Translator: Sara Múnera Reviewer: Maria Pericleous
I want to ask you to imagine, to picture something for me.
So if you will, if you're comfortable I'd ask you to close your eyes.
You're driving home from visiting a friend's house,
the road is what you see in front of you.
It's late at night, you turn a corner
and you see a deer.
And almost without thinking, you swerve to the right,
there's a telephone pole in front of you.
And what happens from then is kind of this blur.
The blur involves you remembering being transported to a hospital,
remembering going in and out of one test or another test.
You kind of slowly come to, and you realize that you can't move.
Your arms don't work,
your nose itches and you can't reach up to touch it.
Go ahead and open your eyes.
Doctors come in to see you, you're in a fog half the time,
they tell you that you've had a spinal cord injury.
And what that means is that your spinal cord
has been severed or damaged around the area of the neck,
and your arms don't follow the commands that your brain is putting out.
They tell you that yours is complete and the chances of recovery
are low to none, they try to give you hope,
and eventually they tell you that you're doing well enough,
that the fog will lift, the pain will be gone,
and that you can go to a rehabilitation facility
where they'll work on getting you to be more independent.
You go to the rehab facility, meet a new team of people
and a young researcher walks into the room,
and says "Hey, I want you to be in a research study.
The research study is about
the most amazing piece of assistive technology.
A technology to help you be more independent.
And I want you to be part of this study that's going to teach us the value
of this amazing piece of assistive technology".
They bring a wheelchair into the room,
and they ask you if you want to be a part of the study.
And probably what you'll say is, "No."
I know that,
because that was one of the first research studies I tried to do.
The reason you'll say no is that you've seen the television shows
where the person just worked hard enough
and what they tell you is that they triumphed over their disease.
They were able to walk out of the hospital.
You're going to be one of those people,
you're going to work hard enough that you don't need the wheelchair,
that's going to be you.
Let me tell you about a study that we did.
We asked 100 people with spinal cord injury
who were living in the community
about what keeps them from participating in daily life.
What is it that prevents them from going out?
It was a multiple choice, we listed choices for them.
Two of the choices were
the wheelchair, and another choice was their paralysis.
Those were the top two choices people listed.
And the number one choice by far was that the wheelchair
kept them from going out.
Not the fact that they couldn't move their legs.
So a couple of interesting perspectives on that.
I saw that study, and I felt great and bad at the same time.
I felt great because when I can't see out of my glasses,
it's because they're blurry, it's not because I have bad eyes.
And the act of getting past a spinal cord injury -
we all have bad things that happen to us -
the act of recovery, the mental act of recovery,
is accepting your disability,
and then what it becomes is about the technology.
What they were saying to me was,
"This technology that you're doing research on
stinks.
It doesn't work like we want it to."
I'll tell you another story, we again polled people,
now there are thousands with spinal cord injuries
and we said, "Tell us how your wheelchair works for you,
tell us how often it breaks down".
And in a six month period of time, the wheelchair that they were using
broke down,
Fifty percent of the people had a wheelchair failure
in that six month period of time.
Stopped working often, stranding them, injuring them.
In my mind that explains this,
"The wheelchair is what's keeping me from doing more".
We have the technology to build wheelchairs that will climb stairs,
go through sand, and won't break down,
and everybody who uses a wheelchair knows that,
and they are frustrated by the technology: and why does that exist?
Well to some degree, it's a social-political problem.
Wheelchairs are paid a certain amount for, most payers in the United States
will pay a certain amount for a power wheelchair,
so what the engineering constraint becomes is engineering for cost.
It's not about making the wheelchair that makes you the most independent,
it's about making the wheelchair at the lowest cost,
that makes you the most independent,
and that automatically constrains the system.
So I want to tell you about another set of research
I've had the pleasure to be involved with.
Andy Schwartz and Doug Weber,
two brilliant neuroscientists at the University of Pittsburgh,
and I were meeting, they wanted to talk about
working with people with spinal cord injury,
because Andy Schwartz had done this amazing thing.
He had gotten a monkey
to feed itself using a robotic arm
and nothing but the monkey's thoughts.
So he had implanted a chip into the brain of a monkey,
he was able to record
the electrical signal from the monkeys brain,
interpret that signal, and have it control a robotic arm.
So an important concept here in control,
and when you think about movement,
there's degrees of freedom, degrees of freedom of movement.
So if you have one degree of freedom,
you can control something that is moving back and forth along a line.
If you have two, you can actually control a mousepad,
you can move up, down, left, right, but you are constrained to one plane.
And if you have three degrees of freedom, you can reach in space.
That's almost the magic number, right?
If you get to four, you can reach and grasp.
With seven degrees of freedom you can move your wrist in any direction,
reach and grasp, and as you get into ten degrees of freedom and more
you can actually manipulate things with the hand.
Our arm probably can be controlled with 14 degrees of freedom,
and he had gotten a monkey to get above four degrees of freedom,
which nobody else had done.
And he said to me, if we could implant that chip in a human,
we could get them to play the piano, someone with a spinal cord injury.
What does that chip look like?
Well is about the size, a little bit bigger,
than an eraser on the tip of a pencil.
It has a hundred tiny pins on it, and the tiny pins get pushed down
during the operative procedure,
using that plunger that you can see on the screen, into the brain
and then those pins are able to record the signal.
My job, what they trusted me with in the OR,
was, not being part of the sterile field,
being a little bit removed from the table,
hitting the button that had that plunger and push it in.
The brain is pulsating,
and they wanted me to do it when the brain was lifted as high as it was.
And this is what the brain looks like.
Who we are, if you see the structure around that plunger,
is determined by this white matter with blood vessels running through it.
Now let me tell you a little bit how we get to this level of control.
It turns out that when we move our arms,
when I move my arm up here, back and forth like this,
there are nerves in your brain, there are cells in your brain that fire.
They fire at a different rate, depending on which direction I'm moving.
They are directionally tuned, and they fire faster if I move faster.
And so we worked hard with the regulatory bodies
and we found some amazing people
who were willing to volunteer to have neurosurgery.
We would have them sit in front of a robotic arm,
watch the arm move,
while we recorded the signals from the brain.
We built a decoder that would say
when they are moving this direction or when they are grasping,
this is what the brain is doing,
and we would just tell the person who participated, Jan was her name,
that she should think about moving,
and then that would enable her to control the arm.
So I'll show you a clip of her and her talk
related to controlling this arm.
Remember as you are watching this the degrees of freedom,
watch the movement, she is doing this with nothing but her thoughts.
(Video) Jan: "I'm here as I have been through the whole experiment,
to further push the science.
I'm here because future generations
of quadriplegics, paraplegics,
and amputees will benefit from this,
long after all our names have been forgotten,
the science will live on.
My goal is to feed myself chocolate
and I did that today, I fed myself chocolate.
I'm excited to think that our work here in the lab
will inspire more people to come forward, and for the work to continue".
Michael Boninger: Pretty amazing, right?
We wrote this up, it was accepted into a paper,
60 Minutes followed Andy Schwartz's career for a while
and they asked to be there,
in fact they were in the OR while we where doing the surgery,
and my other job was to keep the cameraman
away from the sterile field.
Jen Collinger led that study, wrote the paper up,
and the Journal and 60 Minutes talked to each other,
and said, we need to do this all at one time,
we need to make a splash.
On one day there was a press conference at UPMC, at the University of Pittsburgh,
there were camera crews from all over the place,
there was a 60 Minutes story,
the conference was on Monday morning,
the 60 Minutes story was on Sunday night,
as they always are,
and the publicity was unbelievable.
I had people calling me from all over the world,
wanting to do interviews, wanting to have me on television.
Heady stuff, and amazing stuff.
But there is a part of me, as a physician,
not the bio-engineer part of me,
that thought about how many people
I have helped with this brain-computer interface research.
The answer to that question is: no one.
The participant in this study
had to have the electrodes explanted at some point,
and even when they were implanted,
the only time she could do these activities
was when she was in our lab.
I had done numerous studies on wheelchairs
and nobody called me.
Not one person.
And I want you to picture yourself now,
and you are back in this hospital bed,
you have kicked the researcher out of the room,
and the physical therapist comes in next
and says, "Stupid research study anyway".
But you do really need to learn how to drive this wheelchair,
how to work with this technology, it's how you are going to get home.
But the night before, you got a phone call from a friend,
and the phone call from the friend was, "Did you see the 60 Minutes story?"
"There is a guy out there putting chips in someone's brain,
there's a team of researchers,
they can get someone to control a robotic arm
with nothing but their thoughts. It's only a matter of time".
And if it's not about the robotic arm,
maybe is about an exoskeleton you saw,
where, like iron-man they are able to put a suit on and walk again.
Or maybe it's about stem cells.
We just inject some stem cells into the spinal cord
and we will cure paralysis.
They tell you that,
and what I worry about with that,
is that you say, "I don't need to learn how to use this wheelchair,
the cure, exoskeletons, brain-computer interfaces,
they are five years away maybe."
Five years and we will get back to that in a second.
I want to tell you about one last research study.
So we did a research study
where we followed people who were in rehab
and we looked at, when they left the rehab hospital, were they walking?
People with spinal cord injury.
If you have enough muscle strength left
you can walk, it's a matter of how much.
If you have a complete injury,
then you are not going to walk out of the hospital.
You can though, even with a complete injury,
you could support yourself with a walker,
and really lifting yourself with your arms.
Then what we said is, lets look at different groups,
lets look at a group of people who walked out of the hospital
and then, a year later, lets see what they are doing.
So a group of people walked out of the hospital,
and a year later were using a wheelchair, we compared them to all others,
including people who used a wheelchair when they left,
and were using a wheelchair a year later.
And that group of people who walked out of the hospital
and were using a wheelchair a year later,
had more pain, more depression,
were much less likely to be participating in society.
So this fear of this arrest in the recovery process,
seems like it might be real.
And at the same time, I'm getting the question,
when can we implant this in a patient?
And the email from the mom with a kid who has cerebral palsy,
saying, "Is there a chip for my son with cerebral palsy?
I really want him to be able to move normally again".
And I worry about the impact
that the research that I now do is having
on the populists out there that want so desperately to have that quick cure.
Stem cells are a case in point.
When I was a medical student 30 years ago,
stem cells where five years away from leading to a cure,
and for the past 30 years they have been five years away.
It's the perfect length of time,
because what happens when you get asked that question,
I have to worry about the funding of my research projects,
and if I say, "We are going to cure spinal cord injury,
we are going to cure it in a hundred years",
no one wants to fund me.
Fascinatingly enough, if I proposed a research study
that wants to help people tomorrow, because of wheelchairs,
I can make a better wheelchair,
they are saying, what is new under the sun in wheelchairs?
Haven't you've been working on that for 30 years?
So there is this knife edge there.
I need to be really clear about something,
I'm really proud of the brain-computer interface work; it's amazing stuff.
It has to continue.
The stem cell work has to continue,
the exoskeletal work has to continue.
There is hope for the cure.
There is hope that we can take someone with a spinal cord injury or an amputation
and give them this new freedom.
But what we have to be careful about is the knife edge between hype and hope.
If I hype it too much then someone buys in and they get stuck,
they keep thinking, I'm just going to wait until someone cures me,
I don't really need to learn how to use that wheelchair.
If we don't hype it enough we don't get funding,
and in the meantime, we need to work on the funding
for the technology that helps us move, mobility, the wheelchair, today.
I have to tell you that when I give these talks,
I feel this combination of pride
in what the teams I've been a part of have accomplished,
and some concern about where we are going in the future.
But I look out at these University of Pittsburgh students,
who got out of bed this morning,
decided to spend the day listening to people talk;
and I think about the artists in the room
who need to be able to help us express this;
art is this wonderful way of recovering from a spinal cord injury
and I think about the city planners, and the political science majors,
and the engineers in the room,
and there is no doubt in my mind that you guys can solve this problem.
We can walk that edge,
we can give people hope and we can help them today.
Thank you.
(Applause)