Community Research and Development Information Service - CORDIS

One small step for man. One giant step for research

A European research consortium has achieved a medical breakthrough by enabling a paraplegic man to stand up from his wheelchair and walk, despite being paralysed for ten years. The researchers and their patients were greeted by the European Commissioner for Research, Mr Philip...
A European research consortium has achieved a medical breakthrough by enabling a paraplegic man to stand up from his wheelchair and walk, despite being paralysed for ten years. The researchers and their patients were greeted by the European Commissioner for Research, Mr Philippe Busquin, along with a throng of journalists from across Europe, when they met in Brussels to reflect on their results and discuss how to take the research one step further.

In an emotional speech, Mr Marc Merger - the first patient to receive implants enabling him to stand up and walk - thanked the scientists:

'I don't feel proud for myself, but I'd like to say thank you on behalf all the paraplegics who will benefit from this research in the future. I would also like to thank the whole research team, Mr Busquin personally and the European Commission for making this possible,' he said.

Until now paraplegic patients had no hope of ever being able to walk again. But the project called 'Stand up and walk' (SUAW) has given new hope to paraplegics across the world. On February 14 this year, scientists from the University of Montpelier successfully operated on Frenchman Marc Merger giving him an implant which enables him to achieve the goal defined by the project title.

Some 300,000 Europeans are paralysed. The average age of a paraplegic person is 31 and most (around 65%) end up in wheelchairs after car crashes (Mr Merger is one of this group), while another 10% are paralysed following sports injuries. More than half of all paralysed people are confined to wheelchairs because of accidents that cut the nerves in the spinal cord that control their legs.

The damage is irreversible. But in such accidents the muscles beneath the damaged nerves are still alive and connected to the spinal cord by nerves. These muscles contract and become rigid because they are disconnected from the brain. For some time, scientists have theorised that if the commands to move the muscle could be generated a patient would partly recover the use of their limbs.

The theory led to the development of 'electrostimulation techniques'. Two electrodes, placed on the skin, stimulate the underlying muscles and make them contract. But the European research team believed it preferable for a patient to have an implant, controlled by an antenna which would send it radio signals.

Patients with paralysed lower limbs could therefore use two crutches or a frame incorporating a walkman-sized programmer with control buttons, incorporating settings for commands like 'start', 'slow down' 'accelerate' or 'change direction', for example.

'Stand up and walk' was one of the first demonstration projects to receive funds under the European Commission's BIOMED II programme in July 1996. The consortium includes research institutes from Denmark, France, Germany, Italy, the Netherlands and the UK. The project was funded to 50% of its cost by the EU. 'Without this EU funding the project would never have come to fruition in the first place', said consortium coordinator Professor Rabischong.

The researchers aimed to implant concurrently six patients from six European countries and compare their recovery over a six month period. But technical difficulties (not uncommon for any demonstration project) put plans behind schedule. Mr Merger is therefore the only patient yet to have received implants.

The Frenchman can now straighten his legs and stand up and walk when his sub-lesional muscles are stimulated with an electric current. While such stimulation could already be performed by partners in the project - as well as other research teams - the approach is far from practical as it involves the patient's body being covered in electrodes and hooked up to a stationary computer and power source.

So, in 1992 researchers established a European rehabilitation network. It aimed to determine the clinical protocols corresponding to the five phases of the project. These were: patient selection, pre-surgical exercise (to re-accustom the muscles to stimulation), implantation in patients and post surgical exercises for everyday use.

During the demonstration project itself, researchers built the implants (including fine tuning and encapsulation) and designed a portable programming device to attach to the patient's belt to transmit instructions to the implant. At the same time the team selected patients (who received preliminary training) and chose and fine tuned the electrodes. Finally Mr Merger received his implant in December 1999. Technical problems with interference between the two types of electrodes caused a setback at this stage, but after careful recalibration, and a second operation on 14 February 2000, Mr Merger was able to take his first steps on 3 March.

His recovery has been assisted by a carefully crafted physiotherapy programme, devised by a network of rehabilitation centres called CALIES, and tested by the Dutch partner Roessingh.

The electronic chip and the signal transmission system were developed by the industrial partners IBM and Thomson-CSF, the ten electrodes by the Fraunhoffer Institute for biomedical technology and the complete implant was put together by a new spin-off company - 'Neuromedics' - based in Montpellier.

Speaking in Brussels on behalf of the research team, project coordinator, Professor Rabischong explained that Mr Merger is more than a 'patient':

'Marc is extremely motivated, said the Professor, 'he understood the risk. He's our 'test pilot'. He is a real research partner and a member of this team'.

Stressing the importance of international collaboration to the project, he continued:

'This work could never have been carried out by one research team alone. The patient's muscles needed to be prepared, the electrodes and transmitter to be designed, and the operation itself to be undertaken. A multidisciplinary approach from the best researchers in Europe was needed.

On behalf of the European Commission, Mr Busquin underlined the importance of funding projects like SUAW. 'This project brings actual results and specific benefits', he said, 'It is not abstract, but involves human beings from the world'.

Echoing Mr Busquin's position on a European Research Area, Professor Rabischong explained how his team's work is an excellent example of what Europe can do.

'European funding is enabling researchers to come together', he said as he emphasised the need for continued public funding and support.

The European project has also led the way for the 'Free hand' project in Cleveland, USA where researchers are trying to help quadriplegics move their upper body.

'Restoring walking to quadriplegics would be extremely difficulty', says Professor Rabischong, 'because you need arms strong enough to support and assist gait. This is not feasible at present'.

Mr Merger moves shakily with a frame. Yet while he will never again walk as he did before his accident, he at least has the opportunity to learn how to walk all over again. Sadly not every disabled person will be able to benefit from the new technology because many paralysed patients do not have muscles. In addition, not only must patients have overall good health, but the lesion must have occurred between their fourth and eleventh vertebrae, and the remainder of the patient's nervous system must be intact.

No less of a restriction is the cost of the treatment. Each implant, Professor Rabischong indicated, would cost around FF200,000 (30,489 euro).

To make the treatment accessible to patients who can't afford it, the Professor suggested a European fund for implants should be set up in the future.

'You're seeing the end result and its been hard and arduous to get here. You have the means at EU level to help us [paraplegics] and you are doing just that,' said Mr Merger.

The Community phase of the project comes to a close on 31 March 2000. The SUAW team hopes to persuade the Commission to continue funding their work under the Fifth Framework Programme.

Source: European Commission, Research Directorate-General.

Related information


Follow us on: RSS Facebook Twitter YouTube Managed by the EU Publications Office Top