Cleveland FES Center Expands its Focus to Novel Forms of Neuromodulation

by Jennifer French, senior editor

October 2017 issue

When this publication first profiled the Cleveland FES Center more than 10 years ago, the center was unique for its collaborations and unquestionably a premier research institution in neuroprosthetics. Today, the center still thrives on collaboration but has expanded and diversified its role in the neurotechnology field.

During the recent “State of the FES Center 2017” talk, executive director Robert Kirsch stressed that success is based on enabling trans-disciplinary collaborations. Case Western Reserve University, MetroHealth Medical Center, University Hospitals, Cleveland Clinic, and the Louis Stokes Cleveland VA Medical Center partner to develop the technology that holds the institutions together. Notably, Kirsch highlighted the renewal of five years of funding from the U.S. Department of Veterans Affairs’ Rehabilitation Research and Development Service to support the Center of Excellence.

Total funding for the FES Center jumped to $23 million in 2016-17, up from $18 million the prior year. The bulk of that funding is from the NIH, followed by support from the VA and foundations and industry. Industrial partnerships, overseen by Andrew Cornell, are a significant pathway forward. “The focus of the FES Center has always been to provide function. In order to do so, we need industrial partners,” he said. With vendors such as Cirtec Medical, Synapse Biomedical, Bal Seal, and Ardiem Medical, these relationships are viewed as the way for the center to make “societal impact.” In the spectrum of medical device development, the “sweet spot” for the FES Center is concept to first in human. Later stages of translation to larger clinical trials, standard of care, and clinical practice are transferred to existing companies, start-ups, or the new Institute for Functional Restoration.

The FES Center employs 66 investigators with specific expertise in modeling, technical development, surgical techniques, and regulatory consulting. Research centers around four areas: movement restoration, pain mitigation, brain health, and autonomic systems. Movement restoration has been the mainstay of the center since its inception. New technologies are helping restore meaningful function and integrating with modern control systems. In 2016, investigators implanted a networked neuroprosthetic system. This fully implanted system enables multiple functions within one system. Earlier this year, the center demonstrated the first system to combine implanted FES-based arm and hand function with an intracortical BCI, allowing a person with severe paralysis to use his hand by thought. An FES-evoked cough system for those with weak pulmonary function can also be integrated with diaphragm pacing, merging both independent breathing and cough in one system.

A recent diversification is the brain health program. The program is focused on the development of novel technologies to tap into brain plasticity. Over the last five years, the center expanded research into autonomic physiology. Modulating the autonomic nervous system has the potential to address hypertension, gastric function, migraine, autonomic dysreflexia, and bowel and bladder disorders. Dennis Bourbeau is leading the effort to develop a noninvasive genital nerve stimulation approach to improve urinary continence and bowel motility.

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