May 27, 2018
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After stroke, college student fights to walk again, and gets help from new device

By Fred Tasker, McClatchy Newspapers

MIAMI — When Brian Riscigno, a chemistry major at Florida International University, suffered a stroke at age 24, the young man who was accustomed to jogging four miles a day could no longer walk or speak or drive the beloved 1984 Nissan ZX Twin Turbo his grandparents had given him.

But Riscigno’s a fighter. Today, he speaks with just a slight hesitation and takes daily walks with his mother, Sylvia, around the 1.1-mile lake near their house in southwest Miami. He was even able to walk through the sand in the Florida Keys earlier this year as best man at a buddy’s outdoor wedding.

Riscigno credits his recovery to his own hard work, the help of his physical therapist and his mother — and to a relatively new medical device called Bioness L300 Foot Drop system. It has taken over some of his brain’s former work in sending signals to his legs and ankles, telling them to lift his foot to take a step. The same device is retraining nerves around the damaged area in his brain to slowly take over some of the work themselves.

“It has changed his life,” his mother says.

Before the 2008 stroke, Riscigno was doing well, working on his dream to become a high school chemistry teacher. Then came the day his headache wouldn’t go away.

“He said to me, ‘Mom, I feel kind of weird.’ Then he fell against me and onto the floor,” says his mother, Sylvia. “It was a nightmare.”

Doctors had to cut away a piece of his skull to relieve the brain swelling and keep him in Baptist Hospital of Miami for nearly three months. They blamed a rare, hereditary blood-clotting disorder.

The stroke damaged his brain and took away most of his speech, part of his eyesight and the use of his right arm and foot.

“I couldn’t even speak for two months,” he says now. “I couldn’t sit up or eat solid foods. I didn’t fully understand what had happened. I was just out of it.”

After the stroke, two grand mal seizures, a major operation and months in the hospital, Riscigno started to recover.

“I think I coped fairly well once I started recognizing faces and people again,” he says. “But I would have crying episodes, pity parties. My psychologist explained it was part of the way the brain heals itself.”

“I didn’t leave the hospital for weeks,” his mother says. “I slept in a corner. I slept on the floor.”

Even after weeks of standard physical therapy, Riscigno couldn’t properly raise his right foot to take a step. So therapists fit him with the new “foot-drop” system developed by a California medical firm.

“It was a beautiful thing,” says Baptist physical therapist Lida Rivera-Perez. “The first time he used it, he got a muscle contraction and he was able to walk across the room, maybe 30 feet, with a cane and somebody helping him.”

With a few adjustments to the device and dozens of therapy sessions, Riscigno regained his ability to walk.

“He can negotiate stairs, walk on grass and uneven terrain,” says Rivera-Perez. “He can keep up with anybody walking. They don’t have to slow down for him.”

The foot-drop device, called a neurological prosthesis, won FDA clearance in 2006 and is used in up to 600 hospitals and clinics around the United States, says Keith McBride, vice president for global marketing and corporate training for its maker, Bioness Inc., of Valencia, Calif.

The system consists of a small computerized device called a “functional stimulation cuff” strapped to the leg just below the knee, a “gait sensor” attached to the ankle with a plastic pad extending beneath the heel and a patient-operated control unit similar to a TV remote control.

When the patient begins to take a step, his heel lifts off the pad, and the gait sensor sends a wireless message to the cuff, which in turn sends radio frequency signals through the skin to the leg muscles that trigger the ankle to lift the foot.

The NESS L300 costs $6,000. Some insurance policies will pay, others won’t.

The idea, called “functional electrical stimulation (FES),” has been around since World War II, but only in the past few years has the equipment become sophisticated enough and small enough to be carried on the patient.

An earlier FES device by another firm, replete with boxes, multiple wires and doctors’ control panels, was used to move the paralyzed legs of “Superman” actor Christopher Reeve to exercise them and prevent muscle atrophy. Reeve experienced some “functional gain” to his leg muscles before he died of other causes, according to the Christopher & Dana Reeve Foundation’s Paralysis Resource Center.

The newer device now is used for patients of stroke, partial spinal cord injury, multiple sclerosis and traumatic brain injury. Veterans of Iraq and Afghanistan are using it in Veterans Administration hospitals around the country, McBride says. A more advanced unit costing about $10,000 is coming out now, stimulating patients’ knees, legs and hips, he says.

Neurologists say the foot-drop system can do more than help the patient walk.

When patients suffer stroke or other head injury, messages from the brain no longer reach the ankle to raise the foot to take a step, according to a February 2010 article in the academic journal U.S. Neurology by Dr. Richard C. Senelic, neurologist and medical director of the Rehabilitation Institution of San Antonio. Paralysis of the legs’ flexing muscles causes the foot to flop downward. It’s called “foot drop.”

But over time, the repeated motions stimulated by the device strengthen the patient’s muscles and re-educate nerves surrounding the damaged area in the brain to take over the functions once performed by the damaged area.

“At Baptist, we use it early after a stroke, and we can speed up the patient’s natural recovery,” says Dr. Bradley Aiken, medical director of rehabilitation at Baptist, who has used it with a “couple dozen” patients in the past three years. “In some cases, we’re able to wean them off the units.”

Riscigno sees improvement.

“I’ve regained a bit of movement in my ankle even without the device. I don’t have much power, but I can move. It’s a big step for me.”

He still can’t drive his ’84 Nissan because of his impaired vision, his mother says, but he tinkers with it from time to time. And he still hopes to get that chemistry degree from FIU. He’s taking neurological and psychological tests to see if he’s able to resume his studies.

“I try to be a positive person,” Riscigno says. “My parents and grandparents and whole family have been really supportive.”

Riscigno got rid of his cane a year ago. He’s not sure if he will ever be able to walk properly without the device.

“Right now? No,” he says. “But anything’s possible.”


(c)2011 The Miami Herald

Distributed by MCT Information Services



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