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Veteran Josh Burch walks in an exoskeleton with support from Jonathan Colson, a clinical research assistant.
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The exoskeleton program was created in 2014.
Ashraf Gorgey has devoted his life to treating major spinal cord injuries because of the people he’s met who were told that they’d never walk again.
“In so many cases, this is the wrong answer,” says Gorgey, the constantly on-the-move director of Spinal Cord Injury Research at the Central Virginia Veteran Affairs Health Care System and an associate professor with the VCU School of Medicine. The Egypt-born expert in physical medicine and rehabilitation is in a checkup room in the labyrinthian confines of Hunter Holmes McGuire VA Medical Center. He’s looking in on the progress of research volunteer Josh Burch, who has been outfitted with a space-age exoskeleton and is getting ready for his regular workout.
Burch, a paralyzed U.S. Marine Corps veteran, has no control over his lower body and has only started to regain some movement in his arms. And yet, with the aid of this impressive metallic frame and a Bluetooth-powered inner electrical system, he’s standing upright with ease, and he’s ready to take a little walk.
“When Josh thinks about moving, it sends a very simple signal to this area and activates the circuits responsible for locomotion, allowing him to stand and step and walk,” Gorgey explains matter-of-factly and not as if we were in a futuristic science fiction story. “Normally, he would have no control over the exoskeleton. This is what we tried to change when we added epidural stimulation.”
Burch has been infused with electrical stimulation units — tiny leads that go into his spinal cord and give off small, strategic charges. “This activates the nerves below the injury,” Gorgey says. “Even with little support, he can control his trunk.”
“The hardest part is the thought process of it,” Burch says as he’s getting fixed up with monitoring wires. To control the exoskeleton and use his lower extremities, he adds, “It takes a lot of training. Three days a week, three or four hours a day.”
Gorgey picks up a device akin to a remote control device. “If you want to activate the stimulation inside his body, you choose a program with this. It could be standing only. Or locomotion, or both ... sending electrical signals to specific parts of his spinal cord.”
Ashraf Gorgey
Gorgey came to McGuire in 2008 and started the exoskeleton program in 2014. He’s fully invested in the idea that exoskeletons, coupled with targeted electrical stimulation (using implants with minimally invasive surgery), can transform the lives of those with paralyzing injuries. By combining different techniques, he says, patients can learn to control their bodies again.
“We’re now looking for what we can do to enhance upper-extremity functions, like hand grasping, daily activities,” he says. “Your upper extremity is so complex — it’s multidimensional, so it’s very hard for a single intervention to enhance function. For 40 years of research, every intervention just focused on one dimension of the upper extremity, but we propose a multimodal approach, where we focus on dual interventions that enhance different aspects of the upper extremity.”
His research into the approach is funded by a $2.2 million grant from the National Institute on Disability, Independent Living, and Rehabilitation Research. The award comes as a result of The Virginia Consortium for Spinal Cord Injury Care, a partnership formed between CVVAHCS, Virginia Commonwealth University’s Center for Rehabilitation Science and Engineering, and Sheltering Arms Institute. Last year, this merged concern won federal designation as one of 14 Spinal Cord Injury Model Systems Centers in the United States.
Gorgey is a co-principal investigator on the grant, along with Zina Trost. She’s a clinical health psychologist and associate professor in the VCU Department of Physical Medicine and Rehabilitation, where she heads up a research program that adapts virtual reality and gaming technologies to address pain and rehabilitation.
The centerpiece of the consortium’s charge is Gorgey’s research into using electrical stimulation to improve arm and hand function in individuals with tetraplegia. “We are doing something called transspinal stimulation,” he explains. “We are still waiting on the necessary approvals to get started. It’s electrical stimulation that [targets] the cervical spinal cord so that the patient can eventually send signals to his upper extremity.” As many as 12 volunteer subjects are slated to receive the treatments during the study’s five-year span.
“We’ve had two patients receive the procedure so far,” says Dr. Robert Trainer, one of the pain-medicine specialists who perform the noninvasive surgery using leads inserted through the skin that join with the cervical spinal column. “They’re just like an epidural catheter we put in for labor delivery, but with electrical contacts at the end.” The process has usually been used to treat pain. “We’re the first to do this” for mobility, Trainer says.
It took more than a year for the Food and Drug Administration to OK the epidural stimulation process. Brandon Kasnick, a Special Forces veteran from North Carolina, says he was eager to be one of the first subjects. He underwent the transspinal stimulation procedure in May. “The technology has been out there for a bit and used overseas,” he says, “but until Dr. Gorgey talked to me, I didn’t think it was a serious thing.”
Eight years ago, the former Green Beret had an epileptic seizure on a ski lift. He fell, which left him paralyzed. He says that the transspinal stimulation is enabling him to do unfamiliar things — like stand up. “It feels awkward,” he says, laughing. “It seems so forgotten now.”
Kasnick has kept in good physical shape, which is key, considering the physical strength needed to wield the equipment and to move. “None of this has been easy. It’s not like turning on a switch. It’s all been slight, subtle changes you’d notice incrementally ... standing up, doing squats or going one leg forward, one back. It’s a lot of work.”
“That’s one drawback to all of this,” Trainer agrees. “There is so much rehab.”
There is another component to the Virginia Consortium for Spinal Cord Injury Care’s mission. It aims to study inequities in health care and offer solutions to improve access and health outcomes for people from rural areas as well as those who are part of racial and ethnic minority backgrounds.
“It is exciting to have these advances in treating spinal injuries,” Gorgey says, “but we need to make sure all kinds of people have access to these treatments.”
