02/02/2017
Predicting the future of medicine can often involve separating science fiction from practical achievement. Yet, over the past decades, medical and technological innovations have turned many dreams of better possibilities into realities.
Recently, Paradigm Chief Medical Officer Michael Choo, M.D., conducted a webinar on exciting developments in research and technology that have the potential to revolutionize rehabilitation and recovery. Dr. Choo discussed the history of medical innovations from 25 years ago to the incredible potential medical realities over the next 25 years.
Take a look at Dr. Choo’s selection of the top ten upcoming medical technologies and see if you agree that they may be the major game changers in how we approach catastrophic injuries in the future.
Repetitive transcranial magnetic stimulation (r-TMS) is a noninvasive method for brain stimulation induced neuroplasticity using a strong magnetic field that targets a specific area of the brain. Electrical depolarizations involving specific areas of the injured brain can lead to recruitment of residual neurons to stimulate repair and/or create new neuronal connections to compensate for the brain injury. The patient’s MRI is uploaded to the computer and aids in identifying the specific target areas for stimulation. This therapeutic modality ultimately causes the brain to repeatedly practice the desired neural pathways to hardwire the new neuronal connections necessary for the desired function. In theory, one TMS is the equivalent of 5,000 repetitive practices. This type of treatment is currently being researched for its potential in improving motor function in TBI and stroke patients as well as potential application in comatose patients.
The Neuro-Spinal ScaffoldTM created by InVivo Therapeutics Inc. is a polymer scaffold designed for early implantation at the site of injury within a spinal cord. The Neuro-Spinal ScaffoldTM provides structural support to the spared spinal tissue and facilitates the stem cell repair process. It is biodegradable and disappears within several weeks. It holds stem cells so they can attach easily and promotes cell growth within the spinal cord. As a result of successful animal trials, the FDA approved an InVivo human trial (INSPIRE) for 20 patients in January 2016. The goal is to achieve 25% improvement in SCI patients with AISIA and at least one AISIA grade improvement within six months of implantation or intervention. At the time of the webinar presentation by Dr. Choo, eight patients were enrolled with a 60% AIS conversion rate.
Acute intermittent hypoxia (oxygen therapy) has been shown to benefit respiratory, physical, and motor functions in people with spinal cord injuries. This treatment is non-invasive, has a low cost and shows no side effects. It improves both respiratory and non-respiratory motor neurons through spinal plasticity. The physiology behind the treatment involves stimulation of serotonin receptors in the spinal nervous system and increases the production of the BDNF (Brain-Derived Neurotrophic Factor). BDNF is an important protein that is responsible for survival and remodeling of nerve cells in the nervous system. Currently, there is an ongoing clinical trial at Emory University with 19 patients.
BCI is truly modern day science fiction. A BCI device can receive and translate thoughts or thought imagery in real time. BCI collects brain signatures and sends them to a computer, which applies a processing algorithm. Then the computer sends a specific command to an external machine (e.g., robotic arm) to carry out the function or movement being visualized. In short, the BCI device becomes an artificial spinal cord connecting the brain to an external machine. Currently, there are two types of BCI devices: surgical implanted microsensors and noninvasive sensors. A 2012 Brown University BrainGate research lab showed the world how a paralyzed woman used a BCI device to translate her thoughts and take a drink from a cup controlling an external robotic arm. The next generation of BCI will look like a pacemaker and be small, wireless and have a long battery life that is rechargeable. In a 2013 Brown University study, the first prototype was successfully tested on a monkey. Human trials are set to start in 2017.
BCI with limb reanimation can bypass the injured spinal area and directly control the intended muscles through stimuli applied to muscles, nerves or the spinal cord below the level of injury. In 2016, this innovation was used by a young paralyzed patient from Ohio. The BCI chip was implanted in his brain and connected via wire to a computer. The computer then sent signals to his arm cuff that was studded with functional electrical stimulator (FES) electrodes so he could move his hand and fingers to grasp a cup, play video guitar and actually swipe a credit card.
Stentrode has been created by Bioscience Technology. This coil, made out of nickel and titanium metal, collects and records brain signals, and the endovascular device is delivered to the brain via a catheter, much like a cardiac stent is delivered into a coronary artery in the heart. Animal tests have been successful, but human trials have not been performed yet. If approved, this would be the most practical BCI with the ability to control limbs without cables coming out of the head.
Optogenetics represents a new frontier in medical science research that will lead to a huge paradigm shift in how we treat neurological and behavioral problems. This technology uses light and genetics to turn on and off specific nerve cells and neuro circuits. It’s extremely precise when it comes to controlling specific nerves and neuropathways, as opposed to other conventional electric and magnetic stimulation which cannot discriminate between and among cells in the area being stimulated.
Researchers discovered that certain algae possessed a protein molecule that can convert light into electrical impulses that stimulate the nervous system. In 2004, with the advances in genetic therapy, researchers were able to implant a gene from this specific algae into a rodent’s brain neurons, allowing control of its behavior and brain function with a light source. Currently, this technology is only in its experimental stages and there are no human trials scheduled. It is very promising that as the neurological pathways get better defined, this can become a powerful therapeutic tool for treating brain diseases such as addiction and epilepsy.
Integrated Tissue and Organ Printing System (ITOP) is technology that has the ability to bio-print tissue and organs. Now there is a proven 3-D printing technology that can print skin cells for skin reconstruction of burn wounds. This is a significant innovation because burn survival depends on how quickly the wounds can be covered. Researchers at Wake Forest School of Medicine designed a 3-D bio printer where a laser scans the burn wound and generate/print skin cells to cover the burns within an hour. This type of technology leads to better skin growth and less skin contractures. An animal study showed that it took 10 – 14 days for the printed skin cells to organize into skin structure, and the wound healed within three weeks – much faster than traditional skin recovery. If this technology continues to be refined and is approved, it will change how we approach burn injury care and have a positive impact by reducing costs associated with burn care and complications.
Dr. Zhenan Bao, Stanford professor of chemical engineering, created a rubbery plastic “skin” which can provide “sensory feedback” by detecting varying degrees of pressure that can be converted into electric signals providing sensory input to a brain cell. The plastic skin consists of flexible transistors derived from carbon nanoparticles that respond to pressure and electricity. The skin system can be wrapped around a prosthetic and, if approved, it will be a game changer in the prosthetics world.
Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) is a gene editing technology which can cut DNA strands with great accuracy to repair and replace DNA within a cell. There are a number of ethical issues surrounding this technology, but right now much of the focus is on the benefits of its utility in human science. It all began in 1987, when a Japanese scientist noticed that bacteria had an immune system mechanism that could remember the DNA of previous viruses. The bacteria would then create a specific RNA enzyme defender to track down the virus to cut apart its DNA. This CRISPR methodology is not yet ready for human application, but there are many incredible applications including a discussion of an enzyme which can be used as antimicrobial solution against infections such as MRSA and E.coli. Given the increasing antibiotic resistance and the number of infection-related complications, such a genetic engineering option would be a great benefit to medical science.
Despite the incredible possibilities future medical advancements bring, every innovation has its limitations. Paradigm will continue to provide position papers on the evolving technologies as they come to market. As always, Paradigm strives to bridge the gap between the cost of the technologies and the true benefits to the injured workers, achieving functional improvement. For more details on this intriguing topic, listen to a replay of our December 2016 webinar, Imagination to Innovation: The Future of Medical Technologies. Stay tuned for upcoming topics in our quarterly webinar series
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