advances in sci rehabilitation indego exoskeleton …...advances in sci rehabilitation indego...
TRANSCRIPT
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Advances in SCI Rehabilitation
Indego Exoskeleton and more
PM&R
St. Charles Hospital
Assistant Professor
Stony Brook University
Jun Zhang MD
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Stem Cell and REPAIR
Neuromodulation
Brain-Computer Interfaces
Wearable Robots
Virtual Reality
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Stem cells as therapy o replace cell lines that have been lost or destroyed
o modify the behavior of other cells
Stem cells as targets of drug therapy
Stem cells to generate differentiated tissue
for in vitro study of disease models for drug
development
Role of stem cells in clinical medicine
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Signature characteristics of stem cells
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development to stem cell type
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Reprogramming adult cells
to become pluripotent cells
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replacement therapy
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Transplantation of human ES-derived
oligodendrocyte progenitor cells into adult
rats, seven days after the induction of a
spinal cord injury, was shown to enhance
remyelination and promote improved motor
function.
Role of stem cells in clinical medicine
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Human embryonic stem cell-derived
oligodendrocyte progenitor cell transplants
remyelinate and restore locomotion after spinal
cord injury.
Keirstead HS, Nistor G, Bernal G, Totoiu M,
Cloutier F, Sharp K, Steward O
J Neurosci. 2005;25(19):4694
Role of stem cells in clinical medicine
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Stemcell Inc. – Pathway study – STOPPED
Neuralstem Inc. – Neural Stem Cells –
RECRUITING PATIENTS
Combination therapy: (Stem Cells +) InVivo
Scaffold – HUMAN TRIAL SUSPENDED
(CHRONIC SCI) – ACUTE SCI study: temporarily
HALTED)
Current stem cells study
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Nose Cells and Nerve Graft – Pr Raisman (UK)
and Dr. Tobakow (PL)- RECRUITING
Schwann Cells and combinations – Miami
Project- RECRUITING
Dr. Wise Young- Umbilical Cord Blood Stem Cells
+ combinations – PUBLISHED- Phase– Slovenia
Current stem cells study
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Bone Marrow Stem Cells Intrathecal Injection- Dr.
Vaquero Phase II clinical trial (Spain) – Phase II trial
completed.
Neuroplast (The Netherlands) – Autologous BoneMarrow-
derived Stem-Cells – Clinical trial in preparation for both
chronic and acute SCI
BioArctic – SC0806 (biodegradable device+ FGF1) –
clinical trials approved, recruiting patients- Sweden –
Slovenia
Current stem cells study
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Scar appears a few days or weeks after the injury
prevents any axon from growing away from the lesion
area.
One of the key scar reduction strategies :
Chondroitinase enzyme
REPAIR
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ReNetX Bio – NOGO TRAP
intrathecal delivery of the NoGo Trap protein
CHASE IT: Chondroitinase and gene therapy for chronic
SCI
bacterial enzyme called chondroitinase, has repeatedly
been proven to degrade the scar, to promote growth and
to improve recovery in animal experiments
REPAIR
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Stem Cell and REPAIR
Neuromodulation
Brain-Computer Interfaces
Wearable Robots
Virtual Reality
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Virtual Reality
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VR can “trick” the brain into believing that it is physically
performing the actions being simulated in the VR
environment.
In healthy people, this can produce feelings of vertigo in
VR settings featuring sheer cliffs or drops.
In people with traumatic brain injuries, this can encourage
the brain to stimulate neurological pathways that have
been “turned off” following an injury.
Virtual Reality
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Virtual Reality
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Stem Cell and REPAIR
Neuromodulation
Brain-Computer Interfaces
Wearable Robots
Virtual Reality
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Neuro-stimulation is the process of using gentle electrical
currents to stimulate the spinal cord below the point of
injury, enabling nerve circuits in the spinal cord to ‘hear’
and act upon messages coming from the brain.
Based on various studies, those techniques seem to
generate light functional return as well as some
improvement of the patient’s autonomic function.
Neuro-stimulation
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Epidural Stimulation: Dr. Harkema University of Louisville, Kentucky
Epidural Stimulation Study in Minnesota
Transcutaneous e-stim
Project Edge – Neuromodulation – Dr. Reggie Edgerton, Spinal Cure
Australia
Dr. Gregoire Courtine, EPFL Zwitserland/ GTX Medical
Transcranial Magnetic Stimulation (TMS) or Deep Cranial Stimulation
Study
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Stem Cell and REPAIR
Neuromodulation
Brain-Computer Interfaces
Wearable Robots
Virtual Reality
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BCI
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8888
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8888
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Stem Cell and REPAIR
Neuromodulation
Brain-Computer Interfaces
Wearable Robots
Virtual Reality
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Exoskeleton
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Powered exoskeletons did not
start as assistive devices. The
first patent for a powered
exoskeleton, filed by a
Russian inventor named
Nicholas Yagn, was approved
on January 28, 1890.
Exoskeletons
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In 1965, funded by U.S. military,
General Electric started developing
Hardiman, Human Augmentation
Research and Development
Investigation” and “MANipulator.”,
Called HardiMan
The machine was huge—once
built, it would weigh 1,500 pounds.
Exoskeletons
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Exoskeletons
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Belgrade 1970, for paralysis
patients.
Miomir Vukabratovic
partial active exoskeleton.
far lighter, just 26 pounds
no power source integrated
into the device
Exoskeletons
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2000 Defense Advanced
Research Projects Agency
Berkeley Lower-Extremity
Skeleton, or BLEEX.
University of California,
Berkeley,
Exoskeletons
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Exoskeletons
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Lightweight
At just 26 pounds
no exposed cables
No upper-body apparatus
No backpack mounted components
Indego Exoskeletons
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M
o
d
u
l
a
r
D
e
s
i
g
n
Indego Exoskeletons
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Intuitive Controls
Mirroring natural human movement, lean
forward to initiate standing or walking and lean
backward to stop and sit.
Indego Exoskeletons
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Wireless Operation
Mobile app allows user to control operation,
change settings, and capture data without the
need for tethered controls.
Indego Exoskeletons
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Compatible
A slim profile is compatible with standard
mobility aids and can be worn while seated in a
wheelchair.
Indego Exoskeletons
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Quick Setup and Fit
A single-hand strapping and retention system
allows Indego to be put on, taken off and
adjusted to fit without assistance.
.
Indego Exoskeletons
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Versatile
Indego allows over ground training or personal
mobility on a variety of surfaces both indoors
and outdoors.
Indego Exoskeletons
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Extended Power
With up to four hours of use and easy-to-
change, fast charging batteries, Indego’s power
source allows for extended use in therapy and
at home.
Indego Exoskeletons
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Uniquely Personal
well suited for use in the clinical setting and
allows for an easy transition to use at home.
Indego Exoskeletons
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Function Electric Stimulation
Coming soon…
Indego Exoskeletons
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Intuititive
Versatile
Exoskeletons
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Lots of hope for SCI
patients,
some here already,
some on the way…
Conclusion
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Indego Exoskeletons
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Introduction