A breakthrough in paralysis treatment

JIM TANKERSLEY
Last updated 16:10 24/06/2014
bionic
LEE POWELL / The Washington Post

BIONIC MAN: Electrodes are attached to Ian Burkhart’s arm during a training session earlier this month at Ohio State's Wexner Medical Center.

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LEE POWELL / The Washington Post
Ian Burkhart tests the device during a training session. . A port at the top of his head has a transmitter that carries signals from a chip implanted in his brain to a computer. He studies hand movement simulations on the screen that he tries to replicate with his paralyzed hand.
bionic
LEE POWELL / The Washington Post
Ian Burkhart moves his paralysed hand through the power of thought.

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First they screwed the end of the gray cord into the metal silo rising out of Ian Burkhart's skull. Later they laid his right forearm across two foam cylinders, and they wrapped it with thin strips that looked like film from an old home movie camera. They ran him through some practice drills, and then it was time for him to try.

If he succeeded at this next task, it would be science fiction come true: His thoughts would bypass his broken spinal cord. With the help of an algorithm and some electrodes, he would move his once-dead limb again — a scientific first.

"Ready?" the young engineer, Nick Annetta, asked from the computer to his left.

"Three. Two. One."

Burkhart, 23, marshalled every neuron he could muster, and he thought about his hand.

The last time the hand obeyed him, it was 2010 and Burkhart was running into the Atlantic Ocean.

The hand had gripped the steering wheel as he drove the van from Ohio University to North Carolina's Outer Banks, where he and friends were celebrating the end of freshman year.

The hand unclenched to drop his towel on the sand. Burkhart splashed into the waves, the hand flying above his head, the ocean warm around his feet, the sun roasting his arms, and he dived.

In an instant, he felt nothing. Not his hand. Not his legs. Only the breeze drying the saltwater on his face.

His friends had saved him from drowning. A helicopter carried him to a hospital. He learned that he had smashed into a sandbar, hidden by the waves, and broken his neck. He rehabbed at a special facility in Atlanta. He returned home to the Columbus suburbs, unable to move anything below his elbows.

He lived in his father and stepmother's basement. He needed help with almost everything. Showering took 2 1/2 hours, with assistance. When it was time to eat, family members strapped a fork to his limp hand; using his shoulders and elbows, he could spear bites. The night before the doctors strapped Burkhart's arm into an electrode sleeve, before he tried to make that hand move again, he had to call his dad to come turn him from his side to his back so he could sleep.

His doctors said he signed up for this experiment — for elective brain surgery — because he hoped, someday, if the technology could get there, to ease his parents' burden in caring for him.

"I'd say that the thing I miss most is just being independent," Burkhart said in April, shortly before doctors implanted a chip in his brain. "You have to rely on other people so much.

"It would really be nice," he added, "to just do something as simple as open up a water bottle myself."

The next day, doctors opened Burkhart's skull. They crowned his head with a small metal cylinder, attached to bone by screws, and ran a wire between it and the chip they stuck like Velcro to his brain.

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The wound healed nicely, though Burkhart's head hurt a lot, especially when, in the days after the operation, his hospital wing decided it was a good time to test its fire alarms. Burkhart finished his finals at Ohio State University, where he had enrolled after the accident. He helped coach the lacrosse team at his old high school — where he had been a standout goalie — to the state finals.

Three times a week, he rolled his wheelchair up to a computer monitor and allowed scientists from Battelle, a nonprofit research organisation that invented the technology they hoped would let him move his hand with his thoughts again, to plug into his brain. Together, they practiced. He would watch a digital hand move on the screen, and he would think about moving his hand the same way. The computer would read his thoughts and move a second, animated hand at his direction.

Finally, last Wednesday, four years and a week since he lost command of the hand, it was time to try for real.

Burkhart rolled his electric wheelchair into a narrow room at Ohio State's Wexner Medical Center in Columbus. He wore a green T-shirt over a white T-shirt. His father had shaved his head that morning with electric clippers. The round port stuck awkwardly out of it. When they plugged the cord in, he looked like Neo, the Keanu Reeves character from "The Matrix" movies.

When the time came to start the attempt, the room was packed with several journalists, at least seven cameras, two Battelle engineers (Annetta and Chad Bouton, the project leader), two doctors (Ali Rezai, who had performed the brain surgery, and Jerry Mysiw, the rehab specialist who recruited Burkhart to the project) and Burkhart's father, Doug.

The doctors knew the chip was in the right place to pick up the brain signals. The engineers knew their algorithm was translating his thoughts to movements. They believed the film strips strapped around his forearm, which they called a sleeve, would stimulate his muscles to make those movements a physical reality. The big variable was Ian Burkhart: Could he will his hand to move?

"He's got to focus on the task," Rezai, the surgeon, said. "Imagine the task."

They started with the drills Burkhart had done for weeks, moving the animated hand on the screen with his thoughts. He repeated the sequence several times. "Both Ian and the computer are learning at the same time," Bouton said.

The last drill ended. "Awesome job," Annetta told Burkhart.

And then it was time.

Before Burkhart's surgery, Bouton had talked about this day, and his hopes for it, which boiled down to one finger. They hoped Burkhart could move one finger. Now the day had come, and Bouton was more ambitious. He wanted Burkhart to do something that would be a building block — a movement that could lead to him eating or brushing his teeth, someday, by himself.

"We're going to see if Ian can open and close his own hand," Bouton told the cameras. To Burkhart, he added: "No pressure."

Annetta counted down from three.

Ian Burkhart thought about his hand. "You really have to zone everything else out," he would say later, "and focus on that movement."

At 2.58pm, his fingers quivered. His hand opened. Not all the way, but it opened.

A moment later, he balled his hand into a fist, and he curled the fist toward himself, like a weightlifter doing curls.

Again and again, he balled his hand and curled his fist.

"What do you think?" Bouton asked Ian's father.

"Pretty cool," he replied.

Ian Burkhart smiled.

Later, the doctors and engineers would talk about the possibilities now seemingly open to them, in the bionic future they had just ushered in. They talked of sleeves that would slide over paralysed limbs, headbands that would do the work of a brain chip, cellphones that would do what the computer did now. That's all far away; Burkhart would unplug and go home and be stuck with a body that still didn't follow his orders, at least not yet.

"It's not a matter of if" he would get movement back in his limbs, Burkhart would say. "It's a matter of when."

Mysiw said most of his patients spend at least some part of every day asking whether it would have been better if they had just died in their accidents. Most of them, but not Burkhart. "What drove him" to volunteer for this, Mysiw said, "was the need to contribute".

With the sleeve strapped on, Burkhart trilled his fingers. He opened his hand wide. He curled his wrist some more.

His last task was a spoon. A first step toward feeding himself. Bouton placed it next to Burkhart's hand on the table.

There was no practice, no visualisation. Burkhart grabbed the spoon by the handle, flipped his hand over and held on for a beat.

Then he dropped it, like a towel on the sand.

-The Washington Post

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