Iron Woman: How a Young Quadriplegic is Making Big Strides
How science is helping a young Nova Scotia quadriplegic get back on her feet.
Four and a half years after she broke her neck in a car crash and lost movement in all of her limbs, Amy Paradis is standing again. "Oh, man, this is so weird!" says the 20-year-old, who, instead of gazing up at everyone, is looking each of us straight in the eye.
It's June, the first day of a week-long training session at FootPrints, a spinal cord injury rehab centre in downtown Windsor, N.S. Paradis's mother, Marlene Belliveau, opened the facility in 2012 in hopes of witnessing what happens next: her daughter walking. Secured to Paradis's feet, legs and chest is a motorized exoskeleton. With therapy, Paradis has regained much of her arm function, but she has no mobility below the waist. The sensor-rich carbon-fibre frame is designed to remedy that. It registers her efforts to shift her weight before taking a step, and it delivers the power she needs to follow through. Close behind is Marki Wong, Paradis's kinesiologist, and Jennifer Macievich, a physical therapist from Ekso Bionics, the California-based company that created the robotic suit.
The exoskeleton-or Ekso-exposes normal walking for what it is: a series of small, connected motions. Wearing two lithium-ion batteries like a backpack, Paradis marches forward using a walker to stay centred. Ball-screw motors at the hip and knee joints sigh with each stride, as though the machine is as pleased as Paradis.
Then, a problem. Paradis is overshifting the walker, steering her upper body left while her feet angle right. Wong presses a button on the unit's receiver, and Paradis finds herself frozen mid-stride, neither foot flush with the floor. She looks searchingly over her shoulder. "I got ya," says Macievich, who nudges Paradis's feet evenly beneath her. With Paradis squared up, the three women complete two lengths of the room. But Paradis continues to have trouble: the walker shoots ahead, and her right foot snags on the carpet. Macievich squares her again. "I feel really off," Paradis says. "I don't know what's going on."
Time for a break. The trio heads to a wooden bench. After Macievich unfastens the leg and chest straps, Paradis transfers herself from the bench to her wheelchair. Her arms are a fresco of tattoos, including a white-feathered dream catcher that covers her entire right shoulder. On her wrist is written, This too shall pass. Then she puts a hand to each eye to stem the tears.
Five passengers were in the station wagon speeding down Chester Road on December 26, 2009, when Paradis's 19-year-old friend Ian Stephens pushed the speedometer past 130 kilometres an hour. Paradis says that while everyone was "laughing and carrying on," she wasn't alone feeling scared. She was, however, the only one who undid her seat belt: she wanted off the joyride and was preparing to jump. Stephens came up on a bend too fast. The car hit the shoulder and rolled to the bottom of a snowy ditch.
"She's breathing on her own," Belliveau was told by one of the trauma physicians at the QEII Health Sciences Centre in Halifax. "For now." The only person injured in the crash, Paradis was placed in a traction halo. X-rays showed four fractured vertebrae; she had surgery the next evening. The teen didn't wait long to display her fighting spirit. Video taken 10 days after the accident shows Paradis using a suction tube to lip-synch to Ja Rule's "Livin' It Up." When her respirator pops out, she continues to groove, arms bobbing above the hospital linen.
Both mother and daughter resented the textbook assessments they were given by hospital staff. One of the initial attending physicians told Belliveau, "I don't see her making much of a functional recovery." And several clinicians suggested any therapy was likely to plateau about 18 months after the event. "She was told, 'Here's your chair, you'll be here the rest of your life,'" Belliveau says.
Rehab was not Belliveau's field of expertise-she has a background in social work-but she canvassed researchers in Canada and the United States, and learned everything she could about improving impaired movement after a spinal cord injury. It became clear that, to see real progress, her daughter needed a dedicated space with specialized workout gear. Using her savings, she built one.
The idea paid off. Belliveau brought in a home therapist to work with Paradis from 2011 to 2012, but her core strength gains have accelerated in the past year and a half under Wong's guidance at FootPrints. Paradis submits to a two-hour three-day-a-week regimen of pelvic tilts, back extensions and standing ball throws. Now and then a wow moment happens. "I'll feel a muscle clench or move, a muscle I didn't have yet," she says, preferring not to think of her legs as frozen, but asleep. Subtle improvements have led to more significant ones. Paradis can sit up in bed, she can do a kicking motion, and she has sensation all the way to her toes.
At the time of the crash, Paradis had been accepted into volunteer firefighter training. She also had a spot in a local auto mechanics program. And then those options were made irrelevant. She was miserable a year later when Stephens was sentenced to three years probation. "I can't do anything," she told reporters that day, from her wheelchair. "I'm in prison."
Paradis shrugs when reminded of the quote. "I'm a lot happier than I used to be," she says. In a gloomy bit of irony, Paradis says Stephens rarely leaves his house. Recently they've started to chat on the phone. She's forgiven him, and she likes to think she's important to him. Is he a friend? "Definitely," she says. Then she adds, "I actually don't have any friends," and grins as though to neutralize the thought. "I like to keep it in the family."
Her brood-which includes a sister and four brothers-powers her determination. "I stopped accepting the way I was, and started using the positive energy around me to recover." Paradis firmly believes she will walk again on her own, as does Wong ("No doubt in my mind") and her mother. "There will be disappointments," Belliveau says. "But we'll get there."
FootPrints houses one of three Eksos in Canada (the others are in rehabilitation centres in London, Ont., and Vancouver), with 60 in use worldwide. When the U.S. Department of Defense sought a way for soldiers to lift heavy loads over long distances, Berkeley Bionics responded in 2008 with the Human Universal Load Carrier (HULC), a titanium suit able to haul up to 90 kilograms across any terrain. After licensing the HULC to Lockheed Martin, Berkeley-which became Ekso Bionics in 2011-repurposed the wearable robot to help those with mobility issues stand, walk and sit. Belliveau discovered the suit during her research into assistive devices for paralysis. "I knew we had to have it," she says.
What the device gives back to Paradis is a sense of where her body parts are in space, an ability known as proprioception. Macievich says proprioception is part of the "enormity of processes" the able-bodied take for granted. Most of us don't actively think our way down the stairs or up the street. "We get constant sensory feedback," Macievich says. "The body is always recalculating, even as higher tasks are going on." She acknowledges the Ekso is a marvel, but says it only replicates the basics. Paradis remains more impressive than the machine.
From her wheelchair, Paradis studies the $110,000 piece of robotics engineering. Its battery pack is slumped; its mechanical legs dangling. The Ekso is like a stranger offering her something familiar, something remembered. But it's also strange: an apparatus from the future and, as such, an embodiment of the unknown, of possibility. If the Ekso had eyes, it would be staring back. Ready for another go?
The next day, the group decides to move a few blocks down the street to Windsor's community centre. The auditorium will allow for longer stretches of continuous stepping. Paradis is rested and in good humour. Gym gear is piled near one of the corner exits, and she spies a few coloured hoops. "Hey, can I hula in the Ekso?"
The town's recreation director says she'll be back to take a photo of Paradis for the mayor's newsletter. Windsor (population 3,705) has held fundraisers for Paradis's Ekso bills, helping the family make a $12,000 down payment last winter. With over $90,000 still owing, financing the unit represents its own long road.
Paradis transfers herself from the wheelchair to the bench. Macievich straps her into the Ekso, and Wong takes the receiver. The suit makes an exhaling sound as it raises Paradis to her feet.
Paradis determinedly completes a couple of laps of the auditorium, but once again she struggles to keep the walker aligned with her power-driven gait. Two hours later, she's already taken 773 steps versus 554 the day before. But some victories don't come with a winning feeling. When she's striding cleanly in the machine, Paradis brings to mind a movie cyborg-oblivious to hindrance, programmed to meet its objective by any means necessary. Futuristic though it may be, the device can't reassure her that by week's end she will have surpassed 4,000 steps. Paradis is only human, and the Ekso is only a machine. It's a shaky partnership. "I want to perfect it," she says. "I realize it will take time."
During one of Paradis's laps, the centre's power goes out. Emergency lights click on above the corner doors. Sunlight through the tall windows lies on the floor like sheets of foolscap. Paradis's focus is tested. Macievich keeps two calm hands on the young woman's shoulders and broadcasts each step with a word of simple applause: "Good. Good. Good." There's nothing for Paradis but to keep going, to try to finish the day well.