NMMC Rehab Patient First in State to Use Personal Robotic Exoskeleton
TUPELO, Miss.— A patient at North Mississippi Medical Center’s Outpatient Rehabilitation Center recently became the first in Mississippi to use the ReWalk robotically-assisted walking system.
Carla Belue, 42, of Red Bay, Ala., has been a paraplegic since a car accident on Sept. 16, 1992, when she was a freshman at Northeast Mississippi Community College coming home for a visit. Belue is an incomplete paraplegic, meaning that her spinal cord was bruised rather than severed. She has sensation in her legs but little movement.
She first heard about ReWalk while attending a conference this spring with her husband, Rodney, who is an investigator for the Red Bay Police Department. “We were in South Carolina, and I met a lady whose husband was using the ReWalk,” she said. “It was God intervening. I called immediately to look into it.” At the time, the closest training facility was in Dallas, Texas.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with spinal cord injury like Belue to stand upright, walk and turn.
In May, Belue evaluated for ReWalk at a newly-approved training site in Birmingham. That day was the first time she had stood and walked in more than 10 years. “I had done physical therapy after the accident, but insurance doesn’t pay for therapy for very long,” she said. “That day was amazing.”
The technology does not come cheap—each system costs $77,000 and is not covered by insurance. The Belues started fundraising in September and met their goal by October, thanks to tremendous community support.
In November, God again intervened. Belue was in Tupelo visiting her grandmother at North Mississippi Medical Center. In the hallway she ran into neurosurgeon Dr. Louis Rosa, who implanted her spinal pump to treat spasticity in 2002 and continues to treat her.
“He asked how things were going, and I told him that I was soon to start training on the ReWalk in Birmingham,” she said. “He asked if I would be interested in training in Tupelo if they could arrange it. Of course I was! Tupelo would cut several hours off my driving time each week.”
Dr. Rosa enlisted help from Steve Bryson, a physical therapist at NMMC’s Outpatient Rehabilitation Center. The manufacturer trained Bryson to use the equipment, and he began working with Belue the week of Thanksgiving.
“I needed a way to be able to stand and walk and exercise without my legs buckling under me,” Belue says. “My goal is to be able to stand and walk more because it will reduce the swelling in my feet, and it’s just better overall for my health.”
Belue starts by strapping the device onto her legs and torso and uses forearm crutches to stabilize herself. She controls the ReWalk through a “remote” worn like a wristwatch. “The remote initiates everything—whether you want to sit or stand or walk—but my body has to initiate the move to get it to go,” she said.
The ReWalk controls her movements by sensing subtle changes in Belue’s center of gravity. A forward tilt of the upper body, for example, tells the exoskeleton’s motors—located at the hip and knee— to initiate a forward step. If she does this continually, the ReWalk generates a sequence of steps that mimics her natural gait. The medical team closely monitors her progress and is adjusting as needed for spasticity vs. flexibility. While she is still in training, Bryson walks behind Belue to help her readjust if she leans too far in any direction. With each session, she needs his help less and less.
Belue spends an hour and a half three days a week in therapy learning to use the Rewalk and to build up her endurance. “At the end of every session I am exhausted, but it’s the best kind,” she says. Once she is sufficiently trained to operate it independently, she will take the unit home.
“I plan to use it around my house all the time,” she says. “I hope to eventually be able to use it at church and in other controlled environments.”
“Carla is one of the most determined patients I've ever worked with,” Bryson said. “One day she came in and looked pretty tired already. I asked her about it, and she said she did not sleep well the night before physical therapy. I asked her why, and she said she it was because she was ready to walk some more. I told her she is like a kid on Christmas Eve!”
Bryson said Belue often has to work through pain from spasms in her back and legs, as well as fatigue and dizziness. “But she always wants to keep going,” he said.
Anyone who knows Belue knows better than to doubt her. After her accident and despite physical limitations, she graduated from Northwest Shoals Community College with an associate’s degree in computer information systems and earned a bachelor’s degree in social work from the University of North Alabama. She now works as a substitute teacher with the Franklin County School System. In addition to husband Rodney, her cheering section includes daughter Allyson, who is a senior at the University of Mississippi, and 5-year-old daughter, McKenna.
“It is our plan at NMMC to look at becoming a center for the use of these devices and to seek approval through the Veterans Administration to accept applications here in Tupelo, making it more convenient for patients in our area,” Dr. Rosa said. Physical medicine and rehabilitation physicians at NMMC are planning to add a device to use on site as a training aid for patients with neurological dysfunction.”
For more information about services at NMMC Outpatient Rehabilitation Center, call (662) 377- 7215 or 1-800-THE DESK (1-800-843-3375).