Two sides to the story: Part 2 – Robotic Rehab

“It is a fantastic time to be a rehabilitation physician”, says Ilse van Nes. “We can now use technology to help people with things they can’t do for themselves, or can’t do well. That’s a great benefit for spinal cord injury patients, and it’s very inspiring for a rehabilitation doctor to be involved in.”

Caring for patients with spinal cord injuries. This is what Ilse van Nes, rehabilitation physi- cian at the Spinal Cord Injury Department of the St. Maartenskliniek has been doing since 2008. Some patients have a complete spinal cord injury, where the brain and body are no longer communicate. Other patients have an incomplete spinal cord injury, where part of the connection is still intact.

The effects of a spinal cord injury depend on where the damage is located. For example, a high spinal cord injury may also paralyse the arms, whereas a low spinal cord injury may only cause problems from the hips down. “In addi- tion, a spinal cord injury has many ‘invisible’ effects”, says Van Nes. “Think of bladder and bowel problems, problems with sexuality, less skin sensation because nerve impulses don’t get through, disturbed body balance, and so on.”

Encouraging Exercise
Van Nes combines patient care and scientific research, which she believes is ideal, because the most important research questions arise during care. The St. Maartenskliniek is all about optimising chronic care. Van Nes: “One way we try to do this is through the comprehensive aftercare clinic, where the entire team exam- ines all patients with a spinal cord injury every two years. We also look at ‘invisible’, secondary complications, such as a low bone density, possible wounds and infections, spasticity and bladder and bowel problems.” Another essential part of their approach is to get patients moving as much as possible. Exercise has health benefits in almost every area. “So we strongly encourage patients to move”, says Van Nes. “We have done this so with a rigid exoskeleton in patients with complete spinal cord injuries. These patients cannot walk on their own, but with the help of such an exoskeleton and a lot of training, sever- al people have managed to walk again.”

Soft exoskeleton
Meanwhile, with a TopZorg grant from ZonMw, Van Nes and colleagues have also started their research on the MyoSuit, a soft exoskeleton that is considerably cheaper, more flexible and easier to use than the hard exoskeletons used for patients with complete spinal cord injuries. Van Nes: “Theoretically, some patients with incomplete spinal cord injury can put on such a MyoSuit themselves. We are investigating whether this is actually the case and whether the suit also leads to them walking more in their home environment.”

The St. Maartenskliniek has purchased four MyoSuits for this study. The participants will be able to try out the suit for six weeks, to experi- ment in their everyday environment. Do they use the suit, do they walk more and further, is it user-friendly enough, or do they quickly cast it aside? “We use sensors to monitor actual use”, says Van Nes. “And we conduct user interviews to find out what they like and dislike about the suit. These factors will determine its success. For the time being, anyone who wants to continue using the suit after the study is over, will have to buy it themselves. Dutch health insurance com- panies do not (yet) reimburse the purchase.””