Gert-Jan Oskam could no longer walk after a cycling accident 12 years ago in China.
He suffered an incomplete spinal cord injury, so while he had some sensation in his lower body, he used a wheelchair after he returned home to the Netherlands.
But he wanted to be able to stand.
That’s why Oskam, 40, agreed to be one of three participants in a Swiss pilot study of an experimental brain implant in 2017.
The implant would allow him not just to stand, but to walk. When he pressed a button, a processor worn in a backpack would analyze his brain signals to try to activate his leg muscles for walking.
It worked, but not completely — his gait was stiff and robotic, and his steps were delayed because they were automated.
Oskam’s implant system is an upgrade on a previous version he used in a pilot project. He can now walk further, more fluidly and over uneven ground. (Nature)
Then a few years later, the researchers recruited Oskam to “test pilot” an upgraded implant system that would translate his thoughts into motion. When he thought about walking, electronic implants on his skull would pick up his brain signals, register them as instructions to move his legs, and send them to the corresponding muscles through another implant on his spine.
“You’re creating a sort of digital bridge” between the brain and spinal cord, said Canadian neurosurgeon Jordan Squair. Squair treats spinal cord injuries at the Swiss Federal Institute of Technology in Lausanne, Switzerland, where work on Oskam’s implant is based.
In May, the researchers reported on Oskam’s progress more than a year into the study. His walking is now fluid. He can climb stairs and handle rough terrain; he can walk faster and farther; and he’s able to use the technology outside the lab at his home.
“The stimulation before was controlling me, and now I’m controlling the stimulation,” Oskam said in a media briefing.
In 2024, medical researchers plan a pivotal clinical trial to test the safety of the implant in more subjects. Their goal is to miniaturize the system and make the technology available worldwide.
Implants have multiple benefits
Oskam’s progress and other advances in treatment of spinal cord injury — including a pioneering type of microsurgery that’s now being performed in Toronto — signal a promising turning point for the field.
In Canada, more than 86,000 people live with spinal cord injury, according to Praxis Spinal Cord Institute (formerly the Rick Hansen Institute). Doctors say about half to two-thirds of those are incomplete injuries like Oskam’s.
Quirks and Quarks8:39Digital bridge for spinal cord allows paralyzed man to walk again
Researchers in Switzerland have developed a system to restore communication between the brain and the spinal cord in a paralyzed man who was told he’d never walk again. By surgically implanting devices in the patient’s brain and spinal cord, they were able to digitally bridge the communication gap to allow him to control his legs again. Henri Lorach, the head of the brain interface unit at NeuroRestore and a neuroscientist at École Polytechnique Fédérale de Lausanne, said the patient can now walk with crutches even when the device is turned off. Their research was published in the journal Nature.
Squair said linking spinal cord stimulation to help people walk better by decoding their thoughts, as Oskam’s implant does, is a true technological step forward.
Not only does the approach help people with spinal cord injuries regain mobility — which they often rank as their top priority, say Squair and Praxis — but it can help people whose injuries are in the neck to control dangerous spikes in blood pressure.
“People are experiencing a lot less episodes of what we call autonomic dysreflexia — these hypertensive episodes when blood pressure goes up really high,” he said.
“We found that over time, as people use the stimulation, that is starting to go away, which is really exciting because those episodes can be life-threatening.”
Until now, few existing treatments have worked long-term, he said.
Venture capitalist John Ruffolo is recovering from a spinal cord injury. A new type of microsurgery helped ease the pain in his spine. (Submitted by John Ruffolo)
‘You will feel this deadness’
John Ruffolo of Toronto takes a keen interest in how the field of spinal cord treatment is progressing as part of his own recovery from severe injuries.
When Ruffolo watches videos of Oskam walk, his reaction is: “I’ll be there soon.”
He hasn’t received an implant, though he says he would get one if he had the opportunity.
An avid cyclist, Ruffolo, 57, was riding his bike on a sunny day in September 2020. He was heading down a rural road about 50 km north of the city when he heard the screeching air brakes of a tractor-trailer coming up on his rear wheel.
He doesn’t remember the pain of being hit.
After he landed, he tried to move his legs as his upper body seared with pain.
“You will feel this deadness on your body,” he said. “My first reaction was, ‘Oh s–t, I’m paralyzed.’ I was trying to wiggle my toes, and nothing.”
On impact, his pelvis split into six pieces. The force broke every rib in multiple places, collapsing a lung and taking out a kidney. Doctors said he lost 50 per cent of his blood volume.
Witnesses, paramedics and physicians expected he’d suffocate to death because of the broken ribs around his chest, which can hinder breathing.
Paramedics rushed him to Toronto’s Sunnybrook Health Sciences Centre, a major trauma hospital.
When he made it 36 hours past the accident, doctors performed multiple surgeries to repair his pelvis and then his back, drilling vertebrae and then delicately placing rods and screws.
Each move had to be carefully planned, like removing a block from a Jenga tower, without causing more damage or even death.
Ruffolo and his wife, Carryn, were told he’d never walk again.
Asked about his reaction, Ruffolo lowers his voice to a whisper, his voice cracking.
“The issue is, never remove someone’s hope, right?”
Sunnybrook’s surgical team considered Ruffolo to have a complete injury of the spinal cord, which traditionally has a guarded prognosis.
The surgeon had to leave several large bone fragments floating in his spinal fluid because they were located in an area that made them too risky to remove. Ruffolo said his spinal cord felt like it was being squeezed and bruised.
A few weeks later, he met with neurosurgeon Michael Fehlings at the Krembil Brain Institute at Toronto’s University Health Network. Fehlings told Ruffolo he could remove the fragments with a type of microsurgery called decompression surgery.
Dr. Michael Fehlings, a neurosurgeon with Toronto’s University Health Network, says new international guidelines on spinal cord injury coming out in 2024 will highlight the benefits of early decompression surgery. (Submitted by Michael Fehlings)
Fehlings told him the surgery could help relieve the squeezing to improve his odds for a significant recovery, but there were risks.
“I looked at him and I said, ‘Dude, I’m a VC,'” said Ruffolo — a venture capitalist in the tech industry. “I make investments when there’s a one per cent chance. I didn’t even flinch, and I said, ‘Do it.'”
Ruffolo, founder and managing partner of Maverix Private Equity, now does 18 to 20 hours of intense physiotherapy a week. He can walk with a walker, walking poles or on a treadmill.
“You just gotta keep on going,” he said.
“I’m not stopping until I walk independently.”
Patient’s recovery ‘gratifying’ for surgeon
Ruffolo is also able to ride again using modified recumbent and upright bikes. When he shares video of his rides with Fehlings today, it inspires the physician.
“While the injury presented huge challenges to him, where he’s at now and where he might have been without the decompressive surgery, I think is quite striking,” Fehlings said. “That’s very gratifying for me to see.”
Rick Hansen reflects on rehabilitation journey 50 years after crash
Premier David Eby joined Rick Hansen and health officials at the G.F. Strong Rehabilitation Centre in Vancouver to mark Hansen’s 50 years of spinal cord injury rehabilitation, and to present the Difference Maker Awards to those who have helped him on his road to recovery.
But Fehlings, who is also a professor at the University of Toronto and a clinician scientist, notes that Oskam’s and Ruffolo’s injuries should be kept in perspective: not every patient will respond as well to treatments because no two patients are identical in the degree and location of their spinal injury. It also helps that both patients were physically active before and after their accidents.
Not everyone with a spinal cord injury is keen to receive implant technology, either, Fehlings said, although he added it is possible the Swiss implant could help Ruffolo’s motor recovery.
“The technology was really quite remarkable,” Fehlings said. He isn’t involved in the experimental device but sees how it could fit in with efforts in restorative and regenerative medicine.
Another thing giving him optimism is the set of international guidelines on treating spinal cord injury, created with Canadian input, that is set to be published in early 2024. They include evidence on the benefits of early surgical decompression to reduce pain, improve mobility and manage other symptoms like bowel and bladder control.
“We’re really on the cusp right now of a remarkable era in regenerative neuroscience,” Fehlings said.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
