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Imagine being in an accident that leaves you unable to feel any sensation in your arms and fingers. Now imagine regaining that sensation, a decade later, through a mind-controlled robotic arm that is directly connected to your brain.
That is what 28-year-old Nathan Copeland experienced after he came out of brain surgery and was connected to the Brain Computer Interface (BCI), developed by researchers at the University of Pittsburgh and UPMC. In a study published online today in Science Translational Medicine, a team of experts led by Robert Gaunt, PhD, assistant professor of physical medicine and rehabilitation at Pitt, demonstrated for the first time ever in humans a technology that allows Mr. Copeland to experience the sensation of touch through a robotic arm that he controls with his brain.
“The most important result in this study is that microstimulation of sensory cortex can elicit natural sensation instead of tingling,” said study co-author Andrew B. Schwartz, PhD, distinguished professor of neurobiology and chair in systems neuroscience, Pitt School of Medicine, and a member of the University of Pittsburgh Brain Institute. “This stimulation is safe, and the evoked sensations are stable over months. There is still a lot of research that needs to be carried out to better understand the stimulation patterns needed to help patients make better movements.”
This is not the Pitt-UPMC team’s first attempt at a BCI. Four years ago, study co-author Jennifer Collinger, PhD, assistant professor, Pitt’s Department of Physical Medicine and Rehabilitation, and research scientist for the VA Pittsburgh Healthcare System, and the team demonstrated a BCI that helped Jan Scheuermann, who has quadriplegia caused by a degenerative disease. The video of Scheuermann feeding herself chocolate using the mind-controlled robotic arm was seen around the world. Before that, Tim Hemmes, paralyzed in a motorcycle accident, reached out to touch hands with his girlfriend.
But the way our arms naturally move and interact with the environment around us is due to more than just thinking and moving the right muscles. We are able to differentiate between a piece of cake and a soda can through touch, picking up the cake more gently than the can. The constant feedback we receive from the sense of touch is of paramount importance as it tells the brain where to move and by how much.
For Dr. Gaunt and the rest of the research team, that was the next step for the BCI. As they were looking for the right candidate, they developed and refined their system such that inputs from the robotic arm are transmitted through a microelectrode array implanted in the brain where the neurons that control hand movement and touch are located. The microelectrode array and its control system, which were developed by Blackrock Microsystems, along with the robotic arm, which was built by Johns Hopkins University’s Applied Physics Lab, formed all the pieces of the puzzle.
In the winter of 2004, Mr. Copeland, who lives in western Pennsylvania, was driving at night in rainy weather when he was in a car accident that snapped his neck and injured his spinal cord, leaving him with quadriplegia from the upper chest down, unable to feel or move his lower arms and legs, and needing assistance with all his daily activities. He was 18 and in his freshman year of college pursuing a degree in nanofabrication, following a high school spent in advanced science courses.
He tried to continue his studies, but health problems forced him to put his degree on hold. He kept busy by going to concerts and volunteering for the Pittsburgh Japanese Culture Society, a nonprofit that holds conventions around the Japanese cartoon art of anime, something Mr. Copeland became interested in after his accident.
Right after the accident he had enrolled himself on Pitt’s registry of patients willing to participate in clinical trials. Nearly a decade later, the Pitt research team asked if he was interested in participating in the experimental study.
After he passed the screening tests, Nathan was wheeled into the operating room last spring. Study co-investigator and UPMC neurosurgeon Elizabeth Tyler-Kabara, MD, PhD, assistant professor, Department of Neurological Surgery, Pitt School of Medicine, implanted four tiny microelectrode arrays each about half the size of a shirt button in Nathan’s brain. Prior to the surgery, imaging techniques were used to identify the exact regions in Mr. Copeland’s brain corresponding to feelings in each of his fingers and his palm.
“I can feel just about every finger—it’s a really weird sensation,” Mr. Copeland said about a month after surgery. “Sometimes it feels electrical and sometimes its pressure, but for the most part, I can tell most of the fingers with definite precision. It feels like my fingers are getting touched or pushed.”
At this time, Mr. Copeland can feel pressure and distinguish its intensity to some extent, though he cannot identify whether a substance is hot or cold, explains Dr. Tyler-Kabara.
Michael Boninger, MD, professor of physical medicine and rehabilitation at Pitt, and senior medical director of post-acute care for the Health Services Division of UPMC, recounted how the Pitt team has achieved milestone after milestone, from a basic understanding of how the brain processes sensory and motor signals to applying it in patients
“Slowly but surely, we have been moving this research forward. Four years ago we demonstrated control of movement. Now Dr. Gaunt and his team took what we learned in our tests with Tim and Jan—for whom we have deep gratitude—and showed us how to make the robotic arm allow its user to feel through Nathan’s dedicated work,” said Dr. Boninger, also a co-author on the research paper.
Dr. Gaunt explained that everything about the work is meant to make use of the brain’s natural, existing abilities to give people back what was lost but not forgotten.
“The ultimate goal is to create a system which moves and feels just like a natural arm would,” says Dr. Gaunt. “We have a long way to go to get there, but this is a great start.”
The lead author on the research publication is Sharlene N. Flesher, of Pitt. Additional authors on this research are Stephen T. Foldes, PhD, Jeffrey M. Weiss and John E. Downey, all of Pitt; and Sliman J. Bensmaia, PhD, of the University of Chicago.
Primary support for the study was provided by the Defense Advanced Research Projects Agency’s (DARPA) Revolutionizing Prosthetics program through contract N66001-10-C-4056. Additional support was provided by the Office of Research and Development, Rehabilitation Research and Development Service, US Department of Veterans Affairs, grant numbers B6789C, B7143R, and RX720 and the National Science Foundation Graduate Research Fellowship grant DGE-1247842.
L. Dade Lunsford, MD, Lars Leksell Distinguished Professor of Neurological Surgery at the University of Pittsburgh and director of the UPMC Center for Image-Guided Neurosurgery, has been chosen for the 2016 Cushing Award for Technical Excellence and Innovation in Neurosurgery by the American Association of Neurological Surgery.
The award is bestowed on an AANS member for technical prowess and skill and/or innovation in the development of new procedures that have become part of the arsenal neurosurgeons use to treat disease or trauma.
In announcing the award, the AANS cited Dr. Lunsford for his “ability to improve the delivery of neurosurgical care by enhancing safety and efficacy and by making the field of neurosurgery safer, more accessible, more efficient and more effective.” The award is one of the highest recognitions bestowed upon a neurosurgeon.
Dr. Lunsford is an internationally recognized authority on stereotactic surgery, radiosurgery, and minimally invasive surgery. In 1987, he was responsible for bringing the Gamma Knife to then Presbyterian University Hospital, the first hospital in North America to offer the innovative, non-invasive, bloodless form of brain surgery. The installation of the Gamma Knife revolutionized neurosurgical care, drastically reducing hospital stays while significantly improving patient care.
In the nearly 30 years since it’s installation, more than 13,500 patients have undergone radiosurgery in the department’s Gamma Knife units. Dr. Lunsford’s team has published numerous books and more than 400 peer reviewed outcome studies, and his team has trained more than 1,700 physicians and physicists from around the world in the role, methods, and long-term outcomes of Gamma Knife radiosurgery.
Dr. Lunsford has also played a leading role in assisting Gamma Knife manufacturer Elekta develop further models of the Gamma Knife. In 2016, the latest version of the unit, The Leksell Icon®, will debut at UPMC Presbyterian.
Raymond F. Sekula Jr, MD, MBA, associate professor of neurological surgery at the University of Pittsburgh and director of the department’s cranial nerve disorders program, is co-editor of the newly released, first edition textbook, Microvascular Decompression Surgery, an update on MVD surgery, widely accepted as an effective remedy for cranial nerve hyperexcitability disorders including hemifacial spasm, trigeminal neuralgia, and glossopharyngeal neuralgia.
Shi-Ting Li, MD, PhD, and Jun Zhong, MD, PhD, from the department of neurosurgery at XinHua Hospital and Shanghai Jiao Tong University School of Medicine, in Shanghai, China, are co-editors of the book.
The book’s author, Springer, notes “the authors describe in detail those steps of the process that need the most attention in order to achieve an excellent postoperative outcome, including positioning, craniectomy, approach and identification of the culprit, etc. Though it primarily focuses on surgical principles and technical nuances, the book also addresses the intraoperative electrophysiologic monitoring and pathogeneses of hemifacial spasm and trigeminal neuralgia.”
Dr. Sekula is known internationally for his development of microvascular techniques and has lectured worldwide on the subject.
For more information on the book, please visit the Springer website.
UPMC CancerCenter First in World to Treat Patient with New Cyberknife MLC that Shapes Radiation to Tumor, Decreases Treatment Time
PITTSBURGH, March 2, 2015 – UPMC CancerCenter last week became the first center in the world to treat a patient with the CyberKnife® M6™ System’s new multileaf collimator, which enables precise shaping of radiation beams to any irregularly shaped tumor, sparing healthy surrounding tissues and reducing the time patients must undergo treatments.
The CyberKnife® M6™ System with the InCise™ Multileaf Collimator (MLC) was used for the first time on Feb. 26 on a 56-year-old western Pennsylvania woman being treated for a benign brain tumor. UPMC CancerCenter was one of the InCise MLC evaluation sites working in collaboration with Accuray, the device’s manufacturer. The patient’s treatment lasted 22 minutes, about half of the time treatment would have taken without the use of advanced software and novel technologies, said Dwight E. Heron, M.D., FACRO, FACR, director of Radiation Services at UPMC CancerCenter, a partner with the University of Pittsburgh Cancer Institute.
This new technology will be especially useful for tumors in the body that are hard to reach or tend to move, he said. The treatment was administered as a multidisciplinary effort between Steven Burton, M.D., from the department of Radiation Oncology and Johnathan Engh, M.D., from the department of Neurosurgery.
“Our patient was diagnosed with a brain meningioma and was a good candidate for the highly-focused treatment that can be delivered by the CyberKnife,” said Dr. Heron, who oversees the largest system in the U.S. accredited by the American College of Radiation Oncology. “With the addition of the MLC, we were able to precisely target the tumor and spare healthy tissue, and it took us significantly less time to do it. This real-world case is consistent with our InCise MLC technical evaluation experience and exceeded our expectations in its efficiency.”
The M6 Series delivers radiosurgery and stereotactic body radiation therapy, enabling precise, high-quality dose distributions to be administered to patients with extreme accuracy over a minimum number of treatments, reducing side effects and preserving patients’ quality of life. The system is able to adjust and automatically stay on target in real-time, accounting for patient and tumor motion. CyberKnife is the only robotic radiosurgery system available today that delivers such high-precision treatments throughout the body.
“We congratulate Dr. Heron, Dr. Saiful Huq and their team on treating the first patient using the CyberKnife M6 System and InCise MLC,” said Joshua H. Levine, president and chief executive officer of Accuray. “With the addition of the MLC, clinicians can deliver the same precise radiosurgery treatments they have come to expect with the CyberKnife System for a wider range of tumor types, including larger and different kinds of tumors than were previously treated.”
Landmark Study Shows Clot Removal Reduces Mortality, Improves Patient Outcome in Large-Vessel Stroke
PITTSBURGH, Feb. 11, 2015 – Researchers have completed an international, randomized, controlled trial showing that a clot-retrieval procedure, known as endovascular treatment (ET), can dramatically improve patient outcomes after an acute ischemic stroke. The study, in which the University of Pittsburgh enrolled more participants than any other American site, also shows a dramatic reduction in deaths from stroke. The results were published in the Feb. 11 online edition of the New England Journal of Medicine (NEJM).
The results of this landmark study will be published in the March 19 print edition of NEJM and presented at the American Heart Association’s International Stroke Conference in Nashville, Tenn.
Overall, positive outcomes for patients increased from 30 percent to 55 percent. In many cases, instead of suffering major neurological disability, patients went home to resume their lives. Led by researchers at the University of Calgary, the study found that overall mortality rate was reduced from two in 10 patients for standard treatment of care to one in 10 patients – a 50 percent reduction with ET.
“These results mean we are on the verge of a revolution in stroke care,” said Tudor Jovin, M.D., associate professor of neurology and neurological surgery, director of the UPMC Stroke Institute and leader of the Pitt arm of the study. “This is a devastating condition from the standpoint of death and disability. Finally, we are able to offer these patients a treatment that really works.”
Ischemic stroke is caused by a sudden blockage of an artery to the brain that deprives the brain of critical nutrients, such as glucose and oxygen. Currently, the international standard of care based on Canadian, U.S. and European guidelines is to administer a “clot buster” drug called tPA, to attempt to dissolve the blood clot.
In this trial, known as ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times), 316 patients who fit the criteria for ET and arrived for treatment within 12 hours of their stroke were randomly assigned to receive either standard medical care, which included tPA where appropriate, or standard medical care plus ET.
ET is performed by inserting a thin tube into the artery in the groin through the aorta and into the brain vessels to the clot using X-ray-guided imaging. A retrievable stent opens the blocked vessel to restore blood flow and then withdrawn, pulling the clot out with it.
Endovascular treatments were first developed in the 1990s, but ET has only recently been technically possible. The ESCAPE team says the success of the trial can be credited to very fast treatment and the use of brain and blood vessel imaging. Researchers were on average two hours faster in opening the blocked blood vessels than in previously reported trials.
ESCAPE is the second ET trial that demonstrates the efficacy of the treatment and the first trial to demonstrate reduced mortality. The previous trial, known as MR. CLEAN (Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands), was published in NEJM in December 2014.
ESCAPE included 22 sites worldwide and patients in the U.S., U.K., Ireland and South Korea. Canada had 11 participating hospitals and enrolled two-thirds of the patients.
“This was a trial that was very carefully designed to tell us for certain whether endovascular therapy should play a role in the treatment of stroke patients,” said co-investigator Lawrence Wechsler, M.D., Henry B. Higman Professor and chair, Department of Neurology, Pitt School of Medicine, and the institute’s founding director. “The UPMC Stroke Institute is a leader in advancing stroke care, and we encourage our patients to take advantage of the opportunity to participate in important clinical trials like this one.”
The study was funded by The Heart and Stroke Foundation of Canada, Alberta Innovates-Health Solutions and Medtronic, along with generous donations to the Calgary Stroke Program.
View a video of Dr. Jovin performing the ET procedure: http://youtu.be/s7wY9RgAFTk
PITTSBURGH, Nov. 20, 2014 – Faculty from the University of Pittsburgh Department of Neurological Surgery were among the experts who presented at the Congress of Neurological Surgeons (CNS) Annual Meeting in Boston. Faculty research was presented in practical courses, live surgical presentations, scientific sessions, original science programs, seminars and forums, presentations, and posters, and included topics such as:
- 3-D Anatomy (Supratentorial and Infratentorial)
Course co-director: Juan Fernandez-Miranda, MD
- Multidisciplinary Management Strategies for Unruptured Aneurysms
Faculty member: Robert Friedlander, MD
- Endoscopic Endonasal and Keyhole Approaches to the Skull Base — Part 2: Endoscopic Endonasal Skull Base Surgery (Cadaver Course)
Faculty members: Juan Fernandez-Miranda, MD, Paul Gardner, MD
- From Kona to Kilimanjaro — A Metaphor for Neurosurgery
Speaker: Joseph Maroon, MD
- The Pediatric Hydrocephalus Guidelines: Infection Treatment
Speaker: Mandeep Tamber, MD, PhD
- Balancing Clinical Research and Individualized Care: The Era of “Personalized Medicine”
Speaker: Elizabeth Tyler-Kabara, MD, PhD
- Degenerative Scoliosis and TL Burst
Speaker: David Okonkwo, MD, PhD
- New Frontiers and Innovations in Radiosurgery
Faculty member: Ajay Niranjan, MD
- Brain Tissue Oxygenation and 3- and 6-Month Neurological Outcome in Severe Traumatic Brain Injury
Authors: David Panczykowski, MD, Ava Puccio, RN, PhD, Yue-Fang Chang, PhD, David Okonkwo, MD, PhD
- Cervical and Cervicomedullary Spinal Cord Stimulation for Chronic Pain: Efficacy and Outcomes
Authors: Zachary Tempel, MD, Gregory Weiner, MD, John Moossy, MD
- Spanning the Spectrum of Neurosurgery
Author: Andrew Ducruet, MD
- A Blinded, Case-Control Trial Assessing the Value of Heavily T2-Weighted MR in the Diagnosis of Trigeminal Neuralgia
Authors: David Panczykowski, MD, Raymond Sekula Jr., MD
- Post Traumatic Cervical Nerve Root Avulsion with Epidural Hematoma
Authors: W. Christopher Newman, MD, Elizabeth Tyler-Kabara, MD, PhD
For more information and a complete listing of presentations from the CNS 2014 Annual Meeting, please visit the conference page.
PITTSBURGH, Sept. 30, 2014 – University of Pittsburgh researchers are key players in a national “dream team” that seeks to identify the best biological and imaging markers of traumatic brain injury (TBI) to improve the ability of clinical trials to find effective treatments for the condition, which annually affects 2.5 million people in the U.S., including athletes and soldiers.
The $17 million initiative, called the TBI Endpoints Development (TED) Award, is funded by the U.S. Department of Defense (DOD) and includes many universities, the U.S. Food and Drug Administration (FDA), companies and philanthropies. It is overseen by the University of California, San Francisco.
“This project is going to redefine how we measure the outcomes for traumatic brain injury studies,” said TED investigator Stephen Wisniewski, Ph.D., senior associate dean and co-director of the Epidemiology Data Center at the University of Pittsburgh Graduate School of Public Health. “We need a more robust, detailed way to determine what challenges a person faces when he suffers a traumatic brain injury, and that is what we’re setting out to accomplish with this ambitious study.”
Under Dr. Wisniewski’s leadership, Pitt Public Health will run the data analysis for the project, meaning the school will compile data from previous studies and analyze it to see what existing methods for measuring traumatic brain injuries prove most promising. That information will be used as a launch point for clinical evaluation in real-life situations.
David Okonkwo, M.D., Ph.D., associate professor of neurological surgery and clinical director of the Brain Trauma Research Center at Pitt’s School of Medicine, is co-leading the second branch of the project to test those findings through the previously announced $18.8 million National Institutes of Health (NIH) project called Transforming Research and Clinical Knowledge in TBI, or TRACK-TBI.
“In the clinical component of the TED project, we will take the insights Dr. Wisniewski and his team gather from their systematic review of previous research and apply that to real-world TBI cases,” said Dr. Okonkwo. “If we can more accurately identify and quantify these injuries, we will be better able to select appropriate patients for clinical trials and to evaluate the success or failure of our therapies.”
TED will examine data from thousands of patients to identify effective measures of brain injury and recovery, using biomarkers from blood, new imaging equipment and software, and other tools. The research collaborators will be collecting a broad range of long-term data from existing studies and databases, and integrating these into a dataset that can be interrogated for TBI associations and causes in a way that has never before been possible.
The project is specifically designed to overcome the difficulty in demonstrating the effectiveness of TBI drugs and medical devices by actively involving the FDA in clinical-trial design from the outset. It also fosters collaboration between the DOD, the NIH, foundation-funded research networks, industry co-sponsors such as General Electric, and patient advocacy groups to try to develop procedures, outcomes measures and standards for interpreting clinical data.
Each year, more than 2.5 million people in the U.S. seek medical care for traumatic brain injuries that arise when blows to the body or nearby explosions cause the brain to collide with the inside of the skull. According to the U.S. Centers for Disease Control and Prevention, an estimated 2 percent of the U.S. population now lives with TBI-caused disabilities, at an annual cost of about $77 billion. No TBI treatment has proved to be effective.
“TBI is really a multifaceted condition, not a single event,” said UCSF neurosurgeon Geoffrey T. Manley, M.D., Ph.D., principal investigator for the new award and chief of neurosurgery at San Francisco General Hospital and Trauma Center, a UCSF partner hospital. “TBI lags 40 to 50 years behind heart disease and cancer in terms of progress and understanding of the actual disease process and its potential aftermath. More than 30 clinical trials of potential TBI treatments have failed, and not a single drug has been approved.”
Physician network Doximity, along with U.S. News & World Report, announced the first comprehensive national evaluation of residency programs. In these results, 11 UPMC programs ranked in the top 10.
To determine the rankings, 3,691 residency training programs were evaluated by combining over 50,000 peer nominations from board-certified US physicians. U.S. News & World Report, nationally known for their education and health care rankings, consulted on the methodology.
Here is a listing of UPMC programs in the top 10:
- Anesthesiology: No. 10
- Obstetrics and gynecology: No. 3
- Plastic surgery (integrated): No. 3
- Otolaryngology: No. 4
- Emergency medicine: No. 7
- Physical medicine and rehabilitation: No. 7
- Psychiatry: No. 7
- Orthopaedic surgery: No. 8
- Pediatrics: No. 8
- Neurological surgery: No. 9
- Surgery: No. 10
The results are used in a free tool from Doximity called Residency Navigator. The tool is designed for third- and fourth-year medical students.
PITTSBURGH, July 7, 2014 – Stroke Update 2014 will be held at the Wyndham Grand Pittsburgh Downtown in Pittsburgh, Pa., on Friday, September 5, 2014.
This conference will cover the identification, management, and treatment of stroke in young adults, intracerebral hemorrhage, subarachnoid hemorrhage, and intracerebral swelling. Clinical applications for telemedicine and the benefits of telestroke also will be discussed.
Who Should Attend
This conference is designed for neurologists, neurosurgeons, interventionalists, emergency medicine physicians, family practitioners, internists, nurses, nurse practitioners, pre-hospital personnel, and hospital administrators.
Wyndham Grand Pittsburgh Downtown
600 Commonwealth Place
Pittsburgh, PA, 15222
Tudor G. Jovin, MD
Associate Professor of Neurology and Neurosurgery
Director, UPMC Stroke Institute
Department of Neurology
Lori M. Massaro, MDN, CRNP
UPMC Stroke Institute
Department of Neurology
Ashutosh P. Jadhav, MD, PhD
Assistant Professor of Neurology
UPMC Stroke Institute
Department of Neurology
To view the full course brochure, or to register online, please visit the Upcoming Events page at the Center for Continuing Education in the Health Sciences and click the ‘Stroke Update 2014′ link.
Continuing Education Credit
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credits™. Each physician should claim only credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded 0.6 continuing education units (CEUs) which are equal to 6.5 contact hours.
Nursing: The University of Pittsburgh Medical Center (UPMC) is an approved provider of continuing nursing education by PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. This program is awarded 6.5 contact hours. Participants must attend the entire day and complete an evaluation form to be awarded a certificate and 6.5 contact hours.