When endurance athlete Michael Haddad was first introduced to LAU’s leadership he reportedly said: “I’m paralyzed from the chest down and defying the odds. I need someone to defy them with me.”

Seven years since this encounter, Haddad’s collaboration with LAU is still going strong.

His condition, caused by a spinal injury at the early age of six, typically renders individuals dependent on a wheelchair for mobility and unable to walk or stand up.

Haddad, however, overcame this impediment by walking, climbing and descending stairs using the swing-to-gait method – whereby he maintains his balance with his upper body while thrusting his legs forward with the help of crutches. This movement – seemingly simple because walking requires very little mental effort for most people – is in fact proof of Haddad’s exceptional brain endurance.

Former Associate Professor and Neurology Chair Rechdi Ahdab from LAU’s Gilbert and Rose-Marie Chagoury School of Medicine explained, “Since Haddad cannot rely on his spinal locomotor centers, ambulation is consciously implemented by his brain.” This means that at any given moment, his brain coordinates the movements of dozens of muscles in his upper body, calculating the trajectory of his next step, planning his landing, anticipating hazards and reacting to miscalculations or unexpected dangers – while simultaneously completing other motor tasks, as well as maintaining balance in spite of a highly deficient balance system.

“This compares to walking on a thin wire on a windy day,” said Dr. Ahdab.

Inspired by Haddad’s method, Associate Professor of Mechanical Engineering Barbar Akle pitched to his students at the School of Engineering a project to develop a walking aid, challenging them to contribute on a volunteer basis.

Since then, the initiative grew exponentially, first into several undergraduate capstone projects, a graduate project and thesis, and then into several fundraising initiatives and collaborations with experts across the board.

From a scientific standpoint, exoskeletons developed for paraplegics are typically heavy, battery-and-motor operated machines that the person can control through minimal motion. These machines are expensive, have limited range, and worst of all, require little physical effort from the user, which is unhealthy.

LAU’s creation, on the other hand, is a much lighter “training suit” powered by the person wearing it, himself becoming “the battery and motor,” without a need for an external source of energy.

Inspired by Haddad’s swing-to-gait movement, the exoskeleton fortifies the upper body by enabling the user to achieve balance through an active control system with feedback sensors, while lower orthoses or braces help him or her retain their energy as they go, without breaking momentum.

“This scheme provides relative independence for the paraplegic,” explained Assistant Professor of Practice Ali Ammouri. Considering how the lack of physical activity can cause severe health complications, “the opportunity for movement that the exoskeleton provides has long-term health advantages,” he added.

As the exoskeleton is being developed, the approach has shifted from building assistive technology to creating a training tool that will, hopefully, free the paraplegic to walk independently.

Ultimately, “the goal of this project is to develop a training suit that will controllably help and train the balance, while specific regions in the brain are being activated with transcranial magnetic stimulation to accelerate the learning curve,” said Dr. Akle. In parallel, special orthoses reduce the energy required by the user, as a training protocol is put in place to help build the required muscle strength and support the balance requirements.

From a neurological perspective, this started with a comprehensive study of Haddad’s nervous system, spearheaded by Dr. Ahdab.

The experimental findings suggest that Haddad utilizes a great deal of motor planning and imagery in order to ambulate, which did not surprise him, as he had repeatedly defined the key to his successes as “lots of focus” and “proper planning.”

“Michael has a special type of intelligence akin to that of all-time great athletes — those who see, react and understand the game in a manner that sets them apart from others,” said Dr. Ahdab.

To help the LAU team test and perfect the exoskeleton, Haddad has been trying it out on walks across tough terrains, such as the Beirut walk for inclusion, a five-km-walk in Oyoun El Simane, the Egypt walk for “Stepping Ahead of COVID,” as well as a number of fundraising events and initiatives, where engineering students and faculty observed and collected data.

Another team from the American University of Beirut’s Physical Education and Nutrition programs has also tailored a physical training protocol along with a special diet.

In 2019, the United Nations appointed Haddad as Regional Goodwill Ambassador for Climate Action. To that end, he plans to walk 100 km across the North Pole to raise awareness on the devastating impact of the Arctic melt, and the detrimental consequences of climate change. While this endeavor was originally planned for 2020, it was postponed until spring 2022 due to the COVID-19 pandemic.

In the meantime, testing and improving the exoskeleton is still going strong. The scientific team hopes to produce a first working prototype of the suit within two years.

From an academic standpoint, “this has been a tremendous learning experience for engineering students as they continue to engage in solving a worthwhile problem – a truly inspiring effort,” said Dr. Akle. Not only have the students been involved in developing the exoskeleton, but have had to build other gadgets for the project, he added. In response to COVID-19, for example, the team created a ventilated face mask for Haddad, who expends approximately 30 times more energy while walking, and therefore requires more oxygen than the average person.

The project has broken new ground in research and innovation which could lead in the long run to developing an integrated Neurorehabilitation program that combines classical physical training and “brain training” tailored to the needs of paraplegic patients.