Last night’s Christmas-rific Glee ended with what seemed like a holiday miracle. Artie, a character confined to a wheelchair, took a few halting steps with the help of a machine called the ReWalk. “It was invented by some guy in Israel,” he said, before using the ReWalk and crutches to move across the floor. But was ReWalk’s Christmas-saving screen time on Glee just Hollywood magic or based on real science?
The ReWalk exists (and was, in fact, invented by some guy in Israel) but was only recently approved in the U.S. for institutional use by the Food and Drug Administration. That means only hospitals and rehab centers will be able to purchase the device, starting early next year, so it’s not going to end up under anyone’s Christmas tree any time soon. But the doctors who are using it in a clinical setting are optimistic about its ability not to “cure” paralysis—the spinal-cord injury remains and no sensitivity is restored to the damaged limbs—nor to restore all mobility to those who have had a spinal-cord injury, but to help those patients regain independence, get better exercise, and avoid complications that can come with life in a wheelchair.
The device itself is a robotic exoskeleton—practically a full-body computer, worn around the legs, chest, shoulders, and back. It “consists of a lightweight wearable brace support suit, motorized joints, rechargeable batteries, an array of sensors and a computer-based control system,” according to MossRehab, a division of Albert Einstein Healthcare Network, in Philadelphia, which was the only U.S. institute to take part in the clinical trials. The ReWalk is powered by a backpack computer that sends signals to the leg supports when it detects subtle movements indicating changes in gravity. Wearers can control the motion of the legs via sensors in the upper body and the use of crutches. Because of the need for upper-body support and movement, the machine is intended only for paraplegics, who can control their arms and shoulders.
Moss has been testing the device for more than a year with a dozen patients (though one had to drop out of the trial due to medical issues). In that time, Alberto Esquenazi, M.D., the director of the gait-and-motion-analysis laboratory and regional amputee center at Moss, has been impressed with the results. “We’ve seen marked improvement in cardiopulmonary response—basically, they’re exercising in a more natural way,” he says, noting that the simple acts of standing and walking actually offer tremendous exercise benefit, from cardiovascular development to bone strength. “We’ve seen an improvement in their tolerance to standing and a sense of emotional reward in being able to stand and walk again. In the long term, we suspect that it’s going to be beneficial for bones.”
After all, paralysis is more than just losing the ability to walk. Because people with spinal-cord injuries are not getting that natural exercise from walking, they lose bone mass and have inhibited blood flow. They’re at risk for sores and lesions, muscle spasm, and bone decay. They can have trouble performing essential functions such as bowel movements or sweating, and their emotional health takes a toll as their physical health declines.
So far, the ReWalk (known in the scientific literature as ARGO, or advanced reciprocating gait orthosis) hasn’t been studied for how it addresses most of these ancillary issues, but Esquenazi says he’s optimistic, and that some patients are reporting better bowel function and fewer muscles spasms. Currently the patients use ReWalk for an hour a day, three times a week, but Esquenazi sees a broader application.
“The goal is to eventually make this device to be usable at home so they could use it for many hours a day,” he says. That’s closer to the situation presented on Glee last night, but it’s not yet a reality—not only is there no FDA approval yet for home use, but users first must undergo strenuous training (it takes about 20 hours to understand how best to use the device) and fitting—because people with spinal-cord injuries have minimal or no feeling in their legs, they are susceptible to sores, scrapes, and other injuries if the leg supports don’t fit properly.
So how much did Artie’s mysterious benefactor (most likely Coach Bieste, the sweetest Santa in recent TV memory) shell out for the device? The U.K.’s Daily Mail reports that ReWalk will sell for about $100,000—a cost that its inventor says is far less than the “costly complications that often arise in people who can’t walk.” Because of that, the website of Argo Medical Technologies, the Israeli maker of ReWalk, says the company expects some of that cost will be covered by insurers.
But for now, people with spinal-cord injuries who are looking to recreate Artie’s Christmas miracle will have to settle for a part-time solution.
by Kate Dailey