Restoring mobility to people living with paralysis is one of the great challenges of modern medicine, and until recently, it remained more of a hope than reality. But in a pioneering clinical study, scientists may have finally crossed the frontier.

They’ve developed a cutting-edge new technology that — for the first time — has allowed a human with paralysis to move his hand again, a breakthrough described in a study published Wednesday in the journal Nature.

The technology is the product of a decade’s work involving close collaboration among experts in neurology, physiology and engineering.

The result is a complex “neural bypass” system that’s able to decode brain waves and use them to control a muscle stimulator that empowers movement in a paralyzed limb. And it’s been brought to life by 24-year-old Ian Burkhart, the first — and so far, the only — person ever to use the system.

The journey to a breakthrough

Swiping a credit card was something Ian Burkhart, 24, never thought he would do again. Image: Ohio State University Wexner Medical Center/ BatTelle

Five years ago, it looked as though Burkhart might never move his hands again. Then 19, he was on vacation with friends at the Outer Banks of North Carolina, celebrating the end of his freshman year of college. While swimming in the ocean, Burkhart dove into a wave and crashed headfirst into a hidden sandbar, breaking his neck.

Today, Burkhart — currently studying business management at Ohio State University — maintains mobility in his head, neck and shoulders down into his biceps. His forearms, hands and lower body remain paralyzed. But despite the severity of his injury, Burkhart has been forward-thinking from the start.

"What they have been able to achieve is nothing short of amazing."

“I had mentioned to [my doctors] that I was interested in some sort of research,” Burkhart, who lives in the Columbus area, told Mashable.

“Because I kind of knew from the get-go after my injury, the way science and technology and medicine are progressing, there would be something that would come along that would improve my quality of life.”

At the same time, a team of researchers from Ohio State and Battelle Memorial Institute were looking for a participant willing to test a system they were developing.

It turned out that Burkhart met all their qualifications, and he jumped on board without hesitation.

“I kind of felt like it was my social obligation to be a part of it,” Burkhart said.

The science behind the system

The neural bypass system consists of three major components: a tiny chip in the brain that receives brain signals via a microelectrode array; a computer algorithm that decodes (and later recodes) the signals; and a special sleeve, equipped with dozens of electrodes, that wraps around Burkhart’s arm and stimulates the muscles.

Image: Ohio State University Wexner Medical Center/ BatTelle

The first step was actually implanting the chip in Burkhart’s brain. In order to figure out the exact area of the brain that controls hand movement, the researchers used functional MRI to measure brain activity while Burkhart imagined himself performing tasks with his hand.

“That functional MRI gives us a preoperative targeting approach in terms of being able to see that area,” said Ali Rezai, director of Ohio State’s Center for Neuromodulation and the surgeon who performed Burkhart’s 5-hour operation in 2014. “And we incorporated those images into our surgical computers that we use for navigating and targeting the different brain regions.”

The chip is connected by a tiny cable to a port on the top of Burkhart’s head that can be hooked up to a computer. The idea is that if Ian concentrates on performing a task with his hand, his brain signals are relayed to the computer, decoded by an algorithm and then used to direct the electrodes in the sleeve around his wrist, stimulating his muscles and enabling his arm to move.

Before actually attempting motion, Burkhart spent several practice sessions imagining himself performing movements with his hand. Finally, about a month after his surgery, the researchers hooked up the system to try it out for the first time.

Nick Annetta, right, of Battelle, watches as Ian Burkhart, 24, plays a guitar video game using his paralyzed hand. Image: OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER/ BATTELLE

“Going into that day, I was pretty excited,” Burkhart said. “I thought, ‘Hey, this is maybe the day I can actually see something happen.'”

But the system’s success exceeded even his own expectations.

“The first time we did it I was able to think ‘open my hand’ and I opened my hand, and think ‘close my hand’ and I closed my hand,” Burkhart said.

“It gave me a huge flicker of hope toward the future, knowing that this stuff works, it could become a reality.”

Through human and machine learning, Burkhart is now not only able to open and close his hand, but he can also pick up and move around objects.

Man and machine learning together

Over time, Burkhart has been able to improve and build on the movements that he can make with his hand using the system — and that’s the product of his brain and the algorithm working and learning together. The researchers have designed a process that makes this process more efficient.

Image: Ohio State University Wexner Medical Center/ BaTtelle



“The way it works is we start by showing Ian movements on the screen through a virtual hand, an animated hand that can make all sorts of movements and finger types of gestures, and we’re collecting brain activity simultaneously,” said the project’s leader, Chad Bouton, formerly of Battelle and currently the vice president of advanced engineering at the Feinstein Institute for Medical Research on Long Island.

"The more and more attention that any of this type of research can get is a win for humanity."

“And we actually learn over time the patterns that are generated in Ian’s brain that are associated with these movements.”

Using machine learning, the algorithm is actually able to improve its own performance, according to Nick Annetta, lead electrical engineer for Battelle’s NeuroLife program. The project’s team of engineers are also able to connect to the system and make their own tweaks as needed, he added.

And while all this is happening, Burkhart’s brain is also becoming more comfortable and adept at using the system.

The system’s success so far offers hope that it could one day be used to help people like Burkhart live easier and more independent lives by regaining the use of their hands.

“What they have been able to achieve is nothing short of amazing,” said Nicholas Opie, a biomedical engineer at the University of Melbourne, who was not involved with the project, in an email to Mashable.

The road ahead

This particular system is not the only approach to paralysis that’s in development. Other research groups have also explored the idea of harnessing brain waves to direct motion in prosthetic limbs or assistive devices.

Image: Ohio State University Wexner Medical Center/ BatTelle

The BrainGate system, for instance, is meant to allow humans to control external devices — anything from computer mouse cursors to prosthetic limbs — with their thoughts. And a company called SmartStent, founded by Australian researchers, hopes to allow patients to control a robotic exoskeleton with brain signals.

To date, though, the new neural bypass system is the first to allow controlled movement in the body of a person with paralysis. And Burkhart remains the only person to have ever used the system.

The researchers are hoping that will change, though. They plan to expand the project to a handful of other participants in the near future, and they hope that ultimately the system can be made portable. For now, the only time Burkhart is able to use it is when he comes into the lab at Ohio State for a session, which he does a few times a week.

The researchers are also working toward enabling the technology to be applied to more than one part of the body at once, but this would involve the implantation of multiple chips in the brain.

Eventually, the system could be completely external, with an outside monitoring device used to pick up brain waves instead of via a chip in the brain.

This would help avoid the risks involved in brain surgery.

Ian Burkhart, seated, poses with members of the research team (from left) Dr. Ali Rezai and Dr. Marcie Bockbrader of The Ohio State University Wexner Medical Center and Nick Annetta of Battelle. Image: OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER/ BATTELLE

“The issue with technology that involves open brain surgery is the risk of this surgical procedure,” said Opie, the Melbourne researcher who is also the chief technology officer of SmartStent.

“While these risks are relatively low, this is still a limitation of this technology.”

He also pointed out that previous research has suggested that electrodes placed directly in the brain “may cause reactions to occur that reduce the signal quality over time.”

Researchers still aren’t sure how long the chip in Burkhart’s brain will last. So far, it’s been functioning for nearly two years with no sign of slowing down.

For now, the team has no concrete timeline for when the system might be available for a broader range of people. Its development could still be years in the making. Though Burkhart understands that, he is still optimistic.

“The more and more attention that any of this type of research can get is a win for humanity because it’s definitely a big problem that needs to be solved," he said. "And if we don’t do anything about it, then nothing’s going to happen."