Restoring movement and autonomy after paralysis

As Canada’s population ages, there is a growing need for new paralysis treatments. Older people are at a higher risk for strokes and falls, which can result in a spinal cord injury (SCI). These injuries are life-altering for the individual and their family. At a national level, the growing prevalence of SCIs and stroke will strain the country’s health-care system.

However, a Canadian research project could revolutionize the treatment of paralysis and restore people’s ability to move again. “RE-MOVE: Restoring movement, removing barriers” will harness the fundamentals of neuroscience and technology to connect a person’s paralyzed limb with a surgical implant in the brain or spinal cord, essentially building a communication bridge.

“This is the next frontier,” says Christian Iorio-Morin, a neurosurgeon and professor in the faculty of medicine and health sciences at Université de Sherbrooke. “If you think about the history of medicine, we’ve invented antibiotics for infections, stents and pacemakers for the heart, and we are better at detecting and treating different types of cancers. So right now, the next limit to better quality of life and longevity in humans are neurological diseases.”

A transformational undertaking

Currently, there is no cure for paralysis, but there is reason to be optimistic. Iorio-Morin points out that seemingly paralyzed muscles often retain some level of function because the neurons controlling them—mainly located in the spinal cord—are largely intact.

The RE-MOVE project, which was recently awarded a $24 million grant from the 2024 competition of the New Frontiers in Research Fund Transformation stream, focuses on user-control and sensation, which the team believes will enable more natural, functional muscle use that can get stronger over time.

Fitting all the pieces of the puzzle together

As the nominated principal investigator on RE-MOVE, Iorio-Morin will lead an interdisciplinary research team, incorporating expertise from across Canada in neuroscience, technology, engineering, ethics and law.

“Each researcher on the team has a specific mandate, a piece of the puzzle, and we’ll put them all together to make it work,” Iorio-Morin says.

Using an approach called “ethics by design,” ethical, technical and regulatory considerations are integrated in RE-MOVE from the start, ensuring that each technological advancement respects users’ rights and well-being.

The team will start by focusing on people who have lost the use of one leg after a stroke. The researchers will attempt to restore the person’s use of the paralyzed leg by giving them a smart glove that can detect finger movement, control the stimulator implanted around the spinal cord, and generate leg movement. The technology would offer somatosensory feedback (sensation in the body) so that the person can sense their limb moving and gradually begin to refine it.

“This is a conversation”

Dorothy Barthélemy, a Université de Montréal professor and SCI researcher, leads patient engagement and inclusivity efforts for RE-MOVE. “There is a lot of enthusiasm for the project,” she says.

RE-MOVE has a people with lived experience (PLEX) advisory committee that meets every one to two months to review, advise and guide the project. Through this close collaboration, the research team has acquired a deeper understanding of how paralysis affects people. As one of the PLEX committee members said, “It is not only about the neurons that are broken; it is about the life that changed.”

Barthélemy says, “This is a conversation. People with lived experience are involved not just at the end, but at the building stage.”

Iorio-Morin adds, “People with lived experience put things in perspective. Maybe we think we want to help them walk. But they tell us, there are things more important to their quality of life than walking. They want to restore their balance, or their bladder control, or sexual function.”

For example, at a recent meeting, the team’s engineers were talking about making sure the surgical incisions would be as small as possible—but members of the advisory committee countered that the size of the incision wasn’t important to them; they just wanted the technology to work.

The finished product

The culmination of the RE-MOVE project will be a human feasibility study to demonstrate movement restoration in 12 participants who have had either a stroke or spinal cord injury, or who have multiple sclerosis.

“We’ll start with that, and then build from there,” Iorio-Morin says.

A more complex, long-term goal Iorio-Morin has is to build a system that reads the intent to move in the brain and transmits it directly, without the use of a device like a glove.

The technology produced by the RE-MOVE team could be game-changing for people with paralysis around the world. The team wants this technology to be accessible and affordable, so it will create open-source software that brings the technologies together in a plug-and-play format. This will allow other scientists to build on their design, leading to accelerated developments, discoveries and solutions for people with paralysis.