One of the effects of suffering a stroke can be reduced lower-extremity mobility. Spending months or years without walking can greatly reduce a stroke survivor’s independence, mobility, health, and chances of regaining their normal gait. Thankfully, the development of the ReStore Exo-Suit — a modern gait-training technology available at Brooks Rehabilitation — has broken some significant barriers to regaining post-stroke mobility.

So, what is the ReStore Exo-suit? What purpose does it serve? What features does it have? And who qualifies to use it? Keep reading to learn more.

Post-Stroke Loss of Mobility

The ReStore Soft Exo-Suit is a wearable assistive device pioneered by medical technology developer ReWalk. It’s a lightweight, powered device used in stroke rehabilitation physical therapy, particularly by those who have suffered loss of their lower-limb mobility.

The ReStore Exo-Suit is the only FDA-approved gait-training solution used specifically for post-stroke rehabilitation physical therapy. It was conceived, designed and built to help a stroke survivor by assisting them to regain normal movements like plantar flexion and dorsiflexion.

Plantar flexion refers to the extension of the ankle, allowing the foot to point downwards and away from the leg — people use their plantar flexion when standing on their toes, or engaging a car’s gas or brake pedal. A stroke can commonly affect several ankle, foot, and leg muscles, which are key to plantarflexion. These muscles include:

• Gastrocnemius
• Soleus
• Plantaris
• Flexor hallucis longus
• Flexor digitorum longus
• Tibialis posterior
• Peroneus longus
• Peroneus brevis

Conversely, dorsiflexion refers to the backward bending and contraction of the foot. It occurs in the ankle by drawing the toes back toward the shin. One has to contract the shin bone and flex the ankle joint to dorsiflex one’s foot. Dorsiflexion also occurs when lifting the ball of one’s foot off the ground, while keeping the heel planted on the ground.

People use dorsiflexion when walking, bearing weight, or pushing off the ground, as when jumping or climbing stairs.

Stroke can affect dorsiflexion through a condition referred to as foot drop. This condition makes the toes catch the ground when pushing off the ground. It also makes you lift your feet higher than usual.

How it Works

The ReStore Exo-Suit is designed to aid with improving post-stroke mobility and gait training, and provides a lighter or more elegant solution than a traditional, rigid powered lower-body exoskeleton. It combines natural movements with support for assisting in and “re-teaching” plantar flexion and dorsiflexion to adaptively synchronize with a patient’s gait, and facilitate a functional walking cycle.

In addition to being a powered assistive device, the Exo-Suit is data-driven — it gives real-time feedback via a computer interface, so a therapist can adjust its capabilities to the level best suited for a patient’s progress and optimal outcome.

The Restore Soft Exo-Suit operates in three modes: Assist, Brace, and Slack. With the Assist mode, its sensor identifies a patient’s unique foot gait. The Exo-Suit contracts a cable behind the patient’s calf and pulls the patient’s heel to trigger a plantar flexion, and propel the body forward. The ReStore Exo-Suit will then contact its anterior cable and lift the toes to trigger correct dorsiflexion while maintaining ground clearance.

The patient’s unaffected leg remains free from any movement during therapy in Assist mode. If the patient imbalances, they can move and attempt to recover their balance on their own.

The Exo-Suit’s Slack mode allows the ankle to move freely by releasing the cables, but continues to measure the patient’s gait while in motion, and analyze the critical elements of their motion.

The Brace mode is triggered when the system detects an error. In this mode, the cables lock the ankle, putting it in a neutral position in order to prevent any instability or further injury.

The ReStore Exo-Suit can also be individualized to various levels of assistance and compatibility with support aids, and ensure that therapists customize it to different patients with needs across the gait rehabilitation spectrum. Patients can use this soft Exo-Suit device on a treadmill or overground, up to a maximum walking speed of 5km/h (or 3.11 mph).

The Exo-Suit also allows its users to sit, stand, walk, and turn comfortably. (It is not intended for assisting users in participation in sports, or for climbing stairs.) Finally, you can use the device for approximately three years, as long as you consider timely and regular servicing.

Features of the ReWalk ReStore Soft Exo-Suit

The ReStore Exo-Suit is a soft, lightweight, battery-powered assistive therapeutic device of structured fabric-based construction. It’s worn comfortably around the lower leg, and connected to a waist pack via mechanical cables. This adjustable, belted waist pack is where the Exo-Suit’s integrated control unit is housed, and also features a support handle that therapists can use to provide guarding and support to patients.

The ReStore Soft Exo-Suit’s groundbreaking design offers comfort, range of motion, ease of use, and unprecedented versatility in customization to help patients progress from assisted and unassisted walking during stroke rehabilitation physical therapy.

Qualified therapists and clinicians control the ReStore Exo-Suit system through a convenient, user-friendly mobile app that connects to the device wirelessly using Bluetooth technology. Two rechargeable lithium-ion batteries power the Exo-Suit’s components.

This leading-edge combination of modern technology and proven medical know-how senses the force a patient applies during physical therapy. It initiates plantar flexion and dorsiflexion through motors and gears at the waist pack, which are transmitted through Bowden cables to the textile components worn at the foot and calf.

ReStore Soft Exo-Suit Qualifications

Medical technology manufacturer ReWalk designed the ReStore Exo suit to help patients to regain their lower-waist mobility. In addition to disability as the result of suffering a stroke, patients can also lose elements of their lower-limb mobility through different types of orthopedic and neuromuscular impairments, such as:

• Cerebral palsy
• Multiple sclerosis
• Muscular dystrophy
• Arthritis
• Spinal cord injury

Even though this device is suited for a wide variety of different diagnoses, a patient must meet various physical and functional prerequisites to ensure safe use and elevate the odds of successful physical rehabilitation therapy.

Any recovering patient should have adequate trunk control (stability of hip and lower back muscles), and should be able to complete weight transfer with minimal assistance. Patients should also be able to tolerate prolonged upright positioning, and have a healthy bone density in the lower extremities — this will help prevent fractures or other further injury.

Patients should also have hip, knees, and ankle range of motion to ensure that their gait is adequate. However, they can configure the ReStore Soft Exo-Suit to accommodate their individual range of motion through the lower extremities.

There are a few conditions that contradict the use of the ReStore Soft Exo-Suit. These include:

• History of severe neurological injuries apart from spinal cord injuries, such as TBI or ALS
• Severe concurrent illnesses such as lung disease, heart disorder, infection, and circulatory
• Active pressure sore
• Severe uncontrolled spasticity
• Unhealed fracture
• Psychiatric and cognitive disabilities
• Heterotrophic ossification (abnormal bone formation) that is active or limits ankle, knee, or hip motion
• Pregnancy

As one of the early adopters of the ReWalk ReStore Exo-Suit, there’s no better place in the U.S. to undertake your post-stroke mobility rehabilitation than Brooks Rehabilitation. We’re committed to providing the best stroke rehabilitation experience available, including therapeutic programs incorporating the ReWalk ReStore Exo-Suit. Our therapists are ready to utilize their experience using this device to guarantee the safest and most effective post-stroke rehabilitation. Contact Brooks Rehab today to learn more about the ReWalk ReStore Exo-Suit and all of the therapeutic technologies we employ.