Electrical Stimulation, Stem Cells, and Brain-Computer Interfaces

A look at spinal cord injury rehabilitation research advances and promising avenues for the future.

September was officially recognized as Spinal Cord Injury Awareness Month just over a decade ago, so what better time to look at research advances over the past 10 years and promising avenues for the future? To learn more about spinal cord injury (SCI) rehabilitation research at Shepherd Center and advances in SCI research in general, we caught up with Edelle Field-Fote, PT, PhD, FAPTA, FASIA, director, Spinal Cord Injury Research and The Hulse SCI Research Laboratory at Shepherd Center.

Can you tell us about the focus of your research in the Hulse SCI Research Lab?

The field of SCI research can be divided into two paths. First, there's work focused on repairing the spinal cord, and second, there’s work focused on trying to reorganize the spinal cord so it can be more functional despite the damage. This second path is where the work of the Hulse SCI Research Lab is focused. Based on the research that is currently available, the best way to help the spinal cord reorganize in a way that allows people to move better is rehabilitation. Our studies compare rehabilitation approaches to determine which ones are most useful. We also study ways to amplify the effects of training using electrical and mechanical stimulation. This approach is called “neuromodulation,” where we use stimulation to activate the same circuits that are activated by training.

How has the approach to electrical stimulation evolved over the last decade?

One type of neuromodulation, transcutaneous spinal stimulation, is currently a top focus of the Hulse SCI Research Lab. There has been a lot of attention to this approach in recent years, and our lab has been a leader in these publications and advancements. We use stimulation over the spinal column to activate spinal circuits in a way that can make it easier for someone to move. So, when someone has even a little bit of voluntary movement, if you combine that with transcutaneous spinal stimulation, they can get more movement from the same amount of effort. Also, spasticity is a big problem for some people with SCI, and we are investigating the best transcutaneous spinal stimulation approaches to help manage spasticity.

What about research focusing on the repair of the spinal cord?

Beyond the research being done in my lab, Shepherd has a phenomenal clinical trials team. The clinical trials team works with outside investigators who want Shepherd to help them with research studies focused on the repair of the spinal cord. Most of the time, these involve recruiting research participants who have recently sustained an SCI, which we call the acute phase of injury. However, there have been times when outside investigators have partnered with Shepherd’s clinical trials team on repair strategies for participants with chronic SCI. 

What are other aspects of the mission of the Hulse SCI Research Laboratory?

In addition to research, the Hulse SCI Research Lab is very involved in training rehabilitation scientists. Training is integral to what we do because we need the next generation to pick up the baton and continue advancing research. Currently, we have three research scientists who joined the Hulse SCI Research Lab as scientific trainees. Jennifer Iddings, Ph.D., and Anastasia Zarkou, PT, Ph.D., completed their postdoctoral training with me, and Nick Evans, Ph.D., completed his Ph.D. training with me. While trainees generally move to another institution after their training, Shepherd is such a great environment that all three of them have stayed on as research scientists and are now submitting their own grants. In addition to our three research scientists, we have two PhD students, both of whom have clinical doctorates in physical therapy, Evan Sandler, PT, DPT, and Jake Creech, PT, DPT.

What are some other advancements in SCI research, and what are the challenges?

Stem Cells.

Stem cells are exciting because they have the opportunity to replace damaged cells, but there are some significant limitations. First, if you want to replace neurons, the cells that are implanted have to live, grow, and develop connections with other cells. Most of the time, the goal is to get the cells to cross the injury site and make connections with cells below the injury.  To date, no scientists have been able to accomplish this. So, there are a lot of steps that have to be successfully completed for stem cells to be useful, and this has been a real scientific challenge for many reasons.  

Brain-Computer Interfaces.

There is a lot of exciting work going on with brain-computer interfaces or BCI. Current work is centered on people with tetraplegia who are unable to move their hands and arms. The devices record brain signals and, with training, allow people to control a device like a computer cursor or a robotic arm using their brain signals. Other researchers are using brain signals to control stimulators that can activate muscles so people can use their hands and arms. This work is still in its early stages, but I can imagine that someday, it might be used to stimulate muscles in the arm to allow reaching and grasping for activities of daily living.

Exoskeletons for walking.

Exoskeletons for walking have come a long way. Shepherd was very involved in the development of the Indego exoskeleton device. One of the challenges that still needs to be addressed is the development of exoskeletons that can balance by themselves. This is important both to reduce the risk of falling while in the device and to eliminate the need to use crutches for balance so that the hands can be free. My vision for where it could eventually go is something like what we saw in the character RoboCop, where the person can strap themselves into the device and use the brain-computer interfaces we talked about earlier to control it — so the person thinks about walking and signals from the brain send commands to the exoskeleton.

How is Shepherd Center uniquely positioned to advance SCI research?

We have research in so many avenues. The Hulse SCI Research Lab team’s neuromodulation research has immediate applications for clinical practice. Our clinical trials team is involved in repair research that may have future potential. Importantly, we also have valuable device-related studies and interventions through Shepherd’s Center for Assistive Technologies.

One recent initiative that I’m especially excited about is SCI Ventures, for which Shepherd Center is a founding partner. This is an angel investment fund that was established to support the most promising SCI research around the world. They are taking a high-level view of the research and determining what approaches are most likely to have true value for people with SCI. They invest in these companies to help them reach the next level. For all the reasons I talked about earlier, Shepherd is very well-positioned to be part of the most promising research that comes out of this initiative.

How can people get involved?

People with spinal cord injuries who volunteer to be research participants are an important part of our study team. They help us answer questions that can affect the types of treatments available for people with SCI. We are so grateful to our participants because we couldn't do it without them — they're essential to the success of the studies in the Hulse SCI Research Lab.  There are opportunities to volunteer, so I encourage folks to visit Shepherd’s Research web pages at shepherd.org/research to learn about our studies.

Interview by Ruth Underwood

About Shepherd Center

With five decades of experience, Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center ranked by U.S. News as one of the nation’s top hospitals for rehabilitation, Shepherd Center is also recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.