Walk Again Project: What comes after the historical kick

June, 2014. The world’s eyes were on Brazil, more precisely on the Corinthians Football Stadium, in São Paulo, where Juliano Pinto, a young Brazilian completely paralytic in the lower truck was about to kick-off the opening game of the Fifa World Cup. Wearing a mind-controlled armour, he managed to walk to the middle of the field, lift his leg, give the ball a kick and initiate the event that would define the world’s best football team – which turned out to be a national trauma for the host country, widely remembered as 7:1.

talks@swissnex invites Solaiman Shokur.

Pinto was wearing an exoskeleton developed by the Walk Again Project (WAP), an international research project that dates back to 1999 with the goal to demonstrate how brain-machine interfaces and virtual reality can help motor rehabilitation of paraplegics.

Six months earlier, in January 2014, Afghan-born Solaiman Shokur arrived in São Paulo. Solaiman grew up in Switzerland, where he studied Computer Engineering at EPFL (Swiss Federal Institute of Technology in Lausanne) before starting his PhD in the field of Brain-Machine Interface based on Virtual Reality in the Robotic Systems Laboratory, lead by Professor Hannes Bleuler. During his doctorate, Solaiman was co-oriented by WAP’s coordinator and founder, the Brazilian neuroscientist Miguel Nicolelis. After spending significant time at Nicolelis’ lab at Duke University, in the USA, it was only natural that Nicolelis would call him to be part of the São Paulo Lab’s team.

Solaiman Shokur is currently Senior Scientist at the São Paulo laboratory of the Walk Again Project. swissnex Brazil recently visited the lab in São Paulo to see the exoskeletons and enjoy explanations on the project’s functioning and challenges for the future.

Ten to twelve professionals currently work at the lab, treating 15 patients daily, seven of them from the initial training group. Besides Solaiman, there are only two other foreigners, one of which an EPFL student who is writing her Master’s Thesis. The EPFL continues its scientific collaboration by contributing to WAP in the area of robotics and tactile feedback, which already lead to several joint publications.

The functioning of the exoskeleton can be explained more or less like this: the patient’s thinks of/imagines moving his or her legs. Through the means of electrodes, those thoughts are transformed into “commands” to the exoskeleton, which executes the movement. Through a specially-fabricated shirt (developed by researchers at EPFL) that vibrates when the legs swing, the patient gets a real-time tactile feedback. In the meantime, a virtual reality-part has been added to the original training with the exoskeleton. It is designed for the patients that struggle to recall the memories of moving their legs, a phenomenon which surges in most long-term paraplegics. With VR goggles, the patient “sees” his legs moving and stimulates new “memories” of the movements that will subsequently command the exoskeleton.

The combination of brain control with physical training has shown astonishing results: several members of the original training group have regained feeling in their limbs – something unimaginable before the WAP – and are now training to autonomously walk. The interdisciplinary nature and geographical proximity of the various contributors are key factors for the incredible success of the project. Having scientists, patients and doctors working together in one single space, the São Paulo laboratory, not only speeds up the exchange of information and data, but allows for direct feedback, which avoids that scientists spend time and energy to develop something that isn’t feasible or doesn’t benefit the patients.

Solaiman recalls an episode of his time at the Robotics Lab at EPFL, when he and his colleagues laboriously developed a camera for blind people that would be worn as a type of hat and warn the blind person from obstacles at face-level (that a white stick doesn’t grasp). When they presented it to a blind friend of one of the researchers, his response was crushing: “I’m blind, but I’m not a fool”, meaning that he wouldn’t walk around with a moving camera on his head, that besides drawing a lot of attention, would look quite ridiculous. The episode shows beautifully how interdisciplinarity can avoid “empty runs” and increase efficiency of the whole scientific process.

The big question that Solaiman and his colleagues want to answer now is howtheir therapy works. They concluded that paralyzation should be understood more as a technical term, referring to the limitation of movements, than as a medical term for the complete “cut” of fibers in the spinal cord.

A hypothesis mentioned by Solaiman is that, by stimulating the brain and undergoing physical training, those fibers can be recovered and new fibers created. In order to understand the mechanism behind the progress, the patients from the second training group are undergoing distinct therapy protocols – basically different combinations of the existing and some additional methods applied in the WAP. The efficiency of those different protocols is currently being assessed with the ultimate goal to create a “clear recipe for rehabilitation of paraplegic patients” until the end of this year.

We will be following closely!