Sunday, 12 February 2017

#ResearchSpeak: restoring walking - stimulators vs. exoskeletons

Are exoskeletons the solution to MS-related walking impairment? #ResearchSpeak #MSBlog

The case study below describes a man with MS who lost the ability to walk, but with the clever use of implanted nerve stimulators they were able to restore his ability to walk. Use of nerve stimulation is only possible because MS is a disease of the central nervous system and leaves the so called peripheral nerves, or peripheral wiring, intact. This is why FES (functional electric nerve stimulation) works. The technique use here is invasive and expensive; it requires the implantation of electrodes and expensive hardware. I personally think this is not the solution to walking-related MS disability. In an ideal world we would want to prevent walking impairment from happening in the first place; we are trying to do that with our treat early and effectively (treat-2-target of NEDA with zero tolerance) paradigm. If this does work then we need a more pragmatic approach. I suspect this will end-up being the commercialisation of exoskeletons that have already been shown to work. At the moment they are too expensive for broad use, but as with all technologies the price will plummet with time. At the moment they are not available for pwMS under the NHS. 


If you are pwMS who is unable to walk or are finding it increasingly difficult to walk, would you use an exoskeleton or at least want to try one? 

Selkirk et al. Feasibility of Restoring Walking in Multiple Sclerosis with Multichannel Implanted Electrical Stimulation. Am J Phys Med Rehabil. 2017 Feb 1. doi: 10.1097/PHM.0000000000000692.

A patient with multiple sclerosis-related gait dysfunction was followed over the course of his disease. Despite aggressive treatment, he developed significant weakness in ankle dorsiflexors and hip and knee flexors and was no longer capable of consistently taking a step on his own. With electrical stimulation of hip and knee flexors and ankle dorsiflexors using implanted electrodes, he was able to consistently walk short distances as far as 30 m, thus significantly improving his Expanded Disability Status Scale score. This case study supports further exploration into the potential benefits of an implanted pulse generator to ameliorate gait dysfunction and improve quality of life for people with multiple sclerosis.

9 comments:

  1. Not practical. What about fatigue? Even the exoskeleton will exacerbate fatigue.

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  2. Well, unfortunately, we don't live in an ideal world, you will always have the 10% like me with PPMS, and I have quite limited mobility - I'd love to be able to walk a reasonable distance again - you know, to the end of the street to post a letter, step on and off the kerb, exotic things like that. So yes, I would wear an exoskeleton and am in the early stages of using an FES (though not with implants).
    Exoskeletons may be expensive, but how expensive is treating someone with a DMT for 10/20 years - peanuts? I think not.

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  3. Exoskeleton....sure, whatever it takes.

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  4. I would definately use an exoskeleton - in fact I am following the news about them. My hope as RRMS is a light-weight exoskeleton (I think they're developing one right now).

    The price will come down eventually and the technology will get better so yes it is a great hope for MSers and others.

    My ideal world would not be to stuff myself with drugs but a world where there are NO wheelchairs due to affordable technical devices.

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  5. I'd rather do my best to stay walking, but in case I end up losing it yes, it is a good option

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  6. Here in Brazil has a neuroscientist, Dr. Miguel Nicolelis, doing a study with the use of exoskeletons in paraplegia from accidents. This week they were announcing in newspapers that certain patients after continuous use of the exoskeleton were describing return of sensitivity, touch, etc., and even stammering certain movements.

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  7. Yes I would certainly use it if it was the only way I could walk

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  8. There a few of these types of devices out there now. As has been mentioned the main market is paraplegics. I saw this device being trialled on a local beach by a paraplegic and it looked impressive. Priced at over $1000,000 it is cost prohibitive.

    The accessible type of FES is generally via a rehabilitation cycle called a Motomed - most MS societies in Australia have several - however the stimulation is supplied by direct muscle stimulation via pads placed at muscle innervation sites. How does this compare with transplanted innervation?

    And yes, I too, would use it in a heartbeat if my walking failed.

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