Parkinson's patient walks more smoothly thanks to a robotic Exosuit

Challenges and Innovations in Managing Freezing Symptoms in Parkinson's Disease

Parkinson's disease, a neurodegenerative condition affecting over 9 million people globally, is marked by a prevalent and incapacitating symptom: freezing. This manifestation involves an abrupt loss of the ability to move the feet, typically happening mid-stride. It leads to a series of disjointed and progressively shorter steps until the individual comes to a complete stop. The occurrence of these episodes significantly increases the risk of falls among individuals living with Parkinson's disease. Despite various approaches, including pharmacological, surgical, and behavioral therapies, currently employed to address freezing, none of these interventions have demonstrated high efficacy in managing this challenging symptom. This persistent need for more effective treatments highlights the complexity of addressing freezing episodes and emphasizes the ongoing pursuit of innovative solutions within the medical community.

Currently, a range of approaches, including pharmacological, surgical, and behavioral therapies, are utilized to address freezing in Parkinson's patients. However, it is noteworthy that none of these interventions have demonstrated high efficacy in managing this challenging symptom. The persistent need for more effective treatments underscores the complexity of addressing freezing episodes and highlights the ongoing pursuit of innovative solutions within the medical community.

Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) and Boston University Sargent College of Health & Rehabilitation Sciences researchers have successfully utilized a soft, wearable robot to assist an individual with Parkinson's in walking without freezing. Worn around the hips and thighs, the robotic garment provides a gentle push to the hips during leg swings, enabling the patient to achieve a longer stride.

This innovative device completely eliminated the participant's freezing while walking indoors, resulting in an increased walking speed and distance compared to unassisted walking. Conor Walsh, the Paul A. Maeder Professor of Engineering and Applied Sciences at SEAS and co-corresponding author of the study, expressed, "We found that just a small amount of mechanical assistance from our soft robotic apparel delivered instantaneous effects and consistently improved walking across a range of conditions for the individual in our study."

This research highlights the promising potential of soft robotics in addressing the challenging and potentially dangerous symptom of freezing in Parkinson's disease. The application of soft robotic technology could not only enhance mobility but also restore independence to individuals living with this condition.

For more than a decade, Conor Walsh's Biodesign Lab at Harvard's School of Engineering and Applied Sciences (SEAS) has been dedicated to advancing assistive and rehabilitative robotic technologies aimed at enhancing mobility for individuals post-stroke and those affected by conditions like ALS. One notable technology developed by the lab is an exosuit designed for post-stroke gait retraining, which received support from the Wyss Institute for Biologically Inspired Engineering. Harvard's Office of Technology Development facilitated a license agreement with ReWalk Robotics for the commercialization of this technology. In 2022, SEAS and the Sargent College at Boston University secured a grant from the Massachusetts Technology Collaborative to bolster the development and translation of next-generation robotics and wearable technologies. The research activities are centralized at the Move Lab, whose mission is to advance human performance enhancement by providing collaborative space, funding, R&D infrastructure, and expertise necessary to transform promising research into mature technologies. The goal is to facilitate collaboration with industry partners for the effective translation of these technologies.

Soft Wearable Robot Breakthrough: Alleviating Freezing of Gait in Parkinson's Patients

The development and application of soft wearable robots to address freezing of gait in Parkinson's patients required a collaborative effort among engineers, rehabilitation scientists, physical therapists, biomechanists, and apparel designers, according to Conor Walsh. Walsh's team closely collaborated with Terry Ellis, professor and Physical Therapy Department chair at Boston University, for this project.

The researchers worked intensively for six months with a 73-year-old man with Parkinson's disease who experienced frequent and debilitating freezing episodes despite undergoing surgical and pharmacologic treatments. These freezing episodes severely impacted his ability to walk independently in his community, necessitating the use of a scooter for outdoor mobility.

Building on previous research that demonstrated the effectiveness of soft, wearable devices in augmenting hip flexion for energy-efficient walking, the team applied a similar approach to address freezing in this study. The wearable device, utilizing cable-driven actuators and sensors around the waist and thighs, employed algorithms to estimate gait phases and generate assistive forces synchronized with muscle movements.

The results were immediate and promising. The patient, without special training, was able to walk indoors without freezing and experienced only occasional episodes outdoors. Remarkably, he could walk and talk without freezing, a rare occurrence without the device. Jinsoo Kim, a former Ph.D. student at SEAS and co-lead author on the study, expressed the team's excitement about the technology's impact on the participant's walking. The patient himself provided valuable feedback, stating that the suit helped him take longer steps and maintain a higher quality of life.

The wearable device not only addresses freezing of gait but also holds the potential to contribute to understanding the poorly understood mechanisms behind gait freezing. The study suggests the benefits of a "bottom-up" approach to treating gait freezing by restoring almost-normal biomechanics, altering peripheral dynamics, and potentially influencing central processing of gait control. The co-authors of the research include Jinsoo Kim, Franchino Porciuncula, Hee Doo Yang, Nicholas Wendel, Teresa Baker, and Andrew Chin. Asa Eckert-Erdheim and Dorothy Orzel contributed to the technology's design, while Ada Huang and Sarah Sullivan managed the clinical research.