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EksoNR Success Story: Manooshak

Australian-first tech is light at the end of the tunnel for 77-year-old stroke-survivor Manooshak

For over 50 years, Manooshak (which translates into Violet) has welcomed visitors, family and friends to her home with open arms. Armenian sweets and tea flowed freely from the matriarch of the family whose hospitality knows no bounds. But life for her family took a dramatic turn in July 2020 when Manooshak, walking from the dining table to the kitchen, unexpectedly fell. Her son followed the sound and found his mother on the floor with his father hovering nearby.

“My dad was there when it happened, but he wasn’t sure what was going on. He has dementia and was asking mum to get up,” said Manooshak’s daughter Mariam who is now her mother’s primary carer. “My brother realised something was seriously wrong and called the ambulance straight away.”

Tests later confirmed Manooshak had suffered a stroke to the right side of her brain, known as a right thalamus and right internal capsule infarct.

The stroke left everything on the left side of her body, affected including eating, drinking, swallowing.

‘’I was told mum will likely not ever walk again, and that she will require a hoist and carers for her everyday needs,’’ Mariam said.

Australian-first use of EksoNR Exoskeleton Brought Newfound Hope

Age and the seriousness of the stroke would normally mean a nursing home for someone like Manooshak. Although the initial prognosis was that she would always be bed bound, never able to sit or walk, Mariam noticed some promising signs and advocated for her mum to receive rehabilitation.

After five and a half months in hospital, she moved in with Mariam and began as a client with the Transitional Aged Care Program which provided ongoing rehabilitation at home. It was at this point in her recovery that she began working with the Royal Rehab team.

Manooshak was able to walk short distances but required full assistance including a stick, foot splint, walk belt, and shoulder sling. Significantly, there was some movement in her left leg, however she was heavily compensating on her right leg to walk.

During one of her weekly home physiotherapy sessions, Royal Rehab physiotherapist, Stephanie, recommended incorporating EksoNR, an advanced robotics exoskeleton, into her program as a tool to help Manooshak re-train the brain and muscles, correct and stabilise her walk and regain a normal walking pattern over time.

“I was so excited – I thought ‘I am going to be a robot’,” Manooshak said.

“I was never scared. I was so happy because I knew it will help me to walk.”

Mariam viewed it as a relief. “I was tired of hearing my own voice saying ‘lift your knee’ with every step. I was trying to correct her walk by gently reminding her all the time so that she does not get into a bad habit or style of walking. I’m a firm believer in the saying ‘practice does not make perfect – perfect practice makes perfect’. I was trying to get it right so she can eventually balance herself while trying to walk. I knew [EksoNR] was exactly what she needed. It was the only barrier I couldn’t see past. The light at the end of the tunnel. I remember saying ‘100 per cent – we’re in!’”

Although Manooshak has had only four sessions with EksoNR so far, Stephanie says the benefits are already starting to show.

“When we first saw Manooshak walk, she would throw her leg forward and couldn’t lift her foot. This meant her good side is doing a lot of work. The EksoNR helps her use the strength she does have to correctly shift her weight, lift her leg and place her foot down in a normal way,” Stephanie said.

“Already, I can see Manooshak is walking better both with and without the device. She doesn’t tire as quickly because there is a bit of power in it, and because she can get more practice, she’s building strength. We know with stroke recovery, that the more practice she can get, the better. She is a motivated lady – we’ve been able to reduce the EksoNR assistance level as she continues to make progress,” she said.

EksoNR is Supporting Independence, Sooner

Royal Rehab is the first to bring EksoNR to Australia. While the world’s most advanced robotic exoskeleton has been used successfully in other countries, it has never been used in Australia before and is available exclusively through Royal Rehab.

EksoNR can help fast-track recovery for people with a range of conditions, including stroke, complete spinal cord injuries at levels C7 and below, incomplete spinal cord injuries, multiple sclerosis, acquired brain injury, Parkinson’s disease, and Guillain-Barré syndrome.

In Manooshak’s case, the EksoNR guides her body to move in the correct way. It also gathers data – such as whether her legs are doing unequal work and by how much – which helps the Royal Rehab physiotherapists refine her rehabilitation program.

Stephanie, a physiotherapist for 11 years working in neurorehabilitation for most of that time, says EksoNR is good news for Australians.

“I think it’s very exciting. Its been great to see this level of technology come into rehabilitation. It means people can start walking earlier, so their discharge plans could be very different”.

“It is also a good addition to our overall program. If we’re assisting, it’s physically hard work. It’s also difficult to control the many joints involved in walking; an ankle, foot, knee and hip. It takes many hands and a degree of lifting. EksoNR does this for us, which means the number of repetitions a person can do isn’t limited by how tired their therapist might get,” Stephanie said.

“When you see the change, when people are outside the device and you can see they have the muscle memory – that makes my day,” she said.

While it is still early days, Mariam feels optimistic for her mum about how EksoNR is helping her to regain her independence more quickly.

“Every bit of progress is a bonus. She is not flat on her back in a nursing home. Prayer is important to mum and she still remembers the words of the psychologist at the hospital, who helped her form a different outlook on her situation,” said Mariam.

“Perfect practice makes perfect. If you walk 1000 times up a hall and you walk crooked, it’s not good; you are going to be great at walking crooked. But a few perfected steps from the start means there’s nothing to fix later. If you have the chance to use EksoNR, don’t hesitate. It could make all the difference.”

“Growing up, our house always had an open door’’ laughs daughter Mariam. “Everyone would joke that when they went to mum’s house, even if they were not hungry, they’d still end up eating. Yes, life is different for mum and the family now, but it’s still life. That’s something we’re always grateful for,” Mariam said.