An artificial exoskeleton, new hope against the fallout from stroke | Sciences

When speaking, Estibaliz Zabalza (Pamplona, ​​1975) steadily fixes his blue eyes. It is an example of struggle and overcoming. In 2019, his life turned upside down when he suffered a stroke. It wasn’t the first, but it was the most brutal. “That night I lost the normal life that everyone has. I need sticks to walk, my language has slowed down a lot,” he explains. Since then, he has been working to restore movement and sensation on the left side of his body, one of the most common consequences of acquired brain damage. Now he has another reason for hope: an industrial-use exoskeleton weighing barely 1.9 kilograms, which, through a system of pulleys, allows him to extend the range of motion of his arms. It was initially designed to assist factory workers with tasks such as weight lifting, but the Association for Acquired Brain Injury of Navarre (Adacen) has discovered that it could be useful in rehabilitating such patients.

Adacen is now studying the rehabilitative use of exoskeletons with an ambitious goal in mind: that people with acquired brain damage may one day have an exoskeleton in their homes. The research is part of the Autonomía al Cuadrado project, funded by the Innova Social Program of the La Caixa Foundation and Caja Navarra. They have a period of two years and financing of 130 thousand euros. The study started with 32 users, and in January it was limited to 10 people who were worked on individual goals, says Amaia Aguas, a rehabilitation specialist at the entity.

The exoskeleton, in and of itself, is not a novelty in the field of health. In its automated version, it has been used for years to alleviate, for example, amputations. However, their cost is quite high, and can reach 100,000 euros. The device tested in Adacen is simpler, has no motor and its price is lower, between 4,000 and 5,000 euros. The affordability has put it in the spotlight in the industry, details Cesar Gonzalvo, commercial director of Iruña Automation Technologies, a company that lent Adacen the two exoskeletons it’s testing. Still amazed by the initial results, he explains that they were originally used to make it easier for physical therapists to transfer patients. It was then that the association found that it could be of greater use. “The first time they tried it on a user, we almost fell on our backs, because the person was moved, they cried because they could finally feel their arm,” he recalls.

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Aguas adjusts the outside structure on Estíbaliz Zabalza.
Aguas adjusts the outside structure on Estíbaliz Zabalza.Paul Lassosa

This exoskeleton repositions the body and makes it easier for the user to move its limbs, which generates a stimulus in the brain, the damaged organ. When there is a stroke or acquired brain damage, one of the most common consequences is that affecting the motor part, and this is always associated with a decrease or change in sensitivity. When I want to move a limb, I have to feel it. Sometimes, when placing the device, the brain sees the arm better, and if I feel it and know where it is, I will be able to do the movement better, ”explains Gonzalfo. It is a simple tool, quick to install and adapts to different user profiles. However, he emphasizes, given Because they have an industrial purpose, small adjustments have been necessary, such as the placement of homemade scales to fine-tune the aid given to each of the limbs.

Much more needs to be done, warns Aguas. They have already started the intensive phase of the study with 10 people, grouped by rehabilitation goals. Six of them have the ability to grab and drop objects with their hands; The other four do not have it and its purpose is to work on the control goals at the level of the shoulder, ”the rehabilitation points out. Some, like Estibaliz Zabalza, suffer from hemiplegia, that is, weakness or paralysis on one side of the body. “With which we seek greater ranges of movement and that fatigue appears a little later,” explains Aguas as the user performs one of the exercises, combining virtual reality glasses with the use of an exoskeleton. “If we had done it without him, he wouldn’t have been able to spend so much time with his arms raised and it would have been a gesture Pointed from the wrist, not from the shoulder, which is what we want,” explains Aguas.

It is also useful for profiles such as those of Milagros Azcona (Uterga, 60 years old). In 2009, she suffered two strokes, which left her in a difficult situation. “I didn’t move anything, not even my fingers, it felt so bad,” he explains. Today, Azcona uses a wheelchair and is already in a chronic phase. In other words, a noticeable recovery is no longer expected, but work is being done to maintain the mobility it has. By spending all day in the chair, Azcona explains, the exoskeleton helped him “straighten his back and move his arms.” As Aguas explains, “The upper extremities are not affected, but spending a lot of time in a flexed position makes it difficult to lift the arms.” The improvement is visible. “I’m glad my back hurts less and I feel lighter,” Azcona smiles.

Patient Estíbaliz Zabalza performs an exercise with an exoskeleton and virtual reality goggles.
Patient Estíbaliz Zabalza performs an exercise with an exoskeleton and virtual reality goggles.Paul Lassosa

Two different files, with an improvement in both cases. However, the rehab insists it is still an early stage study. “Now we’ve started the six-month intensive phase with 10 users. After that, the idea is to be able to take it home. Maybe as a rehabilitation tool to add to what they’re doing at the center. Hopefully in the future they’ll be able to have it in their homes.” As Aguas says.

The rehabilitator understands that it is essential to manage users’ expectations. “The results so far are very positive, but more time must pass to see how applicable they are,” adds Andries Elundin, director of Adacen. This project was born, Ilundáin details, out of the entity’s innovation unit, what NeuroLab calls, “a space for co-creation between companies, users, universities and professionals”. “Users tell us their needs and we try to find solutions,” he says. New technologies are necessary, such as virtual reality glasses or electrical stimulation, which also help in cognitive rehabilitation. For example, in users with spasticity, a common sequel to acquired brain damage that causes “the hand to remain rigid, without movement, causing a lot of pain.” The goal, he insists, is to “try to give them more autonomy, to make them more self-serving”. To do this, it encourages companies to collaborate with them in a relationship.”the win“.

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