The year 2020 has been dominated by COVID and its myriad implications for delivering safe and effective trauma care alongside the changes imposed on our working practices and general way of life. The collective attention of the world’s scientific community and consequently the financial backing to go along with it has been concentrated on developing effective treatments and vaccines to combat the virus. The economic, physical and mental health implications of having a similar or even worse 2021 do not bear thinking about. It is a testament to the human spirit that a number of seemingly effective vaccines have been developed and rolled out in a matter of months.
Whilst not progressing at a similar pace, the world of trauma and injury has continued to see a number of technological innovations that may well shape things for years to come. Not least in the often-neglected world of trauma rehabilitation.
Wearable bionics are playing a growing role in patient rehab and the restoration of independence after debilitating injury. Weight re-distributing exoskeleton devices such as the Paexo Back are finding increasing popularity in the warehousing and distribution industries where back pain and repetitive strain injuries are a leading cause for sickness absence. The EksoNR system is the latest in a line of exoskeleton systems developed by Ekso and has received FDA approval as a powered exercise device for rehabilitative purposes. Initiating movement through body weight shifts and external controls, the device is most useful for patients with mid-thoracic to lower lumbar spinal cord injuries. A clinical trial evaluating its effectiveness commenced at the beginning of the year and is due to report its findings in due course.
Neural interfaces or brain-computer interface devices establish a direct communication pathway between the brain and external devices enabling faster and more intuitive communication and control for individuals with motor disabilities. What differentiates them from traditional assistive devices is that user commands are extracted directly from brain activity without the need for users to exert any overt movement. Motor system neurophysiology studies have shown how the activity of motor cortical neurons are modulated by movement and that firing rates of a population of motor cortical neurons can be used to predict hand movement direction, speed, and position. Motor function can then be elicited via cutaneous electrodes in a process known as functional electrical stimulation (FES). FES devices continue to get more compact and more capable as the years go by and as developments in artificial intelligence continue to bear fruits, with an example being the L100 Go from Ottobock which is a minimalist cuff-based system designed to fit around the leg beneath clothes and treat drop foot.
Peripheral nerve regeneration remains one of the great challenges of rehab and regenerative medicine. Existing treatments include nerve grafting, which has a limited success rate and a number of drawbacks common to any kind of graft or transplant surgery. Electrical signals can offer critical bioactive cues to promote neurite extension and accelerate nerve functional recovery. There were promising results from a Chinese group [HN6] this year who developed a biodegradable, self-electrified, and ultra-miniaturized conduit device for promoting peripheral nerve regeneration, which simultaneously offers structural guidance and sustained electrical cues without additional surgical complications. The device made from a dissolvable galvanic cell was successfully tested on rat models and may well be making its way into humans in the near future.
The year 2021 promises to start off where 2020 finishes. In the midst of a global pandemic, with a large amount of the money, equipment and research attention diverted to COVID. As we begin to get on top of things there will no doubt be more exciting news to emerge from the world of trauma.
Obi Nnajiuba is a British surgical resident with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.
