Traumatic Brain and Spinal Injury Patients, Walk Again

Traumatic brain and Spinal injury patients, who have been paraplegics in the past for the remainder of their lives, have new hope to walk again on the horizon.

There has been a lot of activity in brain-computer interfaces to help such people.
Another pioneering research group in this area is the laboratory of Miguel Nicolelis at Duke University Center for Neuroengineering. Nicolelis and colleagues have shown that a rhesus monkey in North Carolina could, using only its brain, control the walking patterns of a robot in Japan. In 2011, they got a monkey to move a virtual arm and feel sensations from it.
This team is leading the Walk Again Project, an international consortium of research centers dedicated to creating brain-computer interfaces to restore movement.

A 29-year-old paraplegic literally kicked off soccer’s World Cup competition in Brazil, using a mind-controlled exoskeleton that looks as if it came from the “Iron Man” movies.

The organizers of the international Walk Again Project said the symbolic soccer-ball kick was performed during the World Cup’s opening ceremonies in São Paulo’s Corinthians Arena by Juliano Pinto. He’s an athlete from Galea in Brazil’s São Paulo State who lost the use of his legs after a car accident in 2006.

Seven other paralyzed patients who volunteered to go through months of training for the task watched from the sidelines.

“We did it!!!!” the project’s leader, Duke University neuroscientist Miguel Nicolelis, tweeted. Nicolelis spearheaded a team of more than 150 scientists to create the exoskeleton — an effort that he says cost the Brazilian government $14 million over the past two years.

Was Pinto’s few seconds of fame worth the cost? Probably not, if we’re just talking about a kickoff that took a couple of seconds to complete. But the project’s researchers said the advances made in the course of the years-long effort — and the exposure given to the next generation of brain-controlled prosthetic — could be priceless.

“The World Cup demonstration is ceremonial, as we have only a moment to show a kick,” Sanjay Joshi, a roboticist from the University of California at Davis who was involved in the Walk Again Project, told NBC News via email from Brazil. “But maybe that kick will inspire a child somewhere in the world to become a doctor, engineer or scientist.”

Joshi said the project’s long-term aim is to bring together neuroscience, engineering and medicine to build brain-controlled devices that can change the lives of paralyzed patients. Nicolelis struck a similar tone in a post-kickoff statement: “It is only the beginning of a future in which people with paralysis will be able to leave the wheelchair and literally walk again.”

How it works

The system blends the hardware of a battery-powered “Iron Man” exoskeleton with a control system that’s guided by brain waves. Pinto wore an electroencephalogram (EEG) cap dotted with electrodes, which picked up and magnified the faint electrical signals emanating through his skull. Sensors were built into the suit to detect muscle movements.

At first, Nicolelis considered using brain implants to control the suit, but he and his colleagues quickly determined that the EEG cap was less intrusive and more manageable.

During the training period, Pinto and the seven other subjects learned to think about moving their feet in such a way that the corresponding signals from their brains and muscles would register with the computerized guidance system. The exosuit’s wearer received feedback from the feet in the form of buzzing vibrations felt on the skin.

All eight patients learned to walk using the suit, and one overachiever took “a total of 132 steps, to the awe of everyone present,” Nicolelis told NBC News.

At the World Cup ceremonies, all it took was a tap from Pinto’s robo-leg to send the soccer ball rolling. Meanwhile, assistants stood on either side, helping to steady the bulky suit. The moment passed so quickly that many TV viewers missed it.

What it means

In the wake of the World Cup kickoff, experts who weren’t involved in the Walk Again Project debated whether the effort scored a winning goal.

“The demo did not advance the state of the art,” Jose Contreras-Vidal, a biomedical engineer at the University of Houston, told NBC News in an email. “Certainly our NeuroRex was the first and remains the only brain-controlled exoskeleton to allow spinal cord injury patients to walk over-ground unassisted, and we have been able to do so with about 10 percent of the funding Dr. Nicolelis has received to develop their exo.”

Contreras-Vidal said one of the metrics for evaluating the return on investment should be the number of Brazilian scientists and students who benefit from their involvement in the Walk Again Project.

“I suppose the infrastructure will remain in Brazil, which is good,” Contreras-Vidal wrote. “What matters now is what the plans are for the future. Clinical (longitudinal) trials must be done with patients, once the system is completed and validated. Dr. Nicolelis is not known for working with EEG and walking robotics, and thus expertise in these areas would need to be developed and retained in Brazil to continue the project. We hope he succeeds.”

Anil Raj, a research scientist at the Florida Institute for Human and Machine Cognition, agreed that the project’s real value depends on what comes after the kick.

“A successful kick is a demonstration event, but the technological development needed to be able to attempt the demo is the contribution to the future of exoskeletons for those with spinal cord injury,” Raj said in an email. “$14 million for training eight patients and building a novel exoskeleton and brain-controlled interface seems to me to be a reasonable expenditure.”