Top: Brian Gomez works on building his arm strength during a therapy session at Ronald Reagan UCLA Medical Center. Second: Gomez roasts coffee beans at his home business in San Dimas, California. Third: Since undergoing an experimental spinal-stimulation surgery at Ronald Reagan UCLA Medical Center, Gomez has experienced significant increase in the function of his hands. Bottom: Dr. Daniel Lu checks the grip of Gomez’s hands and fingers. Photos: Clark Powell/MediaSource
UCLA doctors have implanted a spinal stimulator that is showing early promise in returning hand strength and movement to a California man, who broke his neck in a dirt-biking accident five years ago. Brian Gomez became one of the world’s first patients to undergo surgery for the experimental device in June 2016 at Ronald Reagan UCLA Medical Center. UCLA scientists positioned the 32-electrode stimulator below the site of Gomez’s spinal-cord injury, near the C-5 vertebra in the middle of his neck. That’s the area most commonly associated with quadriplegia — the loss of function and feeling in all four limbs.
“The spinal cord contains alternate pathways that it can use to bypass the injury and get messages from the brain to the limbs,” says Daniel Chia-Hsing Lu, MD, PhD, director of the UCLA Neuroplasticity and Repair Laboratory and the UCLA Neuromotor Recovery and Rehabilitation Center. “Electrical stimulation trains the spinal cord to find and use these pathways.”
While other devices have shown promise in treating paralysis, these approaches involved animals or relied on robotic arms. This approach is unique because the device is implanted in the spine instead of the brain and is designed to boost patients’ abilities to move their own hands. Dr. Lu likened the approach to a commute on a busy freeway. “If there is an accident on the freeway, traffic comes to a standstill, but there are any number of side streets you can use to detour the accident and get where you are going,” he says. “It’s the same with the spinal cord.”
In addition to the stimulator, doctors implant a small battery pack and processing unit under the skin of the patient’s lower back. Small enough to fit in the palm of a hand, the implant is paired with a remote control that patients and doctors use to regulate the frequency and intensity of the stimulation. “It is an ongoing process that retrains the spinal cord and, over time, allows patients to strengthen their grip and regain mobility in their hands,” Dr. Lu says.
The UCLA team performed the world’s first implant surgeries of this kind on two cervical spinal-cord-injury patients prior to Gomez. Dr. Lu and his colleagues saw an increase in finger mobility and grip strength of up to 300 percent. Dr. Lu is working with UCLA neuroscientist Reggie Edgerton, PhD, to build upon the success of their previous findings in patients with lumbar spinal-cord injuries. Their research already has made a huge difference for Gomez, who owns a coffee-roasting business in his hometown of San Dimas, California.
“I use an industrial roaster that heats up to 450 degrees, and just a few months ago, I reached up to pull a lever to empty a batch of beans after they’d finished roasting. But because I didn’t have the arm or core strength, I burned myself,” he says, revealing the scar on his forearm. “That doesn’t happen anymore because of the strength and dexterity I’ve developed.”
People who suffer spinal-cord injuries usually have a window of only a few months to get the rehabilitation they need to maintain at least partial use of their hands, making Gomez’s improvements especially encouraging. Gomez visits a UCLA laboratory several times a week for rehabilitation exercises and to help scientists fine-tune the stimulator. The UCLA team’s goal is to improve hand function enough to allow patients to perform everyday tasks. As the technology develops, patients might expect further improvements.