Growing up is tough enough. Now imagine being unable to lift your arms high enough to drink from a cup, throw a ball or even turn the pages of this magazine. Sitting in her wheelchair, three-year-old Bailey Buchanan is being introduced to her new “robot arms.” Wearing pink socks and a pink shirt emblazoned with a picture of a dog wearing sparkling glasses, Bailey smiles, lifts up her right arm and scratches her nose … for the very first time.
A small moment in a growing child’s life, like a tiny ripple in a free flowing stream. Almost unnoticed. Except, watching closely, Bailey’s mother, Tawny Reynolds, wipes the tears from her eyes.
Bailey’s robot arms are officially known as WREX—the Wilmington Robotic EXoskeleton. The WREX is an arm orthosis, meaning a functional support that helps children with very little residual strength to move their arms in space. It’s custom made for each person and can be used by people with muscular dystrophy, spinal muscular atrophy, cerebral palsy and rthrogryposis.
Quite simply, the WREX is an evolutionary and revolutionary improvement in orthopedic therapy. It has a kid-friendly name and comes from a kid-friendly place. The WREX was created at the Nemours/Alfred I. duPont Hospital for Children, which conducts world-class research and development to improve the lives of kids with neurodevelopmental and musculoskeletal disorders.
The hospital’s Anthony N. Fusco Sr. Atrium is modern, open, spacious and welcoming. Inside the main lobby, someone is playing the grand piano, and children flap their arms like birds and jump up and down in front of a giant wall-sized interactive video screen. Parents pull their children in wagons down hallways over checkerboard floor tiles in bright, primary colors. The walls are decorated with paintings and photographs of therapy dogs and giraffes. Inside a waiting lounge is a model of a dinosaur, SpongeBob, an electric train set, a foosball game, and an unusual sound.
“Listen to the laughter,” says Alfred I. duPont spokesperson Steve Maurer. “It’s the most common sound we hear at the children’s hospital.”
At the Pediatric Engineering Research Lab located within the hospital, Jinyong Wee picks up and places a large metal arm brace onto the table. It’s heavy, inflexible, old school, and looks more like a restraining device than a therapeutic tool. The research engineer then places a WREX arm support next to the metal brace. This version is smaller, lighter, colorized and flexible. He picks up the WREX and demonstrates how it can help a child move her arms.
“The WREX attaches to a wheelchair or a lightweight upper-body cast,” says Wee. With it, the child can move her arms up and down, in and out, from side to side, and also rotate them. We can increase or decrease tensile strength by adding or subtracting rubber bands. It’s like anti-gravity—almost as if the user’s arms are floating in space.”
Wee continues: “Using the 3-D printer here at the lab, each WREX can be custom made and modified for each individual user. Using a 3-D scanner, we first measure for the dimensions of each child. Then we enter that data, create a design and print the parts—all in a matter of hours. It’s a better fit in less time.”
The 3-D printer also allows for modifications. “Taking each plastic part of the WREX, we can bend it, twist it, make it bigger, then print it,” Wee says.
“The 3-D printed parts are for the smaller kids,” adds Tariq Rahman, a senior research scientist and head of the lab. “Larger kids and adults use metal parts, as the plastic printed parts are still not strong enough for larger forces.”
Adult stroke patients can even use the WREX as an exercise device. “A Swiss company licensed the WREX for this purpose,” Rahman says. “They connected a larger WREX to a computer, allowing the patients to interact with a screen while doing therapy.”
When the WREX was first being developed at the hospital, meetings were held with families of children who could potentially benefit from it. Each family’s input was sought and taken into account. Almost universally, parents most desired for their kids to be able to manipulate objects on tables, and feed and groom themselves. They had witnessed firsthand the frustration inherent in their children’s lives caused by dependency on others for personal care. They wanted their kids to become independent.
One early WREX user—a teenage boy with spinal muscular atrophy—was able master a computer keyboard. He went on to win a college scholarship and plans to graduate with a degree in math and computer science.
“My daughter has arthrogryposis,” says Tawny Reynolds, mother of three-year-old Bailey, the WREX beneficiary mentioned earlier.
A child with arthrogryposis is born with joint contractures. Some of the joints don’t move as much as normal, and they may even be stuck in one position. Often, the muscles around the joints are thin, weak, stiff or missing.
“I want people to read about her and learn about the WREX,” says Reynolds. “Maybe it could help one other child.”
Bailey is smiling, cradling her baby doll in her lap and wearing a WREX for the first time. She turns her head, searching for her grandfather, Doug Buchanan, and wants to show “Pop Pop” the picture she’s drawn. She is also talking nonstop.
“Her favorite word is humongous,” says her granddad.
Tracy Shank, a certified hand therapist, works closely with Bailey while she’s wearing her WREX. Shank has been a therapist for 20 years, working with the WREX for more than three.
“I’ve worked with children who can’t lift a cup to their mouths, can’t throw a ball or stack blocks,” Shank says. “Typically, they feed themselves using their knees and feet. The WREX gives them a play space in front with added depth and height. It teaches the child how to explore and increases her play space exponentially.”
“Wearing the WREX also has social benefits,” Shank adds. “Their vision is now off the ground and they’re looking up, seeing other people’s faces and interacting more.”
Using the WREX for the first time can be exhausting for Bailey. That in mind, Shank explains to her mother and grandfather how to begin using it properly.
“We have to build up her tolerance, “ says Shank. “Using the WREX will help Bailey build her strength and her motor memory, and her brain will learn and remember how to move.”
After the WREX has been custom created and fitted, children and their caregivers take the devices home with them to use. They return to the hospital for periodic therapy sessions and mechanical adjustments as the kids grow older.
What’s the future of WREX? Invisibility.
“Most kids don’t like ‘stuff’ attached to them, and they’d like these to be inconspicuous,” says Rahman. “We’d like to make the WREX as small as possible and still provide necessary function. Ideally, it could be worn under a shirt or jacket.
“We’re working on it.”