Gert-Jan Oskam became paralyzed from the neck down in 2011. Thanks to a so-called brain-spine interface (BSI) he can now walk and stand independently again. ‘It was a long journey.’
In 2011, Gert-Jan Oskam (40) suffered a spinal cord injury due to a bicycle accident and became paralyzed from the neck down. The spinal cord injury was not complete, so he still had some control over his leg muscles, but not enough to walk or stand on his own.
But now he can do that again, thanks to a so-called brain-spine interface (brain-spinal cord interface), an implant that picks up signals from his brain, translates them and forwards them to an implant connected to his spinal cord. “It was a very long journey,” Oskam says in a video about the brain-spine interface (BSI).
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That trip has brought Oskam something. Thanks to BSI, he can walk, even over uneven terrain, climb stairs and – very importantly – can stand on his own. Oskam: ‘A few months ago I was able to stand up straight and have a beer with my friends for the first time in ten years. That was very cool.’
Years of research
BSI is the result of years of research by French and Swiss research groups and the Dutch company Onward from Eindhovenwho describe the results in an article in the scientific journal Nature.
One of the authors is Ilse van Nes, Oskam’s rehabilitation doctor at the Sint Maartenskliniek in Nijmegen. ‘I think along with him about all the consequences of the spinal cord injury,’ says Van Nes. ‘Gert-Jan is very motivated to improve his possibilities, so when I heard about this research, I immediately called him.’
This initially involved an earlier project, Stimo, in which an implant was placed on the spinal cord to stimulate the nerve cells. Van Nes: ‘Gert-Jan then had sensors on his foot and when he moved his foot forward a little, the stimulator sent a current to the spinal cord to stimulate the walking movement. So he first had to make a movement himself to start walking.’
That worked and Oskam was able to walk again with a walker after a lot of training. ‘We also noticed that there was some recovery,’ says Van Nes.
Because he could walk, the nerve connections that were still functioning were strengthened and walking gradually improved. Still, Oskam reached a ceiling over time and it remained difficult to walk over uneven terrain or stairs. Standing for long periods of time was also difficult and Oskam remained dependent on his wheelchair.
Motor cortex
The next step was to fit implants on his skull cap. Those implants pick up electrical activity in his brain with sensors. They are placed on the left and right sides of his head, slightly behind the crown, above the so-called motor cortex, the part of the brain that controls movement.
A kind of helmet with electronics picks up the signals and sends them to a computer that Oskam carries in a backpack. That computer translates the signals and sends them to the spinal cord stimulator. Van Nes: ‘Now all he has to think about is walking. This is then detected and passed on. By this brain-spine interface the connection is more direct and also faster.’
And that was noticeable. After five months of research and training, Oskam is running even better and faster. And again there was a training effect, strengthening the remaining nerve connections and muscles, so that he can now also walk for parts without BSI. ‘He can now just grab his rollator, get up and walk a bit, which also makes it much easier to train,’ says Van Nes. ‘Gert-Jan is still dependent on a wheelchair, especially for longer distances, but he can do many things again.’
Hope for the future
Oskam was a particularly suitable test subject, says Van Nes. ‘He is very much looking to improve his functioning and very motivated. For example, he had already built a footbridge himself, with a pulley, for training.’
The research offers hope for people with partial spinal cord injury and possibly even for people with complete spinal cord injury. ‘But with the latter there will be no training effect in which the existing connections are strengthened.’
A BSI is still far from being within reach for most people because much more research is needed to further develop the technique and apply it more widely. Van Nes: ‘I therefore hope that this research will also give other research groups an impulse.’