. In general terms, it is very important to have stood upright on a regular basis (prevention of osteoporosis); be able to stand upright without experiencing dizziness, and have free range of motion in the extremities involved.

How is therapy with robotic exoskeletons performed?
Exoskeleton therapy will always consist of a first phase to properly adjust the exoskeleton. Subsequently, a process of familiarization, learning, and training on how to use it and, finally, practice and seek the maximum degree of independence in its use.

Why did you decide to join the ABLE team?
I had been using an exoskeleton in my clinical practice for many years, and at some point, I had considered studying something related to biomedical engineering. I like learning, I like research, and I think that part of the future of my profession will go in this direction.

I had never imagined being in a project like this, but when I saw the job offer, without knowing that this type of job existed for my profession, I thought it was just what I was looking for.

“…the device has been designed focusing on the user, and that is the user who drives the exoskeleton, who decides when to walk and when to stop.”

How does the ABLE Exoskeleton differ from other commercial exoskeletons?
The biggest difference: the device has been designed focusing on the user, and that is the user who drives the exoskeleton, who decides when to walk and when to stop. Another important difference would be its lightweight and ease of adjustment between different users.

Which role do you play in the development of the ABLE Exoskeleton?
On the one hand, I participate in testing sessions with different types of users with different levels of injury, and report what works and what does not. I work on the process of continuous improvement of the ABLE Exoskeleton. On the other hand, I am in contact with different rehabilitation centers and clinics. And finally, to keep up to date with the advances that are published.

Who integrates the testing sessions team?
It is a very interdisciplinary work (one of the things I like most about the job), but mainly engineers (from different specialties) and me, as a healthcare professional.

At ABLE, how is the process of collaboration with hospitals/rehabilitation centers organized?
It depends on the rehabilitation center and the objective of the collaboration.

First, we have the centers where clinical investigations have been performed (Institut Guttmann, Heidelberg University Hospital, and Asepeyo). And then, there are the rehabilitation centers that are interested in our device. In this case, we sign a collaboration agreement where the possibility of performing punctual visits is stated, to perform demonstrations with the exoskeleton and get feedback to further improve the device.

Which clinical institutions have tested the ABLE Exoskeleton?
Institut Guttmann (Badalona); Heidelberg University Hospital (Heidelberg), Asepeyo Hospital (Sant Cugat); CEN (European Center of Neurosciences) (Madrid); Vall d’Hebron Hospital (Barcelona); SIRN (Barcelona); Isidre Esteve Foundation (Sant Cugat); National Hospital for Paraplegics (Toledo); Association of Multiple Sclerosis and other neurological diseases (Toledo).

What do you feel when you see the reaction of patients in the first session?
Motivation. It constitutes the strength needed to keep working for them. Our goal is to make their daily lives easier and help them as much as possible.

What is the current situation in Spain and the world regarding the field of exoskeletons for rehabilitation?
I think it is in full expansion. Large centers are already working with great technology. It should be more affordable for small rehabilitation centers and be introduced gradually into routine clinical practice.

Regarding home use, there is still a lot of work to be done.


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