RICHMOND, Va. (WRIC) — Marine Lance Corporal Joshua Burch is working to become the first Department of Veterans Affairs (VA) patient to regain function in his lower body through a multi-phase study being conducted at the Hunter Holmes McGuire VA Medical Center in Richmond.
Burch’s injury stemmed from a 2015 accident, when he was stationed in Guam. He said that he doesn’t remember exactly what happened, just that he woke up without the ability to use his legs.
Burch had fractured his seventh cervical vertebrae, which plays a vital role in the motor function of a person’s arms and legs. He was then transferred to McGuire’s Polytrauma Rehabilitation Center, where he met Dr. Ashraf Gorgey, the director of Spinal Cord Injury Research.
“Josh was recruited to be a part of a study that primarily looks to use the combination of exoskeleton training with epidural stimulation,” Gorgey said. “It is a study that is funded by the Department of Veterans Affairs, as well as the Department of Defense (DOD), and, eventually, it will be a four-year study that we’re looking for 20 participants.”
Burch was the first.
“We have talked for years, almost decades, about the possibility of a person with a spinal cord injury to restore their ability to stand and walk again,” Gorgey said. “For years, doctors, researchers, specialists, rehab specialists always thought that, ‘Okay, we’re going to do our best. But we know that this will never happen.’ Now, we have a glimmer of light.”
The study, happening in Richmond, begins with 12 weeks of exoskeleton training with a walker. Gorgey said that the wearable machine weighs approximately 50 lbs., its motorized joints minimizing the strain on Burch’s body by providing lift support, weight dispersion, posture correction and other capabilities to help him walk.
“Everyone has their own learning curve,” Gorgey said. “Once the patients attain this process, they move from being able to use a walker to use crutches and become independent in walking. We try our best to break down their assistance.”
It’s a challenge to see what each patient can endure on their own. Gorgey said that patients, like Burch, started with 100% assistance from the exoskeleton, meaning that the machine supported all of the patient’s body weight.
“Josh is a fighter. Josh is really very, very strong and challenging himself first, and he put goals and he tries to work on these goals,” Gorgey said. “He hasn’t missed any visits since we started the program.”
Once the team at McGuire determined Burch’s so-called optimum level, or the lowest amount of assistance he could endure, the study entered the implantation period. Gorgey said that this began with a one-week, temporary implant, which used epidural stimulation to activate special circuits within Burch’s spinal cord.
“The idea of temporary implantation is to see if the patient is a good candidate for the trial or not because the device itself is very expensive, and we want to make sure that the patient responds really well to the implantation before we proceed to permanent implantation,” Gorgey said. “During this period also, we try to map their spinal cord.”
Burch now has a permanent implantation, which Gorgey said was put in using noninvasive surgery.
“We implant a generator and tunnel the leads, the percutaneous leads, in his spinal cord or in his spinal canal, with the idea to have this permanently with him, and then we go back for six months of rehab using the exoskeleton,” Gorgey said.
The idea is to see if paralyzed veterans will be more successful in regaining motor functions with epidural support than they would be without the additional stimulation.
So far, Burch has worked his way down to 55% assistance from the exoskeleton with crutches. But there is much work to be done.
“The hope is to get the muscles activated or stimulated to generate a pattern very similar to standing, stepping, walking — of course, with a lot of what we call task-specific training,” Gorgey said. “We split the training into morning sessions and afternoon session, so we can give the patient some rest in between.”
Burch wheeled himself into the VA Medical Center Monday morning for his first session of the day. The team at the rehabilitation center helped him get into the exoskeleton, and then it was time to stand. Using a walker, Burch pulled himself up to stand, and then switched to crutches to begin his laps around the Spinal Cord Injury Research wing.
Gorgey said that Burch typically walks laps around the wing for an hour in the morning. What’s going through his head that whole time?
“A lot of concentration,” Burch said. “‘Don’t fall over. Left and right.'”
The team at McGuire helps steady Burch as he makes his laps. Gorgey said that the exoskeleton will beep if Burch fails — the machine, taking the step for him, rather than Burch initiating the movement. Monday morning, the only time the exoskeleton beeped was when Gorgey told Burch to stop walking for a moment.
“It takes time and it’s not going to come instantly,” Burch said. “I do want to be the first one to do this within the VA. It’s a huge milestone for everybody — for myself, for the research team, for the world.”
The afternoon session focuses on Burch’s ability to stand, which he said is more mentally challenging than the morning session.
“It’s like 90% me trying to stand on my own with the team assisting me, holding my knees or holding me upright,” Burch said. “With the exo, it’s a lot easier, I guess, because it’s just me balancing myself.”
Researchers at the Hunter Holmes McGuire VA Medical Center are hopeful that epidural stimulators combined with exoskeleton therapy will help paralyzed veterans like Burch recover motor activity and control over their cardiovascular and bladder functions.
“It is still a research study,” Gorgey said. “Our goals are high, and we are hopeful that we can achieve this, and benefit a lot of veterans and civilians.”
The work is grueling. But Burch is determined.
“It’s like starting from scratch at the gym, just bit by bit, building the muscles up again and hopefully, building them up enough to be able to stand on my own,” he said. “The ultimate hopeful end goal is to be able to stand and take steps.”