How neural bypass procedures are changing the future of medicine and giving patients with severe spinal cord injuries and paralysis a new lease on life.
Lying on the white sands of a North Carolina beach, Ian Burkhart struggled to comprehend what was happening around him… and to him. Just moments before, the athletic, fun-loving 19-year-old Ohio University student had ran and dove into a crashing wave in the nearby Atlantic waters. Now he found himself lying on the beach, face up and surrounded by his friends, unable to feel anything but the warm summer sun on his face.
When he dove into the ocean, Ian’s head was pushed down by the wave and hit a shallow sandbar, causing him to suffer a severe spinal cord injury at the C5-C6 level of his spine. The medivac flight and the hustle and bustle of the emergency room were a blur as the drugs used to calm and comfort him took effect.
“I kept thinking, ‘I’m going to be OK. I’m going to be OK,’” he says. “I just need to rest and soon it will heal up and I can go about my life again.”
He soon found out that he wasn’t going to be OK—his spinal cord injury wasn’t temporary and life would never be the same again. Doctors told Ian that from that day forward he would be a quadriplegic, unable to move any part of his body below his shoulders.
Hope in a Time of Hopelessness
“I’d led a very active life,” he says. “I loved being outdoors, and I loved sports, but, by far, the greatest loss I suffered was my independence. I went from living a normal, healthy life to being unable to scratch my own face if it itched. It took about six months before I fully realized that I would be dependent on others for many of my needs. That was a very hard and challenging time for me.”
Ian underwent rehabilitation and physical therapy at Ohio State University in Columbus, which is only a 25-minute drive from his home in Dublin.
“I had exhausted my medical insurance and was told that I’d made all the physical progress I should make, but I wanted more,” he says. “I kept bugging my therapists and doctors, asking if there wasn’t something more I could do.”
It turns out there was something more. Physicians and neuroscientists at the Ohio State University Wexner Medical Center were actively looking for the perfect candidate for a new clinical trial that was about to get underway. The study involved a device called Neurolife that had been developed by the Battelle Memorial Institute, located just blocks from the medical center.
Battelle had spent more than a decade learning how to map the thought processes in the human brain that initiate and control certain muscle movements. After using computer software programs to map out these “thoughts,” they developed the Neurolife device.
According to Doug Boyd, the director of Battelle’s Medical Devices and Health Analytics, “The device has three fundamental components. 1. A chip that is implanted on the participant’s brain to read the participants brain signals. 2. A computer that receives those brain signals, determines the participant’s motion intent from them and establishes the needed muscle stimulation to effect the desired motion. And 3. A stimulation sleeve that non-invasively activates the paralyzed muscles to realize the desired motion.”
Ian was their perfect candidate. He was chosen to be the first quadriplegic to wear and test the Neurolife device. A microelectrode was surgically implanted in his brain, and Ian was fitted with a neuromuscular electrical stimulation sleeve on his right arm. The microelectrode is part of the “Utah array,” a system that utilizes a “pedestal interface” to send signals from firing neurons to a computer through a cable hookup. The computer “reads” Ian’s mind and sends an electrical signal to the sleeve on his arm. The sleeve then electrically stimulates the muscles in his arms and a miracle occurs—his injured spinal cord is bypassed, and Ian moves his arm, hand and fingers by envisioning their movement in his mind.
It took several grueling months just to rebuild the atrophied muscles in his arm and hand.
“I would leave those sessions completely drained,” he says. “It took such a tremendous amount of focus in the beginning. It is hard to comprehend how much it takes out of you mentally and physically to attempt to move a paralyzed arm or hand. You have to break down the individual movement of each muscle. A healthy person doesn’t even have to think to lift a spoon to his mouth, but I can tell you, it takes a lot of effort when you have to think about each muscle.”
Since he first opened and closed his hand in June 2014, Ian has made tremendous progress. He can now pour liquid into a cup, pick up an object such as a spoon, hold a phone to his ear, swipe a credit card, play the electronic music game Guitar Hero, and he’s adding new movements to the list at a steady rate.
“It has now become almost second nature to me. It isn’t nearly as hard as it was when I started,” he says.
According to Battelle’s Boyd, they hope to soon produce a wireless, miniaturized, wearable less-invasive version of Neurolife that will be available to persons suffering from all types of spinal cord injuries, strokes or any type of debilitating nerve trauma. He says they also want to focus their efforts on helping American veterans who have suffered neurological losses.
“When I was first injured, I became very, very depressed,” Ian says. “Some days it was just hard to get out of bed. I still have good days and bad days, but now life has changed. I have hope. Hope for the future, and I thank the people at Ohio State and Battelle for this opportunity. I hope that through all of our efforts, other people suffering from spinal cord injuries around the world will one day be able to have Neurolife included as part of their rehabilitation immediately after they are injured.”
Ian is now a student at Ohio State University where he studies accounting, and he coaches the Dublin Jerome High School boys’ lacrosse team. He also created the Ian Burkhart Foundation to help others who suffer from spinal cord injuries. It can be accessed at ianburkhartfoundation.org.
Sources: nature.com. https://wexnermedical.osu.edu
Conquering Spinal Pain
In 2007, Alisha Martin was in the prime of her life. At 28 years old, she was married to the man of her dreams, had just received her master’s degree and started an exciting new job. It seemed that her entire life was ahead of her—until a semi-tractor-trailer swerved into her and her husband Victor’s car on the interstate.
The crash left her with several crushed vertebrae and damaged discs and in excruciating, relentless pain.
“Doctors kept telling me that I was young and that I would heal, but instead, I just continually worsened,” she says. “My legs would go numb, and I would fall. My husband had to literally carry me into the doctor’s office and explain to them that I couldn’t walk anymore.”
Alisha could only move about with the aid of a wheelchair, walker or cane. She underwent spinal fusion, several discectomies, nerve ablations, nerve blocks—all in all, she had 11 major pain intervention procedures—yet she continued to worsen. The pain became virtually unbearable.
“The pain was so intense that I was diagnosed with PTSD and major depressive disorder,” Alisha says. “At one point, I was on 22 medications, and I would sit and pray for just five seconds of relief. I became extremely suicidal, and to be honest, if things hadn’t changed, I don’t think I would be here today.”
While talking on the phone with her aunt in Arizona, Alisha discovered that her uncle worked as an engineer for Medtronics, a company that produces devices called neurostimulators.
Neurostimulators can be implanted near the spinal cord to help reduce pain. These rechargeable, battery-driven devices contain an electrical stimulator with attached electrodes that can be threaded into the epidural space next to the spinal cord. When the stimulator is activated, a continuous stream of very low voltage electricity masks pain signals being sent to the brain and pain intensity can be greatly diminished.
“I found a doctor in Brandon who implanted the stimulators, and he implanted two, one in my neck and one in my mid-back,” she says. “I immediately felt a difference—it felt weird, and then I realized that the weirdness I felt was a lack of pain.”
Two months after her surgery in 2011, Alisha began to work out at a local gym. Today she is 70 pounds lighter and is an Olympic power lifter and CrossFit competitor. In 2014, she gave birth to her son, Gabriel, a feat doctors told her she would never be able to do following the accident. Today she works as a team leader at BB&T bank and leads a very active life. And she no longer takes any pain medication.
“I control the stimulator with a device that allows me to determine the intensity of how much stimulation I need and where it needs to be directed,” she says. “I can adjust the stimulator to mask any pain that I feel. If I have a headache, I can mask the headache pain, and if I have a pain in my foot, I can adjust it for my foot. It gives me a tingling feeling in my body, like you might feel if your arm or leg went to sleep, and that diminishes any pain. I wirelessly recharge the batteries every couple of weeks, and I’m good to go. Everywhere I go, I tell people about this amazing device that has changed my life. If you’re in pain or know someone who is in chronic pain, tell them about spinal cord stimulation. I control my pain, and my pain doesn’t control me. I call myself a bionic woman, and I have literally been given a new life.”