How a Small Hospital on a Hill Helped Launch a Quest for Neuroprosthetics
For more than 40 years, Hunter Peckham has been working to help patients with spinal cord injuries live more independent, functional lives.
As a doctoral candidate in biomedical engineering at Case Western Reserve University in the 1970s, Hunter Peckham worked in a research lab at Highland View Hospital.
Perched on a pastoral hill in Warrensville Township, the facility specialized in treating and rehabilitating patients with spinal cord injury, neuromuscular disorders, stroke or other chronic illnesses.
“I worked with the spinal cord doctors and the spinal cord patients from day one,” says Peckham, founder of the Cleveland FES Center, co-director of the MetroHealth Rehabilitation Institute and professor in the department of biomedical engineering at Case Western Reserve University. “That interdisciplinary training was part of our DNA.”
Opened in 1953 and known for its innovative physicians and treatments, Highland View helped spinal cord injury patients achieve greater independence and functionality. Peckham collaborated with Dr. Alvin A. Freehafer, a pioneer in tendon transfer surgery that restored partial function to paralyzed hands and arms.
The duo made a good team — at times working side by side in the operating room. Peckham’s research to map muscle properties enabled Freehafer to become more precise in his work and produce better results.
Eventually though, Peckham and Michael W. Keith, M.D., recognized the limitations of tendon transfer surgery and began experimenting with neural prostheses — tiny, implantable devices that use electrical impulses to stimulate motor nerves in paralyzed areas. “We each had a lot of common interests,” says Peckham. “We could each contribute something to a program to create better outcomes.”
As this spinal cord injury research in the upper and lower extremities began to gain momentum, attract more researchers and coalesce around Case Western Reserve, there became a need for a shared space, improved laboratory facilities and consolidated leadership. So, in 1991, Peckham helped establish the Cleveland Functional Electrical Stimulation Center, a research collaboration that consisted of Case Western Reserve, the Cleveland VA Medical Center and the MetroHealth System.
“If you’re going to do something important,” says Peckham, “you have to be able to build partnerships.”
Cool Runnings: At Highland View, Peckham’s lab was one of the only rooms with air conditioning. It became a gathering place for doctors, researchers, patients and their families. “You became very impassioned about their needs,” Peckham recalls. “You could see 100 ways their independence, quality of life and all sorts of things could be improved through technology.”
Lasting Relationship: The first functional electrical stimulation systems for motor control were fully external and placed on the surface of the skin. But by 1986, Peckham’s work had advanced to an eight-electrode device implanted through the skin and connected to an external stimulator. Jim Jatich, a Firestone engineer who had suffered a cervical-level spinal injury diving into a pool almost a decade earlier, became the initial subject. “He used it for 27 years,” says Peckham. Jatich worked with Peckham to enhance and further develop FES systems until he passed away in 2013. “You become pretty close.”
Kindred Spirits: In his late 20s while working at Highland View, Peckham saw himself in many of the patients. “Did you drive that car too fast? Did you dive into that shallow pool? Did you get on that motorcycle?” Peckham asks. “Maybe it was crazy, but maybe you were just as crazy as they were.”
The Big Bang: Along with Elliot Krames and Ali Rezai, Peckham edited Neuromodulation, the first comprehensive textbook on the subject, which covered fundamental principles and therapies applied to the brain, spinal cord and more. Published in 2009, the two-volume set had 91 chapters and more than 1,000 pages. “In 2018, we allowed ourselves to be sucked into doing a second edition,” Peckham laughs. By then, the field had exploded, and the book grew to three volumes and more than 1,800 pages. “There’s so much growth in that period. It’s hard to say what the greatest advances have been.”
Into the Wild: Peckham recalls meeting a man on a California street who was using one of the FES systems he helped develop. Without saying who he was, Peckham asked about it. The man explained what it was, how it worked and what it allowed him to do. “He said, “Oh, did I tell you I can drive now?’” Peckham recalls. “So the impact is broad.”
High Hurdles: And yet, Peckham understands the significant obstacles to bringing some of these technologies out of the lab and into the market. In the 1990s, he was one of the founders of NeuroControl Corp., which raised $30 million in startup funding and had two Food & Drug Administration-approved functional electrical stimulation products for spinal cord patients. But the Valley View-based company eventually failed. “It was an incredible clinical impact,” he says. “But the sales impact wasn’t enough to turn the corner on the business proposition.”
Commercial Vehicles: Peckham founded the nonprofit Institute for Functional Restoration at Case Western Reserve in order to bridge the gap from clinical trial to commercialization. Because the market is relatively small for spinal cord injuries (approximately 288,000 people in the U.S.), the devices must be pushed farther along the development pipeline by driving down manufacturing costs and improving quality. Yet with federal research grants focused primarily on innovation, the institute hopes to tap private philanthropy. “We’re focusing on incubating the business aspects to get this technology out to these orphan populations,” says Peckham.
Three G: Now in its third generation, the networked neuroprosthesis Peckham developed acts like a networked computer inside the body, sending electrical pulses to activate individual muscles and restore function. The Institute for Functional Restoration expects to launch a pivotal clinical trial targeting hand function in 2020 that would expand to include participants at additional sites before seeking FDA approval. “Fundamentally, what you want to achieve is the same for everyone — you want to achieve functional movement,” says Peckham. “The trick is to conceptualize that technology so it meets the variability between subjects in what muscles you stimulate and how hard you have to stimulate them to get essentially the same movement.”
