‘Somebody Has to Do the Research’

‘Somebody Has to Do the Research’

Bill Kochevar’s lasting legacy will be his selfless commitment to helping others with quadriplegia regain control over their limbs.

Bill Kochevar had a saying. He repeated it frequently to those around him and in media interviews when his story began to make headlines worldwide.

“Somebody has to do the research,” he’d say.

Yet Kochevar wasn’t a doctor or scientist. Paralyzed from the shoulders down in a bicycling accident in 2006, the 56-year-old Clevelander became the first person in the world with quadriplegia to regain functional control of his arm and hand using technology implanted in his brain and limb.

Robert Kirsch, executive director of the Cleveland FES Center and chair of Case Western Reserve University’s department of biomedical engineering.
“He felt like he was part of our team,” says Robert Kirsch, executive director of the Cleveland FES Center and chair of Case Western Reserve University’s department of biomedical engineering. “And he was part of our team.”

For three years, Kochevar worked with researchers at Case Western Reserve and the Cleveland FES Center. He underwent surgery to implant two micro-electrode arrays in the motor cortex to capture his brain activity and electrodes in his upper and lower arm to stimulate his muscles and fingers. A few times a week, Kochevar spent hours in the lab hooked up to a computer that used mathematical algorithm to translate his thoughts into arm movement commands that, at first, moved a virtual limb on a monitor but eventually would stimulate his muscles and reanimate his arm.

Adventurous and technically adept, Kochevar frequently sent assessments of that day’s work and notes on the study’s progress to Kirsch and other researchers. He did it all with the hope that maybe, someday, possibly, he could perform a few small everyday tasks.

“Even if I don’t get any benefit out of this, eventually someone’s going to benefit from what I’m doing,” Kochevar says in the documentary , which chronicles the journeys of three individuals who receive experimental neural implants to restore physical functions that were lost or compromised due to neurological injuries. “That makes you feel special.”

But in December 2017, Kochevar passed away just months after the groundbreaking research was published in The Lancet and covered by  and other media.

“It was devastating when he passed away,” says Kirsch. “He was a pioneer.”

While Kochevar had achieved some of his goals, like using a spoon to eat mashed potatoes and drinking from a straw, he wanted to be involved in the next phase of the trials. “When he passed away, it was a time of reflection,” says Kirsch. “We stepped back and took an evaluation of where we were and where we needed to go.”

 Bolu Ajiboye, associate professor of biomedical engineering at Case Western Reserve and research associate at the Cleveland FES Center and Louis Stokes Cleveland VA Medical Center.

Almost two years later, Kirsch and his fellow researchers are ready to move forward with the next stage of research, known as the Reconnecting the Hand and Arm to the Brain (ReHAB) System. With up to 12 research participants approved by the Food and Drug Administration, the first trials are expected to begin by early 2020. ReHAB, which will include a more advanced functional electrical stimulation system and additional brain sensors, greatly benefited from Kochevar’s efforts.

“It basically set the foundation for everything we are doing going forward in terms of developing technology, in terms of understanding how to decipher intended movements from the brain and in terms of knowing where improvements needs to be made,” says , one of the lead investigators on the study, associate professor of biomedical engineering at Case Western Reserve and research associate at the Cleveland FES Center and Louis Stokes Cleveland VA Medical Center.

Jonathan Miller, MD, director of Functional Neurosurgery at University Hospitals, associate director of clinical affairs at the Cleveland FES Center, and professor of neurological surgery at Case Western Reserve School of Medicine
, director of Functional Neurosurgery at University Hospitals, associate director of clinical affairs at the Cleveland FES Center, and professor of neurological surgery at Case Western Reserve School of Medicine

“This is the next step,” says Jonathan Miller, director of Functional Neurosurgery at University Hospitals, associate director of clinical affairs at the Cleveland FES Center, and professor of neurological surgery at Case Western Reserve School of Medicine. “We’re using brand new approaches on both the brain side and the arm side, which is really exciting.”

Here are five big things researchers learned from their work with Kochevar.

Proof Positive: Kochevar was the first person to have a brain-computer interface paired with an implanted stimulation system that activated his muscles using brain signals. “He would think, I want to make a movement,” says Kirsch, “then we would stimulate his paralyzed muscles to make those movements happen.” While this was a giant leap forward, it also was just an initial step in the long process of going from experimental technology in a lab to something viable for everyday life. “The work that we did with him was a feasibility demonstration that was very successful, but relatively limited in scope,” says Kirsch. “Because it was the first time we had done it, we were exploring a little bit.”

Cuff Links: For practical reasons, the FES system used with Kochevar was relatively simplistic. Electrodes were inserted through the skin into the muscles using a hypodermic needle. While the electrodes can easily be removed, the placement of the electrodes could be imprecise and may shift over time. “The system we were using probably wasn’t sophisticated enough to fully exploit what could be done,” says Kirsch. The ReHAB trial will employ nerve-cuff electrodes, which are expected to greatly enhance fine motor control over the hand, arm and fingers.

Body Positive: In many of the previous studies of brain recordings that attempted to understand how movement is controlled, participants manipulated computer animations, virtual reality limbs or external robots. Yet, those methods initially didn’t work well when paired with the functional electrical stimulation system intended to move Kochevar’s arm and hand. Kirsch surmises that this has to do with expectations the brain has when moving your arm. “It’s part of your body,” says Kirsch. “It’s not some other thing that you’re controlling.”

Lift Master: And yet, researchers were pleasantly surprised when Kochevar was able perform brain-controlled movements of his paralyzed arm the first time he was given the opportunity. In those early trials, Kochevar had to think hard to move his arm from point A to point B. “But over time, he said he didn’t even have to think about it at all,” says Ajiboye. This represented two major discoveries: The technology was not cognitively burdensome, and they were tapping into the proper brain networks, even years after the spinal cord injury.

Happy Thoughts: While the physical achievements were significant, the psychological impact on Kochevar may have been even greater. “Bill oftentimes used to say that he felt like he was controlling his own arm,” says Ajiboye. “He didn’t feel like it was a tool which is completely detached from him.” Having agency over his own body again provided an enormous emotional boost for Kochevar. So too was the power in the potential to impact others. “He would challenge us in terms of pushing the envelope of what was possible,” says Ajiboye. “His excitement was contagious.”