Paralyzed man regains voluntary leg movement with electrode array implant

By Darren Quick

From: http://www.gizmag.com

Rob Summers, 25, in the harness that provides support while he receives electrical stimulation to his spinal cord (Image: Rob Summers)
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In a move that gives cautious hope to the millions of people suffering some form of paralysis, a team of researchers from UCLA, Caltech and the University of Louisville has given a man rendered paralyzed from the chest down after a hit-and-run accident in 2006 the ability to stand and take his first tentative steps in four years. The team used a stimulating electrode array implanted into the man's body to provide continual direct electrical stimulation to the lower part of the spinal cord that controls movement of the hips, knees, ankles and toes, to mimic the signals the brain usually sends to initiate movement.

Instead of bypassing the nervous system to directly stimulate the leg muscles, the electrical signals provided by the array stimulate the spinal cord's own neural network so it can use the sensory input derived from the legs to direct muscle and joint movements. The stimulation therefore doesn't induce movement, but taps into a network of spinal cord nerves that are capable of initiating movement on their own without the help of the brain, which then work together with cues from the legs to direct muscle movement.

The research team's work builds on previous research at UCLA that showed animals with spinal-cord injuries could stand, balance, bear weight and take coordinated steps while the outermost part of the spinal canal - or epidural space - is stimulated.

Thanks to the breakthrough the test subject, 25 year old Rob Summers, is able to supply the muscular push required to stand up and remain standing for up to four minutes at a time. With periodic assistance, Summers is able to stand for up to an hour, and with the aid of a harness support and some assistance from a therapist he is able to take steps on a treadmill.

Prior to implantation with the epidural stimulating array, Summers, who suffered a complete motor injury at the C7/T1 level of the spinal cord, was unable to move even his toes. But after implantation he was able to not only stand and make repeated stepping motions on a treadmill with the assistance of a harness, but also regained the ability to voluntarily move his toes, ankles, knees, and hips on command. However, once the stimulation is turned off, Summers loses the voluntary control of his limbs.

Over time, Summers also experienced improvements in several types of autonomic function, including bladder and bowel control and temperature regulation. The researchers say these autonomic functions began to return before there was any sign of voluntary movement, which took around seven months after he began receiving epidural stimulation to emerge.

Although the researchers still aren't yet fully sure how these autonomic functions were regained, the results indicate the treatment could help improve the quality of life of spinal cord injury sufferers other than those with the strength to undergo the rigorous physical training Summers did as part of his treatment. The researchers say the relief from secondary complications of complete spinal cord injury - including impairment or loss of bladder control, sphincter control and sexual response - could even prove to be ultimately as, or more important in terms of improving the quality of life of such patients

While obviously encouraged by the results, the researchers are quick to point out that the study represents just one case and that there's no way to tell how other patients may react. They also point out that Summers, who was an athlete in comparatively excellent physical condition before his accident, retained some sensation in his lower extremities after his injury indicating his spinal cord was not completely severed, which may have played a part in the level of success he was able to attain.

However, the researchers are hopeful that their work could one day provide some individuals suffering spinal cord injuries with the ability to stand independently, maintain balance and take effective steps through the use of a portable stimulation unit and the assistance of a walker. Additionally, the researchers believe the approach could potentially also help in the treatment of stroke, Parkinson's, and other disorders affecting motor function.

The team has received approval from the FDA to test five spinal-cord injury patients and will next try and replicate their initial results with a patient that matches Summers in terms of age, injury, and physical ability. They will then turn to patients who have no sensation to see how that influences the outcome.

Interestingly, the device implanted into Summers is FDA-approved for back pain only and its use was meant only as a test to see if the researcher's concepts would work. As a result, the researchers say the current implants have many limitations and that further advances in the technology should lead to better control of the standing and stepping process. They are also looking at whether it might be possible to move the array higher up on the spinal column to see if it could also be used to affect the arms and hands.

The UCLA, Caltech and University of Louisville researcher's work is detailed in the paper, "Epidural stimulation of the lumbosacral spinal cord enables voluntary movement, standing, and assisted stepping in a paraplegic human," which is published in The Lancet.

Professor V. Reggie Edgerton discusses the breakthrough in the following UCLA video:

Wheelchair Lacrosse a Hit with Palo Alto Vets

It could be the next big sport to hit the Paralympic circuit: wheelchair lacrosse... coming to a VA near you.
By Aaron Selverston
From: http://paloalto.patch.com/

With only two organized teams in the country, wheelchair lacrosse remains in its infancy, but organizers at a demonstration for veterans at the Palo Alto VA insisted the sport would become the next paralympic hit.

More info at:

NorCal Wheelchair Lacrosse Team Page

www.wheelchairlacrosse.com
www.borp.org
www.usparalympics.org

Brain–Computer Interface Allows Paralyzed Patients to Play Music with Brainpower Alone

By: Philip Ball

From: http://www.nature.com/

The brain-computer interface allows paralysed patients to play music just by thinking about it.ICCMR Research Team - University of Plymouth

A pianist plays a series of notes, and the woman echoes them on a computerized music system. The woman then goes on to play a simple improvised melody over a looped backing track. It doesn't sound like much of a musical challenge — except that the woman is paralysed after a stroke, and can make only eye, facial and slight head movements. She is making the music purely by thinking.

This is a trial of a computer-music system that interacts directly with the user's brain, by picking up the tiny electrical impulses of neurons. The device, developed by composer and computer-music specialist Eduardo Miranda of the University of Plymouth, UK, working with computer scientists at the University of Essex, should eventually help people with severe physical disabilities, caused by brain or spinal-cord injuries, for example, to make music for recreational or therapeutic purposes. The findings are published online in the journal Music and Medicine¹.

"This is an interesting avenue, and might be very useful for patients," says Rainer Goebel, a neuroscientist at Maastricht University in the Netherlands who works on brain-computer interfacing.

Therapeutic use

Evidence suggests that musical participation can be beneficial for people with neurodegenerative diseases such as dementia and Parkinson's disease. But people who have almost no muscle movement have generally been excluded from such benefits, and can enjoy music only through passive listening.

The development of brain–computer interfaces (BCIs) that enable users to control computer functions by mind alone offer new possibilities for such people (see Mental ping-pong could aid paraplegics). In general, these interfaces rely on the user's ability to learn how to self-induce particular mental states that can be detected by brain-scanning technologies.

Miranda and his colleagues have used one of the oldest of these systems: electroencephalography (EEG), in which electrodes on the skull pick up faint neural signals. The EEG signal can be processed quickly, allowing fast response times, and the instrument is cheaper and more portable than brain-scanning techniques such as magnetic resonance imaging and positron-emission tomography.

Previous efforts using BCIs have focused on moving computer screen icons such as cursors, but Miranda's team sought to achieve the much more complex task of enabling users to play and compose music. Miranda says that he first became aware of the then-emerging field of BCIs more than a decade ago while researching how to make music using brainwaves. "When I realized the potential of a musical BCI for the wellbeing of severely disabled people," he says, "I couldn't leave the idea alone. Now I can't separate this work from my activities as a composer."

The trick is to teach the user how to associate particular brain signals with specific tasks by presenting a repeating stimulus — auditory, visual or tactile — and getting the user to focus on it. This elicits a distinctive, detectable pattern in the EEG signal. Miranda and his colleagues show several flashing 'buttons' on a computer screen, which each trigger a musical event. The users push a button just by directing their attention to it.

For example, a button could be used to generate a melody from a preselected set of notes. The user can alter the intensity of the control signal – how 'hard' the button is pressed – by varying the intensity of attention, and the result is fed back to them visually as a change in the button's size. In this way, any one of several notes can be selected by mentally altering the intensity of pressing.

With a little practice, this allows users to create a melody as if they were selecting keys on a piano. And, as with learning an instrument, say the researchers, "the more one practices the better one becomes".

Back in control

The researchers trialled their system on a female patient who has locked-in syndrome, a form of almost total paralysis caused by brain lesions, at the Royal Hospital for Neuro-disability in London. During a two-hour session, she got the hang of the system and was eventually playing along with a backing track. She reported that "it was great to be in control again".

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Goebel points out that the patients still need to be able to control their eye movements, which people with total locked-in syndrome cannot. In such partial cases, he says, "one can usually use gaze directly for controlling devices, instead of an EEG system". But Miranda points out that eye-gazing alone does not permit variations in the intensity of the signal. "Eye gazing is comparable to a mouse or joystick," he says. "Our system adds another dimension, which is the intensity of the choice. That's crucial for our musical system."

Miranda says that although increasing the complexity of the musical tasks is not a priority, music therapists have suggested it would be better if the system were more like a musical instrument — for instance, with an interface that looks like a piano keyboard. He admits that it is not easy to raise the number of buttons or keys beyond four, but is confident that "we will get there eventually".

"The flashing thing does not need to be on a computer screen," he says. It could, for example, be a physical electronic keyboard with light-emitting diodes on the keys. "You could play it by staring at the keys," he says.

• References

  1. Miranda, E. R., Magee, W. L., Wilson, J. J., Eaton, J. & Palaniappan, R. Music and Medicine advance online publication doi:10.1177/1943862111399290 (2011).

eLEGS Makes Walking Possible for Paraplegics

Bionic legs offer new mobility for the wheelchair-bound.

By Jaymi Heimbuch 

San Francisco, CA From http://planetgreen.discovery.com/

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Screengrab via video from BerkeleyBionics

Few things are likely more amazing than regaining the use of your legs if you're wheelchair bound. Berkeley Bionics has created an exoskeleton that allows a paraplegic person to stand up and walk. Typically, the inventions coming from the labs at Berkeley Bionics help add strength and endurance to people traveling long distances with heavy loads, such as military personnel. However, they've upped the bar on their inventions, so to speak, and unveiled eLEGS last week.

CEO Eythor Bender stated in a press conference, “Many of the 6 million Americans who live with some form of paralysis today were highly active and at the top of their game when they sustained their injury. As they research their options for increased mobility, they discover that wheelchairs are pretty much it... We want to enhance their independence and freedom of movement."

You can see from the video below that the possibilities of strength training and freedom of movement are extraordinary, thanks to the electronic exoskeleton. While it will be used primarily for rehabilitation at medical centers, one day it could possibly be used as an alternative for wheel chairs.



eLEGS is battery powered, and can go as quickly as 2 mph depending on the user's abilities and strength. It works by sensing the user's gestures and intentions to move forward, and reacts accordingly, a little bit like the brain-powered wheelchair.

Paralysed dog walks again after pioneering treatment that could help humans with spinal injuries

By Daily Mail Reporter

A paralysed dog has been put back on his feet again, raising hopes of a treatment for humans with severe spinal injuries.

Henry the miniature dachshund was unable to walk after discs ruptured in his spine last November.

In a pioneering treatment, scientists at Cambridge University took cells from his nose and injected them into his spine.

Back on four legs: Henry the miniature dachshund, who was paralysed, has taken his first steps after pioneering treatment by scientists at Cambridge University

These cells are used because they aid the growth of new nerve fibres.

Now the six-year-old dog is walking and wagging his tail again.

Scientists originally found the treatment worked on rats. Professor Nick Jeffery and Professor Robin Franklin, who are running the trial, then decided to try the procedure on dogs because spinal injuries are common in many breeds.

Henry has also received physiotherapy and is monitored on a treadmill.

More...

• Tiny porkers with a big price tag: £700 'micro-pigs' are the latest celebrity pet craze

Dr Jeffrey said: 'We hope if the results are positive in a few years time the treatment could perhaps be used to help people.'

Scientists at Cambridge Veterinary School took cells from Henry's nose and injected them back into his spine.

'It's incredible, I didn't think Henry would ever be able to walk again, but over the last few months he has been wagging his tail and taking small steps,' said owner Sarah Beech, 34, from Birmingham.

'The vet told me to put him to sleep because he wouldn't have a very good quality of life and he was very depressed. But this treatment has really helped.'

Scientists took cells from Henry's nose and injected them into his spine

Henry had always enjoyed going for walks but suddenly lost the use of his legs about a year ago.

'One day he yelped when I picked him up and two days later he couldn't walk,' she added.

'The discs in his back were pushing into his spinal cord and eventually he lost the use of his back legs and continence.

'I think he may have fallen down the stairs at some point before I bought him as his spine was quite badly damaged.' Henry was given an operation to ease the pressure on his spine, but it didn't work.

Then Sarah heard about the new treatment for severe spinal cord injuries and decided to enlist him in the trial.

Cells were harvested from his nose in March and injected back into his spine after four weeks.

Just a month later Henry took his first steps.

Step by step: Henry undergoes treatment

'He can take at least four steps now so he is making good progress,' said Sarah.

'His tail is also starting to get back to its original shape which shows he is getting some feeling back.'

Dr Jeffery said: ''Most dogs with spinal injuries can be treated conventionally and make a good recovery, but this procedure is intended for particularly severe cases.

'Cells are collected from inside the back of the nose as these special cells are capable of supporting the growth of new nerve fibres.

'We then increase the cell numbers, purify them and place them back into the damaged region of the spinal cord, where they help new fibres to grow.'

After the procedure dogs are given physiotherapy and monitored on a treadmill to see how much movement has returned to their legs.

'The potential of this procedure is enormous,' Dr Jeffery added.

'We hope if the results are positive in a few years time the treatment could perhaps be used to help people.'

Read more: http://www.dailymail.co.uk/news/article-1218810/Paralysed-dog-walks-pioneering-treatment-help-humans-spinal-injuries.html#ixzz0TTLceXSw

Paralyzed Rats Walk Again

Three-pronged treatment let their legs move, bear weight without brain signals

By Jennifer Thomas, HealthDay Reporter

SUNDAY, Sept. 20 (HealthDay News) -- A three-pronged approach to treating spinal cord injuries allowed paralyzed rats to walk without receiving signals from the brain, scientists report.

Spinal cord injuries result in paralysis when the nerve fibers that carry information to and from the brain are damaged or severed. Much of the focus of research into spinal cord injuries has been exploring ways of regenerating those nerve fibers and connections, which has so far met with limited success in people.

In the new study, rats were treated with a combination of drugs, electrical stimulation of the spinal cord and locomotor training, a rehabilitation technique. The combined treatment enabled the rats to walk with a near-normal gait on a treadmill, without the muscles receiving signals from the brain.

"The study demonstrates that the lower spinal cord has circuitry that is sufficient to support virtually normal, weight-bearing locomotion," said senior study author V. Reggie Edgerton, a professor of physiological sciences and neurobiology at the University of California, Los Angeles.

The study appears in the Sept. 20 online edition of Nature Neuroscience.

Previous research has been able to coax a stepping motion using one or two of those techniques, said Susan Howley, executive vice president of research for the Christopher & Dana Reeve Foundation, which provided some funding for the current research. But this is the first study to achieve actual weight-bearing walking, as opposed to the motions of walking.

"The thing that's very exciting about this is that for the first time they actually showed they can get these rats, with no input from the brain, to step near normally," Howley said. "On the treadmill, they were able to bear weight and step virtually as well as they had been prior to the injury. That's a remarkable achievement."

In the study, researchers put rats whose lower legs were paralyzed in a harness on a slow-moving treadmill and gave them a drug called quipazine, a serotonin agonist that enhances the function of the spinal nerve circuitry. The researchers then used an epidural to apply electrical currents to the dura of the spinal cord, the protective membrane that surrounds it, below the point of injury.

The combination of drugs and electrical stimulation caused the rats to begin walking. Several weeks of daily locomotor training on the treadmill enabled near-normal weight-bearing walking -- including backward, sideways and running.

Because the brain was still unable to direct the walking, the rats could only walk when hooked up to electrical stimulation on the treadmill.

Previous studies have shown that the nerve circuitry of the spinal cord is able to generate rhythmic activity that can direct leg muscles to step, the researchers said. With the right input, the nerves can learn to interpret sensory information from the stepping motion even without help from the brain.

"Previous research has shown the spinal cord can learn whatever task it's being trained to do," Edgerton said. "The spinal cord can interpret the sensory information associated with the stepping, respond to that sensory information and sustain the stepping based on the sensory information."

Locomotive training is a rehabilitation technique that uses that concept to retrain the spinal cord circuitry after injury. Widely used in some European countries, locomotor training involves placing people with spinal cord injuries in harnesses while physical therapists move their legs in a walking motion.

People who undergo locomotor training often see improvements in respiration, bladder function, blood sugar levels and circulation below the level of the lesion, which can help prevent the skin breakdown that can occur as a result of paralysis, Howley said. Others even recover trunk stability, which can enable them to move from a bed to a wheelchair, or a wheelchair to a car, without assistance.

Though a treatment using the three-pronged approach is at least several years away, the study suggests the potential of using neuroprosthetic devices to activate spinal cord rhythmic circuitry, said study author Gregoire Courtine, a professor in the department of neurology at the University of Zurich in Switzerland. His team is currently developing a device that they hope to begin testing in small clinical trials in three to four years.

About 5.6 million Americans, or one in 50, has some level of paralysis, according to a survey released in April of 33,000 U.S. households by the Christopher & Dana Reeve Foundation. About one-quarter of the nearly 2 percent of the U.S. population living with paralysis is due to a spinal cord injury.

More information

The Christopher & Dana Reeve Foundation has more on the latest spinal cord injury research.

SOURCES: Susan Howley, executive vice president, research, Christopher & Dana Reeve Foundation, Short Hills, N.J.; V. Reggie Edgerton, Ph.D., professor, physiological sciences and neurobiology, University of California, Los Angeles; Gregoire Courtine, professor, University of Zurich, Switzerland; Sept. 20, 2009, Nature Neuroscience, online

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Spider Bite Cures Paralyzed Man: Miracle or Bad Reporting?

By Christopher Wanjek, LiveScience's Bad Medicine Columnist

posted: 24 March 2009 02:48 pm ET

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Christopher Wanjek is the author of the books "Bad Medicine" and "Food At Work." His Bad Medicine column appears each Tuesday on LiveScience. [Bad Medicine Column Archive]

It sounds like something out of the pages of The Weekly World News, right next to an alien abduction story: Paralyzed California man bit by brown recluse spider walks again. Only it was reported for real last week on CNN, ABC, NBC and CBS.

Yes, a miracle — a miracle this could make the evening news, for this was a phenomenally poorly reported story bereft of the simplest of fact-checking. Of the three basic facts reported by these apparently professional journalists — paralyzed man, brown recluse spider, and walking — two are surely false.

Yet more than just another example of lousy broadcast journalism, such stories bring false hopes and even danger to those desperate enough to experiment with venom to cure their paralysis.

Talk to a doctor

Here's the full story as sort-of reported: A man named David Blancarte of either Modesto or Manteca, Calif. (reports vary), who was either paralyzed or confined to a wheelchair (reports vary) after a motorcycle accident either 20 or 21 years ago (reports vary), was bitten by a brown recluse spider two years ago and sought treatment in a hospital. An unnamed nurse there noticed muscle spasms; concluded his nerves were just "asleep"; ordered tests; got him to rehab; and got him walking again.

"Extraordinary claims require extraordinary evidence," the late astronomer Carl Sagan liked to say. None of the news reports, however, included a doctor or scientist commenting on the possibility of a spider curing paralysis, let alone confirming Blancarte's recollection of the medical facts.

I'm not saying this guy wasn't in a bad way for 20-some years. What likely happened was that Blancarte's legs weren't completely paralyzed and, in fact, were slowly healing. A bite of some sort — more on this below — got him to a hospital, where medical professionals realized that there was nerve and muscle activity unrelated to the bite. Through physical therapy he slowly regained the ability to walk, albeit with a walker.

Good for him. What a great stroke of luck. But that's a far cry from headlines such as "NorCal Paraplegic Cured by Spider Bite."

Talk to your local arachnologists

There's a touch of Spider-Man in this tale, with the venom of a spider imparting superhuman powers. But the journalists' spider senses weren't tingling enough to understand that there are no brown recluse spiders in California. These tiny spiders — no bigger than a quarter, legs and all — are rarely seen west of the Rockies, inhabiting the Midwest from Texas up to Canada.

Chances are, it wasn't even a spider that bit Blancarte. As reported in a 2005 article in the New England Journal of Medicine, 80 percent of patients seeking medical care for a spider bite were actually bitten by something far more benign, such as a tick, flea or beetle.

The brown recluse spider, in particular, gets a bum rap. As the name implies, these spiders aren't aggressive and don't like to be around anyone. In the states that do have lots of them, reports of bites are rare or non-existent. Yet in states that don't have them, such as California or Colorado, reports of bites number in the hundreds, according to a study in the journal Toxicon led by Rick Vetter of University of California, Riverside, who seems to be on a crusade to stop myths about spider bites.

Alas, there's a new twist to this strange story. Blancarte can walk but apparently he can't run from the law. With his sudden fame alerting police to his whereabouts, Blancarte was arrested last week on a contempt-of-court charge stemming from a domestic violence case — that is if you believe the news reports.

Exoskeleton suit helps paralyzed people walk

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ReWalk helps paraplegics stand upright, climb stairs

HAIFA, Israel - Paralyzed for the past 20 years, former Israeli paratrooper Radi Kaiof now walks down the street with a dim mechanical hum.

That is the sound of an electronic exoskeleton moving the 41-year-old's legs and propelling him forward — with a proud expression on his face — as passersby stare in surprise.

"I never dreamed I would walk again. After I was wounded, I forgot what it's like," said Kaiof, who was injured while serving in the Israeli military in 1988.

"Only when standing up can I feel how tall I really am and speak to people eye to eye, not from below."

The device, called ReWalk, is the brainchild of engineer Amit Goffer, founder of Argo Medical Technologies, a small Israeli high-tech company.

Something of a mix between the exoskeleton of a crustacean and the suit worn by comic hero Iron Man, ReWalk helps paraplegics — people paralyzed below the waist — to stand, walk and climb stairs.

Goffer himself was paralyzed in an accident in 1997 but he cannot use his own invention because he does not have full function of his arms.

The system, which requires crutches to help with balance, consists of motorized leg supports, body sensors and a back pack containing a computerized control box and rechargeable batteries.

The user picks a setting with a remote control wrist band — stand, sit, walk, descend or climb — and then leans forward, activating the body sensors and setting the robotic legs in motion.

"It raises people out of their wheelchair and lets them stand up straight," Goffer said. "It's not just about health, it's also about dignity."

Kate Parkin, director of physical and occupational therapy at NYU Medical Centre, said it has the potential to improve a user's health in two ways.

"Physically, the body works differently when upright. You can challenge different muscles and allow full expansion of the lungs," Parkin said. "Psychologically, it lets people live at the upright level and make eye contact."

Iuly Treger, deputy director of Israel's Loewenstein Rehabilitation Centre, said: "It may be a burdensome device, but it will be very helpful and important for those who choose to use it."

The product, slated for commercial sale in 2010, will cost as much as the more sophisticated wheelchairs on the market, which sell for about $20,000, the company said.

The ReWalk is now in clinical trials in Tel Aviv's Sheba Medical Centre and Goffer said it will soon be used in trials at the Moss Rehabilitation Research Institute in Pennsylvania.

Competing technologies use electrical stimulation to restore function to injured muscle, but Argo's Chief Operating Officer Oren Tamari said they will not offer practical alternatives to wheelchairs in the foreseeable future.

Other "robot suits," like those being developed by the U.S. military or the HAL robot of Japan's University of Tsukuba, are not suitable for paralyzed people, he said.

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