Interesting, but only two cases. I highly doubt I would be a candidate considering how much dead brain I have and the location of that dead brain.
Toronto researchers test new rehabilitation method for paralyzed patients
The field of brain-machine interfaces
has taken off in recent years, with Silicon Valley leaders joining the
fray. Companies such as Facebook and Elon Musk’s Neuralink envision we will one day be able to use this type of technology to control our laptops and smartphones with our thoughts.
In
Toronto, Cesar Marquez-Chin has a very different idea for the use of
brain-machine interfaces, which use brain signals to communicate with
electronic devices. He is among a small number of international
researchers using a relatively low-tech form of this technology to help
train people paralyzed by stroke or spinal-cord injury to move again.
Dr.
Marquez-Chin, a scientist at the Toronto Rehabilitation Institute’s
research arm KITE (Knowledge, Innovation, Talent, Everywhere), is
testing the use of a non-invasive brain-machine interface to enhance an
increasingly common rehabilitation technique called functional
electrical stimulation.
Functional
electrical stimulation (FES) delivers electric impulses to specific
muscles, causing them to contract. For individuals who have experienced
stroke or spinal-cord injury, therapists apply FES to the paralyzed body
part, with the aim of retraining movement over many sessions. But for
reasons that are not yet entirely understood, the technique does not
work for everyone.
Dr. Marquez-Chin
says he believes this is where the brain-machine interface comes in.
With a single electrode placed on the skull, the patient’s own brain
signals control when the electrical impulse is delivered to the
paralyzed body part. This then bridges the patient’s intention to move
with the action of moving, he said.
So
far he has completed tests of the approach on two research
participants, a tiny sample among the roughly 86,000 Canadians living
with a spinal-cord injury and around 400,000 others living with
long-term disability from stroke. But both participants, who had severe
chronic hemiplegia, or paralysis on one side of their body after a
stroke six years prior, regained much of the voluntary movement in their
hands and arms after 40 and 80 sessions respectively. Neither had
improved with earlier attempts using FES therapy alone.
His
results mirror those of researchers elsewhere. A small number of
studies using similar brain activity-controlled FES by researchers in
other parts of the world, including in Switzerland, Japan and the U.S., have also shown participants have regained movement after repeated training.
Milos
Popovic, KITE director and collaborator of Dr. Marquez-Chin, calls it
an “exciting” approach, and while their research is in its infancy, his
team’s initial results suggest they are on the right track. “Patients
are doing absolutely outstanding,” he said.
The
Toronto researchers published a case study of their first participant
in the journal Case Reports in Neurological Medicine in 2016. They
published their second case study in the American Journal of Physical Medicine and Rehabilitation in early 2019.
Dr.
Marquez-Chin is now conducting a follow-up study, testing the approach
on eight individuals with tetraplegia, or paralysis from the neck down,
due to spinal-cord injury. In a presentation at the University Health
Network’s CRANIA Conference in September, he showed videos of two
participants, whose identities are protected, initially unable to make a
fist or lift their arm. After 27 sessions, one participant, who had a
spinal-cord injury two years prior, was shown lifting a bottle of water
to his lips. The other, who had a stroke six years earlier, was able to
put on his hat.
Brain-machine
interfaces are not without controversy. Some, such as Suzanne Rivera,
an associate professor of bioethics at Case Western Reserve University
in Cleveland, caution there are numerous ethical considerations for
testing this type of technology, including questions about the physical
risks involved, as well as risks to participants’ dignity and privacy
that might arise, for example, if a device is hacked.
Moreover,
she said in an e-mail, “If participants benefit from the experimental
device, what are the plans to make it available to them once the trial
is over?”
Compared with the
brain-machine interfaces proposed by the likes Facebook and Neuralink,
those used by Dr. Marquez-Chin and his peers are less sophisticated, and
patients are hooked up to the technology for only as long as their
rehabilitation sessions. Even so, the researchers still have a lot more
work to do before the use of brain-machine interfaces with FES is widely
adopted. For example, they have yet to figure out the ideal duration
and number of sessions, whether there are side effects, which patients
might benefit most and how the intervention compares with current
therapies.
“This isn’t something
that can go out and be widespread today or tomorrow,” said Patrice
Lindsay, Heart & Stroke’s director of systems change and stroke
program. “It’s great if we can go there with it, [but] I think there’s a
lot we still have to learn about how it works [and] which patients are
the right patients.”
Nevertheless,
the early results reflect a shift in thinking about rehabilitation for
those with chronic paralysis. Previously, it was widely believed
recovery was impossible once the initial period after a stroke or
spinal-cord injury had passed, Dr. Marquez-Chin said. Now, it appears
it’s not too late, even years later, to see improvements.
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