A team of neurosurgeons and biomedical engineers from Johns Hopkins received $ 13.48 million from the Defense Advanced Research Projects Agency (DARPA) to develop implantable ultrasound and other devices that can revolutionize care for people suffering from spinal cord injuries. The results could benefit thousands of US military personnel and civilians who suffer spinal cord injuries each year.
The electronic device is designed to be the size and flexibility of a small Band-Aid ™ and will use high-resolution ultrasound technology to help doctors monitor and treat changes in blood flow and prevent tissue death from occurring. immediately after a traumatic injury to the spinal cord.
The research program, supported by DARPA’s Bridging the Gap (BG +) program, will draw on the clinical experience and ingenuity of its co-leaders, Nicholas Theodore, MD, professor of Neurosurgery and Biomedical Engineering and Amir Manbachi, Ph.D. , assistant professor of Neurosurgery and Biomedical Engineering at the Johns Hopkins University School of Medicine, to bring the devices of the concept to human use on an ambitious five-year schedule.
“There are few places that look closely at how engineering approaches can improve the treatment of spinal cord injuries. I think there are tremendous opportunities here, ”says Theodore, who has also worked for more than 10 years as a neurosurgeon in the U.S. Navy, treating soldiers and sailors with spinal cord injuries.
While the team’s primary mission is to develop devices that can be deployed for military personnel on military fronts, the researchers plan to make the technology available to benefit approximately 17,000 civilians who suffer spinal cord injuries in the U.S. each year.
“The main factors that make a device usable in a theater of war are the size and ease of application in low-resource environments – both of which can only improve our clinical approaches as well,” says Theodore.
The project’s strategy is to target the interruption of blood flow that occurs along with spinal cord injury. By using technology to create images and stimulate blood vessels and tissues at the spinal cord injury site, as well as controlling the dynamics of spinal fluid, the supply of oxygen and nutrients can be optimized. This approach can prevent further damage to the spinal cord, which can lead to increased inflammation, pain and worsened paralysis.
“There are very few treatment options available to minimize damage initially – for example, to increase the patient’s blood pressure; however, we still need to understand, in real time, how the body reacts to these treatments ”, says Manbachi. “When Dr. Theodore first described this challenge to me, four years ago, as an acoustic engineer, I immediately thought of using ultrasound as a tool to monitor and stimulate these damaged tissues.”
To achieve this, electronic devices will use ultrasound “pulse echoes” – similar to those that radar submarines use to navigate – as well as electrical stimulation to monitor and treat tiny previously unobservable blood vessels and surrounding tissue in the local spinal cord injury.
“This will be a real engineering feat,” says Manbachi. “Typical ultrasound transducers are bulky and designed to collect images of larger structures. We want to take this technology and reduce it for use in structures the size of a little finger, while still capturing clear ultrasound images of the microvasculature of the spinal cord ”.
These images, the researchers say, will allow doctors to observe how blood is flowing to the injury site. This can provide valuable information on the amount of oxygen, nutrients and medications that are arriving in the area. The data will allow doctors to respond to their patients’ condition in real time, administering medications or possibly electrical or ultrasound stimulation to improve blood flow, stop inflammation, offer pain relief and neuroprotective therapies to stop damage to injured tissue.
The sound waves generated by these implantable devices can also be used to stimulate healing in the area. Similar to how the sun’s rays can be focused by a magnifying glass, the device’s therapeutic sound waves can, in theory, be focused to promote blood flow to the injury site to promote healing.
The five-year timeline for bringing completely new technology to animal studies, FDA regulatory approvals and human testing will push the limits of the typical pace of innovation that could otherwise take decades.
“It is an extraordinary team effort to bring together the most intelligent engineers and neurosurgeons to solve this problem,” says Theodore. “There are very few places in the world that are able to pool the resources we have for this project.”
The team hopes that the initial technologies will be used experimentally and clinically to treat acute spinal cord injuries. The researchers’ ultimate goal, however, is to develop more advanced versions applicable to patients suffering from chronic spinal cord injury.
The project will be coordinated by Senior Project Manager Chad Restrick, MSM-CRA, at Johns Hopkins University with key collaborators from the Departments of Neurosurgery, Biomedical Engineering, Radiology, Neurology and Intensive Care Medicine at Johns Hopkins Medicine, as well as external collaborators, including Ken Shepard, Ph.D., at Columbia University; Kyle Morrison, M.S., of Sonic Concepts Inc .; Monique Beaudoin, Ph.D. (Program Manager), George Coles, Ph.D., Francesco Tenore, Ph.D., and Steve Babin, M.D.-Ph.D. (technical collaborators) of the Johns Hopkins Applied Physics Laboratory.
reference: Manbachi A, Silva TD, Uneri A, et al. Clinical translation of the LevelCheck decision support algorithm for targeting spine surgery targets. Ann Biomed Eng. 2018; 46 (1548–1557). It hurts:10.1007 / s10439-018-2099-2
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