• Video: See the Kickstart device in action.
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Jim Martin said the stroke he had two years ago wasn't that bad. The aftereffects are the problem.
Martin's left side doesn't work well. His left hand is clenched most of the time. He can walk slowly with a cane.
Martin, 73, hopes that a new walking device he was fitted for on Wednesday will help him move faster and reduce his fear of falling.
Every year, nearly 800,000 people in the United States suffer a stroke, which occurs when blood flow to part of the brain is stopped. About 30 percent of those people will experience significant weakness on one side of their bodies, said Dr. Pierre Fayad, director of the Vascular Neurology and Stroke Program at the University of Nebraska Medical Center.
People with such limited mobility often can use a cane in their home but, like Martin, must use a wheelchair for long trips outside the home. They usually also wear some sort of brace that supports their ankle and foot. Some must wear a leg brace that goes up to the hip.
Stroke patients usually will go through inpatient rehabilitation, then do outpatient therapy after going home, said Jacob Keough, who makes orthotics and prosthetics at OrthoMedics in Omaha. Eventually, if they stop making progress, he said, insurance companies won't approve additional therapy.
Keough, who fitted Martin with the device, called Kickstart, on Wednesday, said the device could help people show enough improvement so that insurers will approve additional physical therapy sessions.
A spring in the Kickstart, which looks like a flexible leg brace, helps move the leg forward. The device is secured to the leg by a hip belt, with supports above and below the knee and a connection at the shoe.
Brian Glaister, CEO of Cadence Biomedical, which makes Kickstart, said the concept came out of the Cleveland Clinic. A researcher there, he said, studied how horses walk and run.
“He found out that one of the reasons why horses are so much more efficient than humans is that they have really long tendons,” he said. “The human tendon stretches a few inches across the joint and horse tendons go along the entire leg. The tendons end up doing a lot of the work in walking. That way, the muscles don't have to work as hard.
“The thought was that you could put a long spring on a human, and they could do the same thing. It turns out to be very effective for people recovering from strokes or multiple sclerosis with weakness in the hip flexor muscles.”
Glaister's Seattle-based company licensed the patent on the device and took it from the idea stage to the market. Most of the device's users are on the West Coast. Martin is the first user in the Midwest, Glaister said.
Fayad, of UNMC, looked over the device on the company website. He said the concept sounds reasonable and it could work for some people, but he couldn't find any clinical trial results showing how much it helps a large sample of patients.
Glaister said the device didn't have to be approved by the FDA, so his company didn't conduct trials before bringing it to the market. A trial is being conducted now, he said, and case-study data will be published soon.
“Kickstart doesn't do the work for you,” he said. “It just gives you a little bit of a boost.” Users, he said, “have to have a little bit of strength and control.”
Martin and his wife, Kay, learned about Kickstart through Martin's physical therapist, Tammy Roehrs. She was on hand Wednesday to watch as Keough and Glaister adjusted the device that was customized for Martin.
A retired feed mill operator from Blair, Martin was among 17 people who had tried out a Kickstart demonstration model this spring at Roehrs' clinic.
“When we put the device on Jim, his performance changed immensely,” Keough said. “He was walking much faster, much more confidently, and his weight was more symmetrical when he would take steps rather than leaning to one side. That made him really a no-brainer to get into one of these.”
Keough worked for about a half-hour to get the Kickstart fitted to Martin, adjusting straps, positioning Martin's leg, marking spots where holes needed to be drilled on the hip belt, adjusting tension and stringing a cable through a pulley and running it down to a spot near Martin's ankle.
“Now you're ready to walk, Jim,” Keough said as he helped Martin stand. As Martin took a few tentative steps, Glaister told him, “Remember, the bigger the step you take with your right foot, the better it works on the left.”
Martin walked down a hallway in Keough's office, then turned around as Keough kept hold of him. “How you feeling, Jim?” Keough asked. “Oh,” Martin said, “I think it will work.”
Martin ended up walking about 100 feet before he sat back down. His speed had picked up by the end of the session.
“It felt strange,” Martin said. “I feel like I'm going to have to get used to it. But I think it's a step in the right direction. I could feel the tension is really helping me raise my left leg to bring it forward, and that helps considerably.”
Keough said Medicare will pick up about $2,000 of the $7,500 to $8,000 cost of the device. Glaister said that in most states Medicaid doesn't cover it, but the Departments of Veterans Affairs and Defense do, and some private insurers cover the entire cost.
The Kickstart device in action