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Emory DPT, Georgia Tech Collaborate on Robotic Knee Device for Children with Walking Disabilities

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As a former college athlete, Emory DPT Assistant Professor Ben Rogozinski, PT, DPT, remembers the slew of minor injuries that would keep some athletes out of action for weeks. But when he had a chance to work with children as a physical therapy student at the University of South Carolina in the early 2000s, he was blown away by the toughness that children, many of them with permanent mobility issues, would exhibit on a daily basis.

“These kids had such amazing, profound disabilities but when you talked to them and interacted with them, you wouldn’t even know it,” says Rogozinski.

That experience, combined with a love for integrating rehabilitation with engineering and technology, has led Rogozinski to his role as main clinical collaborator on an innovative project that uses robotics to enhance the mobility of kids with walking disabilities. The effort is a partnership between the Emory DPT program, Georgia Tech, Shriners Hospital for Children and Children’s Healthcare of Atlanta and has secured funding from the Imlay Foundation and Shriners Foundation as part of two similar, but separate, research projects.

A large number of children with cerebral palsy and traumatic brain injuries have difficulty walking due to problems in the knee joint. The common problem, known as genu recurvatum, occurs when the knee bends backwards while walking. Over an extended period of time, this knee hyperextension can contribute to other problems such as knee pain, knee osteoarthritis and other abnormal gait compensations.

Led by Georgia Tech Engineer and Assistant Professor Aaron Young, a team of scientists, engineers, clinicians and students came together in 2017 to design a lightweight, robotic device that would help these children walk with a corrected gait through repetitions. The device can be set to provide modular assistance to the knee at various levels depending on the needs of the child. While there are FDA-approved exoskeletons in the marketplace for adults with walking disabilities, according to Young, there is nothing specifically for children.

Young, who completed his master’s and doctorate degrees in biomedical engineering at the Rehab Institute of Chicago, came to Georgia Tech with a background of designing wearable robotics for rehabilitation, but had no experience with the pediatric population. Upon his arrival to Atlanta, he was introduced to Emory’s Rogozinski who, prior to his current position, worked for several years in the motion capture lab at Shriners Hospital in Greenville, S.C. with a team of engineers, biomechanists and orthopedic surgeons analyzing and crafting solutions for individual children with mobility challenges. Young knew he needed Rogozinski’s clinical expertise to get the project off of the ground.

Two years and a few iterations later, Young and his team have developed a fully wearable, lightweight, autonomous device that can be worn under clothing with no lines or tethers to a computer. It can provide assistance in four gait phases including early and late stances, swing flexion and swing extension says Young.

“We’re setting the parameters so that it forces them to adopt a good, clean gait,” he says. “We use repetitive task-based training to have them learn that profile. Over time, the idea is to dial that assistance back down. You can remove some of that assistance over the therapy so that they’re contributing more, and the device is contributing a lot less.”

After testing the device on adults, typically developing children and some children with disabilities, the project earned approval from institutional review boards and most recently, received critical grant funding. The same device is used for both grants, but the Imlay Foundation grant focuses on children with genu recurvatum gait patterns due to multiple underlying neurological conditions while the Shriners Foundation will focus on kids with crouch gaits due to cerebral palsy.

While COVID-19 halted the team’s work for several months this year, Young looks forward to continuing testing to refine the robotic and ultimately, secure additional funding to begin a full clinical trial which can be a four- to five-year process. While he would like to see the device ultimately reach the rehabilitation marketplace, his team still has a long way to go to prove the exoskeleton is clinically effective.

“The device itself has been engineered really nicely,” says Young.“It provides good, smooth assistance, it’s lightweight and it’s low profile. We have a long way to go as we test it on patients, but we’re definitely excited about it.”

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