The latest news and information about what's going on with SCI science and research. Brought to you by Sam Maddox, author of the Christopher & Dana Reeve Foundation Paralysis Resource Guide.

Big Month For Robo-Bionics

Quite a couple of weeks for the neuro-bionic bid to address paralysis. An exoskeleton system just got approved commercially in the U.S., a quad in Ohio used a brain bypass to activate his hand, and of course there was the first kick in the World Cup stunt, wherein a young Brazilian used his brain signals to bump a soccer ball with his foot (hard to call that a kick).
If you read the press releases about any of these engineering feats, the neuroprosthetics universe has been properly rocked. Maybe so, but they are all early stage projects, and therefore still rather crude. Meanwhile, there’s something about function that comes with an on-off switch that doesn’t work for some; anti-robot sentiment has gotten some traction among a group who want their cure served biologically.
First, from Brazil. I didn’t see this live but it was impossible to avoid the build-up. Indeed, the principal investigator for this brain-machine demonstraion, Miguel Nicolelis, began selling what he called his “moonshot” at least three years ago while discussing a paper he had just published showing that his team could not only activate limbs using a monkey’s brain signals but could add a tactile sensory feedback dimension (reported in this blog).
Nicolelis is a force in neuroengineering. He and his group reported in 2000 that an owl monkey connected to the Internet could controlled an arm located 600 miles away. In 2008, the team described how a rhesus monkey could determine the pace of a jogging robot – across the globe in Japan. Nicolelis heads the Walk Again Project, a nonprofit collaboration by way of the Duke University Center for Neuroengineering, the Technical University of Munich, the Swiss Federal Institute of Technology in Lausanne, the Edmond and Lily Safra International Institute of Neuroscience of Natal in Brazil, The University of California, Davis, the University of Kentucky, and Regis Kopper of the Duke Immersive Virtual Environment.
In the Brazil case, the subject wore a skull cap fitted with sensors – no brain surgery here. The signals are translated by computer to activate specific muscle patterns; the subject was trained using virtual reality to voluntarily move his paralyzed leg -- in this case, with a kick. I must say, the World Cup effort succeeded in showcasing the idea of a brain-machine interface, but the kick itself was barely a spasm, not as convincing as the diagrams supplied by Duke showing the subject leaving his wheelchair, standing and approaching the ball (check for yourself, it is preserved on the Internet -- YouTube and news coverage). My hunch is that the engineers didn’t quite have things worked out; they did the best they could in front of a world-wide audience.

Robofootball: it wasn't as cool as this drawing.

“We want to galvanize people’s imaginations,” Nicolelis told the Washington Post.  “With enough political will and investment, we could make wheelchairs obsolete.”
OK, now how about the bionic guy in Ohio? Widely covered in the press, hard to miss this one either. This technology implanted a small, 96-electrode sensor chip in the subject’s brain. Signals are sampled and translated to a cuff with electrodes on the subject’s arm and thus, facilitate movement. Quad Ian Burkhart, with a small connection box fitted to the side of his head, could open and close his “dead hand” and even pick up a spoon during the first test of the chip. As was reported, this gives “hope to millions of accident victims and stroke sufferers of a new bionic era of movement through thought."

From a press release:
It’s much like a heart bypass, but instead of bypassing blood, we’re actually bypassing electrical signals,” said Chad Bouton, research leader at [engineering firm] Battelle. “We’re taking those signals from the brain, going around the injury, and actually going directly to the muscles.”

The Neurobridge technology combines algorithms that learn and decode the user’s brain activity and a high-definition muscle stimulation sleeve that translates neural impulses from the brain and transmits new signals to the paralyzed limb. In this case, Ian’s brain signals bypass his injured spinal cord and move his hand, hence the name Neurobridge.
Moving along to the first FDA approved commercial exsoskeleton, the ReWalk system, this one based on Israeli technology. The unit has been on the European market for almost two years, as has its U.S.-made competitor from Ekso. Having seen both systems in side-by-side demonstrations, I would be hard pressed to give one or the other an edge, although the Ekso is perhaps getting closer to practical cosmesis. Call me a skeptic, but none of these robot suits will gain widespread market share until they can be worn all day, hidden under clothing, and priced in the range of a Honda Civic, around $20k.
The ReWalk is kinda spency, at $69,500. And it’s kind of bulky at 50 pounds, and limited: this is not for strolling in the park, it’s for rehab, mainly, and one can’t use it alone. You need a trained assistant.
From the maker, Argo Medical Technologies:
ReWalk provides user-initiated mobility through the integration of a wearable brace support, a computer-based control system and motion sensors. The system allows independent, controlled walking while mimicking the natural gait patterns of the legs, similar to that of an able-bodied person.
And more:
"This revolutionary product will have an immediate, life-changing impact on individuals with spinal cord injuries," said Larry Jasinski, CEO of ReWalk Robotics. "For the first time individuals with paraplegia will be able to take home this exoskeleton technology, use it every day and maximize on the physiological and psychological benefits we have observed in clinical trials."
Physiological data is, so far, mainly anecdotal, but the Argo notes that people who use their robot devices have reported “potential improvements in cardiovascular health, loss of fat tissue, building of lean muscle mass, and improved bowel function. .... Feedback from ReWalk users supports these potential benefits and others, such as better pain management, fewer medications, and potentially reduced hospitalizations.”
Psychological benefits include standing, being able to “look someone in the eye, to hug and be hugged. These are simple acts which many of our ReWalkers thought they would never be able to do again."
From the FDA:
To assess safety and effectiveness of ReWalk, the FDA reviewed testing done to assess ReWalk’s durability, its hardware, software and battery systems, and other safety systems that help minimize risk of injury should the device lose balance or power. 
The FDA also reviewed clinical data based on 30 study participants. The clinical tests assessed the participants’ ability to walk various distances, the amount of time needed to walk various distances, performance on various walking surfaces and slight slopes, and performance walking in areas where jostling might occur. Studies also assessed the risk of certain physical effects on the user. Additionally, observational data from 16 patients were also provided to support use of the device on various walking surfaces in the home and community with various levels of assistance from a trained companion. Risks associated with ReWalk include pressure sores, bruising or abrasions, falls and associated injuries, and diastolic hypertension during use.
ReWalk was developed by Dr. Amit Goffer, an Israeli inventor who became quadriplegic in 1997. "The person walks the system, the system does not walk them. The users are in control -- when they want to sit, they sit, when then want to stand and walk, they do so," said Goffer.
Before leaving the exsoskeleton topic, I want to send a shout out to Reeve Foundation Board member Mark Pollock, who is without doubt the world champion paraplegic robot-man. He has logged miles and miles of steps on an Ekso unit, which he owns and uses in his native Ireland. Here is a fascinating man, one you would want to meet: This is the first line in a very well crafted feature story in the San Francisco Magazine,  “The Incredible Bionic Man:”
Mark Pollock grew up in Northern Ireland during the Troubles. Then he went blind. Then he became a world class adventure athlete. And then he was mysteriously paralyzed. Now he faces his greatest challenge yet.

Mark Pollock, working his Ekso.
Recently, Pollock and his small entourage, including fiancée and fellow Reeve Board member Simone George, spend a couple of months in Los Angeles, working with the Reggie Edgerton lab. From Mark’s blog:
I have been in Los Angeles for the past two months. I’m part of a team that includes a Russian, an American or two, the Irish and British, several Indians, a Finn, of course all of you that got me here and a Robot. We all bring something different, but we are all working towards the same thing: understanding more about human movement. Even the Robot. This is the short-term goal but my aim remains – to help to fast-track a cure for paralysis.
I am approaching this the way I approach athletic pursuits. So, I’ve been breaking my personal bests in my Ekso Bionics robotic legs adding over 10,000 steps a week.
Mark notes that he and the UCLA group are looking at ways to maximize recovery.
As I train in my robotic exoskeleton their team of scientists are tracking what is going on, if anything, in my paralyzed legs. Our primary objective is to determine whether we can improve posture and stepping using two novel ways to neuromodulate (excite and affect) the spinal cord.
No results have been released regarding the Ekso epidural stimulation combo (using a cool new noninvasive tool from the company NeuroRecovery Technologies).
Lastly, while there is a bit of a bandwagon with robotics, not everybody is ready to jump aboard. A group from the Internet community CareCure noted that robots are merely compensatory devices. Like a fancy wheelchair or a crutch. The real solution to paralysis is to heal the body, as noted in this statement from one of the community members:
...  for a majority of those living with paralysis, compensatory devices offer little in the way of dealing with the real problems of paralysis. These wearable devices do not offer any recovery of function resulting in a continuous struggle with bladder, bowel and sexual dysfunction, neuropathic pain, poor circulation and a whole host of other paralysis-related health issues. To some in the paralyzed community it feels as though funding of compensatory devices is money spent on keeping people paralyzed.
I get it that biology is preferable to an on-off button. But I’m not anti-robot. The brain-machine engineers are going to keep going with this. Robotics have wide public appeal (until they start to decide things themselves) and there is money and markets to keep the work going. I would not fear, however, that robotics research will impact funding or scientific inquiry into regenerative biology. Neither path is easy, but give the hardware engineers credit, they have the basics down already and are going to refine the systems – smaller, cheaper, more transparent -- in ways we can only imagine.
Posted by Community Admin on Jun 28, 2014 9:57 PM America/New_York