As a child, Monica Goulette contracted a viral infection, since diagnosed as Lyme disease, which doctors believe lay dormant for a few years. She started showing symptoms when her body went through puberty. One of the consequences was her right leg became completely paralyzed, except for her hip flexors. At 16, Goulette began using a knee/ankle/foot/orthosis. While being fitted for a replacement KAFO, Goulette’s orthotist told her about a new product — the Ottobock C-Brace. Now, says the 21-year-old from Los Altos, California, “I love it. It has opened up a lot of doors I didn’t even know were closed.”
The C-Brace Goulette gushes over can be a game changer for people with incomplete SCIs, stroke, post-polio or other neurologic conditions causing partial paralysis. At first glance the custom molded, carbon fiber device, which extends from high on the hip down to a foot plate, can easily be mistaken for a powered device designed to assist the user to walk, primarily due to the large knee joint unit, which bulges out just above the knee. That unit houses both the brains and the brawn of the system. The brains consist of a microprocessor that monitors the user’s gait pattern at the knee and ankle joints throughout the entire gait cycle. The brawn consists of a hydraulic piston designed to provide resistance at the knee to ensure the user’s knee joint won’t buckle and result in a fall. Power needed to walk comes from the user.
The C-Brace monitors the knee joint every .02 seconds, or 50 times a second, and adjusts the resistance in those joints as needed — in anticipation of the user’s next move. As a result, the brace can respond to changes in terrain, direction and speed. That continual monitoring and near instantaneous response helps prevent falls by providing resistance to uncontrolled knee flexion when sensors read a moment of instability, giving the user the necessary time to recover.
The brace helps normalize the gait through controlled dampening — slowing down knee flexion and extension — which allows a more normalized and efficient ambulation pattern. A strain gauge runs from ankle to knee, which tells the microprocessor where the user’s body weight is in the foot. That information, along with the angle of the knee, determines the amount of hydraulic resistance.
Everyday life is obviously easier with the ability to walk on uneven ground, descend stairs and ramps, and tackle the slopes of sidewalks. The unit’s microprocessor monitors and responds to those obstacles while reducing wear and tear on the sound side.
A conventional KAFO works for people because it locks and stays locked, giving the user confidence that her knee won’t buckle. The downside of those KAFOs is the pronounced “hip hike” necessary to propel the leg forward for the step. The C-Brace’s constant monitoring of joint angles provides support by automatically adjusting resistance while anticipating the next phase of the step. That resistance with the knee or ankle bent is key when going from sitting to standing or climbing a flight of stairs. This real-time monitoring and response allows users to walk with greater ease and less concentration while normalizing the gait pattern and eliminating the hip hike.
The brace can impact a user’s life quite profoundly. For Chris Bridgman, a T10 incomplete para, the brace has eased his transition back to work full time as a loan officer. “I love being able to look people in the eye, standing 6 feet tall. I can go anywhere and not worry about being able to get into a house or a building because of steps or whatever,” says Bridgman.
Bridgman, 38, was injured in 2010 and used a KAFO brace in rehab, but found it impractical. He happened across the C-Brace much the same way as Goulette, by stopping in at his local orthotics shop. Training at Craig Hospital for five weeks with a physical therapist helped him make good progress with both strength and endurance, though he still needed crutches or someone’s hand to hold for stability while walking. He has good quadriceps and hamstring strength in his left leg, but little strength in his right. He continues to use both crutches and says “losing even one seems like a long ways away.”
The C-Brace has also helped Goulette in her job as a kindergarten aide. She says it’s comfortable to wear and allows her to squat, get down on her hands and knees and even walk quite fast without having to worry about falls or trips. “I can go to the gym and work out, ride a bike or the elliptical, or use the treadmill,” she says. “This winter I want to go snowboarding. I’m confident more doors will open as technology improves. Now I have the ease of mind to live a normal 21-year-old life.
“I can go hiking for miles without having to worry about screwing up my spinal alignment and being in pain. The brace gives me a normal gait and prevents misalignment and long-term consequences, both structurally to the spine and possible medical issues as well. I’m not as concerned about the distances I walk because I know my spine is properly aligned, or about falling because the brace gives me the time and support to recover. With the locking KAFO I was falling down five or six times a day and seeing a chiropractor very regularly, but no more since the C-Brace,” Goulette explains.
Not Without Challenges
Both Goulette and Bridgman say to expect a learning curve when adjusting to the C-Brace. “It’s much more challenging to use on a daily basis than a chair. It’s really tough to carry stuff, open doors or use the bathroom,” Bridgman says. “I was surprised by how hard it’s been to master, even though the person who fitted me said it could take months or years to master.” He was dead right. “It feels like a high wire act every time I stand,” he says. The brace forces people to use different, infrequently-used muscle groups, so fatigue is often a big problem, even for people like Bridgman, who rows four times a week and lifts weights as well.
Goulette says she has adjusted over two years of using the C-Brace. “I was used to walking with the locked KAFO, so I got the hang of it quickly and felt comfortable using the brace after about a month,” she says. “The hardest to learn were stairs or curbs. After using a locked brace for three and a half years, using one that never fully locks and trusting the brace to catch me was terrifying.
“The falling has been completely eliminated. If I stumble, the brace senses I’m off-balance and provides more resistance. My walking is much more fluid going up curbs and stairs, and I no longer have to constantly be on guard about being pushed or bumped into.”
Simply putting the bulky brace on also took some getting used to. “Clothing has been a challenge due to the bulkiness of the hydraulic unit,” Goulette says. “Getting used to having something so large strapped to me took time. I occasionally still walk into corners and walls.” Many users alter pants and jeans with a slit to accommodate the hydraulic unit, which requires skin tight contact with the user’s leg.
Bridgman says it takes him about 10 minutes to get the brace on, a testament to its form-fitting nature. “I feel like I’m going into battle or getting ready to do motocross,” he says.
A Life Changer, at a Cost
“Seeing Chris standing and walking for the first time was a ‘take your breath away’ moment,” says Bridgman’s wife, Jennifer. “I stopped seeing Chris’ wheelchair years ago, though I’d forgotten how tall he is or how satisfying it is to walk down the street side-by-side.”
“To me, the C-Brace is a milestone in our ongoing recovery. Now, with Chris being able to choose between the chair and the brace, we’ll be able to attend sporting events as a family and concerts as a couple, bypassing the quick-to-sell-out accessible sections and moving on to previously inaccessible locations. Perhaps most important are the added health benefits, such as cardiovascular strengthening and decreased wear and tear on the shoulders. This brace can potentially change our daily life as we know it. We feel very fortunate.”
If you’ve heard enough, the next question is: Are you ready to fork over $75K?
That is not a misprint.
The MSRP of the C-Brace for self-payers is the price of an exoskeleton. Ottobock couldn’t provide a definite price because the device lacks insurance coding. Lu Aadland, a Denver orthotist with Hanger Prosthetics, says coding and rate agreements vary from funder to funder (presently Worker’s Comp or VA). Each brace is custom molded to the user’s leg, making it a specialty item. On the bright side, the price includes training and necessary mechanical adjustments to the device. Most third party payers will reimburse PT sessions.
If the price seems steep, Aadland says, she’s yet to hear any complaints from users, “because they say you can’t put a price on the independence of walking.” She has done several evaluations and explains that the process begins with an orthotist doing an evaluation to determine suitability for the brace. Candidates are initially fitted to a trial unit, which adjusts to accommodate most people. Once fitted, candidates take the unit for a test drive. If the evaluation is positive and the candidate wishes to proceed, her leg is then measured and casted in plaster — a very intricate casting technique — and then fitted with a diagnostic brace to verify the finished carbon fiber brace will fit like a glove and the knee center joint is properly and accurately located. The tight fit ensures that all the sensors function accurately. Units are then hand made in Utah, making each one unique.
“The C-Brace isn’t something I fit and say ‘good luck,’” says Aadland. “People need to be able to reciprocate. They must have some glute and/or hip extensors, as well as good proprioception. Strong motivation is vital. They need to be committed to learning how to use the brace, which involves 20 to 30 therapy sessions, so they can be walking full or nearly full time.”
When asked to sum up his feelings about the brace, Bridgman offered this: “Knowing what I know now, there is no doubt in my mind that I would still buy it.”
• Ottobock, 800/328-4058; www.ottobockus.com, www.ottobockus.com/orthotics/solution-overview/orthotronic-mobility-system-c-brace/