Exciting research suggests that weekly training with brain-machine interface (BMI) technology may be able to re-engage some previously injured spinal cord nerves that led to lower-limb paralysis. Even more fascinating is that the research has shown promise in patients who have been paralyzed for more than a decade.

The innovative technology involves BMI-based neurorehabilitation programming including virtual reality, touch technology sleeves, robotic walkers and a custom-designed “brain-controlled robotic exoskeleton.” Researchers used the technology on eight subjects to see if they could revive previously paralyzed nerves, and they said the findings were remarkable. All eight patients experienced partial improvements in pain localization and fine/crude touch sensation after a year of training with the BMI device. They all also regained some voluntary muscle control in areas below the level of the spinal cord injury, which led to modest improvements in their walking index score. Other findings from the research include:

• Four patients had their diagnosis upgraded from complete paralysis to incomplete paralysis.
• One woman who had been paralyzed for 13 years could not stand even with braces at the study outset. By the end of the study, the patient could “walk” using braces and a body-weight support system.

“Nobody expected we would see what we found: which is partial neurological recovery of sensorimotor and visceral functions,” said lead investigator Miguel A.L. Nicolelis, PhD, in a statement. “Until now, nobody has seen recovery of these functions in a patient so many years after being diagnosed with complete paralysis.”

Regaining Movement After Spinal Cord Injury

Each of the eight patients, all of whom had been dealing with their SCI for more than a year, began treatment with two hours of BMI training a week. They started by learning to operate avatars of themselves while seated within an immersive virtual reality environment using brain activity. They also received some walking training using overhead harnesses and weight support systems. Eventually they transistioned to more intense training, which included the use of lower-limb exoskeletons and touch-sensitive feedback sleeves that would relay sensations based on the virtual surfaces the avatars were walking on.

“The tactile feedback is synchronized and the patient’s brain creates a feeling that they are walking by themselves, not with the assistance of devices,” said Dr Nicolelis.

By the end of the year, all eight patients “experienced neurological improvements in somatic sensation…in multiple dermatomes,” researchers reported. “These findings suggest, for the first time, that long-term exposure to BMI-based protocols enriched with tactile feedback and combined with robotic gait training may induce cortical and subcortical plasticity capable of triggering partial neurological recovery.”

Additionally, all eight patients showed improvements in gastrointestinal function and overall skin health.

Dr. Nicolelis said the study not only proved beneficial for the patients, but it helps further our understanding of paralyzed nerves. He said that even though some patients have been diagnosed with complete paralyisis, those nerves in their lower limbs may have simply “gone quiet,” and there may be a possibility to reawaken some of them.

“No matter how small the number of nerves that survive the original trauma, you may be able to rekindle them enough to send a message from the brain to the spinal cord,” said Dr. Nicolelis.

The researchers are continuing their study with the patients and plan to publish further findings after 28 months of training.

“People may think a year or 2 years of training is a lot because they think with their own values. But to a person with a diagnosis of complete paralysis, this time frame is acceptable,” he concluded.