A minor electric signal is all it takes to move a couple hundred pounds of human.

When we walk, the brain sends a signal through the spine to the individual muscles of the legs, feet, and core to manage the complex orchestra of contraction and relaxation that makes balance and walking possible. After stroke, the brain may stop sending all or some of those signals. That breaks the ability to walk. It happened to me and millions of others.

There is nothing wrong with my leg, though. The muscles, joints, tendons and nerves in my leg, foot, and core are all still there and as fully functional as they were before the stroke. They're just waiting for he signal from my brain which, in the beginning, never came.

Rehab was about getting the brain to send that signal again. And it started sending some of it. It's not as complete as it used to be. Or as strong. But it's enough that I can walk with my cane and brace well enough, and not quite as well without my aids.

But, again, it's a brain issue, not a leg issue. If you can send a signal to those muscles without the brain, can you effectively get those muscles to move and walk more effectively? Yes you can.

That's what Neural Sleeve from Cionic does.

In this episode, I speak with Cionic CEO and founder Jeremiah Robison about the Neural Sleeve, why it works, how stroke survivors can learn more, and how his daughter inspired this product.

If you don't see the audio player below, visit http://Strokecast.com/ElectricPants to listen to the conversation.

Click here for a machine-generated transcript

Who is Jeremiah Robison?

Jeremiah Robison is the Founder and CEO of CIONIC, an innovative company that builds lightweight and durable bionic clothing driven by powerful algorithms that adapt in real time to each individual's mobility needs.

He started the company in 2018 after his daughter was diagnosed with cerebral palsy and he was frustrated at the lack of effective technology available to help improve her mobility. Four years later, CIONIC introduced the breakthrough, FDA-cleared Cionic Neural Sleeve, the first product to combine sensing, analysis and augmentation into a wearable garment.

Prior to CIONIC, Jeremiah spent twenty years at the intersection of data, algorithms, and the human body, driving innovation in sensing and machine learning at Apple, Openwave Systems, Slide, and Jawbone. Jeremiah has a BS and MS in Computer Science from Stanford University.

Jeremiah's daughter

Jeremiah's daughter, Sofia, was apparently in a rush to meet this amazing world. She was born early, weighing just 2 pounds, 4 ounces. She developed Cerebral Palsy in the process.

Cerebral Palsy (CP) and stroke are similar conditions. In fact, as Dr. Heather Fullerton explained in episode 49 ( http://Strokecast.com/PediatricStroke) roughly 50% of CP is caused by stroke in utero or shortly after birth. CP is the result of not enough oxygen getting to the right part of the brain at the right time of development. Brain cells die or don't develop or don't form the right networks the way they should. As a result, a child can develop any number of challenges around mobility, speech, dexterity, and more. Just like adults (and other children) with stroke.

The damage from stroke in the brain is also, in part, due to lack of oxygen getting to the right parts when they need it due to a disruption in the blood supply.

Stroke survivors have a lot in common with our neuro cousins in the CP and MS communities, to name a few.

Jeremiah talks about wanting to help Sofiawith her gait, as any parent would. Jeremiah was in a position to do something about it, and the Neural Sleeve comes from that experience.

Sofia herself is now 12 years old and has developed a presence on Instagram with the family's nonprofit at @WAWOSORG. Sofia shares her own inspirational tips and exercise strategies for other kids with CP or other disabilities.

View this profile on Instagram

WAWOS (@wawosorg) • Instagram photos and videos

FES

FES stands for Functional Electric Stimulation. I talked about the technology in more detail in episode 92 - Electrodes and a Stationary Bike — FES for Stroke Treatment.

I've used eStim in therapy while I was inpatient and then at home, too. Devices are available on Amazon for $30-$50.* You put 2-4 electrodes on an arm or leg, roughly at either end of a muscle. The AA battery powered unit sends a minor electric signal to the electrode. The nerves at the end of the muscle detect it and think the brain is sending the signal. The nerve then contracts or relaxes the muscle.

The muscle is doing the actual work. It can be a great way to help an affected limb get some exercise, stretch some tendons, and generally not waste away. In the shoulder, it can even treat subluxation.

FES is the next level of eStim. Instead of just making the muscle move, it makes it, and other muscles move much more precisely to accomplish a specific function. In the case of Restorative Therapies, this was to coordinate movement to drive rahab.

https://youtu.be/HJo07_JimOA

Some of the more well-known FES devices are those from Bioness and Walkaide. They specifically stimulate the muscles that lift our toes (the dorsiflexors) to eliminate foot drop while walking. They are an alternative to an AFO. The look like a cuff that a person wears just below the knee. They work great for some folks, but not all. They're also not typically covered by insurance.

I tried them both earlier in my post-stroke life. The Walkaide worked better on my gait, but at $5K-$6K to buy the unit (in 2019), I decided the benefit simply wasn't worth the cost for me. For others, the device is a great solution. Author Maddi Niebanck who survived a stroke at 22 and was in episode 97 uses the Bioness and is a big fan.

The Neural Sleeve takes this technology further. As Jeremiah explained, the network of electrodes in the device means that precise placement is not as important. Software can adjust for that. With its larger assortment of electrodes, it can also stimulate more muscles and address other aspects of gait. And it looks less like a home-release ankle monitor.

The rental aspect of the Neural Sleeve also makes it more accessible to more folks, similar to the approach adopted by show sponsor Motus Nova for its rehab device.

The best rehab gear is the gear you won't need forever, and that rental becomes much more compelling. At least under the American model of health care financing.

Cionic Images

You can get a look at the device in these images. Or visit http://cionic.com.

No Plateau Podcast

Many stroke survivors have heard of Saebo. The make a series of devices for survivors. One of them is the Saebo Step, which is an alternative AFO. They sent me one several months ago, and I use it as my summer AFO. Specifically, it's the one I use when I wear short pants or sneakers.

They also have a podcast called the "No Plateau Podcast" which is a great name for a stroke oriented show. And I'm the guest on episode 6. It was a lot of fun and I didn't have to do the editing.

In the episode, I share my stroke journey and we talk about the good, the bad, and the ugly of stroke rehab. We also talk about what I mean when I say, "Don't get best…get better." And we talk about some of the inequities affecting female presenting and BIPOC stroke survivors.

You can listen right here. If you don't see the audio player below, visit http://Strokecast.com/ElectricPants to listen to the conversation. Or go directly to the audio at this link.

And check out more episodes of the No Plateau Podcast on Saebo's website or in your favorite podcast app.

Hack of the Week

Jeremiah recommends patience. Recovery is a journey as we well know, and we can take it just a piece at a time.

It's also important to capture the process in notes, video, audio, and/or pictures. As we make progress day-by-day we won't see it. It's only when we look back at our records that we see how far we've come.

And of course this aligns well with the idea of "Don't get best…get better." It's that incremental progress that matters…little bits every day that over time add up to success and goal achievement.

Links

Where do we go from here?

To learn more about Cionic, Jeremiah, and Sofia, visit http://Cionic.com or check out the social media links in the table above.
Share this episode with someone you know by giving them the link http://Strokecast.com/ElectricPants
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