Q: I have a C4/5 complete spinal cord injury which means I cannot use my arms or hands and therefore lack any independence. How could your work impact that?  

In most people with an injury like yours, some connections are spared from brain to spinal cord, but the limited number of these spared fibres mean that only very weak muscle activation can be produced. My interest is in finding ways to strengthen these residual fibres to generate functionally-meaningful contractions. Until now, most investigators focussed on the major pathway which controls movement in humans, the corticospinal tract. But I’ve been working on a different system, the reticulospinal tract. This is less important in uninjured people, but after an injury it could play a much more significant role.  

I’ve developed a portable electronic device which pairs weak electrical stimuli to a muscle with clicks to an earpiece, and thereby strengthens reticulospinal pathways. It comprises of a box which can be worn, with wires running to sticky electrodes on a muscle and an earpiece. Importantly, we are not trying to augment function by the action of the device. Instead, we are trying to rewire the nervous system to generate changes, which will last even when the device is taken off.  We have shown, in stroke patients, that wearing the device for four weeks produces a significant improvement of hand function. It should provide similar benefits to tetraplegics.

Q: This sounds like it could make a big difference to our lives. What are the next steps?  

My fantastic PhD student Maria Germann, who is funded by Spinal Research, has spent the first part of her project improving the device stimulation protocols and carrying out a huge number of experiments in uninjured volunteers. The next thing we want to do is run a clinical trial, in injured subjects, to try to demonstrate a beneficial effect on upper limb function. We are hoping to run the trial early in 2021, in one or more centres in the UK.  

Q: How long before any therapies are widely available?  

Firstly, we need to run the trial to prove carefully if the device provides benefit. That’s the easy part; we should have results by the middle of next year. Much harder is making the device more widely available. We need to obtain a CE mark under the Medical Device Directive. Perversely, one challenge is that the device is too simple. Venture capitalists are put off as they fear that other companies could easily make something similar, which would stop us recouping their investment. These are the biggest barriers to translating advances to help patients. But I remain hopeful that we can navigate a route through to make our device available.  

Q: How has the pandemic affected your work?  

My work in human volunteers had to stop during the lockdown but fortunately Maria had already gathered a lot of data and we used the time to write it up. We are now back up and running. Currently doing more tests in uninjured volunteers at the same time as planning for the clinical trial.