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Better computers and advances in neuroscience have created a recent flurry of progress in brain interface technologies and robotics. Now researchers are betting that these technological breakthroughs can pay big dividends for paralyzed patients. They can reduce the need for attendant care and improve the quality of life for the approximately six million people in the United States living with paralysis.
On the administrative side of things, a new type of initiative known as enterprise imaging can reduce medical costs and improve patient outcomes through better data sharing and lower barriers between medical specialties. But there are a number of other technologies, from stem cells to exoskeletons that could begin to directly help paralyzed patients within the next few years and decades.
The Walk Again Project, a nonprofit, international collaboration among various world-class universities, is experimenting with using a brain-computer interface — essentially, a direct communication pathway between a wired brain and an external device — to restore neurological and physical activity in paraplegics with spinal cord injuries. The results of the first study were published in August. According to CNN, the patients were first placed in a virtual reality environment, where they could control a digital avatar with their thoughts. Whenever the patients were standing on a surface, the virtual reality device tricked the mind into believing that it had received feedback from the feet or legs, “helping the brain remember what it’s like to walk.”
Months of practice in the virtual environment prepared the patients for the experience of moving around in the real world with the help of a motorized robotic exoskeleton. The interesting thing is that before the trial the patients’ brain “had erased the concept of moving by walking,” according to one researcher, but the stimulation of the neurological system during the trial helped “reawaken a small number of nerves that may have survived,” creating connections again between the brain and certain muscles. After a year of intensive training, all eight patients in the study recovered at least partial sensation and muscle control over their lower limbs, as well as some of their bladder and bowel functions.
Epidural stimulation is a highly experimental technology, still in its infancy. It involves surgically implanting a device over the lower spine that applies an electrical current. According to an article published on Live Science, the stimulation doesn’t directly induce movement, but instead it “taps into a network of spinal cord nerves that are capable of initiating movement on their own, without the help of the brain.” The one trial done so far has enabled four people living with a spinal cord injury to recover voluntary movements and the ability to stand. The Christopher and Dana Reeve Foundation are now attempting to expand the clinical trial to encompass an additional 36 people.
A similar technique, called transcutaneous stimulation, was developed in 2015 — the first time that stimulation had ever been delivered non-invasively. Instead of requiring surgery, transcutaneous stimulation delivers an electrical current to the spinal cord through electrodes placed on the skin of the lower back. According to the National Institutes of Health, the five patients who received the stimulation were able to “double their range of motion” after just four weeks, due to the “ability of electrical stimulation to reawaken dormant connections that may exist between the brain and the spinal cord of patients with complete motor paralysis.”
Stem cell therapy holds a great deal of promise for people with spinal cord injuries, even in its early stages. According to Bloomberg, a recent study involving an experimental therapy derived from human embryonic stem cells “appeared to help five out of five paralyzed patients regain some feeling and motor control in their arms, hands and fingers.” Nevertheless, the Reeves Foundation warns that there are potential risks for undergoing stem cell treatments that have not been validated.
Exoskeletons with computerized control systems and motion sensors, although very expensive, are allowing people with limited mobility to walk again. They may not regenerate tissue or recover lost nerves, but they will greatly improve patient’s quality of life, and unlike many of these other technologies, they are on the market now.