Note: This video was created in January 2020

Almost 18,000 Americans every year. Many of these people are unable to use their hands and arms and can’t do everyday tasks such as eating, grooming or drinking water without help.

Using physical therapy combined with a noninvasive method of stimulating nerve cells in the spinal cord, 91̀½»¨ researchers helped six Seattle area participants regain some hand and arm mobility. That increased mobility lasted at least three to six months after treatment had ended. The research team Jan. 5 in the journal IEEE Transactions on Neural Systems and Rehabilitation Engineering.

“We use our hands for everything — eating, brushing our teeth, buttoning a shirt. Spinal cord injury patients rate regaining hand function as the absolute first priority for treatment. It is five to six times more important than anything else that they ask for help on,” said lead author , a 91̀½»¨senior postdoctoral researcher in electrical and computer engineering who completed this research as a doctoral student of rehabilitation medicine in the 91̀½»¨School of Medicine.

“At the beginning of our study,” Inanici said, “I didn’t expect such an immediate response starting from the very first stimulation session. As a rehabilitation physician, my experience was that there was always a limit to how much people would recover. But now it looks like that’s changing. It’s so rewarding to see these results.”

After a spinal cord injury, many patients do physical therapy to help them attempt to regain mobility. Recently, have shown that implanting a stimulator to deliver electric current to a damaged spinal cord could help paralyzed patients walk again.

The 91̀½»¨team, composed of researchers from the , combined stimulation with standard physical therapy exercises, but the stimulation doesn’t require surgery. Instead, it involves small patches that stick to a participant’s skin like a Band-Aid. These patches are placed around the injured area on the back of the neck where they deliver electrical pulses.

The researchers recruited six people with chronic spinal cord injuries. All participants had been injured for at least a year and a half. Some participants couldn’t wiggle their fingers or thumbs while others had some mobility at the beginning of the study.

To explore the viability of using the skin-surface stimulation method, the researchers designed a five-month training program. For the first month, the researchers monitored participants’ baseline limb movements each week. Then for the second month, the team put participants through intensive physical therapy training, three times a week for two hours at a time. For the third month, participants continued physical therapy training but with stimulation added.

“We turned on the device, but they continued doing the exact same exercises they did the previous month, progressing to slightly more difficult versions if they improved,” Inanici said.

For the last two months of the study, participants were divided into two categories: Participants with less severe injuries received another month of training alone and then a month of training plus stimulation. Patients with more severe injuries received the opposite — training and stimulation first, followed by only training second.

While some participants regained some hand function during training alone, all six saw improvements when stimulation was combined with training.

“Both people who had no hand movement at the beginning of the study started moving their hands again during stimulation, and were able to produce a measurable force between their fingers and thumb,” said senior author , a 91̀½»¨associate professor of electrical and computer engineering, rehabilitation medicine and physiology and biophysics. “That’s a dramatic change, to go from being completely paralyzed below the wrists down to moving your hands at will.”

In addition, some participants noticed other improvements, including a more normal heart rate and better regulation of body temperature and bladder function.

The team followed up with participants for up to six months after training and found that these improvements remained, despite no more stimulation.

“We think these stimulators bring the nerves that make your muscles contract very close to being active. They don’t actually cause the muscle to move, but they get it ready to move. It’s primed, like the sprinter at the start of a race,” said Moritz, who is also the co-director of the Center for Neurotechnology. “Then when someone with a spinal cord injury wants to move, the few connections that might have been spared around the injury are enough to cause those muscles to contract.”

The research is moving toward helping people in the clinic. The results of this study have already informed the design of that will be co-led by Moritz. One of the lead sites will be at the UW.

“We’re seeing a common theme across universities — stimulating the spinal cord electrically is making people better,” said Moritz, who also holds the CJ and Elizabeth Hwang professorship in electrical and computer engineering. “But it does take motivation. The stimulator helps you do the exercises, and the exercises help you get stronger, but the improvements are incremental. Over time, however, they add up into something that’s really astounding.”

, a research scientist at the UW; , a 91̀½»¨doctoral student in rehabilitation medicine; and , an associate professor of neurological surgery in the 91̀½»¨School of Medicine, are co-authors on this paper. This research was funded by the Center for Neurotechnology, the Washington State Spinal Cord Injury Consortium and the Christopher and Dana Reeve Foundation.

For more information, contact Inanici at finanici@uw.edu and Moritz at ctmoritz@uw.edu.

Grant number: EEC-1028725

Building on seven years of research that helps patients with sensory and motor neurological disorders, the Center for Sensorimotor Neural Engineering is updating its name to the (CNT). The CNT, which is based at the 91̀½»¨ but includes researchers from the Massachusetts Institute of Technology, San Diego State University, Caltech and other partners, changed its name to highlight the key role that neurotechnologies play in its mission.

“In the beginning, our mission was quite broad, ranging from developing virtual reality therapies for rehabilitation to creating anthropomorphic robotic hands for amputees,” said , co-director of the CNT and a professor in the UW’s Paul G. Allen School of Computer Science & Engineering. “Over the years, we have narrowed our focus to maximize our impact in an area in which we are acknowledged as leaders in the field: developing neurotechnologies that can electrically record and stimulate the brain and spinal cord to repair damaged neural circuits.”

Rao and co-director wanted the center’s name to reflect this shift.

“Our team has pioneered the concept of engineered neuroplasticity, the idea that we can use electronic devices to guide the nervous system to rewire and heal after injury,” said Moritz, who is an associate professor with joint appointments in UW’s electrical engineering department and 91̀½»¨Medicine’s rehabilitation medicine and physiology & biophysics departments.

The name change comes as the National Science Foundation announced Aug. 31 that it will renew the center’s funding, promising up to $8.4 million over the next three years.

Since 2011, the CNT has received $27 million from the NSF and has made significant research advances in the field of engineering neuroplasticity, developed educational tools about neurotechnology and brain-computer interfaces, and become a leader in the field of neuroethics.

“As we build devices that directly interact with the brain, and even change the wiring of the nervous system, it is critical that we address the ethical implications of our work at the earliest stages of design and implementation,” Moritz said.

Looking to the future, both co-directors are excited to see how the neurotechnologies the CNT develops will help patients with a variety of neurological conditions regain lost functions.

“We are proud of the vibrant multidisciplinary community of collaborating students and researchers that the center has created over the past seven years,” said Rao, who is the of computer science & engineering and electrical engineering. “I doubt if there is any other center in the world where you will find philosophy students embedded in engineering labs asking important neuroethics questions on a project that also involves neurosurgeons and industry partners.”

Scroll down to see more of the CNT’s accomplishments:

###

For more information, contact Moritz at ctmoritz@uw.edu and Rao at rpnr@uw.edu.

An international team led by researchers at the (CSNE) based at the 91̀½»¨ is one of three finalists in a race to produce an implantable wireless device that can assess, stimulate and block the activity of nerves that control organs.

For the GlaxoSmithKline the team is working on an implantable device that could help restore bladder function for people with spinal cord injuries or millions of others who suffer from incontinence.

“For people with spinal cord injuries, restoring sexual function and bladder function are some of their top priorities — higher than regaining the ability to walk,” said , deputy director of the CSNE and 91̀½»¨associate professor of rehabilitation medicine and of physiology and biophysics.

“The vision is for these neural devices to be as ubiquitous as pacemakers or deep brain stimulators, where a surgeon implants the device and it’s seamless for the patient,” he said. “We’re really excited to make a difference in people’s lives and to help push these technologies forward.”

The CSNE team — one of 12 to compete in the challenge — joined forces with another team of experts from the University of Cambridge and University College London for the second round of the competition. The company will award up to $1 million in additional research funding to each team.

Another $1 million prize will go to the first group to deliver a device that is functional in small animal models.

“This open innovation construct provides the platform for future public and private collaborations, which will advance pre-clinical and clinical research concepts and ultimately deliver novel treatment paradigms to address unmet patient needs,”’ said Roy Katso, Director of Open Innovation and Funding Partnerships for GlaxoSmithKline.

The final implantable wireless device will be able to stimulate and block electrical signals that travel along the nerves and control specific organs. Stimulating the pelvic nerve causes the bladder to empty, for example, while blocking those signals could help someone who is unable to control his or her bladder.

However, numerous challenges persist — such as delivering power efficiently and without wires while ensuring the implanted device doesn’t overheat inside the body and limiting tissue reactions at the nerve interface.

The CSNE team at 91̀½»¨is using a wireless power transmitter developed by CSNE leader and 91̀½»¨associate professor of electrical engineering and of computer science and engineering . A similar technology is being used by Smith’s new company WiBotic Corp. to manufacture wireless power systems for robots and drones.

They designed the wireless device to interact with a rat’s pelvic nerve in one of two ways — both electronically and optically. Moritz and team member , 91̀½»¨associate professor of physiology and biophysics, have expertise in optogenetics, which uses light to control neurons. That approach may enable the team to stimulate the pelvic nerve without having to physically touch it, which may reduce swelling and scarring that can occur with direct nerve interfaces.

The University of Cambridge and University College of London researchers have deep expertise in nerve and bladder physiology, as well as packaging implantable devices so they don’t corrode or breakdown in the body’s moist and dynamic environment.

The competition’s big idea is to replace pharmaceuticals, which can affect many systems throughout the body, with wireless devices that enable much more targeted interventions by stimulating or blocking the activity of specific nerves that send signals to organs. These devices could also “read” how the organs are functioning and decide whether any treatment action is necessary at that moment.

“We want to be able to say, ‘Right now the blood pressure is high or the bladder is full — does the device need to do something or can the body be left alone?'” said Moritz. “That dramatically lowers the amount of treatment that’s needed, as opposed to having someone on a drug 24 hours a day, seven days a week.”

After the competition concludes, the next steps will be to disseminate the technologies to the wider research community and begin working on human trials. The goal is to create a flexible platform that could act on a wide variety of organs.

“The idea is that many groups could be pushing towards different human applications at the same time — not just for the bladder but for any organ. So our platform needs to be robust enough that people can dream wildly about what they want to treat with neural devices rather than pharmaceuticals,” said Moritz.

Other 91̀½»¨team members include , postdoctoral fellow in physiology and biophysics, , assistant professor of biology, and , resident in rehabilitation medicine.

Team members from other institutions include , professor of experimental neurology at the University of Cambridge; , professor of neuroprosthesis engineering at University College London; , professor of analog and biomedical electronics at University College London; , assistant professor of materials science and engineering at MIT and a CSNE member; and , postdoctoral fellows at University College London and , postdoctoral fellow at University of Cambridge.

The project builds on research begun at CSNE, a NSF-funded Engineering Research Center that is headquartered at 91̀½»¨and also includes MIT and other educational institutions. Moritz is the deputy director of the center, Smith is the thrust leader for communications and interface who is responsible for hardware research and Anikeeva is a testbed leader.

Early hardware development was supported by funding from the , where Moritz and Smith are .

“It is gratifying to see the center’s hardware research efforts paying off so quickly.  Selection by GlaxoSmithKline in this rigorous international competition shows that technologies emerging from the CSNE are at the leading edge of what is possible,” Smith said.

For more information on neuroscience aspects of the project, contact Moritz at ctmoritz@uw.edu. For technical aspects, contact Smith at jrs@cs.washington.edu.

In the next decade, people who have suffered a spinal cord injury or stroke could have their mobility improved or even restored through a radically new technology: implantable devices that can send signals between regions of the brain or nervous system that have been disconnected due to injury.

That’s the mission driving the , a 91̀½»¨-led effort that includes researchers from the Massachusetts Institute of Technology, San Diego State University and other partners.

To support development of this much-needed technology, the National Science Foundation recently renewed the center’s funding. It has awarded $16 million over the next four years to support research on implantable devices that promote brain plasticity and reanimate paralyzed limbs.

“There’s a huge unmet need, especially with an aging population of baby boomers, for developing the next generation of medical devices for helping people with progressive or traumatic neurological conditions such as stroke and spinal cord injury,” said CSNE director and 91̀½»¨professor of computer science and engineering .

The goal is to achieve proof-of-concept demonstrations in humans within the next five years, Rao said. This will lay the groundwork for eventual clinical devices approved by the Food and Drug Administration, in collaboration with the center’s industry partners.

CSNE was founded in 2011 with an $18.5 million NSF grant. Since then, its of neuroscientists, engineers, computer scientists, neurosurgeons, and has led the way in developing “bi-directional” implantable devices that can both pick up brain signals and send information to other parts of the nervous system.

The devices record and decode electrical signals generated by the brain when a person forms an intention, for example, to move a hand to pick up a cup. The devices are also able to wirelessly transmit that information, essentially creating a new artificial pathway around damaged areas of the brain or nervous system.

“When Christopher Reeve sustained a spinal cord injury due to a fall from his horse, his brain circuits were still intact and able to form the intention to move, but unfortunately the injury prevented that intention from being conveyed to the spinal cord,” Rao said.

“Our implantable devices aim to bridge such lost connections by decoding brain signals and stimulating the appropriate part of the spinal cord to enable the person to move again,” he said.

The same technology could also be used to promote plasticity for targeted rehabilitation in stroke and spinal cord injury patients — essentially reconnecting brain or spinal regions and helping the nervous system repair and rewire itself.

CSNE is also working on improving today’s implantable technologies, such as deep brain stimulators used to treat Parkinson’s disease and tremors. These typically deliver electric pulses to the brain at an appropriate frequency that’s adjusted by a physician to achieve the desired effect.

But this means that the brain is constantly bombarded by electrical pulses even when a person is resting and the pulses aren’t needed. This can lead to unwanted side effects and drain the implantable device’s battery, leading to more frequent replacement surgeries.

By contrast, CSNE researchers and industry partners are working on a next generation of that monitor the brain and deliver targeted electrical stimulation only when it’s needed.

“This funding renewal for CSNE will allow us to advance the frontiers in closed-loop neural interfaces,” said CSNE deputy director , a 91̀½»¨associate professor of rehabilitation medicine and of physiology & biophysics. “We have a fantastic team of engineers and neuroscientists working closely together, and continued NSF support is critical to achieving these ambitious goals.”

The NSF funding will also enable the center to expand its already popular for K-12 students, school teachers, undergraduates and veterans to other partner institutions. The 91̀½»¨is additionally launching an undergraduate minor and graduate certificate program in neural engineering next year.

Other CSNE collaborators include Spelman College, Morehouse College, Southwestern College, the University of British Columbia, the University of Freiburg and the Indian Institute of Science in Bangalore.

For more information, contact Rao at rao@cs.washington.edu or Moritz at ctmoritz@uw.edu.