When William Kochevar’s spinal cord was severely injured in a bike accident, he was almost completely paralyzed, left with only slight movement in his right shoulder. But a new prosthetic technology that plugs into his thoughts is helping him move his arm again.
Kochevar, who has quadriplegia, is now able to use his brain waves and a neuroprosthetic to reach and grasp with his right arm and hand. He’s the first person in the world with complete paralysis to regain those functions, according to the research team’s recent case study.
The reaching and grasping movements enable Kochevar to drink a cup of coffee, feed himself mashed potatoes and complete other tasks that increase his independence.
“It has changed my outlook a little bit,” Kochevar said.
Kochevar is sometimes a “stoic figure” but “he definitely was very happy and very ecstatic the first time his arm moved,”research scientist A. Bolu Ajiboye said. “He’s always pushing (the research team)… Always asking ‘What is the next step?’”
Kochevar was injured years ago when he ran into a mail truck on his bike. With a cervical level-four spinal cord injury, Kochevar has a “tiny, tiny bit of ability to shrug his right shoulder,” but he isn’t able to produce any controlled movements of his arm or hand, said Ajiboye, an assistant professor of biomedical engineering at Case Western Reserve University and lead author on the case study.
Before a doctor at the Cleveland VA Medical Center told Kochevar, a Navy veteran, about the clinical trial, he knew that there was assistive technology available that could help him on a limited basis. But “I thought, ‘Oh, I’m going to be like this and I’m not going to be able to do much more,’” he said.
Kochevar lives in a skilled nursing facility at the VA Medical Center. Nurses and other caregivers help him with “anything I need to do that I can’t do myself,” including propping himself up in a chair, taking his medicine and bathing.
Once he started seeing results during the trial, he thought, “Wow, there’s a whole lot more that I will possibly be able to do in the future.” He’s also hopeful about the outlook for other people with quadriplegia as this technology advances.
The neuroprosthetic Kochevar uses has two basic components: a brain-computer interface and functional electrical stimulation. Before Kochevar could use the device, he had to undergo medical procedures and training in the lab.
For starters, two electrodes were placed in the left motor cortex of his brain. Next, electrodes were implanted directly under the skin of Kochevar’s right arm. The way those electrodes got there is a little trippy. Each of the fine wires was placed inside a hollow hypodermic needle, Ajiboye said. When the needles were removed, the wires remained in Kochevar’s arm.
Once the initial set of electrodes was placed, Kochevar had to master moving a virtual robotic arm using his mind. That virtual reality arm was programmed to have “the dynamics and mechanics of a real arm,” Ajiboye said.
After he learned how to control the virtual arm, it was time for more electrodes to be implanted in Kochevar’s right arm so he could begin regaining use of his own arm.
“We are not at all claiming that we’re repairing the spinal injury,” Ajiboye said.
Rather, the new technology allows Kochevar to “circumvent” the injury. The reaching and grasping Kochevar is able to achieve while hooked up to the brain-computer interface is “directly regulated by him through brain signals,” Ajiboye said.
Right now, the neuroprosthetic can only be used in a lab, he said. And it’s only available for experimental use in the United States, according to a press release.
Before this work, other researchers looked for similar ways to restore functions in people with paralysis, but Ajiboye’s team was unable to find an example of other researchers using electrical stimulation to restore both reaching and grabbing functions in a patient with Kochevar’s level of paralysis, according to the study.
Creating equipment that can be used outside the lab in day-to-day life is a goal for Ajiboye and his team, but there are certain logistical challenges that must be overcome before it’s a possibility.
The equipment is “quite large,” Kochevar said. For practicality’s sake, the brain-computer interface would need to shrink in size from a set of lab computers—its current setup—to a piece of wireless technology that’s about the size of a cell phone, Ajiboye noted.
“If we don’t have a wireless brain interface, it’s a non-starter in terms of using it outside of the lab,” he said.
Also, the electrodes would need to be more deeply implanted, rather than implanted right beneath the skin with wires sticking out, as is the case for Kochevar, Ajiboye said. This would require a more invasive surgery. Those electrodes would be more difficult to remove if necessary.
Still, Kochevar and the researchers are hopeful that the technology will one day be used to help more people with spinal cord injuries achieve increased independence. Kochevar has told the researchers “time and time again ‘I’m in this project for the long haul… as long as I’m still having fun and we’re still progressing really well.’”
For now, Kochevar has three-and-a-half-hour sessions in the lab two or three days a week.
“I’m really doing something to benefit humanity,” he said.