Philadelphia-based Rothman Orthopaedic Institute has been at the forefront of spine care, and recently a team partnered with Thomas Jefferson University Hospital in the same city to develop a device for paralysis patients called NuroSleeve.
Rothman President Alex Vaccaro, MD, PhD, spoke with Becker's about Rothman's work with NuroSleeve and his outlook for similar technologies.
Note: This conversation was lightly edited for clarity.
Question: Can you share more about the development of NuroSleeve?
Dr. Alex Vaccaro: Great strides are being made to allow patients with neurologic disorders to be able to interact functionally with their environment. At The Raphael Center for Neurorestoration at Jefferson University's Farber Institute, Mijail Serruya, MD, PhD, and his team have developed a method to bypass the injured spinal cord and send signals to the extremities to allow useful movements, vastly improving the quality of life of a patient who has lost function.
When someone experiences a spinal cord injury, a cascade of events occur that lead to spinal cord swelling, scarring and cystic degeneration that makes regeneration extremely difficult. The peripheral nervous system, not the spinal cord itself, has the ability to repair itself by sprouting new neurons that over time can supply signals to target muscles allowing them to regain function. Vast research is underway exploring regenerative agents, antiscarring substances, scaffoldings and stem cells that may aid in spinal cord repair. Until that happens, we need to figure out ways to bring self-mobility to those with neurologic impairment.
The Raphael Neurorestoration team developed the NuroSleeve. The NuroSleeve is something you wear on your arm, and it can help a paralyzed person move their hand again. The NuroSleeve was designed with the feedback of children and adults living with conditions like cerebral palsy, stroke, ALS, muscular dystrophy, and spinal cord injury. The system is customizable. There is a motorized exoskeleton that is 3D-printed based on the shape of each person's hand and arm. There is a stimulator that activates muscles to move. A person can trigger their NuroSleeve by making tiny movements or using their voice. Patients can also control it using a functional limb that is directing it via a remote control.
For people who have no muscular movement ability or cannot talk, the device is also designed to accept signals from an implanted brain sensor that can direct the muscles to move. For the implanted system, impulses from the brain go through Bluetooth or a computer to activate the extremities – think if my hand moves, your hand moves.
We are incredibly grateful to receive financial support from Tim Reynolds, my brother’s best friend at graduate school. One day, while Tim was on his way home from work, his driver was involved in an accident that left him paralyzed. Tim donated to help fund this project and the critical research we do.
The team has written several papers on this topic, and we're now using implantable electrodes through a computer that stimulate the muscles distal to the spinal cord injury in a closed loop fashion. This means the device learns, and sort of reacts, to the movement of the extremity to give feedback to allow for future movement. With this approach, we can theoretically help any patient with a complete spinal cord injury improve their walking, as the device monitors movement and communicates feedback to a computer.
Q: What's your outlook for implantable brain chip technology such as Neuralink? Compared to these external devices, which will come out strong in the long run?
AV: Working in this field is fascinating. Although most people associate this kind of technology with Elon Musk and Neuralink, there are actually multiple companies pioneering advancements in the space, such as Precision Neuroscience. These companies are developing brain-computer interfaces aimed at improving the lives of individuals with severe impairments, such as those with specific spinal cord injuries, ALS, or brainstem strokes. These devices can listen to the signals of the brain and also apply gentle stimulation, enabling external connections to a computer via wires or even Bluetooth. This setup can function like an neuroprosthetic device to generate movement in the limbs.
In addition to exploring stem cells and other previous approaches, we're also focusing on enabling movement through technology that interfaces directly with the spinal cord. To simplify it, the technology is basically using a stimulation system called RISES, invented by the Raphael Neurorestoration team. RISES has two versions. One is wearable and can be used without surgery: people with spinal cord injury are receiving this stimulation right now in the clinical trial at Rothman and Jefferson. The second version is implantable. Both versions are closed-loop, which means that the systems adjust stimulation based on what the person is trying to do so they can move their own body.