Friday, June 13, 2014 PT Helps Make the World 'A Different Place' With Role in Brain-Controlled Exoskeleton Call it a "brain-mediated technology breakthrough." Call it a "significant paradigm shift." Call it "an elongation of the continuum of movement." The bottom line is this: on Thursday, June 12, 2014, a young man who has paraplegia stood up, walked, and kicked a ball—all by way of an exoskeleton solely controlled by his brain. No joystick, no outside controller, just his own mind. Actually, maybe the best words for it are "a really, really big deal." For Michel Landry, PT, PhD, who has been involved in the project for about 2 years, the importance of those first steps simply can't be overstated. As he counted down the hours before the debut of the exoskeleton at the opening ceremonies of the World Cup, he put it very simply. "The world will be a different place after 2 o'clock our time," he said. And to Landry's great joy (and maybe relief), the world did in fact witness something historic, when 29-year-old Juliano Pinto completed the ceremonial kick off at the Corinthian Arena in Sao Paolo. Pinto has complete paralysis of his lower trunk. Though the moment was lightly covered by the media—and outright overlooked by several outlets—CBS News did publish a photo and story. Landry spoke with PT in Motion News while he was in Charlotte, North Carolina, to attend APTA's NEXT Conference and Exposition. The conversations took place before the World Cup debut. Landry was, as they say, pumped. "No one in the world is doing what we're about to do," he said. "This elongates the continuum of what is now possible, and makes it possible to address the social injustice being faced by people with severe mobility problems." What Landry's referring to is a $2 million exoskeleton developed through the Walk Again Project (also check out this brief video), a nonprofit international collaboration among the Duke University Center for Neuroengineering, the Technical University of Munich, the Swiss Federal Institute of Technology in Lausanne, the Edmond and Lily Safra International Institute of Neuroscience of Natal in Brazil, The University of California, Davis, The University of Kentucky, and Regis Kopper of The Duke immersive Virtual Environment. The project is led by Brazilian scientist Miguel Nicolelis, MD, PhD. Landry, program director of the Doctor of Physical Therapy Program at Duke, was asked by Nicolelis to join the effort. Though he describes his part in the project as "very much a supporting role," Landry was involved during the past 2 years, from its initial development in Brazil to the completion of the prototype late last year. The exoskeleton has been described as an "Iron Man" suit by the media, and in many ways, the prototype is reminiscent of the pumped up ultra high-tech, ultra-cool getup worn by Robert Downy Jr., in the movies. But this exoskeleton isn't a prop—it's the real deal, powered only by brain energy captured via a noninvasive cap. The mechanics respond to brain patterns, and send feedback to additional sensors in gloves worn by the user—in this way, the user gets a "feeling" of more subtle elements of walking such has foot roll and terrain changes. "It's a smart system," Landry said. "As you walk, the user will have motor learning, and will be getting better with every step." The exoskeleton is the result of work that began with an animal model and a pong-like video game, Landry explained. In the early stages of work, Nicolelis mapped electron "storms" in the brain of a monkey, and soon found that by translating those impulses via sensors on the monkey's head, he could train the animal to play a primitive ball-and-paddle video game simply by thinking about where to move the paddle. The project advanced, and soon Nicolelis found that through the same process, he could train a monkey to make a remote avatar walk—even when the monkey was unable to walk. Essentially, the monkey imagined walking, and brain impulses sparked movement in a set of mechanical legs. Landry admits that the one-of-a-kind apparatus needs much refinement—"The reality check is, this is a much longer process," he said—but he also understands the nature of the advancement at hand, particularly in light of what it could mean for PTs. "If we are in fact about optimizing human movement," he said, "we should recognize the social justice issues that are at stake here, and we need to be doing whatever we can to adopt new environments so that people with these injuries can experience movement and be viewed as equals in our world. High technology is all around us. Why can't we bring that high technology into the world of disability?" Landry is eager to see the technology be refined, mass produced, and made less expensive. The choice of the first user of the exoskeleton was a conscious one—they wanted to showcase the device being used by a youth from one of the world's poorest areas. Though he had yet to see the kick at the World Cup and was more than a little nervous about how the technology would react to multiple unpredictable factors—the weather, the heat, grass conditions, you name it—he was certain that history was about to be made. "This is like the space race," he said. "Everyone has been trying to get to the moon, and we got there first."