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Man with quadriplegia employs injury bridging technologies to move againâjust by thinking
First recipient of implanted brain-recording and muscle-stimulating systems reanimates limb that had been stilled for eight years
Bill Kochevar grabbed a mug of water, drew it to his lips and drank through the straw.
His motions were slow and deliberate, but then Kochevar hadnât moved his right arm or hand for eight years.
And it took some practice to reach and grasp just by thinking about it.
Kochevar, who was paralyzed below his shoulders in a bicycling accident, is believed to be the first person with quadriplegia in the world to have arm and hand movements restored with the help of two temporarily implanted technologies.
A brain-computer interface with recording electrodes under his skull, and a functional electrical stimulation (FES) system* activating his arm and hand, reconnect his brain to paralyzed muscles.
Holding a makeshift handle pierced through a dry sponge, Kochevar scratched the side of his nose with the sponge. He scooped forkfuls of mashed potatoes from a bowlâperhaps his top goalâand savored each mouthful.
âFor somebody whoâs been injured eight years and couldnât move, being able to move just that little bit is awesome to me,â said Kochevar, 56, of Cleveland. âItâs better than I thought it would be.â
Kochevar is the focal point of research led by Case Western Reserve University, the Cleveland Functional Electrical Stimulation (FES) Center at the Louis Stokes Cleveland VA Medical Center and University Hospitals Cleveland Medical Center (UH). A study of the work was published in the The Lancet March 28 at 6:30 p.m. U.S. Eastern time.
âHeâs really breaking ground for the spinal cord injury community,â said Bob Kirsch, chair of Case Western Reserveâs Department of Biomedical Engineering, executive director of the FES Center and principal investigator (PI) and senior author of the research. âThis is a major step toward restoring some independence.â
When asked, people with quadriplegia say their first priority is to scratch an itch, feed themselves or perform other simple functions with their arm and hand, instead of relying on caregivers.
âBy taking the brain signals generated when Bill attempts to move, and using them to control the stimulation of his arm and hand, he was able to perform personal functions that were important to him,â said Bolu Ajiboye, assistant professor of biomedical engineering and lead study author.
Technology and training
The research with Kochevar is part of the ongoing BrainGate2* pilot clinical trial being conducted by a consortium of academic and VA institutions assessing the safety and feasibility of the implanted brain-computer interface (BCI) system in people with paralysis. Other investigational BrainGate research has shown that people with paralysis can control a cursor on a computer screen or a robotic arm (braingate.org).
âEvery day, most of us take for granted that when we will to move, we can move any part of our body with precision and control in multiple directions and those with traumatic spinal cord injury or any other form of paralysis cannot,â said Benjamin Walter, associate professor of neurology at Case Western Reserve School of Medicine, clinical PI of the Cleveland BrainGate2 trial and medical director of the Deep Brain Stimulation Program at UH Cleveland Medical Center.
âThe ultimate hope of any of these individuals is to restore this function,â Walter said. âBy restoring the communication of the will to move from the brain directly to the body this work will hopefully begin to restore the hope of millions of paralyzed individuals that someday they will be able to move freely again.â
Jonathan Miller, assistant professor of neurosurgery at Case Western Reserve School of Medicine and director of the Functional and Restorative Neurosurgery Center at UH, led a team of surgeons who implanted two 96-channel electrode arraysâeach about the size of a baby aspirinâin Kochevarâs motor cortex, on the surface of the brain.
The arrays record brain signals created when Kochevar imagines movement of his own arm and hand. The brain-computer interface extracts information from the brain signals about what movements he intends to make, then passes the information to command the electrical stimulation system.
To prepare him to use his arm again, Kochevar first learned how to use his brain signals to move a virtual-reality arm on a computer screen.
âHe was able to do it within a few minutes,â Kirsch said. âThe code was still in his brain.â
As Kochevarâs ability to move the virtual arm improved through four months of training, the researchers believed he would be capable of controlling his own arm and hand.
Miller then led a team that implanted the FES systemsâ 36 electrodes that animate muscles in the upper and lower arm.
The BCI decodes the recorded brain signals into the intended movement command, which is then converted by the FES system into patterns of electrical pulses.
The pulses sent through the FES electrodes trigger the muscles controlling Kochevarâs hand, wrist, arm, elbow and shoulder. To overcome gravity that would otherwise prevent him from raising his arm and reaching, Kochevar uses a mobile arm support, which is also under his brainâs control.
New Capabilities
Eight years of muscle atrophy required rehabilitation. The researchers exercised Kochevarâs arm and hand with cyclical electrical stimulation patterns. Over 45 weeks, his strength, range of motion and endurance improved. As he practiced movements, the researchers adjusted stimulation patterns to further his abilities.
Kochevar can make each joint in his right arm move individually. Or, just by thinking about a task such as feeding himself or getting a drink, the muscles are activated in a coordinated fashion.
When asked to describe how he commanded the arm movements, Kochevar told investigators, âIâm making it move without having to really concentrate hard at itâŚI just think âoutââŚand it goes.â
Kocehvar is fitted with temporarily implanted FES technology that has a track record of reliable use in people. The BCI and FES system together represent early feasibility that gives the research team insights into the potential future benefit of the combined system.
Advances needed to make the combined technology usable outside of a lab are not far from reality, the researchers say. Work is underway to make the brain implant wireless, and the investigators are improving decoding and stimulation patterns needed to make movements more precise. Fully implantable FES systems have already been developed and are also being tested in separate clinical research.
Kochevar welcomes new technologyâeven if it requires more surgeryâthat will enable him to move better. âThis wonât replace caregivers,â he said. âBut, in the long term, people will be able, in a limited way, to do more for themselves.â
The investigational BrainGate technology was initially developed in the Brown University laboratory of John Donoghue, now the founding director of the Wyss Center for Bio and Neuroengineering in Geneva, Switzerland. The implanted recording electrodes are known as the Utah array, originally designed by Richard Normann, Emeritus Distinguished Professor of Bioengineering at the University of Utah.
The report in Lancet is the result of a long-running collaboration between Kirsch, Ajiboye and the multi-institutional BrainGate consortium. Leigh Hochberg, a neurologist and neuroengineer at Massachusetts General Hospital, Brown University and the VA RR&D Center for Neurorestoration and Neurotechnology in Providence, Rhode Island, directs the pilot clinical trial of the BrainGate system and is a study co-author.
âItâs been so inspiring to watch Mr. Kochevar move his own arm and hand just by thinking about it,â Hochberg said. âAs an extraordinary participant in this research, heâs teaching us how to design a new generation of neurotechnologies that we all hope will one day restore mobility and independence for people with paralysis.â
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We get it, you vape.
Canât believe Iâm posting a vape vid
But like if you cut the vape section out (or skip it) this is a beautiful story about a bubble full of magical mist and itâs encounter with a very spiritual lake that sets it free.
Cooking is something we think of as a one-way process. You add heat to food, it changes forms, and thereâs undoing that. But that process is less one-directional than we thought, at least in some cases. Take boiling an egg. When you add heat to egg whites, it breaks down bonds between the folded proteins and lets those proteins build more bonds with other sections of proteins, eventually solidifying into a seemingly unbreakable mess. You canât break those bonds by adding or removing thermal energy, but you can shake the proteins apart and refold them into their original shapes.Â
Researchers accomplish this by putting the boiled egg whites in a solution of water and urea and spinning them. When they spin the fluid mixture, the fluid near the wall spins faster than the fluid in the center of the vial, which creates shear stress. That shear stress helps untangle the proteins and reform them into their original shapeâthereby unboiling the egg white. Now you definitely donât want to eat the results â urea is, of course, a component of urine â but it does demonstrate that fluid dynamics can be used to reverse chemical processes we thought were irreversible. And that surprising discovery nabbed the researchers an Ig Nobel Prize in 2015. (Video credit: TedEd/E. Nelson; research credit: T. Yuan et al.)
The movie Jaws, tangibly and irreparably, damaged public perception of Great White Sharks, to the point of reducing beach turnout for years to come
Since the movie Fight Club was released, numerous emotionally stunted men have tried to create their own Fight Clubs, all over the world
After the Matrix movies were released by the Wachowski sisters, there were multiple instances of people using the film as a justification for murder - to the point where âThe Matrix Defenceâ has its own wikipedia page
Why am I telling you all these facts?
Because popular media affects reality, it can have measurable influence on public feelings and perception, and in some ways can affect you on a deeper and more visceral level than any straight-forward lesson can.
So if you donât think that the movie Split can cause serious stigma and harm towards people with psychotic mental illnesses - though particularly Schizophrenia and DID - through turning public perception against them, and portraying them as dangerous monsters, then you havenât been paying attention.
Donât give your money to this dangerous, misinformed garbage.
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Woke up to find this upstairs while boyfriend is on his walk.
Kitty, let me hear you say âwayoohââŚ
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