The first time Ximena Barnard stood up she was eight years old. There was one thing that bothered him after all that time in a wheelchair. She donned the red robot and went straight to see if her twin, Paulina, who was born just a minute before her, was taller. She straightened up, stood next to her and smiled: they were the same. Ximena has been the first girl in Latin America to test and use the exoskeleton Atlas 2030, a robotic device developed by the company Marsi Bionics in collaboration with the Higher Center for Scientific Research (CSIC) of Spain. The device has just landed in Mexico, its first destination outside Europe, where in the short term it will be available to at least 200 minors with cerebral palsy. With his arrival, for many families hope begins now.
In the Doctores neighborhood, historically one of the most insecure areas of Mexico City, rests the only robot in Latin America that helps children with motor disabilities get up and walk. The APAC Foundation (Association for People with Cerebral Palsy) is visited daily by 500 minors and adults, but not everyone will be able to use it. It can be adapted for a maximum of 35 kilos and the height that corresponds to two to 11 years. Even so, only in this association there are already two hundred patients for a single device. “These are children who had only been upright with harnesses or with their mothers holding them by the armpits and now with the exoskeleton they can interact on their own, they can play,” says Guadalupe Maldonado, director of APAC, who points out that the transformation in those who already have tried it has been “magical”. A magic created by science.
The robotic operation of the Atlas is “simple” in the words of its creators, but it has taken years of research. It has eight motors, placed in the ankles, knees, and hips. First, the child is seated and a series of fasteners are attached to the limbs and chest. When he is well secured, on the tablet that the robot has attached to be able to direct it, a single button is pressed. The force of the exoskeleton lifts him up immediately.
The robot has two modes: automatic, in which all the force is carried out by the device and is designed for patients who do not have or will not be able to develop muscle strength; and the help mode, where the robot proposes a step and stops halfway, with the knee flexed, and it is the child who must finish it. “We get the child to do strength as if he were going to a gym. That force is in the hip, right knee, or left knee, depending on how the therapist has set it up. That makes him learn to walk”, explains Ignacio Barraqué, co-founder of Marsi Bionics.
The Atlas 2030 has led its creator, the Spanish researcher Elena García Armada, to win the prestigious European Inventor of 2022 award, granted by the European Patent Organization to the most important creations of the year. García Armada, who works at the CSIC, started this project at the request of Daniela’s family, who after having an accident had stopped being able to walk. “At that time there were exoskeletons for adults, but none of the manufacturers had in their business plans to address the pediatric sector,” explains the researcher in a video call with EL PAÍS. It took three years to achieve the first prototype.
There are 17 million children in the world who cannot walk. The great technological barrier for the García Armada team was making the robot adapt to most of them. “What has made the difference between our exoskeleton and the others is not the fact of making it small, but the adaptability of the technology of the joints, with inherent elasticity to adapt to these children who have such complex and variable symptoms”, he points out. the doctor, in relation to the fact that this device can be used in the two extremes of motor disability: the lack of muscular strength of neuromuscular diseases to the rigidity, spasticity, of cerebral palsy.
The patients who are going to use it in Mexico are practically all of this second category. Valeria Baeza has been in a wheelchair for six years: she barely has mobility in her legs or her right arm. She arrives with pink glasses, a pink bow and a giant smile to greet Ximena, mounted on her exoskeleton. She had to try it two days ago and started dancing. Today she lets Ximena be the one to push her chair. “Her first reaction when she tried it was a huge laugh. She was fascinated”, says her mother, Alejandra Mohedano. “The next day she told me: ‘Put me on the robot because I already want to walk’. The fact of feeling that she was on her feet completely motivated her, ”she notes.
The clinical benefits of the exoskeleton are proven: it helps improve posture, breathing and the digestive system. It also allows you to build muscle mass and, most importantly, improve brain neuroplasticity. “Most of these children have some type of neurological damage that requires rehabilitation that goes beyond the physical. For these brain connections to occur, mobility is necessary, a repeated and intense movement, but it has to be connected with motivation. The patient has to be putting all his intention into what he is doing so that he can make changes in the brain, ”explains Dr. García Armada in detail.
The change of attitude is the part that families value most. Violeta Aguilar, Ximena’s mother, says that she is a withdrawn and shy girl, almost always confined to her wheelchair, and that she looks like another of hers when she climbs on her exoskeleton. “Today she really wanted to come because she told me that she had to walk with the robot,” says Aguilar, “this has given her daily life another approach.”
Most of the responsibility for these cerebral palsy patients falls on women; mothers, sisters and grandmothers who, like Aguilar, cross the city every day on a trip of almost two hours there and two hours back to take their children to therapies in APAC, one of the few places in Mexico that has a Comprehensive disability care. There are days that they don’t eat because they don’t have time and they spend hours watching on stools while the doctors and nurses treat their children. “Now it is a dream to see her like this, to see her walk, even with support. It is a triumph. Getting up tired, sleepless, bad weather, but you say: ‘All that has been worth it,’ says Aguilar while her daughter plays with a huge green ball surrounded by physical therapists.
Although the scenario is hopeful, the rehabilitation director of APAC, Héctor Bolaños, puts his feet on the ground. The improvements of the first sessions are guaranteed but the place of the exoskeleton should not be in a test room. “The ideal is for her to be at school, in her classroom, where her friends are, so that she can find meaning in use. Because otherwise the euphoria will pass, shortly. She needs to find more challenges,” Bolaños reasons. The researcher García Armada recognizes that these are the next technological evolutions of the device. The first step was the controlled environment, after which it can be used in the homes and schools of minors.
At the moment there are only four Atlas 2030 working. Mexico’s is fourth, after Spain, Italy and Poland. Until now, the company only had the capacity to manufacture one device per month. The 12 of this 2022 are placed, the majority remain in the Community of Madrid. They have increased the team to double production so that there can be 24 next year. That of that minimum amount one has landed in Mexico has been “a common dream” very expensive, explains Guadalupe Maldonado.
The director of APAC explains that they have had to convince and resort to a large number of companies and foundations —among which are giants such as Santander or Coca-Cola— to raise the five million pesos (about 200,000 dollars) that it cost to bring the exoskeleton to Mexico City. Seeing the first results, they have already managed to get a foundation —of which she omits the name— to buy the second device. This one will be used mainly for research: it will be used with a control group of children at the Anahuác University and the UNAM to observe improvements in mobility and neuroplasticity. But Maldonado already thinks about the third device. Also the mothers of these children: “Having a robot like this within the reach of a family like us with very few economic possibilities changes everything,” says Alejandra Mohedano, “it is essential that they have these types of tools, because we do not we will be eternal all our lives. I want my daughter to be as independent as possible, I want to prepare her for that moment.”
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