Paraplegics are making great strides

By Gabi Falanga Time of article published Aug 12, 2015

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Johannesburg - He looks like a robot and sounds like one too. But every now and then, he pants heavily, giving away that he is human.

Carlton Mabusela, 50, is strapped into a robot-assisted walking machine to help him regain the ability to walk.

Nearly 14 years ago, the police officer was shot through his spine while on duty. Now he’s a paraplegic.

But last year his life changed when someone told him about a piece of equipment at the Netcare Rehabilitation Hospital in Joburg called the Lokomat.

The Star watched as he regained his mobility.

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Physiotherapist Regan Ryan and his assistant Thulani Dube start off by helping Mabusela into a harness.

He’s then hoisted up from his wheelchair by the machine. While he’s hanging above a treadmill, Ryan and Dube strap the robot-like motorised callipers to his legs.

Then it’s time to start walking, something the doctors told Mabusela he’d never be able to do again.

“Walking with the machine is so exciting - that was something I last did 13 years ago. There is progress. The blood circulation is improving. The feeling is growing in my legs. I can now feel sensation above the knees,” he enthusiastically tells The Star.

The Lokomat helps with strengthening, stretching and stimulation, says Ryan.

“It’s a set of callipers controlled by motors at the hips and the knees that copy a normal gait pattern. The research on body-weight-supported treadmill training is showing that this is what’s needed to produce normal gait in a patient.

“If you want to learn to walk you have to get up and walk. You have to feel the weight on the heels and the toes,” he says.

Ryan uses a computer screen to control the variables such as walking speed, range of motion, what percentage of the patient’s body weight is counter-weighted by the machine, and what percentage of walking effort the patient must put in and how much is done by the machine.

Graphs on screens seen by both Ryan and the patient show their progress.

“Sensors on the legs see how hard which muscles are working. We can see when a muscle is activated. Once they’re able to string a set of muscles together to perform a task, we try to get the muscles firing at the right times.

“Carlton was told he’d never walk again, but now his quads are coming back and he even has some hamstring activity, which he hasn’t had before,” says Ryan.

A feedback system in the form of a TV screen with a cartoon on it, which mimics the patient’s movements, assists the patient on a subconscious level in relearning to walk.

“It’s a great tool. It’s not just using the patient’s feeling of his legs, but giving a subconscious image as well,” Ryan says.

Another patient, 29-year-old Matt Cohen, broke his neck in a freestyle motocross accident 11 years ago, leaving him quadriplegic.

He explains what his therapy consisted of before he started using the Lokomat three years ago.

“Before we had this machine, we used to do this manually on a treadmill. Two people had to move each of my legs,” Cohen says.

Ryan adds that the Lokomat is better because, unlike when a therapist has to manipulate a patient’s legs, each step is the same, error due to therapist fatigue is eliminated, and the patient can walk for longer.

It is also safe as there is no chance of a patient falling.

But Ryan points out that for people who’ve been disabled by strokes or brain and spinal cord injuries, the Lokomat should be supplemented with other rehabilitation therapy.

“This is not a silver bullet… you have to put the graft in. This is merely a tool in the rehabilitation process,” he says.

For patients who were told they would never walk again, seeing themselves walking has a positive psychological effect.

The Lokomat was brought into the country “by a wealthy patient of mine who broke his neck in about 2009. We went around the world and he chose the best of the best,” Ryan says.

His patient imported the Lokomat from Switzerland, the country where it was designed.

When the patient emigrated to England three years ago, Ryan convinced him to sell the Lokomat to him so that other patients in the country could benefit from it.

Because Ryan is still paying off the equipment, patients have to pay about R500 a session to use it. Medical aids don’t recognise it yet.

But he is adamant it should also eventually benefit those who can’t afford to pay for it.

“For patients who can’t afford it, we do pro bono cases, but it’s limited. We try to find patients with the best potential to walk again and then offer them those services, but we want to start a fund for people who can’t afford it at all,” he says.

Maintaining the machine is also expensive and Ryan has to get a technician from Switzerland once a year to service it.

But just watching two wheelchair-bound men walking over a kilometre each shows it’s worth it.

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The Star

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