RR&D Research Career Scientist Award Application

Louis Stokes Cleveland Va Medical Center, Cleveland OH

Investigators

Abstract

“… to feel my wife’s hand,” he said with tears in his eyes. This was our subject’s response when he was asked what he wanted to get from participating in our study. His five simple words brought a tectonic shift in my thinking and provided the deep purpose to my work. Patient’s do not need fancy technology. They need to feel whole. They need to be connected. As a neural engineer, I develop neural interface technology that connects to humans. Three additional words are needed to capture my passion and over-arching goal as a VA Research Career Scientist: I develop nerve interface technology that connects to humans to connect humans. For nearly thirty years, I have combined a love for electrical engineering (B.S.E.E., 1992, Michigan Technological Univ, Houghton, MI) and computation algorithms with fascination of the brain and neuroscience to develop technology for communicating directly with the human nervous system (Ph.D. Biomedical Engineering, 1999, Case Western Reserve Univ, Cleveland, OH). I am one of the world’s top experts in development and translation of systems to precisely apply small electrical current injections to nerves to cause targeted action potentials in nerves. Early in my career, I used this technology to restore lost function following stroke or paralysis by activating muscles. I still actively collaborate with other VA investigators (Drs. Ronald Triolo, Gilles Pinault, Bolu Ajiboye, Emily Graczyk, and Robert Kirsch) in a supporting role to implement neural interface technology in clinical rehabilitation programs for spinal cord injury. A decade ago, however, I became much more interested in the power of the technology to communicate to the brain through sensory and autonomic systems. My VA activity fits into three area: 1) sensory technology for veterans with limb loss; 2) hypertension control in veterans that have not been responsive to medications, and 3) development of advances in peripheral nerve interface technology. Sensory Technology restores both functional and emotional connection following limb loss of the upper extremity (with Drs. J. Robert Anderson, Kevin Malone, Kyle Chepla, and Emily Graczyk) and lower extremity (with Drs. Ronald Triolo, Gilles Pinault, and Hamid Chakhkar). My lab in the Cleveland VA Medical Center is the first in the world to have a long-term implant of a peripheral interfaces for sensory restoration following limb loss. Eight subjects, four with upper extremity and four with lower extremity limb loss, have been implanted. Over the past four years, I have led a program funded by both the VA and the Defense Advance Research Projects Agency to develop a fully implantable, Bluetooth®-connected system for bi-directional connection between and external prosthesis and implanted interfaces. My team has secured all necessary regulatory approvals to start the world’s first randomized clinical trial (RCT) of neural-connected advanced prostheses. Over the next four years, this study will complete a critical step in moving the technology to general availability for all veterans with limb loss. Hyptertension: Neural interface technology is applied to modulate function of complex regulation of blood pressure. In individuals that are unresponsive to pharmaceutical approaches, we control hypertension through the baroreflex via activation of the carotid sinus nerve (CSN or Herring’s nerve) (with Drs. Jonathan Baskin, Gilles Pinault, and Elizabeth Heald). The work is in collaboration with a commercial partner to rapidly advance the technology benefit veterans within the next five years. Advancing Interfaces: To continue advancing the clinical capabilities of neural interfaces, advances in technology are continually needed. I continue pre-clinical development and translation of next generation of peripheral nerve technology. This includes increasing the number of channels on each electrode and the distribution of the contact throughout the nerve. This includes collaboration with MEMS fabrication specialist in the Cleveland VA (Dr. Douglas Shire) and Lawrence Livermore National Lab (Dr. Razi Haque) to develop high-density FINE and interfascicular nerve electrodes, implantation techniques, and high-density inline connectors.