Long-Term Training with a Brain-Machine Interface-Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients as originally seen in Scientific Reports
I’ve seen this video crop up on my Facebook feed a few times in the last couple days, and I just had to see what was going on here. The video is slightly misleading of course, but the researchers in this study did many, MANY cutting edge things. But what’s catching everyone’s attention is the outcome: they had 3 (of 7) ASIA A paraplegic patients (completely paralyzed waist down, unable to feel/control bowel, bladder) and 1 (of 1) ASIA B patient (completely paralyzed waist down, can feel/control bowel, bladder to some extent) transition into ASIA C (partially paralyzed, able to feel/control bowel, bladder). That is HUGE and a research first. Not only can they move more, but they obtained some bowel, bladder control, which is usually the number one goal of paraplegics. Simply put: people that are completely paralyzed don’t get better… until now. Here’s how they did it.
Of course they extensively evaluated these 8 brave chronic SCI folks first with the following: ASIA, MAS, further sensory testing of crude and fine touch with Semmes-Weinstein monofilaments, vibration, temperature, proprioception, deep pressure sensations; muscular strength (using a program run on the Lokomat that they used in training too), WISCI-II, SCIM, Thoracic-Lumbar Scale for trunk control, McGill Pain Questionnaire , spasticity score from L-stiff on Lokomat, ROM, WHOQoL-BREF, Rosenberg Self-Esteem Scale, Beck Depression Inventory. So needless to say they were thoroughly assessed.
They then received a treatment protocol which included the following: (I love diagrams!)
The 6 different treatments included
- Brain-Machine Interface (BMI) + Virtual Reality (VR) seated: they thought about walking and controlled a virtual person walking while receiving vibratory-tactile feedback about how the virtual feet were “rolling” along the ground through sensors on the arm.
- BMI + VR standing: basically the same as above, just standing on a tilt table, I think.
- Robotic body weight support gait system: the patient is suspended in the air, while a machine (Lokomat) walks the patients legs on a treadmill
- Overground body weight support gait system: again the patient is suspended in the air while they and/or a therapists moves their legs while they move forward walking on the ground
- BMI + robotic gait system: the patient thinks about walking which controls the robot machine (Lokomat) to walk the legs on a treadmill
- BMI + ekoskeleton: the patient thinks about walking which controls the robot machine (ekoskeleton) to move forward while walking on the ground
They did each kind different amounts as you can see in the diagram above, for a total of 10 active months + 2 month long vacation breaks somewhere in there.
And this is what they got: improved ASIA scores in 50% of the patients (as described above), improved sensation (all types except temperature), real intentional movements from the patients on command, decreased pain and better ability to localize pain below the lesion, neuroplastic changes in the brain in the sensory and motor areas related to the legs as seen in imaging, decreased hypertonicity, improved bowel and bladder function, improved gastrointestinal health, improved skin integrity, some improved bone mineral density, some improved functional independence and minimal psychological fluctuations.
YES, YES, YES! All the YES! Cue the choir of angels! Miracles are happening right here! Now how is this happening? I think it’s time for another diagram, don’t you?
They’re saying that even in “complete” SCIs there are some neurons spared at the site of injury, particularly with the spinothalmic, rubrospinal and vestibulospinal tracts. And by providing these tracts with some input from above (the BMI, vibration-tactile and visual (VR) feedback) and below (robotic gait trainer) they’re reconnecting the body’s own ability to provided internal feedback for itself. How cool is that? (Hint: VERY.)
I do want to mention that these people were all chronic SCIs– at least 3 years post injury– so the likelihood of this being spontaneous recovery is tiny. And that these people had all had “traditional physical therapy” before this which included standing in the tilt table and/or body weight supported treadmill training before and didn’t have improvements with this. What makes this treatment protocol different from I’ve been seeing is that 1) it is non-invasive– no surgical implant in the brain required and 2) the neuroprosthetic devices don’t have to be turned on in order for the patients to move! All the other cool stuff we talked about in IV Step required totting the devices and wires around to continue moving. These people could still move outside the devices! I remember Chet in particular mentioning that this the next step with these lines of research.
*sings* Off we go into the wild blue yonder!
Sorry, I’m just so excited!