If you’re reading this, you might be the parent of a child with cerebral palsy. Or spina bifida, muscular dystrophy, or some kind of incomplete spinal cord injury or knee-extension-deficiency disorder. Something that has somehow compromised your child’s ability to stand, walk, and move with ease, purpose, and joy.
You may already know everything—or most everything—you’re about to read. You may know virtually nothing. Or perhaps you’re somewhere in the middle. Wherever you land on this continuum, you’ve likely experienced confusion, hope, frustration, sadness, and/or encouragement at one time or another.
You may already be fluent in the language of the disorders mentioned above, and the wearable devices associated with their treatment, from crouch gait and neuroplasticity, to orthotics, AFOs, and KAFOs. But you may not be too, so we’ve written this blog to be part primer, part Q&A: to share how we think about these terms and what they mean, in general and in the context of you and/or your child.
A little bit about Bionic Power to start
When people ask us what we do, our simple answer is we defend mobility! We do this by developing powered orthoses for children and youth with gait disorders to help them Stand Taller, Walk Stronger™.
What’s the difference between orthoses and an orthosis—or an orthosis and orthotics? And what’s an orthotist?
Orthoses, also sometimes referred to as orthotics, is just the plural of orthosis. An orthosis is a device that improves biomechanical function, promotes proper joint alignment, or protects an existing limb. An orthotist is a healthcare professional who specializes in determining what orthotic devices will be most beneficial to a patient. They often work in tandem with physicians, therapists, and orthopedic surgeons. At Bionic Power, we work closely with people in all these professional capacities.
What is the Agilik?
The Agilik is Bionic Power’s “smart” orthosis (or “smart” orthotic). It’s smart because it uses advanced sensors and motors to measure and report data like the wearer’s knee angles, their knee-angle velocity (or rate at which their knee flexes and extends), their initial contact with the ground, and their toe-off – that point in a person’s walk where the foot leaves the floor. Using data the Agilik collects, therapists are able to program the device to deliver assistance and resistance during specific phases of the wearer’s gait, helping children and young people stand taller (with better posture) and walk stronger— improving their mobility and quality of life, as a result.
Who’s the Agilik designed for?
Essentially, the Agilik is designed to improve walking in children and adolescents with cerebral palsy and other pediatric disorders that affect mobility, including spina bifida, muscular dystrophy, and incomplete spinal cord injury. We’re going to dig more into CP and spina bifida in this blog but if you have questions about how the device works in people with muscular dystrophy or other knee-extension disorders, send us an email.
More about cerebral palsy
Cerebral palsy (CP) is a group of disorders that affects a person’s ability to move and maintain balance and posture. It’s the most diagnosed childhood motor disability in the United States and Canada, with about 10,000 babies born with CP annually, and another 1,200-1,500 school-aged children diagnosed with the disorder.
Significant to our work is that almost 60 percent of all children and adolescents with cerebral palsy can walk independently. However, almost half of them will experience a deterioration of their ability to walk in early or middle adulthood.
Why such a drop? Mostly because of the energy it takes to get up and move. Children and young people with CP often deal with issues of motor control, posture, and balance, along with spasticity and deformity. Children with CP also expend more energy just to stand and walk. It’s our goal to stop, or even reverse, this deterioration in mobility.
More about spina bifida
Spina bifida is an uncommon birth defect that affects a child’s spinal cord. There are about 120 children born with spina bifida each year in Canada, and about 1,500 babies in the U.S. Most children with spina bifida face mobility and/or orthopedic issues.
Similar to the deterioration in mobility in people with CP, a 2019 study of people living with spina bifida discovered that the percentage of “survivors” (in the words of the authors) who could walk at least 50 meters at 9 and 18 were 51 and 50 percent respectively. But by the time these same individuals had reached age 50, that percentage had plummeted to 27 percent.
More about crouch gait
Bionic Power designed the Agilik to reduce crouch gait, a common symptom across all of the pediatric disorders we mention above. Crouch gait gets its name from how it appears—as if the child is crouching while walking. The child crouches because their knees and hips are bent (in flexion), while their ankles bend forward. It’s tiring to walk when there’s little skeletal support. And, to make things more challenging, over time, contractures—something that happens when normally stretchy (elastic) tissues are replaced by non-stretchy (inelastic) tissue—can form, making walking even harder. Crouch gait itself leads to further deterioration of one’s walking ability, so reducing crouch is a great way to combat the loss of the ability to walk.
The reasons for crouch gait are different for every child. In many children, normal gait patterns are impacted by weak muscles, motor control deficits, and/or muscle tightness. For children with CP, where the disorder damages the child’s brain, sometimes the brain can’t tell the affected muscles to relax. This miscommunication leads to involuntary muscle contractions, or spasticity, which worsens as the child gets older and this spasticity interferes with the development of a normal gait pattern.
How the Agilik device helps alleviate the symptoms of crouch gait?
The Agilik provides assistance to help children extend their knees further. The device can also help flex the knee and reduce toe drag, as well as help wearers to exercise their legs. This mobility not only increases proper body alignment and posture, it can also help wearers develop better gait patterns and can reduce the overall stress on their bodies. As well, the increased mobility often lessens spastic movements—loosening muscles that might otherwise seize up.
The Agilik can also help stretch and lengthen the muscles that have tightened up—even when the child is stationary. And because the Agilik functions by assisting or resisting knee extension and flexion throughout the wearer’s gait cycle, when they’re using this orthotic in resistance mode, the Agilik works the wearer’s muscles in such a way that it improves their strength.
The Agilik, then, can help correct a child’s posture, minimize their spasticity, and help to prevent deformities that might have been developing. Data we’ve gathered thus far also suggests that increases in knee extension and gait speed will continue, depending upon the training regimen, after the child has removed the device.
More about the Agilik
The Agilik is designed as an adjunct to surgery, as a non-invasive way to stretch muscles as children grow. It’s customizable and adjustable to the wearer and is a pediatric-specific design for children aged five and up, or for small adults with a body weight of 70 kilograms/154 pounds or less. The device is intended for use in clinic-based and home rehabilitation to enable more frequent and extensive long-term training and reinforcement of new gait patterns for the brain.
As we said previously, the Agilik is an orthosis similar to KAFOs worn by children and adolescents with impaired gait. Many of you will be familiar with these types of devices. What’s different about ours is we’ve boosted it into another dimension, by giving it power and making it smart!
The Agilik has a powered hinge that’s able to give the wearer a boost of power at a precise moment in the wearer’s specific gait. Think of it as similar to an e-bike when you’re pedaling uphill and need that extra oomph to get you to the top! The Agilik works with the wearer, as a rehabilitation device designed to improve gait, not an exoskeleton that holds the wearer up and walks for them.
What makes the Agilik smart is its onboard sensors, which inform algorithms for gait analysis and torque application. This means that the technology in the Agilik enables clinicians to prescribe a combination of assistance and resistance during training with the device, to enhance gait mechanics and build strength and control. These sensors monitor and record knee extension, range of motion, their maximum flexion and extension angle and speed—flexion is when the knee bends, with the calf rising toward the hamstring; extension is the opposite, when the knee is straightening down toward the floor—as well as utilization tracking (which shows how long and how frequently the Agilik is used). This real-time data collection allows therapists to monitor the wearer’s progress and make informed therapy decisions related to the Agilik’s torque and timing, adjusting treatment as required.
What we’re learning in our clinical trial programs
Since 2019, we’ve been in an ongoing clinical trial with the National Institutes of Health (NIH). In this trial, patient after patient has shown a concrete benefit in gait biomechanics as well as a “training effect” when wearing the device. This means that in session after session using the Agilik, the quality of the child’s natural gait has improved.
Our plan in future trials is to examine whether longer-term use of the Agilik might help a wearer develop and reinforce new gait patterns in their brain, even after the device is removed. This is all about neuroplasticity—the brain’s ability to form and reorganize synaptic connections, especially in response to learning or experience, or following injury. A recent study has shown that walking can “remodel” the white matter in the brain—even into adulthood. The white matter is basically the brain’s wiring, responsible for learning and for transmitting electrical signals.
How we came up with the Agilik device
Like the EpiPen, the Internet, GPS technology, duct tape, and Pringles—yes, those canned potato chips—the Agilik has its roots in technology developed for the military.
Technology in the Agilik has been in development and field testing with the Canadian, United States’, and Israeli militaries for almost 15 years. Its provenance is in exoskeleton technology designed to reduce fatigue and generate electrical power through walking. What we’ve done is transform this proven technology, developed for soldiers, into wearable tech for the young superheroes living with gait disorders. We want Agilik wearers to feel inspired, be autonomous, and be able to do what their peers are able to do.
Today, Agilik devices are available to participants in clinical trials: an ongoing NIH trial in Maryland and one just started in May, 2022, at BC Children’s Hospital in Vancouver, British Columbia. [link to trial blog post]. Bionic Power will be expanding our clinical trial program over the next two years, into clinics and labs across Canada and the United States. We will make a limited number available for sale later this year. For the latest updates, subscribe to our mailing list.
 Jahnsen R, Villien L, Egeland T, Stanghelle JK, Holm I. Locomotion skills in adults with cerebral palsy. Clin Rehabil. 2004 May;18(3):309-16. doi: 10.1191/0269215504cr735oa. PMID: 15137562