AlterG BIONIC LEG™ - CASE STUDY: SHEPHERD CENTER
CEREBROVASCULAR ACCIDENT WITH PUSHER SYNDROME
Author: Christy Brimmer, PT, NCS Shepherd Center
The AlterG Bionic LegTM is the first wearable lower-extremity
robotic trainer that provides patient-initiated assistance during
functional-mobility training in the clinic.
INTRODUCTION:
The patient is a 61 year-old male who suffered a subacute anterior right frontal and basal ganglia
stroke with resultant hemiparesis. After 4 weeks of inpatient rehabilitation, the patient’s mobility FIM
score remained stagnant. However, after 5 therapy sessions with the Bionic Leg over 13 days, the
patient showed dramatic improvement in midline awareness, mobility, and gait, and improved his
mobility FIM score by 6 points.
GOALS FOR ACTIVITIES BASED THERAPY (ABT)
AT SHEPHERD CENTER:
1. Increase motor return to LLE as evidenced by active control in functional
tasks of standing, transfers, and gait
2. Improve midline awareness to allow ability to sit safely in wheelchair and
propel it over level surfaces
3. Improve symmetrical weight bearing in BLE to allow increased functional
skill training in gait and mobility
HISTORY:
Prior to insult, the patient was independent with all activities. He presented to Shepherd Center at a dependent level of care with
a baseline FIM score of 5 in the mobility section. He required total assist for all mobility, and used a Hoyer Lift for transfers. He
presented with severe hemiparesis of his left side and poor midline awareness with severe Pusher Syndrome.
The patient was seen by his primary therapists for a minimum of 3 hours per day including at least 1 hour of intense physical rehab
focused on mobility skills, wheelchair propulsion, and transfer training. All usual modalities were used with this client.
• His FIM scores remained stagnant at a dependent level after 4 weeks of rehabilitation. He exhibited severe pushing behaviors.
• He was unable to sit unassisted and unsupported at the edge of a mat for more than 5 seconds.
• He was unable to propel his wheelchair more than 20 feet.
TREATMENTS WITH THE BIONIC LEG:
He was referred to Activities Based Therapy, where use of the AlterG Bionic Leg™ was initiated. It was used a total of 5 times in 2
weeks. A sit to stand test was completed on the Neurocom Balance Master with and without the Bionic Leg both prior to treatment
and following the final treatment session. (See comparison graph below.) The Activities Based sessions using the Bionic Leg were
in addition to his primary therapy activities.
The patient’s first words upon standing with the Bionic Leg for the first time were
“Oh! So that is where the middle is”.
First Session: • Sit-to-Stands
· From edge of mat, standing position maintained <10 seconds due to pushing.
The patient’s first words upon standing with the Bionic Leg were “Oh! So that is
where the middle is”.
· 30 repetitions with min Ax1
· By end of session, patient was able to stand for 20 seconds before pushing
• Gait Training
· He ambulated 20 feet x2 with min A x2. These were his first steps in 2 months!
• Sitting Balance
· 3 minutes unassisted (Sup A)
Second Session: • Sit-to-Stands
· 30 repetitions with min A x1.
• Standing Balance
· Lateral weight shifts min A.
· Staggered standing with A/P weight shifts with min A x1 and no UE support.
• Pre Gait Activities
· Stepping Exercises- Single limb stance on left RLE step to target with max A
Third Session: • Sit-to-Stands
· 25 reps with min A x1.
• Pre-gait Activities
· 10 min Wt. Shifting and Stepping Exercises to encourage L LE stance
• Gait Training
· Ambulated 100 feet min A x2 with HHA from 2nd person.
Fourth Session: • Sit-to-Stands
· 25 reps with CGA.
• Gait Training
· Ambulated 200 feet with min Ax2.
Fifth Session: • Sit-to-Stands
· 25 reps with CGA.
• Gait Training
· Stair Ambulation- Ascended and descended 12 steps with handrail and
assistance of 2 people – one to manage hemiplegic lower extremity with Bionic
Leg to lift to clear each step and second for safety. He completed stairs with a
reciprocal pattern.
RESULTS:
The patient showed dramatic changes with the Bionic Leg in terms of his midline awareness, functional mobility, and gait pattern.
He tolerated the increased intensity of therapy without complaint and with only mild increases in fatigue at the end of the day
After just 5 sessions over two weeks with the Bionic Leg, he improved his FIM score by 6 points. His midline awareness and
ability to maintain midline without pushing allowed this patient to progress with rehabilitation goals and make significant functional
gains. These gains increased the patient’s functional independence and significantly decreased the burden of care for his wife.
Treatment with the AlterG Bionic Leg allowed him to be discharged to home with a follow-up to a brain injury day program.
Without the improvements shown after therapy with the Bionic Leg, the patient would have been discharged to a senior
care facility.
FUNCTIONAL ACTIVITIES
Activity
Prior to Bionic Leg Therapy
Following Bionic Leg Therapy
Sit to Stand / Transfers
(Bed <> W/C)
Dependent
Mod A x 1
Standing Tolerance
Less than 10 seconds
10 minutes
Ambulation
Unable
200 feet, Min A x 2
Stairs
Unable
Up and down 12 steps, Min A x 2
MOBILITY FIM SCORE CHANGES
Initial
Mobility FIM Score
Admission to Shepherd Center
5
4 weeks post Admission (prior to Bionic Leg)
5
6 weeks post Admission (5 Bionic Leg treatments)
11
NEUROCOM BALANCE MASTER RESULTS
His Neurocom Balance Master sit to stand test for symmetry was as follows:
• Pre test:
· Without Bionic Leg: 27% asymmetric to left with max A x2
· With Bionic Leg: 12% asymmetric to right (uninvolved side) with min Ax1
• Post-test:
· Without Bionic Leg: 3% asymmetric to left and mod A x1
· With Bionic Leg: 0% asymmetry and CGA
BALANCE MASTER TESTING
Without AlterG Bionic Leg
With AlterG Bionic Leg
% Left/Right Weight Symmetry
% Left/Right Weight Symmetry
Day 1
27
50
0
12
(pre-test)
50
50
% Left/Right Weight Symmetry
0
50
% Left/Right Weight Symmetry
Day 13
3
50
0
0
(post-test)
50
50
0
50
AlterG, Inc. | 48438 Milmont Dr., Fremont, CA 94538 | 510-270-5900 | alterg.com