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Stepping Out: Ground-breaking robotic technology is putting this five-year-old on track to greater independence.

Emily Pineda is rocking the lobby of the Health & Technology Center at Good Shepherd. Wearing the Trexo Plus, pint-size, robotic technology that helps children like Emily with cerebral palsy walk, the confident and engaging five-year-old is a social butterfly gliding from one end of the building to the other.

Emily’s first stop is at the café to buy a bag of chips. Then it’s over to the water fountain to fill her cup. After that she is off down the hall to visit one of the receptionists with an offer to share her chips.

From there, she makes a beeline for the front door. It’s a cold January day, but the sun is shining and Emily is having so much fun she doesn’t seem to notice.

“Ok Emily,” says her mother Jennifer after a couple of minutes outside. “Aren’t you cold? Let’s go back in.”

Emily grins, turns around and obliges, walking through the big sliding glass doors, smiling at everyone she meets, flashing the occasional thumbs up sign in greeting. “She’s not a very fussy child,” says Jennifer. “She’s very social and likes to give hugs. She is a child who really loves life and people.”

Kandis Jones is the physical therapist who oversees Emily’s weekly 45-minute sessions in the Trexo Plus, a first of its kind robotic exoskeleton for children that allows Emily to move her legs in a normal gait pattern. “I think she has taken to it pretty easily,” says Kandis, “but we do have to come up with some clever things to keep her motivated. Mom is fantastic finding things Emily likes. She loves to socialize, so we just let her walk around and talk to people.”

Continuing a long tradition of technological excellence and innovation, Good Shepherd is one of six organizations worldwide participating in a research study with the Trexo aimed at improving function for children with mobility challenges. The Trexo is ideal for children ages 3-6 with lower-extremity weakness or spasticity who have been diagnosed with cerebral palsy, pediatric stroke, spinal cord injury, gait disorder, and other conditions.

“Emily’s legs get very stiff, making it harder for her to bend them and walk,” says Kandis, noting that Emily uses a gait trainer at home but needs someone to help move her legs. “The Trexo can take her through that normal range of movement.” 

For Jennifer, who learned about the Trexo from a friend, and her husband Rob, it is well worth the 60-minute drive from the family’s home in Blue Bell to bring their daughter to Good Shepherd for this unique therapy. The reason is simple: results.

The Trexo’s weight- bearing design helps children to walk farther as they gain strength. When Emily first began her therapy she could only take 200 to 300 steps per session. Now she can do up to 1000. “I feel like Emily has gotten more agreeable to taking steps,” says Jennifer. “Before, her legs would lock up. It has improved her ability to squat in a controlled manner, easily pick up things from the floor and sit. She really uses the Trexo as a vehicle to take her places wherever she wants to go, which she hasn’t had before.”

And there are other benefits. “We’re noticing she can keep up her head, and upper body and trunk more on her own,” says Kandis.

The Trexo is not a one-size-fits-all piece of equipment. Kandis can set the motion to varying degrees of resistance, depending on each child’s level of tightness in the hips and knees. A series of sensors relays data to Kandis who uses a handheld computer tablet to capture that information with every step. Different colored lights on the side let Kandis know when Emily is working with the Trexo to take steps. “It’s a partnership between her and the Trexo,” says Kandis.

Emily’s speech is limited (she is taking speech therapy at Good Shepherd) but she is bright and has control over when and where she wants to go in the Trexo. “She has a really good pointer finger so she can turn the device on to make it go. That’s really important because the movement of the Trexo and her body are on her terms,” says Jennifer.

Amanda Kleckner, administrative director of pediatrics, is in the forefront of the Trexo research project at Good Shepherd. “Research has shown the benefits of improving gait in children with cerebral palsy, including the prevention of contractures and an overall improved quality of life,” she says.

Traditional methods of helping children with abnormal gait patterns involves a combination of physiotherapy, bracing, the use of traditional aids, such as walkers, and in some cases, surgical intervention. “However, using a walker does not necessarily lead to restoring (normal) physiological gait patterns,” says Amanda. “Aberrant gait patterns may still be present and can lead to abnormal loads on lower limb joints causing long-term problems, such as joint deformities.”

Robotic technology, such as the Trexo Plus, ensures Emily’s walking pattern is done with everything properly aligned and coordinated. “With the Trexo, it’s the perfect pattern over and over,” says Amanda.

Adds Kandis, “Just the opportunity to be able to practice that movement pattern in the Trexo with a lot of repetition is so important. That’s how kids learn, practice, practice, practice.”

Emily is still too young to fully understand the uniqueness of the technology that is helping her on the path to greater independence, but Jennifer and Rob know different. “Finding Good Shepherd was like finding the unicorn you searched for as a child. You knew if you looked hard enough, you may find it, and we did,” says Jennifer. “We love Good Shepherd, because this was an experience we would have never had anywhere else.”

Emily gives a thumbs up.