How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KOK CHIN YONG
Consultant Neurologist and Internal Medicine Physician
Sunway Medical Centre Velocity
FIRST, LET’S TAKE A LOOK AT STROKE

Stroke is a medical emergency caused by the disruption of blood flow to your brain.

Without enough oxygen, your brain will stop working properly. This is why stroke is often considered the brain’s version of a heart attack.

 

Ischaemic stroke

This occurs when there is blood flow disruption to the brain. This can occur when the blood vessels in your brain are blocked by blood clots or other substances.

This is the most common type of stroke and is often linked to poorly controlled type 2 diabetes, high blood pressure, and/or high blood cholesterol levels.

Haemorrhagic stroke

This type of stroke occurs when there is internal bleeding in the brain. Accumulated blood in certain areas of the brain can exert pressure to brain tissues in these areas and damage these tissues.

While not as common as ischaemic stroke, this type of stroke is especially dangerous because the affected person’s symptoms can get worse very quickly and urgent medical attention is needed to prevent permanent brain damage and even death.

MOST STROKE SURVIVORS EXPERIENCE GAIT DISABILITY

Stroke is one of the main causes of disability.

2005 statistics from the American Heart Association revealed that more than 80% of stroke survivors suffer from gait disability—the loss of mobility due to impaired ability to walk normally.

Gait disability can affect the survivor’s quality of life.

However, there are also other repercussions of this disability on the person: the person’s confidence and sense of independence can be compromised.

Furthermore, gait disability is linked to increased risks of cardiovascular diseases and death in people approaching 80.

Because of this, gait therapy is an important aspect of rehabilitation for a stroke survivor.

ALL IS NOT LOST, AS THE BRAIN HAS A CHANCE TO ADAPT & RECOVER

The brain is an amazing organ. The network of nerves and other tissues involved in brain function can adapt to changes by reorganizing themselves, or ‘rewire’ in response to these changes.

“This can happen after a stroke,” Dr Kok explains, “as the brain begins to compensate for the damage caused by the stroke.”

This process, called brain neuroplasticity, can involve the formation of new connections between remaining healthy nerves and ‘recruiting’ other parts of the brain to take over the functions that were handled by the now-damaged part of the brain.

Much research is being done on the neuroplasticity of the brain to explore possible ways to improve the rehabilitation process of people that had a stroke or other brain injuries that affect their normal day-to-day function.

Currently, research data increasingly suggests that techniques that can stimulate the part of the brain affected by stroke can help improve the rehabilitation of the lost function linked to that part of the brain.

HENCE, GAIT THERAPY IS AN ESSENTIAL COMPONENT OF A STROKE SURVIVOR’S REHABILITATION

Dr Kok Chin Yong mentions that the restoration of a stroke survivor’s ability to walk can be a complex process.

The stroke survivor’s inability to walk normally is usually due to the stroke disrupting the function of the nerve pathways in the region of the brain that plans and controls movement called the motor cortex.

Furthermore, the stroke survivor also often suffers from other debilitations that make it harder for them to walk, such as changes in their muscle tone and strength as well as impaired heart function.

Additionally, the more gait therapy is delayed, the harder it is to achieve a good outcome because the organs involved in walking will further weaken and waste away due to lack of use.

Hence, gait therapy should be prioritized as soon as it is feasible to do so.

ROBOTICS-ASSISTED GAIT THERAPY CAN BENEFIT STROKE SURVIVORS CONSIDERABLY
If you have not read Dr Foong Chee Chong’s explanation of what robotic-assisted gait therapy is, you can do so by clicking here. Have a read, and then hit the back button to come back here and continue reading—it will help you better understand the rest of this article!

Dr Kok explains that the first line of rehabilitation is conventional physiotherapy.

“During this stage, we will assess the patient’s suitability for robotics-assisted gait therapy,” he explains, adding that the criteria for suitability are similar to those explained by his colleague Dr Foong is the above-linked article.

“The main benefit of the use of robotics is that many patients can regain their normal physiological walking at a faster rate than conventional physiotherapy,” he shares.

He elaborates that this is due to the robotic exoskeleton stimulating the neuroplasticity of the patient’s brain, helping it to relearn how to order and control the movement of the patient’s lower limbs at a much faster rate.

He reiterates that such outcome is more likely achieved when the robotics-assisted gait therapy is initiated as early as it is feasible to do so.

Hence, he encourages stroke survivors to consult their doctors further on whether such a therapy is suitable for them.

THIS IS THE SECOND PART OF THE SERIES LEARNING TO WALK AGAIN

Below are the articles in this series:

  1. A Rehab Specialist Explains How a Robot Can Help You to Learn Safely & Successfully to Walk Again
  2. How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate (you’re reading this article now)

References:

  1. Duncan, P. W., Zorowitz, R., Bates, B., Choi, J. Y., Glasberg, J. J., Graham, G. D., Katz, R. C., Lamberty, K., & Reker, D. (2005). Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke, 36(9), e100–e143. https://doi.org/10.1161/01.STR.0000180861.54180.FF
  2. Newman, A. B., Simonsick, E. M., Naydeck, B. L., Boudreau, R. M., Kritchevsky, S. B., Nevitt, M. C., Pahor, M., Satterfield, S., Brach, J. S., Studenski, S. A., & Harris, T. B. (2006). Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA, 295(17), 2018–2026. https://doi.org/10.1001/jama.295.17.2018
  3. Su, F., & Xu, W. (2020). Enhancing brain plasticity to promote stroke recovery. Frontiers in neurology, 11, 554089. https://doi.org/10.3389/fneur.2020.554089
  4. Selves, C., Stoquart, G., & Lejeune, T. (2020). Gait rehabilitation after stroke: review of the evidence of predictors, clinical outcomes and timing for interventions. Acta neurologica Belgica, 120(4), 783–790. https://doi.org/10.1007/s13760-020-01320-7

3 Tips to Work From Home Without Hurting Your Posture

WORDS DR LIM SZE WEI

FEATURED EXPERT
DR LIM SZE WEI
Consultant Orthopaedic, Spine & Trauma Surgeon
ALTY Orthopaedic Hospital

While working from home does come with benefits but it also limits physical movements and takes a toll on our postures.

We started seeing a rapidly rising number of young Malaysian adults that are suffering with neck and back pain, especially those working from home and who work for long hours on their devices.

Consciously, we must remind ourselves to pay attention to the signs our back and neck is giving us, so that we can lower the risk of developing serious spinal conditions down the road.

Tip 1
CREATE AN OPTIMAL WORK AREA
  • Invest in a proper desk and office chair.
  • Ensure that the chair and desk you’re going to be working on is comfortable, supportive, adjustable, and ergonomically sound.
  • Pick a work desk with an optimal height so that the neck, shoulders, and arms remain at a neutral position.
  • Sett up your workstation perpendicular to the window and away from direct light, to minimize the strain on your eyes.
Tip 2
WORK ON YOUR POSTURE
  • Good standing or sitting posture involves having the body be symmetrical, weight evenly distributed and well aligned so it does not strain the neck and back muscles.
  • Use a monitor as a primary working computer instead of a laptop to help improve your posture. If that is not possible, use a book or laptop stand to raise the laptop, so it is at eye level.
  • While being seated, place a small pillow behind your lower back to maintain an arch to lean back in and relieve your back muscles.
  • Keep your forearms and hands leveled and straight by having the keyboard and mouse close to the laptop.
Tip 3
RELAX YOUR MUSCLES
  • The issue isn’t sitting or remaining still while working; It’s being stuck in one place for too long. The body accumulates stress between managing tight deadlines, budget demands, performance reviews, and even the everyday challenges of the day.
  • To keep the mind and, by extension, body healthy, you can combine basic stretches with breathing exercises and other relaxation techniques while you work.
  • Stretches, short walks, or even small bursts of exercise are a great way to get the muscles active and engaged throughout the day.
  • Set alarms or reminders throughout the day to get up and stretch. A 30-second “microbreak” is just enough to change your posture briefly and helps take the pressure off and relax.

Are You Worried That Your Child May Have Scoliosis?

WORDS DR WONG CHUNG CHEK

FEATURED EXPERT
DR WONG CHUNG CHEK
Consultant Orthopaedic & Spine Surgeon
ALTY Orthopaedic Hospital

Scoliosis is a common, sometimes hereditary spinal medical condition, in which a person’s spine curves to the side, typically in the shape of an “S” or “C.”

A stable and mild case of scoliosis does not cause significant lifestyle issues, but severe cases with prominent curves can be harmful to a person’s health.

THE TRUTH ABOUT SCOLIOSIS

People often believe, erroneously, that carrying heavy bags, having poor body posture, participating in sports, or sleeping on one side will cause the spine to bend, but that isn’t quite the case.

The reality is that over 80% of all scoliosis cases have no known cause. Such cases are known as idiopathic scoliosis.

According to studies, scoliosis affects 2-3% of the Malaysian population, or between 600,000 and 900,000 persons . It’s most often detected during adolescence, but it is also known to affect adults and the elderly at a lower rate.

Scoliosis usually progresses very rapidly during the growth spurts and only slows down or stops once the child reaches bone maturity. Signs of scoliosis become more noticeable as a child grows in age or as the curve progresses, but that doesn’t mean that scoliosis is impossible to notice early.

Because the signs are not always visible in mild cases, parents should examine their children on a regular basis.

The earlier scoliosis is detected, the better the odds of preventing scoliosis from causing serious issues down the line.

HOW TO DO HOME-CHECKS FOR SCOLIOSIS IN YOUR KIDS
As scoliosis usually starts just before the child shoots up in height, parents should begin looking for symptoms at that time. Look out for:

  1. Look for an imbalance in the height or position of shoulders, shoulder blades, or hip — for example, one shoulder appears to be consistently dropping below the other.
  2. Also look for a misalignment of the head with the rest of the body.
  3. An uneven waistline or hips, as well as whether one shoulder blade protrudes more than the other.

If you see any signs of scoliosis, regardless of how minor they are, you should schedule an appointment to see a specialist to do further observation and to also check on the severity as some hospitals may not be able to do a comprehensive check.
WHEN SHOULD YOU CONSULT A DOCTOR?

If you are still unsure, it is best to consult a doctor as soon as you can. Sometimes mild symptoms may not be easily spotted, and doctors can help perform more tests and X-ray scans.

An orthopaedist who specialises in pediatric conditions will be able to recommend more tests, examinations, and preventive measures upon further consultation.

If the curve identified is less than 20° degrees, the curve will be observed to ensure that it does not worsen. This is especially important for children who are still developing, although well-grown children may not require more X-rays. Such cases may require more testing like MRI which can be used in addition to the X-rays for more detail.

New imaging modality like the EOS is able to provide better images of the spine with a quarter of the radiation dose.