Nearly four years ago, Michael Bejar was lifting weights in a Folsom gym when he felt a distinct pop in his head. It was a hemorrhagic stroke, followed later by two blood clots in his brain. Together, they left him virtually paralyzed from the neck down. At one point, doctors told his wife that Bejar would never walk again.
But, little by little, over months and years of aggressive physical therapy at home, hospitals and gyms, he’s been slowly, painstakingly recovering. The former security guard has had to relearn everything, from tying his shoes to navigating the stairs at his two-story home. Today, at 61, his left side is still numb but he can stand and walk, albeit haltingly, with two canes.
Despite his hurdles, the father of two grown children has a single-minded goal: “I want to walk around (independently) by baseball season. I’m a Giants fan, so my goal is to be able to walk into the stadium without any assistance: no cane, wheelchair, nothing.”
Toward that ambition, he’s going twice a week to SCI-FIT, a physical therapy center in Sacramento that specializes in treating individuals with stroke or spinal cord injuries. On a recent morning, in sweats and with a bandana tied around his head, Bejar helped a trainer strap his impaired left leg into a Kickstart, one of the newer rehabilitative technology tools designed for patients such as him. Leaning on a cane, he took a wobbly but complete trek around the carpeted room.
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“My left leg is kind of numb so I didn’t feel all of it,” Bejar said afterward, “but I thought it did a pretty good job. … I’m more than willing to try anything.”
He’s one of thousands of Americans who are disabled by strokes or felled by spinal cord injuries each year. In 2013, about 795,000 people suffered a stroke, according to the most recent data from the American Heart Association. And each year, an estimated 12,500 people suffer new spinal cord injuries, according to the National Spinal Cord Injury Statistical Center.
For years, university researchers and companies worldwide have been testing and developing new types of exoskeleton technology to help stroke and spinal cord patients regain or improve their mobility. Originally designed with motorized systems to help military soldiers lift heavy loads, they’ve become more common to help those with neurological damage learn to walk again. With names such as ReWalk or Ekso Bionics, most are robotic devices that use computerized hydraulics to lift a leg into a walking step. Their biggest drawback has been cost.
Nancy Byl, professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California, San Francisco, has worked in physical therapy for 50 years and said some robotic devices can cost upward of $100,000, making them out of reach for most patients. But newer technologies, such as Kickstart, she said, are beginning to change the face of therapy, providing more affordable, accessible alternatives.
“The materials are lighter, more biomechanically aligned to a normal joint, more comfortable,” said Byl, who works with clients at the UCSF Health and Wellness Center.
She did a clinical study of the Kickstart device on three patients, two of whom were a decade or more past their initial stroke. In all three cases, after a year of follow-up, “walking speed and endurance improved dramatically,” according to a study published last year.
Decades of research have shown that sections of neurons in the brain can be trained to replace those damaged by stroke or other neurological issues, Byl noted. It requires steady, repetitive motion over months, if not years. That’s why there’s a need for wearable technology that can be “integrated into a person’s everyday life to get improving function,” she said.
Affordability is part of the plan, as is helping people lose their self-consciousness about wearing such devices at work or out in public.
Brian Glaister, president and CEO of Cadence Biomedical in Seattle, started developing the Kickstart model as a graduate student at the University of Washington where he worked on “really expensive” prosthetic limbs and other projects. Most of these were too costly to ever be used by individuals outside a clinical lab, he said.
Working with several researchers at two universities, he focused on developing a lighter, exoskeleton device that did not rely on cumbersome, expensive robotics. Backed by West Coast angel investors and about $2 million in U.S. Department of Defense grants, his company debuted the Kickstart in 2012. Today, he said, it’s used in about 20 clinics across the country. Another 100 have been sold to individual patients at roughly $2,500 each, covered by Medicare or private insurance, according to the company.
Weighing about 7 pounds, the device is belted around the waist, then padded cuffs are fastened at the thigh and calf. Acting like an external, elongated tendon, it relies on a coiled spring that stores and releases energy to let patients swing their impaired leg and normalize their walking gait.
“Our goal,” said Glaister, “is to have everybody graduate out of it and never need it again.”
At SCI-FIT, co-founder Daniel Dumas sees the Kickstart as another useful tool in helping clients recover from traumatic injuries.
“There’s no quick fix. It’s repetition. It’s the idea that movement breeds movement,” said Dumas, who’s spent the past 10 years recovering from his own spinal cord accident. At 31, while he was vacationing with his wife in Hawaii, a rogue wave knocked him into a rock, breaking his neck. Waking up in the hospital, Dumas was immobile from the shoulders down.
He embarked on a painful, slow progression out of paralysis. Starting with only the slightest flicker in his index finger, he worked years to regain mobility in his hand, then his arm. “I started there. I put my life on hold to walk again.” Moving to San Diego, he spent two to three hours in therapy, five to six days a week, for about three years. Eventually he took his first step. It took another five years before he could abandon his wheelchair.
Today, the 41-year-old father of two walks slowly with a cane. Lean and fit-looking, the Bay Area-based entrepreneur turned his own recovery regimen into a business in late 2007. With his wife and a partner, he co-owns three SCI-FIT physical therapy centers – in Pleasanton, Berkeley and Sacramento. Each is stocked with multiple specialized pieces of apparatus designed to help clients with stroke and other neurological impairments. The Kickstart, which he calls “one tool in the war chest,” is one of the newer additions to his clinics, which include treadmill harnesses and bikes fitted with electrodes to stimulate nerves in the arms and legs.
On a recent weekday in Sacramento, a half-dozen individuals, including Bejar, were working one-on-one with SCI-FIT “neuro-exercise therapists.” Some clients are covered by workers’ compensation insurance, but most pay out of pocket anywhere from $75 to $100 per hour.
One of them is Bejar, whose family was told three years ago that he might need to be institutionalized. Refusing that prognosis, his wife, Tami Wood-Bejar, said they’ve worked relentlessly over the past three years to reach the point where he can climb stairs – with help – at home and walk on his own into the kitchen. “Every day, I see improvements,” she said. “Some are minuscule, but they’re still improvements.”