The Human Neural Prosthetics Program—under the surgical direction of Jorge A. González-Martínez, MD, PhD—is the result of a multidisciplinary effort to explore the utilization of brain computer interfaces for improving the lives of patients with motor disabilities. In 2007, a collaborative group was established—representing expertise in engineering, neuroscience and rehabilitation—to promote clinical trials using brain computer interfaces to control neural prosthetic devices.
Researchers obtained an initial grant to evaluate micro-ECoG grids in patients with spinal cord injury. Data from this study demonstrated that patients could utilize a brain computer interface to control a computer cursor. This grant served as the kick-start for two clinical trials.
In the first, quadriplegic patients are implanted with a custom-designed ECoG grid for up to 30 days. The first subject was able to obtain consistent three-dimensional cursor control using a 3D visual environment. He was also able to successfully control a robotic arm. Additional subjects have also successfully achieved cursor control in a 3D virtual environment and control of a robotic arm. The initial work was funded by the Cortical Control of a Dextrous Prosthetic Hand study funded by National Institute of Neurological Disorders and Stroke (NINDS) and Andrew B. Schwartz, PhD (Department of Neurobiology) was the principal investigator.
A second study utilizes microelectrode arrays that penetrate the surface of the brain. This study is funded by the Defense Advanced Research Projects Agency (DARPA) and is part of the Revolutionizing Prosthetics Program, Phase 3 study for which Michael L. Boninger, MD, former chairman of the Department of Physical Medicine & Rehabilitation, is the principal investigator. In the study, two 96-channel electrode arrays were implanted into the brain of a quadriplegic individual. This study participant was able to obtain control of up to 10 degrees of freedom. Using seven degrees of freedom, she has been able to utilize the robotic arm to perform standardized rehabilitation tasks, such as placing objects on a shelf. Once FDA approval was obtained, she was able to interact personally with the robotic arm and was able to grasp a food item and feed herself. As part of the Revolutionizing Prosthetics Program, Phase 3 study, investigators also obtained FDA approval to place stimulating arrays in conjunction with recording arrays in anticipation of adding sensory feedback to the control of the robotic arm. A second subject was implanted with two recording arrays in motor cortex and two stimulating arrays in sensory cortex. This subject was able to experience a natural-like sense of touch when the fingers of the robotic arm were stimulated by touch. In sensory tests, he was able to correctly identify which finger was touched while blindfolded.
The success of these early studies has led to additional collaborations. The first collaboration is funded by a $7 million NIH grant (Michael Boninger, MD, Physical Medicine and Rehabilitation) to expand our research team to include the University of Chicago. We join Sliman Bensmaia, PhD, and Nicholas Hatsopoulos, PhD, to expand our research efforts with the goal of restoring hand function in patients with paralysis. The second new collaboration is funded by a $1.2 million NIH award (Jennifer Collinger, PhD, Physical Medicine and Rehabilitation) to better understand the underlying neural activity of reaching and grasping. We will be collaborating with University of Pittsburgh researchers, Aaron Batista, PhD, and Patrick Loughlin, PhD, from the Swanson School of Engineering, and Carnegie Mellon researchers Steven Chase, PhD, and Byron Yu, PhD, from the College of Engineering.
Neuroprothetics and spinal cord stimulation expert Marco Capogrosso, PhD—director of the department’s Spinal Cord Stimulation Laboratory—provides unparalleled support through his research efforts in spinal cord injury (SCI) and limb motor control.
In June of 2021, the program was awarded a $6.37 million National Institutes of Health grant to study how population dynamics in motor cortex change with behavioral context and how they are shaped by sensory feedback. Through this proposal, researchers hope to gain a better understanding of how motor cortical activity generalizes across static and dynamic behaviors as well as the potential to drive plasticity within cortical circuits that communicate sensorimotor information, which has relevance for understanding skill learning and improving rehabilitation after injury.
As research in spinal cord injury continues, Dr. Capogrosso is also working with Peter Gerszten, MD, and Robert Friedlander, MD, to verify if spinal cord stimulation (SCS) should not only be seen as a therapy for SCI alone, but more generally as an intervention to tackle dysfunction of the corticospinal tract-motoneuron-sensory afferent circuit in the spinal cord, the building block of movement. They have subsequently started two parallel clinical trials: the first is to explore the effects and mechanisms of SCS for the recovery of upper limb motor control after stroke and the second trial is exploring the effects and mechanisms of SCS for the treatment of motor deficits in patients with spinal muscular atrophy, a genetic disease of the Ia-motoneuron system. The group recently reported the preliminary findings of their stroke trial demonstrating that SCS improved strength, dexterity, and motor control in the first two participants suffering from moderate and severe chronic stroke. While they continue to collect data on preliminary safety and efficacy in both trials, they are simultaneously conducting a battery of imaging and electrophysiology tests in order to study the mechanisms of SCS outside the application of SCI. Drs. Capogrosso, Friedlander and Gerszten hope to be able to show that SCS is a disease modifying intervention for dysfunctions of the spinal sensorimotor units and, therefore, could be applied to a variety of disorders of this simple but critical neural unit in motor control. Hopefully, this research program will contribute to the global efforts to defeat paralysis in all its forms.
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