Man's journey to walk again
GREENVILLE — Phillip Bryant is on a long walk back to being whole again, measured in steps that lead nowhere but everywhere. With him every step of the way are God, his physical therapists and his robot.
A Jan. 8, 2011, car wreck near his home in Ahoskie severely damaged Bryant's spinal cord and left him unable to move from about at his navel down.
"I didn't really have a lot of hope," Bryant said during an interview at Vidant Rehabilitation Center in Greenville last week. "I was told to go home and live my life in a wheelchair. When a doctor tells you you're never going to walk again, who do you reach for? I reached to God and prayed for healing."
He began his self-determined recovery by wearing braces on his legs and moving along parallel bars, just barely standing, then moving along slightly in his braces. When his doctor learned Phillip had taken some steps in his braces, he wrote a prescription for him to use the Lokomat, a robotic therapeutic locomotion device manufactured by Hocoma of Switzerland.
When Bryant first began his therapy, he had no sensation of his lower body, he said. Through repetitive use of the Lokomat on a five-day-per-week regimen, he began to feel parts of his lower muscles when they contracted.
"One day, I got off the machine and could feel my calf muscles pulsating and spasming," he said. "I could feel the burn of my workout, my muscles firing."
He now has between 20 percent and 40 percent uninterrupted nerve impulse flow between his spinal cord and various muscles and joints of his lower body, he said.
The Lokomat will not regenerate a severed or damaged human spinal cord, his therapist said. Nothing known can accomplish that. The device is most effectively applied on patients like Bryant who have partial damage to their spinal cords and those who have damaged brains due to stroke but can stand.
The Lokomat's repetitive motion helps a body retrain its undamaged portion to pick up at least a portion of the neurological load that the permanently damaged portion once performed, an adjustment the body is capable of making, Tart said. In those circumstances, use of the Lokomat in conjunction with other traditional therapies can lead to improved or restored standing and walking ability of people with neurological damage, she said.
"There have been lots of studies that show that repetitive training has better results than once-weekly therapy, by focusing on the use of central pattern generators (CPGs), the central pathways to the brain," Tart said. "We recommend three to five therapy sessions with the Lokomat, for about 30-40 minutes each session to get the maximum benefit."
Six to eight people currently use the therapy.
Once acclimated to moving and performing the motions of walking in his robotic apparatus, Bryant directed Tart to place some small bean-bag toys on the treadmill beneath his feet, to serve as visual obstacles over which he could step.
"It teaches him to lift and flex his leg, using his muscles as well as the machine," Tart said.
The adjustable speed of the treadmill and weight-bearing capacity of the Lokomat device facilitate the user's progress and improvement.
A monitor in front of Bryant can be used to display a video graphic of a walking environment through which a user must navigate, much like a video game. One environment is a park with trees, other people and animals, through which a user can virtually walk. It makes the exercise more fun for children to participate in.
Bryant, however, is usually all business in the therapy room. He prefers to look at a bio-feedback graph that displays his muscular energy output as he walks in the machine; his actual physical contribution to the movement. The graph displays the output at specified parts of the body, including the hips, knees and legs.
"Then, we educate the client to repeatedly lift, lift, lift," Tart said.
The ratio of human-machine contribution is programmable and adjustable to the user's improving abilities, Tart said.
"It's a slow process," Bryant said, "but your body is so smart and communicates with itself."
The Lokomat is a benefit to the therapists as well as the user.
"Working with a person on land, a therapist can get very worn out and tired after 15-25 steps, making therapy hard for both to continue," Tart said. "The nice thing about the Lokomat is that it holds up the user and allows longer training sessions."
Tart said the positive emotional results gained from working on a machine like the Lokomat, combined with the will to thrive and succeed, contributes a great deal to a user's progress.
"The impact of a person's state of mind is huge, huge, and greatly affects how the therapy works," Tart said. "The effect of standing and walking in the machine can be a great motivational experience. It's even a good exercise for those who have never and will never walk or stand alone, providing the kind of lift that you or I get from a trip to the gym."
Bryant puts his rehabilitation in perspective, he said.
"This is my job now. I try not to make it my obsession," Bryant said. "Right now, the Lord has me on this machine, working with these wonderful therapists who really care about me. I definitely expect to be walking freely within five years. I want to take my daughter camping and fishing."