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At the Bench-Subarachnoid Hemorrhage: Spreading Depolarizations Cause Acute, Not Just Delayed, Damage in Subarachnoid Hemorrhage

IMPROVING CROUCh GAIT IN CP The first of the two studies using robotic devices to improve crouch gait in children with cerebral palsy was published on July 26 in Science Robotics, led by senior author Sunil K. Agrawal, PhD, professor of mechanical engineering and rehabilitation medicine at Columbia University. Rather than directly straighten the children’s posture, Dr. Agrawal’s seemingly contradictory approach was to increase the downward force on their pelvis as they attempted to walk on a treadmill. The tension in each wire, attached to a belt on the pelvis, is modulated in real time by a motor placed around the treadmill in response to motion capture data from cameras. Unlike other robotic devices that have been tested for treating crouch gait, the TPAD has no rigid links to the body, permitting free movement of the legs. After training in the device for 15 sessions of 16 minutes each over the course of six weeks, the six participants showed enhanced upright posture, improved muscle coordination, increased step length, range of motion of the lower limb angles, toe clearance, and heel-totoe pattern. “You can see a marked difference before and after,” Dr. Agrawal said. “We heard from families and the children themselves that they were walking faster, with better posture. Now we have to see if we should use a higher magnitude of downward pull, how long each training session should be, and for how many sessions.” Commenting on the TPAD study, Dr. Dobkin said, “The kids who were selected for inclusion were not necessarily the kind who get surgery. They had less of a crouch, a little bit more of a push-off. The question is whether training like this will lead to good over-ground walking. They got a hint of that.” The second crouch-gait study, published on August 23 in Science Translational Medicine, involved a wearable exoskeleton designed for over-land use, and was described by the authors as the first robotic device designed specifically to treat a gait disorder in children and adolescents. Rather than force the lower limb to move in a particular way, “the exoskeleton dynamically changed the posture by introducing bursts of knee extension assistance during discrete portions of the walking cycle, a perturbation that resulted in maintained or increase knee extensor muscle activity during exoskeleton use,” the paper stated. “In the last decade, there’s been a groundswell of work on exoskeletons, but a majority of them are designed to permit mobility after spinal injury in adults who have lost the ability to walk,” said senior author Thomas Bulea, PhD, a staff scientist in the functional and applied biomechanics section of the rehabilitation medicine department at the National Institutes of Health Clinical Center in Bethesda, MD. “There hasn’t been much done for the pediatric population who just need to improve their walking.” A coauthor of the paper, Diane L. Damiano, PT, PhD, chief of the section in which Dr. Bulea works, said the purpose of the wearable exoskeleton is different than that of the TPAD device developed by Dr. Agrawal. “His device is designed to strengthen the calf muscles by increasing the resistance on them,” she said. “His results were good, but this is very different from what we are doing. We have a wearable device. It’s not meant to be used in a lab for training. We’re not necessarily trying to strengthen them, although that would be a desired outcome; we are instead trying to assist their abilities to help them practice being more upright while they walk. This is something that they would wear throughout the day for several months with the goal that their posture will ultimately be improved without the device.” A surprising observation, she added, was that some children saw it as something cool to wear. • Robotic Assist Devices Continued from page 22