Every 40 seconds, an American has a stroke, according to the World Stroke Organization and American Stroke Association.
There are 9.2 million survivors of stroke, and of those survivors, more than 60% find themselves unable to walk or with an impaired gait and in need of intense rehabilitative intervention. If unresolved successfully, these survivors experience a markedly increased fall risk, loss of independence, limited participation in social activities, and lower quality of life. Therefore, effective rehabilitation becomes critical in their recovery to improve their ambulation, as well as other motor skills that are lost or diminished following their stroke. Core to effective rehab is a well-planned, focused, and repetitive practice, based on the principle of neuroplasticity.
In 2007, the revolutionary branch of science called neuroplasticity gained public attention due to the publication of The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Norman Doidge, MD. Previously, it was believed that you could not teach an old dog new tricks because the brain stagnates in adulthood. However, this book shared the growing swell of research on neuroplasticity, which demonstrated that the brain was continuously growing and adapting – especially following neurological injuries like a stroke.
In the context of stroke, the brain begins to engage in neuroplasticity to restore function by reorganizing itself to transfer functions from the damaged areas to unaffected areas. However, during this process, the brain can mistakenly cheat itself and develop unhealthy compensatory habits – such as a pathological gait, or a limp, that disfavors the weakened or paralyzed side. Furthermore, because practice doesn’t make perfect, it makes “permanent” by building and reinforcing muscle memory. Therefore, we see that the longer the unhealthy habit remains unaddressed, the more difficult it becomes to help the patient unlearn the repeated process.
Due to this, stroke rehabilitation during the early stages of recovery, where neuroplasticity is still malleable, becomes most important. Using the same process that can lead to unhealthy compensatory behaviors, proper rehabilitation guides neuroplasticity to rewire and reorganize the brain with heavy repetition on correct step patterns when walking and being able to stand upright or sit down in a single fluid movement. As we repeat and practice, the corresponding pathway in our brains strengthens, and the movement becomes easier for the patient so they can regain functions impacted by stroke, as well as their independence.
Core to leveraging neuroplasticity are exoskeletons, which have created a paradigm shift in stroke rehabilitation to restore ambulation. Exoskeletons ensure the natural neuroplasticity process is effectively engaged in generating the best long-term results for patients so they can learn the correct way to walk during post-stroke gait training. The ideal exoskeleton device is also smart enough to detect when a patient may need assistance facilitating with the rest of the movement. By doing so, exoskeletons prevent the patient from developing compensatory habits, such as limp, which could increase their risk of falls or injuries in the future.
One important thing to remember while utilizing exoskeletons in rehabilitation is earlier is better, because of neuroplasticity. In my personal experience, I have noticed that in acute care, placing patients very early (on day 3 or 4 post-stroke) in gait and ambulation training with exoskeletons has resulted in a faster recovery process when compared with doing so later during recovery. Overall, I believe that 2 weeks of consistent exoskeleton gait training can show significant improvement, especially when compared with standard rehabilitative strategies that can take up to 4 weeks of manual gait training.
For example, I was recently working with a business executive who was in his late 60s when he experienced a stroke and developed paralysis on his left side. Due to the severity of his injury, many of those caring for him were doubtful that he would return to full ambulation and would require a wheelchair to assist his mobility.
However, 1.5 weeks into his in-patient stroke rehabilitation journey, we decided to incorporate the EksoGT exoskeleton into his gait training.
(Within 2-3 weeks of using the device and 5-6 total weeks in rehabilitation, he was discharged, with regained ambulation. This not only enabled him to walk again, but also improved his confidence in his ability to soon return to work after he completed out-patient speech rehabilitation. This successful rehabilitation mirrors our other stroke patients who have used our exoskeletons during rehabilitation and who saw significant improvements in their ambulation and quality of life.
When a stroke occurs, doctors and patients are frequently taught that time is imperative to the brain and to quickly treat stroke to minimize complications or even death. The same principle should also be applied for stroke rehabilitation because of neuroplasticity. Earlier rehabilitation, especially with technologies that engage neuroplasticity like exoskeletons, can ensure patients practice the correct repetitive motions and limit dangerous compensatory behaviors.
(By encouraging stroke survivors with impaired ambulation to seek out rehabilitation that includes exoskeletons, those caring for this patient population are improving their patients’ odds of getting back on their feet and walking earlier while supporting their possibility of maintaining independence at home and in the community.
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