Ronald J. Triolo, Ph.D.; Case Western Reserve University, Peer Reviewed Medical Research Program Principal Investigator

About 11% of Americans have some form of paralysis from an injury to their spine. But 25% of all people with spinal cord injuries are vets. So a spinal cord injury and paralysis in itself is a big problem in the veteran population.

Now as veterans age they typically develop, like all of us, other medical problems-stroke, MS, other kinds of disorders that affect their ability to stand and step. So the issue of mobility and walking and just exerting control over your environment is a pretty high priority for the Veterans Administration.

We received a grant from the Peer Reviewed Medical Research Program to design an advanced orthosis that would help people with complete spinal cord injuries to walk long distances, stand for extended periods of time, and negotiate steps. All of these things are impossible with conventional orthosis and impossible for people with paralysis.

This specific project deals with bracing, actually re-envisioning what orthosis or braces can do for someone with a complete spinal cord injury. It combines novel braces with electrical stimulation of the paralyzed muscles, and the notion is that most conventional braces lock the joints into one fixed position.

So what we're trying to do is develop braces that can lock and unlock the joints in phase with the gate cycle so that walking can be more fluid and natural for these individuals who don't have direct control of their muscles.

What we've been trying to do is to design a new hip mechanism that allows people to vary how much they can swing one leg while they extend the other. So as you walk faster and faster you take longer and longer steps.

Conventional bracing tends to lock the joints into place and restrict their movement and that can be counterproductive to someone who wants to move dynamically and walk or ascend stairs. So by re-envisioning how the orthosis interacts with the body, we think we can overcome a lot of those limitations of conventional bracing.

So the underlying principle of this research is to combine the advantages of electrical stimulation which is very efficient at providing short bursts of impulsive power to swing a limb forward or to move the body forward. But it's not as good at maintaining sort of static phases of gait when you're standing on one leg or standing quietly on both legs.

Conversely, braces are good at that sort of thing so the marriage of the two should be able to take advantage of the benefits of each mode-braces for static components, FES for dynamic components, lock the joints when they don't have to move to turn the stimulation off and allow people to rest. And by combining the advantages of each, by hybridizing the system, we should be able to allow people to walk farther and faster than they could with braces or stimulation alone and we should enable new functions like stair climbing and descent that were impossible with each mode by itself.

These prototypes are giving us invaluable opportunities to explore what will work, what won't work, what the best approaches are, and where the dead ends are so that we can streamline the process in the future once we figure out the best approaches.

This research is done in collaboration with the Department of Veterans Affairs and here at a VA Medical Center. We have the luxury of having two national centers of excellence in Cleveland that have created the environment that lets this work take place.

So the real advantage of the Peer Reviewed Medical Research Program to us has been the ability to focus on the nuts and bolts of the mechanism to assemble prototypes, to do the real engineering that's involved in order to demonstrate whether these concepts will really work in practice. So without the Peer Reviewed Medical Research Program, a lot of our work would still be conceptual and theoretical. They were really instrumental in reducing concept to practice. In our case, it was a god-sent because it allowed us to concentrate on engineering design and the practical issues of building and testing prototypes, getting things into practice; so it's the-it fills the gap between basic science and theory and clinical care.