Getting a leg up

By Ben Olson
Reader Staff

Everything changed for Jake Gemkow last November. While loading wood into his pickup truck at his home in Sagle, Gemkow suddenly lost feeling on his right side and couldn’t see anything.

“I felt like the right side of my face was gone,” Gemkow told the Reader. 

He and his son called an ambulance and Gemkow was rushed to Kootenai Health in Coeur d’Alene, where he later learned he had suffered a brain bleed, or hemorrhagic stroke.

Since then, Gemkow has navigated the after-effects of such a traumatic episode, which caused a loss of mobility in his right arm and leg, as well as a language disorder called aphasia, which limits the ability to speak and understand others.

Gemkow, 48, now uses a wheelchair to get around and realizes he has a long road of recovery ahead of him, but thanks to a new piece of equipment that Bonner General Health acquired last fall, he is steadily marking progress forward.

Rehab assistant Tanya Hindle, left, and physical therapist Elizabeth Neuder, center, check patient Jake Gemkow’s progress while he uses the EksoNR robotic exoskeleton suit at Bonner General Health. Photo by Ben Olson.

Once a week, Gemkow attends an appointment with Performance Therapy Services at BGH to take about 600 steps in the EksoNR robotic exoskeleton suit.

It’s kind of a big deal that BGH’s rehabilitation department has an exo-suit. It’s a robotic suit that uses cutting-edge technology to help patients regain their strength, mobility, confidence and freedom. 

The EksoNR was the first exo-suit that the U.S. Food and Drug Administration cleared for stroke and spinal cord injury neurorehabilitation and the only one the FDA has cleared for acquired brain injury and multiple sclerosis. The technology has transformed the lives of many who have lost the ability to walk due to stroke, injury, multiple sclerosis, cerebral palsy and more.

Physical therapist Elizabeth Neuder, who specializes in neurological rehabilitation, said BGH can thank occupational therapist Beth Weiss for getting the ball rolling on acquiring the suit.

“She really held a flag for getting the exo,” Neuder told the Reader. “She’s had experience with her husband who has a spinal cord injury. They’ve used the suit that’s in Wenatchee, [Wash.] and every time he used the suit he had a benefit.”

Wenatchee is the nearest location to Sandpoint with an exo-suit. There is one in Billings, Mont., but it’s only available for inpatients. Currently, BGH is the only hospital in Idaho that owns an exo-suit.

“It is a very rare opportunity for us to have this,” said BGH Director of Rehabilitation Michelle Tucker, who said the funding to cover the whopping $120,000 price tag for the suit came through a partnership with the Find Your Strength races BGH has sponsored the past two years, as well as contributions from local organizations.

“That money has gone towards the exoskeleton suit, along with assistance from organizations that have partnered with us,” said Tucker, who added that some donations from the annual Heart Ball fundraiser were also earmarked by the donors to be used toward the purchase of the exo-suit. 

Now, instead of patients having to travel several hundred miles to use the state-of-the-art equipment, they have one right here in Sandpoint, which Tucker hopes will also attract other patients from the region to BGH.

“I really have the belief that our patients deserve to have the best care and best technology,” she said. “They shouldn’t have to leave our community to get the best outcome that they should be able to achieve. … If we can provide something that actually improves the quality of life, we know through studies they’ve done that if they get into this suit, they have a higher probability of an outcome that will increase the longevity of their life.”

Gemkow said the suit has helped him make huge forward strides — literally.

“The doctors told me you could be very well without your leg and your arm,” Gemkow said. “He also said the aphasia could be permanent. But my doctor was amazed. I’m almost three months in and he was amazed that I could walk and talk.”

When asked what his goals were, Gemkow replied: “To walk again. Simply walk again.”

When Gemkow begins his session with Neuder, he exits his wheelchair and sits on a chair with the suit laid out. From there, Neuder fits it around Gemkow with a series of straps that adjust to his body.

Powered by a 15-pound battery that provides up to an hour of usage on one charge, the suit is fully programmable by therapists, who can enter different parameters and presets to account for step length, height and width. While the technology offers powered assistance, it’s up to the patient to maintain the momentum.

“It adapts according to the power that Jake is giving to the suit,” Neuder explained as she finished strapping him into the suit. “It will back off so he’s doing as much as possible. As you get stronger, Jake, the suit does less and less.”

Neuder said BGH currently has more than a dozen clients who use the suit regularly. After a month of training wrapped up in October, four rehabilitation specialists are certified to use the suit, including two physical therapists, one assistant PT and one occupational therapist.

Gemkow said walking in the suit feels a bit like walking through mud. When the suit applies less assistance due to the patients’ strength returning, it’s like walking through “thicker mud,” according to Neuder.

Flanked by Neuder and a rehabilitation assistant, Gemkow takes his first step in the suit. Then he exits the therapy room and walks down the long hallway at the BGH Health Services Building, clocking an average of 500-600 steps each session. He grits his teeth in determination with every step, and Neuder provides vocal support along the way. 

While it’s visibly fatiguing to him, Gemkow grins and jokes throughout the therapy session.

“Usually my therapist and my counselor help give me a positive attitude. Also a lot of Prozac,” he said, prompting laughter from the therapists beside him.

Neuder said the suit is a huge morale boost for her patients, but it’s also beneficial to them both physically and mentally.

“The benefits of weight bearing through our legs benefits every system in our body — from our bones and muscles to cardiovascular system, our function and mobility, digestion,” Neuder said. “When we’re not moving around, those systems suffer, so movement is key.”

With more than 5.3 million people in the United States living with a permanent brain injury-related disability, 2.8 million Americans sustaining a traumatic brain injury each year and more than 795,000 people in the U.S. experiencing a stroke annually, it’s clear the EksoNR exo-suit has the ability to serve a lot of people in the Inland Northwest who otherwise would have had to travel all the way to Wenatchee for rehab treatment.

“Our biggest step now is getting the word out about this suit,” said Tucker. “Not just in the Sandpoint area, but in our region. We want to support our region with this amazing piece of equipment. Just like our patients used to travel to Wenatchee, it would be great if people from Spokane and Coeur d’Alene could seek the suit here.”

After two long trips down the hallway, Gemkow walks back into the therapy room and sighs loudly after sitting down. The counter reads 563 steps. With every step, he holds out hope for a return to walking as he did before the stroke.

“It’s hard work, but it’s worth it,” he said.

To learn more about the EksoNR exoskeleton suit, visit Performance Therapy Services inside the Bonner General Health Services building, 423 N. Third Ave., Suite 150, or call 208-265-3325.