title: Restoration of reaching and grasping movements through brain-controlled muscle stimulation in a person with tetraplegia: a proof-of-concept demonstration.
abstract: People with chronic tetraplegia, due to high-cervical spinal cord injury, can regain limb movements through coordinated electrical stimulation of peripheral muscles and nerves, known as functional electrical stimulation (FES). Users typically command FES systems through other preserved, but unrelated and limited in number, volitional movements (eg, facial muscle activity, head movements, shoulder shrugs). We report the findings of an individual with traumatic high-cervical spinal cord injury who coordinated reaching and grasping movements using his own paralysed arm and hand, reanimated through implanted FES, and commanded using his own cortical signals through an intracortical brain-computer interface (iBCI).
  
  
  
  We recruited a participant into the BrainGate2 clinical trial, an ongoing study that obtains safety information regarding an intracortical neural interface device, and investigates the feasibility of people with tetraplegia controlling assistive devices using their cortical signals. Surgical procedures were performed at University Hospitals Cleveland Medical Center (Cleveland, OH, USA). Study procedures and data analyses were performed at Case Western Reserve University (Cleveland, OH, USA) and the US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center (Cleveland, OH, USA). The study participant was a 53-year-old man with a spinal cord injury (cervical level 4, American Spinal Injury Association Impairment Scale category A). He received two intracortical microelectrode arrays in the hand area of his motor cortex, and 4 months and 9 months later received a total of 36 implanted percutaneous electrodes in his right upper and lower arm to electrically stimulate his hand, elbow, and shoulder muscles. The participant used a motorised mobile arm support for gravitational assistance and to provide humeral abduction and adduction under cortical control. We assessed the participant's ability to cortically command his paralysed arm to perform simple single-joint arm and hand movements and functionally meaningful multi-joint movements. We compared iBCI control of his paralysed arm with that of a virtual three-dimensional arm. This study is registered with ClinicalTrials.gov, number NCT00912041.
  
  
  
  The intracortical implant occurred on Dec 1, 2014, and we are continuing to study the participant. The last session included in this report was Nov 7, 2016. The point-to-point target acquisition sessions began on Oct 8, 2015 (311 days after implant). The participant successfully cortically commanded single-joint and coordinated multi-joint arm movements for point-to-point target acquisitions (80-100% accuracy), using first a virtual arm and second his own arm animated by FES. Using his paralysed arm, the participant volitionally performed self-paced reaches to drink a mug of coffee (successfully completing 11 of 12 attempts within a single session 463 days after implant) and feed himself (717 days after implant).
  
  
  
  To our knowledge, this is the first report of a combined implanted FES+iBCI neuroprosthesis for restoring both reaching and grasping movements to people with chronic tetraplegia due to spinal cord injury, and represents a major advance, with a clear translational path, for clinically viable neuroprostheses for restoration of reaching and grasping after paralysis.
  
  
  
  National Institutes of Health, Department of Veterans Affairs.
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA. Electronic address: aba20@case.edu.
authors.forename: A Bolu
authors.initials: AB
authors.lastname: Ajiboye
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA.
authors.forename: Francis R
authors.initials: FR
authors.lastname: Willett
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Young
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Memberg
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Murphy
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Miller
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Walter
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sweet
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH, USA.
authors.forename: Harry A
authors.initials: HA
authors.lastname: Hoyen
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Keith
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA.
authors.forename: P Hunter
authors.initials: PH
authors.lastname: Peckham
authors.affiliation: School of Engineering, Brown University, Providence, RI, USA; Brown Institute for Brain Science, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Simeral
authors.affiliation: Brown Institute for Brain Science, Brown University, Providence, RI, USA; Department of Neuroscience, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland.
authors.forename: John P
authors.initials: JP
authors.lastname: Donoghue
authors.affiliation: School of Engineering, Brown University, Providence, RI, USA; Brown Institute for Brain Science, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
authors.forename: Leigh R
authors.initials: LR
authors.lastname: Hochberg
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Kirsch
mesh_terms: D001921:Brain / Q000503:physiopathology* / Q000601:surgery; D062207:Brain-Computer Interfaces / Q000706:statistics & numerical data*; D004599:Electric Stimulation Therapy / Q000379:methods; D004567:Electrodes, Implanted / Q000592:standards; D005240:Feasibility Studies; D006225:Hand / Q000502:physiology; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008839:Microelectrodes / Q000009:adverse effects; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D009068:Movement / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011782:Quadriplegia / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D012656:Self-Help Devices / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000628:therapy; D014481:United States; D014493:United States Department of Veterans Affairs; D014584:User-Computer Interface