Life Care Plan, Medical Consultation, Vocational Rehabilitation

Recovery From Spinal Cord Injury No Longer A Dream

 March 28, 2017

By  Deborah L Weiner Katz, OTR/L, CCM, CLCP

We rely on technological breakthroughs in order to continually provide the most up-to-date healthcare options to our clients. As such, we have learned to pay attention to the dreamers on this planet. Acclaimed fantasy author Neil Gaiman attended a fantasy convention in China. In the past, science fiction and fantasy had received very little recognition in that part of the world. When Gaiman inquired as to what had changed, the Chinese explained that while they manufacture technology like no one’s business, the ideas come from the west. After visiting major tech corporations in the U.S., the Chinese could not help but notice that most of the individuals responsible for those ideas were dreamers who grew up very much encouraged to read science fiction and fantasy.

One idea that has appeared in plenty of sci-fi/fantasy novels and comic books is virtual reality. Virtual reality is based on the idea that a computer could replicate the five senses so precisely that users can immerse themselves in and interact with a 3-D environment. The apex of this idea in fiction would have to be the 1999 global blockbuster The Matrix, starring Keanu Reeves. In 2016, machines have yet to subvert the human race but you can experience virtual reality in the comfort of your own home. Do you know how excited this makes us? Let me explain.

Two years ago, a 29-year old paraplegic man by the name of Julian Pinto kicked off the opening match at the FIFA World Cup. He was able to perform the feat by controlling a robotic exo-skeleton via a device known as a BMI, or brain-machine interface.This technology was made possible by an international research consortium now known as the Walk Again Project, or WAP.

Today, WAP is using virtual reality to help paraplegic people regain partial sensation and muscle control in their lower limbs. Over a twelve month period, eight serious cases of spinal cord injury (SCI) paraplegia were subjected to a BMI-based neurorehabilitation program. Its purpose was to restore their mobility using the following methods:

  • Intense, immersive virtual reality training.
  • Enriched visual-tactile feedback.
  • Two EEG-controlled robotic actuators.

These robotic actuators allow the subject to walk. There was even use of a custom-made lower-limb exoskeleton that could simulate the feeling of touch for its user. The end result was that all eight subjects regained key somatic sensations such as pain localization, fine/crude touch and proprioceptive sensation.  In other words, they could identify where pain is occurring and even feel movement and positioning of limbs. They regained voluntary motor control in muscles located below the actual spinal cord injury. Their very classification as paraplegics was altered. All of this was attributed to long-term BMI usage.

While VR is certainly a key component in this breakthrough, it was actually a six-step process that produced such prodigious results for the eight participants in WAP’s research:

  1. It does begin with an immersive virtual reality environment where the patient’s brain is connected via 16 channels to an EEG machine. The machine recorded the patient’s brain activity while controlling the movements of a human body avatar. Meanwhile, the patient received sensory feedback.
  2. The first step was duplicated while patients were upright and supported by a stand-in-table device.
  3. Next, the patient graduated to treadmill training. He or she was placed in a robotic body weight support (BWS) gait system.
  4. Training then commenced with the same BWS gait system fixed on an overground track.
  5. At the next level, the BWS gait system was brain-controlled and the patient was back on a treadmill.
  6. The final level involved BWS gait training with a brain-controlled, sensorized, 12 degrees of freedom robotic exoskeleton without the treadmill.

Despite all of this, SCI recovery remains a great challenge. At AdvancedRM, we know this firsthand from our experience with Matthew C. Matthew suffered a severe spinal cord injury in a bicycle accident involving a motor vehicle. Only 11 years old, the boy required immediate surgical intervention followed by an inpatient rehabilitation program. When he was finally sent home, it was clear that this was only the beginning. His discharge included a wheelchair, equipment, medications, supplies, instructions regarding care, and plans for further rehabilitation. Body weight support systems, robotic assistance and functional electrostimulation of the leg were already options to consider. However, somatosensory perception and voluntary motor control remained elusive goals. These new VR-assisted results give us and Matthew great hope in the ongoing battle for recovery.

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