A Brighter Future After Spinal Cord Injuries Is On The Horizon

A team in Switzerland unveiled wireless brain and spinal implants that enabled a paralyzed man to walk.

Gert-Jan Oskam of the Netherlands—victim of a spinal cord injury that left him paralyzed—poses while using implants that allow him to walk naturally in Lausanne, Switzerland on May 23, 2023. Photo by Fabrice Coffrini/AFP via Getty Images.

For many of us, spinal injuries will forever be associated with actor, director, author and activist Christopher Reeve. An avid equestrian, Reeve suffered a broken neck during a competition in 1995 which left him paralyzed from the shoulders down.

The actor best known as Superman—the Man of Steel—became an advocate for spinal injury research and for better insurance coverage for people with disabilities.

Sadly, Reeve died in 2004 at the age of 52, before technology began making major advancements in the treatment of nerve and spinal damage.

It is with Christopher Reeve in mind that we share one of the latest breakthroughs in today's The Big Picture.

— George Takei

In 2017, nine patients with spinal injuries had their ability to walk restored during clinical trials of spinal stimulators conducted at a medical research facility in Switzerland. 

The spinal stimulators were controlled by external devices through wires.

The resulting gait was unsteady, patients were unable to traverse uneven surfaces or climb stairs and the device allowed only limited control by the patient. Still, for those who had their mobility taken away, the positives far outweighed the negatives.

Among those nine patients was a Dutchman—Gert-Jan Oskam—who suffered a spinal injury in a motorbike accident in 2011. Oskam joined Stimulation Movement Overground (STIMO) at the Lausanne University Hospital as part of a seven-month clinical trial. 

Spinal Implants

He had electrodes surgically inserted in his lower back to deliver electrical impulses to the spinal cord to stimulate the muscles with the hope of helping the remaining nerves not severed in the accident to carry signals from the brain to the legs. 

After surgery, Oskam spent his time in Lausanne practicing stretching, standing up and walking. He first needed a harness then crutches, but gradually he was able to take a few steps without any mobility equipment.

You can see his story in this 2019 video.

While it was an advancement, the need for external controllers, wires which could be cumbersome and the limited capabilities drove the researchers to explore self-contained options.

Brain Implants

In August 2021, scientists in New York published research on a splinter-size brain implant doctors could insert deep into the brain to restore muscular control over and sensation from the limbs of a spinal injury patient. 

The team led by bioelectronic medical engineer Chad Bouton of the Feinstein Institutes for Medical Research and Northwell Health found the implant could record and decode the brain's commands, route it through a computer instead of the severed or damaged spinal cord, then stimulate muscles directly—bypassing the patient's damaged nervous system and letting them control their hand again.

The initial research focused on hand control and sensation rather than mobility. The success of initial testing allowed researchers to expand human trials and the scope of their research.

Bouton said of the project:

"There of course has been great work in stem cells and techniques to try to promote neural regrowth and reconnection. And obviously, that work progresses, but there are still challenges. 

"I had the really nice opportunity in my career, early on, to be involved with the BrainGate program. The first time we put these electrode arrays in the brain, in the motor cortex specifically, patients could move cursors."

"All of that really made headlines and we broke new ground and milestones were met, but none of the patients were able to move. It just wasn't the focus of the study."

"So a few years later, I had the idea that if we can decipher or decode signals in the brain from the motor area, if we can understand that someone's thinking about opening their hand and moving different fingers and closing their hand, well, then why can't we now reroute those signals around the injury or the damaged part of the nervous system, and then allow real-time stimulation of the muscles?"

Brain-Spine Interface

Fast forward to May 2023 when the internet was astounded by a new viral video from Lausanne, Switzerland of Gert-Jan Oskam now walking without an external controller and climbing stairs.

The wired controls for a spinal stimulator had been replaced with a brain implant which communicates wirelessly with Oskam's spinal implant. This method combines two separate technologies—brain implants and spinal implants—previously developed and tested as stand alone devices.

One of the authors of the study published in Nature, Grégoire Courtine, said in a statement:

"We have created a wireless interface between the brain and the spinal cord using brain-computer interface technology that transforms thought into action."

Their study combined spinal stimulation with brain-computer interface then used wireless signals to communicate between the two for a brain-spine interface (BSI).

Oskam received his spinal-cord stimulator in the 2017 clinical trial. 

The addition of the brain implant provided much greater control, according to Dave Marver, CEO of Netherlands-based Onward Medical, makers of the spinal-cord device.

The brain implant comes from French-based Clinatec and the government-backed research institute CEA. Unlike other models, it uses a device that rests on top of the brain instead of being placed inside it.

Brain-spine interface (BSI). Onward Medical, Clinatec, CEA.

Marver said:

"The incorporation of the brain-computer interface allows even more natural movement than our spinal cord stimulation does alone."

Oskam now has the ability to pause mid-stride, adjust his stride and navigate irregular terrain including stairs.

Marver added:

"Ultimately, our vision is that a person with paralysis will be able to visit the doctor and select what function they want to restore."

The Future

Companies developing the technology are focused on people who lost the ability to either move or communicate. We're at least five years away from commercial applications of their technology according to Marver.

There is hope the technology can be expanded to help people with congenital or degenerative conditions as well as to restore speech and mobility after a stroke.

But it has also raised bioethics concerns about using implants to enhance the abilities of healthy individuals.

Will implant scans be added to drug tests in future athletic competitions?

These are questions to be asked when the technology goes far beyond assisting those with severe paralysis or disability. 

In the meantime, the incredible advancements in technology are providing people like Oskam true hope to regain much of the mobility and agility they once thought lost forever.

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In addition to writing for The Big Picture, Amelia writes

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