Engineering medical miracles: Ephrem Takele Zewdie helps patients upgrade their own spines to regain the ability to walk

Ephrem Takele Zewdie is nothing short of amazing. Still only 25 years old, Zewdie is fundamentally transforming people’s lives by performing electro-medical miracles. And yet he’s so humble and down-to-earth that he chats about his results with the casualness most people would reserve for discussing how they mowed the lawn.

Zewdie’s a doctoral student in Biomedical Engineering at the University of Alberta. And six years after arriving in Edmonton by way of Hong Kong and Ethiopia, he’s devoted himself to helping people overcome incomplete spinal cord breaks. When asked if he might, one day, help someone walk again, he responds calmly, “Actually, we’ve already helped a couple of people walk again. No, wait… three people.” 

The social cost of spinal cord injuries 

According to a study from the Rick Hansen Institute, about 4200 Canadians experience spinal cord injuries each year—about 42 per cent of which result from car accidents—and currently more than 85,000 Canadians live with the results. Aside from resulting psychological and family trauma, those injuries also cost the Canadian economy around $3.6 billion annually, about half that in direct medical costs.

Some people experience only partial severing of their spinal cords; their mobility loss in limbs and trunk can vary widely from loss of dexterity to loss of the ability to walk. Following post-injury spinal operations, patients may have to wait up to eight weeks to know their fate, because medical tests and surgery can leave tissues swollen or filled with fluid, thus disguising the full extent or even causes of their injuries. For many patients, the long wait is agonising. 

Victory by nervous system plasticity 

But if Zewdie and his colleagues at the U of A’s Biomedical Engineering Department continue to succeed in their work, one day millions of people around the world could regain their mobility. And that’s because, contrary to common belief, the brain doesn’t lose its plasticity, or self-upgrading capacity, after infancy.

“Sometimes we underestimate the plasticity of our brain systems,” says Zewdie. “Even if we are adults, we can manipulate the brain and make it reconnect with some of the disconnected parts.” The implication for improvement in quality of life for the injured and their families is enormous. “Some people,” he says, “increased their function in walking, so their independence increased. When they want to go to the washroom, they don’t need that much help anymore.” 

The re-training and the technology 

Researchers and developers at other institutions are developing their own solutions to paralysis, some of which are as dramatic as the use of spinal electrode implants, or even exo-skeletons: high-powered body-shells or suits that move people’s limbs or bodies according to brain, facial, or hand signals. Zewdie’s approach, while less far exotic, is highly effective.

“We use intensive precision training in which you are supposed to step at different targets,” he explains. “That means you are engaging your motor cortex, [which is] ordering your muscle to contract so that your foot will step on those specific targets [using] those spared connections.” Patients working with Zewdie also engage endurance training which strengthens the nerve connections via two or three hundred steps per session. Many also receive electrical stimulation to restore sensation signals from foot to brain, a process that increases plasticity by growing new lines from the spared nerve connections.

That electrical stimulation comes from a device that looks like something from the original Star Trek or perhaps from the Douglas Trumbull film Brainstorm, and it’s got a name to match: the Transcranial Magnetic Stimulator. It’s a machine that uses a rapidly changing magnetic field to channel, almost painlessly, weak electrical currents through the brain that stimulate muscle action. The TMS also allows mapping of the cerebral cortex and its connections. 

“When we target a specific brain part and record signals at the muscles of the foot,” says Zewdie, “we see increase in the [nerve] signal after training, indicating there are more spared connections getting stronger, and more connections are being made.” 

Changed lives 

The benefits for the patients in Zewdie’s programme aren’t merely theoretical. So far, fourteen people have enrolled, and all of them have improved in the eight-month span of the regimen (which includes two two-month breaks). But patients demonstrate improvements in as little as two months.

“The best example we have, is a patient who came with a wheelchair, and at the end of the programme was walking with a cane to home.” He adds, matter-of-factly, “His family was crying.”

But Zewdie’s team doesn’t merely say goodbye to its “graduates.” Instead, they offer a range of support, including by connecting them with rehabilitation centres, or in some cases purchasing them treadmills so they can perform their prescribed exercises at home. Zewdie predicts that, following refinements of the team’s methods and clinical trials, their approach could be available for the general public within five years. 

A sense of meaning 

Since he was a child, Zewdie was fascinated by both engineering and medicine, and as he grew older he sought an education that could combine the two fields. Following high school in Hong Kong and a full scholarship to study in the Electrical Engineering Department of the U of A, he enrolled in Biomedical Engineering. He also found a way to employ his dual field towards building social justice and transforming personal lives.

“I’m always concerned about disabled people,” he says. “Engineers and scientists spend too much time on helping able-bodied people make the laptop more flat…. Disabled people are always ignored. If scientists or engineers spent more time solving disabled people’s problems, more people would be able¸ rather than making able people more able.” While volunteering at the lab during the third year of his undergraduate degree, Zewdie realised, he says, that such work gave “more meaning not only to my career but also to my life.” 

A personal experience 

Last summer, Zewdie had the chance to deploy his knowledge in a particularly personal context, when during a trip home to Ethiopia, he found his grandmother suffering from a minor stroke. But because she wasn’t receiving rehabilitation, she was continuing to lose function.

“After I went there,” he says, “just doing some rehabilitation techniques using some tools that you can find at home—starting from small plastic cups, just piling them up and taking them down—that really improved her functions, and [after] she was pretty much normal.” 

While some people may assume that Original World countries have insufficient technology to solve complex medical problems, Zewdie argues that the solution is often already at hand. “Sometimes you need to take the technique and use the technology that’s [already] there…. African people are always very creative. It might not be from capacitors or electrons, but they’ll create some device that will help them do rehabilitation.”