Brain Computer Interface: Neuroprosthetic Control of a Motorized Exoskeleton

Study Overview
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Brief Summary
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The BCI project falls within the very broad field of brain machine interfaces. Its multiple applications include the compensation of motor deficits. The subject of the present protocol is the first test of the system in man on the compensation of motor deficits by an epidural brain implant enabling an electrocorticogram (EcoG) to be recorded.

Detailed Description
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Injuries to the cervical spine and to its contents, the spinal cord, cause serious neurological deficits, with loss of motor function and sensitivity of the four limbs, resulting in quadriplegia. The level of the lesion separating the area without deficits, above the lesion, from the sub-lesional area depends on the extent of the spine injury (dislocation, fracture or trauma without final displacement), may cause spinal cord injuries of varying severity, which can range from the benign to a complete section that results in complete and irreversible sensorimotor deficits. Lesions from C1 to C4 are often immediately fatal or cause diaphragmatic paralysis (innervated by the phrenic nerve whose roots originate at C4). C4-C5 paraplegia and below are therefore compatible with life as they spare respiratory autonomy, although they lead to severe permanent disabilities, creating a state of severe dependence in subjects who are often young. The problems created by these patients are those of an extremely heavy individual, family, and societal burden in addition to the individual drama. While paraplegics, by maintaining their motor skills and sensitivity of both upper limbs and back muscles can often reintegrate and find remarkable mobility with wheelchairs, this is not the case of quadriplegics who must be provided with substitutes in order to achieve an acceptable quality of life. This project offers a highly innovative approach by means of a motorized exoskeleton that enables standing, walking and the use of the upper extremities. The validation of the first step of this concept will pave the way for developing increasingly sophisticated exoskeletal neuroprostheses, aimed at giving these patients compatible and ever greater autonomy.

Official Title
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Brain Computer Interface: Neuroprosthetic Control of a Motorized Exoskeleton

Conditions
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Traumatic Tetraplegia With Cervical Cord Injury

Intervention / Treatment
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* Device: Brain-computer interface (BCI) platform including two implanted remotely powered ElectroCorticoGraph (ECoG) recording devices and an exoskeleton


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female aged between 18 and 45 years Stability of neurological deficits in accrued sequelae Lack of adequate compensation for the deficits in terms of quality of life. In other words, the expression by the patient of a need for additional mobility, oriented towards greater autonomy Ambulatory or hospitalized monitoring Fluent in French and able to understand the study procedures, including completing the auto-questionnaires Registered in the French social security scheme Signed informed consent of the patient will be collected before inclusion in the study Exclusion Criteria: Previous brain surgery, Chronic prescription of anticoagulant treatments, Impaired neuropsychological sequelae from an associated head injury, Depressive syndrome with or without suicide attempt. Alcohol or other substance dependence in the last 12 months, with abuse in the - A complete assessment (neurological and neuropsychological) will be conducted among eligible patients. Contraindication to Magnetoencephalography (MEG) and/or Electroencephalography (EEG) Contraindication to Magnetic resonance imaging (MRI)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: BCI<br>Brain-computer interface (BCI) platform including two implanted remotely powered ElectroCorticoGraph (ECoG) recording devices and an exoskeleton | Device: Brain-computer interface (BCI) platform including two implanted remotely powered ElectroCorticoGraph (ECoG) recording devices and an exoskeleton<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with Adverse Events | Complications associated with the chronic implantation of an extradural ECoG measuring implant. | 4 years after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient's level of performance in piloting the degrees of freedom of the exoskeleton | To test the feasibility of compensation of motor deficits due to spinal trauma by a motorized man-machine interface neuroprosthesis controlled by cortical commands from biomarkers extracted from the ECoG. | 4 years after surgery | 
| Patient's quality of life evaluation | Perception by the subject of changes in quality of life. Decrease in dependence on care environment. | 4 years after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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without associated head injury