Paralyzed woman feels like "real Ironwoman" after implants help her take steps again

Marta Carsteanu-Dombi was in the best shape of her life when a bike accident during a 2018 Ironman race left her paralyzed, robbing her of the ability to walk. 

Her spinal cord injury was so severe that doctors told her there was no sign of nerve connections left to her lower body. She also had eight broken ribs, punctured lungs and was bleeding internally. Carsteanu-Dombi, 39, was told by doctors she'd never walk again, but an early clinical trial in Switzerland gave her new hope. 

With the help of the "digital bridge" technology, which wirelessly connects an implant on top of her brain to a spinal cord stimulator, and months of training, she was able to take a few steps on her own: no harness to hold her, just her walker and her iron will. She describes it as gaining a superpower. 

"And now, with these implants, I'm a real Ironwoman," she said.

Innovative technology

When someone gets a traumatic spinal cord injury and is paralyzed, there isn't much doctors can offer. Patients do physical therapy and learn to adapt to life in a wheelchair. It was, for many years, the only option, said Swiss neurosurgeon Dr. Jocelyne Bloch. 

Dr. Bloch and French neuroscientist Gregoire Courtine have been at the forefront of researchers around the world trying to expand those options since 2012. Their lab, NeuroRestore, near Lake Geneva in Lausanne, Switzerland, is a collaboration between the Swiss Federal Institute of Technology, Switzerland's equivalent of MIT, and the Lausanne University Hospital. That's where they've implanted eight paralyzed patients with a device that allows them to stimulate their spinal cords, enabling them to stand, take steps with a walker, and lift weights. The patients use a button to activate the stimulation.

Thanks to Courtine and Bloch's latest technology, which they call a digital bridge, five other patients can now move their paralyzed limbs using their own thoughts.

Normally, there's direct communication between the brain and spinal cord, but a severe spinal cord injury disrupts that signal. 

"So we are aiming to bridge - bypass the injury - by having a direct digital connection between the brain and the region of the spinal cord that control[s] leg movement," Courtine said.

To do that, Dr. Bloch implants a small titanium device, originally developed by a French research institute, in the patient's skull, directly over their motor cortex, the area of the brain responsible for controlling movement. The device has 64 electrodes. 

When a patient thinks about moving a limb, those electrodes record the brain's activity. Then, a computer uses artificial intelligence to translate the recordings into instructions for the stimulation device implanted on the spinal cord. That device sends electrical pulses activating muscles in the legs or arms. All of it happens in about half a second.

Dutch man Gert-Jan Oskam, who four years ago became the first person to get the digital bridge, showed how it works on a walk by Lake Geneva with 60 Minutes. He wore a headpiece that powers the implant in his skull. The computer was on his walker. It's cumbersome and tiring, both physically and mentally, but he can walk up to 450 feet.

"It's able to discriminate [between] walking and talking at the same time," Oskam said. "That's incredible."

The most severely paralyzed patient enrolled in the clinical trial for walking

Courtine and Bloch were working with Carsteanu-Dombi, the most severely paralyzed patient enrolled in the clinical trial to regain mobility in her legs, when 60 Minutes visited in March. At that point, it had been more than six years since her spinal cord was severed during the bike portion of an Ironman race. She was found near a tree. Nobody saw the accident that left her paralyzed.

"I must have had a pretty tough collision because my spine basically broke, like, two dimensions," Carsteanu-Dombi said of the 2018 accident.

Carsteanu-Dombi was intubated when she woke up from surgery and could not talk, so she wrote a message to her mom: "I'm strong."

That strength has been tested. Carsteanu-Dombi spent 10 days in intensive care and more than four months in a rehab hospital learning to adapt to her new life in a wheelchair. 

Carsteanu-Dombi has no feeling below her waist, and isn't able to keep her balance. Sitting up on her own is a challenge.

She had the digital bridge implanted in September, and has worked with a team of engineers and physical therapists to figure out how much electrical stimulation is needed to move her legs. 

Carsteanu-Dombi also had to teach herself to think about moving the exact same way every time, so that the AI can recognize her thoughts. She practiced at first with an avatar and had to relearn what she thinks about when it comes to walking: is it about the hip contracting or the knee lifting?

After training with the digital bridge for just two days, Dr. Bloch and Courtine put her to the test, eager to see if she could take some steps. They told her to show off.

"I did not know if I'm able to show off," Carsteanu-Dombi said. "This was the thing."

But show off she did. With a harness to support about half her body weight and physical therapists to help place her feet on the ground, Carsteanu-Dombi took her first steps using the digital bridge. Despite having no sensation below her waist, she was able to move her paralyzed legs with her thoughts.

"It's not changing my everyday in ways people might think, 'Oh, she's getting back her life she had before'," Carsteanu-Dombi said. "As long as it makes me feel good, that I can stand up and hug my husband or hug somebody that I love, that means a lot."

The digital bridge and restoring arm movement

Swiss journalist Arnaud Robert traveled the world for decades but three years ago he slipped on a patch of ice and was instantly paralyzed from the neck down. Robert regained some function in his right arm with physical therapy and wanted to see if the digital bridge could help him with his left arm.

It's a challenge because opening and closing a hand is more complex than walking, Courtine said.

"The hand is tricky with all these different little muscles. It's very subtle," Dr. Bloch said. 

But after surgery and training at Courtine and Bloch's lab for eight months, Robert was able to use his left hand to help hold a glass and type. 

"There is a long, long way to get it functional for every quadriplegic in the world. But it was certainly a success, because I see that I can do things that I wouldn't, I was not able to do before," Robert said. 

After using the digital bridge over time, both Robert and Oskam have improved their ability to move their paralyzed limbs even when the system is turned off. Since it wasn't possible for Courtine and Bloch to see the changes in their patients' spinal cords at a microscopic level, they did studies in animals to try to understand what was happening. 

What they believe happened was completely unexpected. The training enabled the growth of new nerve connections, Courtine said. 

"New nerves started growing," he said. "And they grow on one very specific type of neuron that is uniquely equipped to repair the central nervous system."

The less severe the spinal cord lesion is, the better the regrowth happens, Bloch added.

"If it's a complete spinal cord injury, it will be hard to regrow. But, indeed, there is something happening," she said.

Hopes for restoring movement in the future

How well the digital bridge works still needs to be studied in a lot more patients. Courtine and Bloch hope to launch clinical trials in the United States in the next two to three years. The Food and Drug Administration has already designated the digital bridge as a breakthrough device, which will prioritize the review process. In 2014, Courtine and Bloch co-founded a company called Onward Medical to bring this technology out of the lab, making it faster, smaller, and widely available. 

As for Carsteanu-Dombi, she has a goal of her own: to visit a park with her family, and take some steps with them. 

"It's not a stroll in the park, how it would look for most other people," she said. "But for me, it's just good enough to make me happy."