From Military.com:
“The VA Is Testing an Implant
That Could Allow Paralyzed Veterans to Walk Again”
(Paralyzed Marine Lance Cpl.
Joshua Burch uses an exoskeleton to attend his promotion to corporal at the
Hunter Holmes McGuire VA Medical Center in 2016.)
Five years ago, Marine Lance Cpl.
Joshua Burch became the first paralyzed service member to walk to his own
promotion ceremony, wearing an exoskeleton that helped him walk and stand to
receive his corporal chevrons. Now medically retired, Burch, 26, hopes again to
be a trailblazer -- the first Department of Veterans Affairs patient to regain
function in his lower body -- to include taking steps -- courtesy of an
electrical implant in his spine that is designed to stimulate his body's
sensorimotor networks. "Even thinking about walking is crazy. I look at
this as a stepping-stone to a future where others like me can walk. I look at
my participation in this research as a way of helping people out," Burch
said during an interview in March with Military.com.
Researchers at Hunter Holmes
McGuire VA Medical Center in Richmond, Virginia, have launched a study to
determine whether epidural stimulators can help paralyzed veterans recover
motor activity and/or control over their "inner systems" -- their cardiovascular
and bladder functions, for example. While epidural stimulators have shown some
degree of success with limb paralysis in research elsewhere, this is the first
such study at the VA, explained Dr. Ashraf Gorgey, chief of spinal cord injury
research at the Richmond hospital. Gorgey said the study has several goals: to
see how well an epidural stimulator made by Medtronic for pain management can
work on spinal cord injuries and to demonstrate the promise of the technology,
which can be implanted with minimum surgery. "With this study, we might
get companies like Medtronic and Boston Scientific to start creating something
more specific for spinal cord injuries," he said. "We also want to
show that you don't need invasive surgery to use this device. We use just a
needle under fluoroscopy, and through the needle, we thread the leads in. On
the same day Josh had his surgery, he was down in this room working out on the
mat." Gorgey plans to implant the epidural stimulators in 20 veterans, who
will then take part in a year of intensive physical rehabilitation therapy and
training. Gorgey and Burch say that with any success, Burch may be able to take
steps on his own within that period, going from strengthening his legs in an
exoskeleton to walking across a floor with a walker."In Josh's
circumstance, the signal that's coming from his brain through his spinal cord
is interrupted. So now we are going to replace this signal with external
signals that help trigger a step in movement. By using the exoskeleton, we can train him to … hopefully
stand up and walk again," Gorgey explained.
Marine lance corporal spinal
cord injury research Burch lost much of the use of his hands and all use of
his legs in a September 2015 accident in Guam. He actually doesn't know what
happened. He remembers being in a hotel room talking to his sergeant in the
afternoon and waking up the next day on the ground outside the hotel, unable to
move. At 21, he had fractured his seventh cervical vertebrae, the lowest
bone in his neck. Burch underwent several surgeries in Hawaii before he
was transferred to McGuire's Polytrauma Rehabilitation Center, where he met
Gorgey and first learned about exoskeletons.
The Perfect Candidate
(Lance Cpl Joshua Burch, right,
is pictured with his friend, Lance Cpl. Jeremy Matos, before a Marine Corps
birthday ball in 2014.)
Fit, in good health and eager to
push his broken body to its limits, he was the perfect candidate for using an
Ekso GT, a lower-body, battery-powered exoskeleton, Gorgey said then. "A
person with a spinal cord injury who has the ability to stand and walk is a
breathtaking thing," Gorgey told Military Times in 2016. "Not only
are there obvious physical and psychological benefits, but the physiological
impact is huge. The act of walking can prevent so many other health issues
associated with long-term paralysis, including heart disease, diabetes, muscular
atrophy, bone loss." The first time Burch used the Ekso GT, he took
256 steps along a hospital hallway. Gorgey had to rein him in a bit, concerned
Burch would injure himself. "He definitely did not want to
stop," Gorgey said. The second time Burch used the exoskeleton, he
clocked 486 steps. He also wore it later that afternoon to his promotion
ceremony. Now, the retired Marine hopes his new implant -- he received a
temporary one March 8 to see how well he tolerated it, then got his permanent
implant April 2 -- will let him one day take steps at the hospital and around
his apartment free of the exoskeleton. "That's what I'm working
toward," he said. Burch has reason to be hopeful: In 2018, in
similar research conducted at the University of Louisville in Kentucky and the
Mayo Clinic in Rochester, Minnesota, three people -- Jeffrey Marquis, 35; Kelly
Thomas, 24; and Jered Chinnock, 29 -- were able to walk after receiving the
same implants. Marquis eventually graduated to walking with balance poles, and
Thomas now walks unassisted.
Claudia Angeli, one of the
scientists at the Kentucky Spinal Cord Injury Research Center at the University
of Louisville, has been studying epidural stimulators for spinal cord injuries
since 2009.Her past research focused on motor restoration. Currently, she is
looking at controlling the systems of the body that regulate blood pressure and
bladder control. Rare individuals are able to achieve "full overground
ambulation," Angeli said. But nearly everyone who has received an implant
in her research has been able to take a few steps at a time during therapy, she
added. "In humans, spinal injuries are all different, so we find that the
parameters are very individualized," Angeli explained. "We are
working hard to improve the technology. A lot of potential exists for it to
interact with the healthy spinal cord below the injury. It allows restoration
of some of the functions that were there before the injury."
A $3.7 Million Grant The
VA study was made possible by a $3.7 million grant from the Defense Department
under the Congressionally Directed Medical Research Program. Dr. Robert
Trainer, a pain management specialist familiar with the Medtronic devices, does
the implantation while Gorgey oversees the program and manages the veterans' post-operative
physical therapy. Burch says he already has seen a benefit from his
implant: a decrease in involuntary movements in his legs known as spasticity
that he hopes will help improve his therapy at the VA and the gym near his
home. That immediate change following the implant bolstered confidence
in his decision to enroll in the research, he added.
When he is not at the VA -- he
spends 90 minutes there three times a week -- Burch works with his brother,
Travis, also a former Marine, renovating and flipping houses in Portsmouth, and
he plays on two wheelchair rugby teams. He credits the sport, once known as
murderball, and his teammates on the Oscar Mike Militia, an all-veterans team,
for his recovery to date. "The first tournament I ever went to, I had my
mom with me because I couldn't really do anything. And my teammates were like,
'You gonna bring your mommy to every tournament?' I was like, 'OK, I need to
learn to be independent,'" Burch said. Gorgey said he is excited to see
how the combination of the epidural implant and use of an exoskeleton works to
improve muscle quality, cardiovascular health and bladder function in the
veteran participants. "We have a whole team that has worked very hard to
get to this point," he said. Burch says he will apply the same quiet
strength he relied on to get through Marine Corps basic training, through
military occupational specialty training as an aircraft rescue and firefighting
specialist and through the dark days following his accident to get the most out
of the research. "And if I don't walk? I'm going to be happy for the
research that comes from the study," he said.
^ It’s great to see the VA work
on something very important and innovative as this. I know there are many
Soldiers (and non-Military) that would benefit if this works. ^
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