Biotech Strategy Blog

Commentary on Science, Innovation & New Products with a focus on Oncology, Hematology & Cancer Immunotherapy

Posts tagged ‘Medical Innovation’

Braingate array

Photo: braingate2.org

Research published online first today, and in the May 17 2012 issue of Nature describes promising results of a clinical trial with tetraplegics (all four limbs paralyzed) that allowed the control of an external robotic arm (DEKA arm) using an embedded microarray in the brain, the BrainGate neural interface system.

One of the two study participants who had the array implanted 5 years ago, was able to use her mind to control a robotic arm and serve herself coffee from a bottle, 15 years after she became completely paralyzed & unable to speak.

The results from a team of researchers from the Department of Veterans Affairs, Brown University, MGH, Harvard Medical School (BrainGate Research Team) and the German Aerospace Center, Institute of Robotics and Mechatronics are promising.

The BrainGate system is the size of a small pill, and consists of a grid of 96 electrodes that are implanted in the motor cortex of the brain. By placing the grid next to the part of the brain that controls movement, neuronal activity associated with a movement can be translated into a computer command that drives an external robotic device.

The results reported by Leigh Hochberg MD, PhD & colleagues in Nature, offers hope to those paralyzed or who have limbs amputed, that in the future, innovations in neurotechnology may allow thoughts to control prosthetics or external robots.

Courtesy of Nature Video, you can watch how a paralyzed woman controls a robotic arm with her thoughts – this is an amazing video that is well worth watching:

How does it work, according to clinical trial subject T2:

I just imagined moving my own arm and the [DEKA] arm moved where I wanted it to go.

Subject S3 commented:

I think about moving my hand and wrist. I’m right handed so, it’s very comfortable and feels natural to imagine my right hand moving in the direction I want the robotic arm to move.

The challenge with this type of medical news is the danger of hype over hope, so to better put the results in perspective, I am delighted to have some expert commentary in the form of a guest blog post from D. Kacy Cullen, Ph.D, Assistant Professor at the University of Pennsylvania, Department of Neurosurgery Center for Brain Injury and Repair.

The Cullen laboratory at Penn applies Neural Engineering principles and technologies to the area of Neurotrauma, and is actively researching how to use neural tissue engineering-treatments to promote regeneration and restore function.

Commentary by D. Kacy Cullen, PhD 

This work is a natural extension/combination of the group’s previous work (1) involving human patients and computer cursor movements, and (2) non-human primates and robotic arm control.  So, this “next step” was anticipated, and in fact larger trials (involving various groups) are being initiated to investigate brain-based neural interface systems to drive the DEKA arm in subjects with limb loss (i.e. absent CNS damage/deficits).

The most compelling features to me were the decoding/training algorithm and the fact that one of the patients had her micro-electrode array implanted 5 years earlier.

Decoding/training: The use of signal filtering/thresholding in combination with open-loop (imagining and watching movement) and closed-loop (controlling the arm with visual feedback) recording/training was innovative and relatively efficient (31 min). However, in each case, the subjects had worked controlling arms previously (over years for S3 and 3 trials for T2).

A major challenge with recording ensemble neuronal activity in the motor cortex (or anywhere in the cortex) is signal attenuation and drift over time; so, each day/session typically requires re-training and re-calibration.

I would be curious to see how the subjects did in other independent trials – perhaps visual feedback can allow the user to “correct” the cortical inputs and hence reduce movement errors more rapidly in subsequent trials.  Nonetheless, it is remarkable that the subjects were able to manipulate the arm and drive it in a controlled and useful manner in a relatively short amount of time.

5 years: using an electrode array implanted 5 years earlier to control the robotic limb is very impressive.  The finding bodes well for the potential of this brain-based approach to yield useful cortical data chronically.

A major challenge is that over time the brain gradually rejects these non-organic electrodes, causing a build up of micro-scar tissue around the electrodes and a decreased neuronal density in the vicinity of the electrodes.

This process is partly due to mechanical mismatch between the electrode the brain causing inflammatory “micro-motion”.  This is likely exacerbated by subject motion/walking, which would not be an issue with the patients in this study but will be for the amputee study.

Nonetheless, this study noted “lower spike amplitudes and fewer contributing (active) channels” compared to earlier years, which is consistent with micro-scar tissue and fewer neurons close to electrodes.

Although this work is a natural next step, I do not want to trivialize the supreme competence, technical savvy, and attention to detail necessary to pull this off.  This group is highly competent and has the experience and skill to execute this very complex and multi-faceted neural engineering project to assist chronically disabled patients.

Reference

ResearchBlogging.orgHochberg, L., Bacher, D., Jarosiewicz, B., Masse, N., Simeral, J., Vogel, J., Haddadin, S., Liu, J., Cash, S., van der Smagt, P., & Donoghue, J. (2012). Reach and grasp by people with tetraplegia using a neurally controlled robotic arm Nature, 485 (7398), 372-375 DOI: 10.1038/nature11076

2 Comments

Today is the first “Innovation Day” at Children’s Hospital Boston. For those, like me, who can’t be in Boston for it, you can follow on Twitter using the hashtag #iday or watch online via live streaming.

Children's Hospital Boston Innovation Acceleration ProgramI’m impressed that the hospital has an Innovation Acceleration Program focused on supporting “clinical care that impacts patients around the world.

I think this event is a really great way to showcase some of the interesting research and collaboration that is taking place in the hospital in the field of device development, healthcare IT and process innovation.

The program starts at 1.00pm EST. On the Agenda are a few talks that caught my imagination:

Does my baby have a “flat head”? Using the web and digital photos to triage visits to the doctor’s office,  Joseph R. Madsen, MD

Pediatric Vision Scanner: A handheld device that diagnoses vision problems in preschoolers,  David Hunter, MD, PhD

New directions in drug delivery: A contact lens that dispenses medication, Dan Kohane, MD, PhD

The Children’s Hospital Boston science and innovation blog (Vector), which is well worth reading, also has a preview of their Innovation Day.

Given the ease and low cost with which events can be webcast or live streamed, and the potential to reach a global audience, I hope that other institutions will follow Children’s Hospital Boston and showcase their innovation in this way.

Good luck to all at Children’s with your first Innovation Day!

Science Translational Medicine June 29, 2011 Cover based on Rodin's The ThinkerWith an image of Rodin’s bronze “The Thinker” on its cover suggesting deep thought and insight, Science Translational Medicine (STM) analyzes the state of innovation in its June 29 issue.

STM states (without any authority) that “A powerful perception that innovation has stagnated persists in the biomedical research community.” STM asks, “Why have remarkable advances in basic biological science been so slow to be translated to improvements in clinical medicine?”

Unfortunately there is no identification of any “remarkable advances” that have been slow in being translated into clinical practice.

That’s not to say they don’t exist, merely the fact that from a hard-hitting science driven journal, it’s hard to hang your hat on mere assertions.

The three Commentaries on innovation by thought leaders in the June 29 issue offer varying perspectives, but like all opinion pieces it’s hard to judge competing views. STM in their editorial notes the only common thread they could detect among the Commentaries on innovation is that  “a new mindset must drive risk-benefit analysis.”

It is good to see a debate on innovation, but I think in the data driven world of science, I expected more from Science Translational Medicine and the American Association for the Advancement of Science (AAAS).

The first Commentary on Innovation published in the June 29 issue of STM is by Elazer Edelman, the Thomas D. and Virginia W. Cabot Professor of Health Sciences and Technology at MIT, and Martin Leon, Professor of Medicine at Columbia entitled “The Fiber of Modern Society.”

Why innovate? This is a good starting point for Edelman’s and Leon’s commentary. After all if innovation does not add value, then it’s a worthless exercise.  The authors, surprisingly for distinguished academics loose the reader in the first few paragraphs through their verbosity and lack of clarity:

Now grafted onto this engrained philosophy is a drop-off in the metrics of novelty and the perception that creation has stagnated—at least in biomedical science. As we are well into the 21st century, it behooves scientists and policy-makers not only to assess the accuracy of this impression but also to validate the long-accepted mantra.

The above causes me pain to read and attempt to process.  Does anyone really “behoove” anything in the 21st century?

The authors touch on competing views about what innovation is, but having raised the question of how to define it, fail to offer their opinion. Instead they move straight on by saying “irrespective of the definition.

Defining innovation is important – science is about preciseness. If you can’t define a theory how can you test it or measure it. While we may have different views of what innovation is, thought leaders on the topic should frame their perspective around some definition.

Is innovation really dead the authors go on to ask? They cite to the large number of publications in recent years that claim the death of innovation or express concern about it. However, while raising third-party concerns they also point out the progress that has been made in the reduction in mortality and morbidity over the past 40 years through advances in technology.

The authors again don’t answer the question they have asked on whether innovation is dead? Instead they move on to their next topic and suggest that “fear of risk stifles innovation” – spending cuts will lead to less creativity. The authors then launch into a diatribe on the pitfalls of a lower NIH budget.   Evidence of the demise of innovation is the decline in the number of registered patents or FDA applications for new molecular entities (NME).

What are the authors conclusions and recommendations?  They state:

“we must find ways to teach and support innovation without falling prey to conflicts of interest, without confusing innovation with greed-directed entrepreneurship.”

However, they don’t offer any specifics on how to do this, and what exactly is “greed-directed entrepreneurship” when it’s at home? Is it wrong to profit from innovation?

This Commentary by Edelman and Leon is not the deep insightful piece that Rodin’s Thinker suggests, instead it is a rambling piece that is disappointing in my opinion.

In future blog posts, I’ll be reviewing the other Commentaries on Innovation published by STM.

ResearchBlogging.orgEdelman, E., & Leon, M. (2011). The Fiber of Modern Society Science Translational Medicine, 3 (89), 89-89 DOI: 10.1126/scitranslmed.3002190

error: Content is protected !!