Dr. Lumy Sawaki cried as she watched one of her patients, who has no motor or sensory function, take a first step.
But it wasn't a normal step. The patient was wearing a helmet and a full-body, robotic exoskeleton — reminiscent of something in a Marvel superhero movie.
Sawaki recalled knowing the paralyzed patient couldn't feel the foot hit the ground, but the patient's eyes lit up and Sawaki considered that step, after months of rehabilitation, a major accomplishment.
Sawaki, an associate professor in the University of Kentucky department of physical medicine and rehabilitation, is also clinical director of the Walk Again Project.
"I am called the crying doctor," Sawaki said, laughing. "It's just so emotional."
The project's doctors, engineers and scientists from around the world have worked for 18 months to demonstrate new brain-computer interface technology that will be used at the 2014 FIFA World Cup Brazil. The project receives funding and support from the Brazilian Innovation Agency and the Edmond and Lily Safra International Institute of Neuroscience of Natal.
On Thursday, a paralyzed spinal cord injury patient will kick the first ball of the World Cup in Sao Paulo using an exoskeleton and brain-computer technology. This will be someone who has absolutely no motor function and can't walk, much less kick a ball.
One of eight trained patients will take 40 seconds of the World Cup to demonstrate the rehabilitation technology.
"We're not going to be able to show science," Sawaki said. "You can't do that in 40 seconds. But we will bring awareness to our work and awareness to the condition."
Sawaki chose eight patients from ages 26 to 38 to train for the demonstration after they completed a rigorous screening process involving physiological tests and physical examinations. All of the patients could walk at some point in their lives but suffered injuries that paralyzed them entirely.
She wanted to work with complete spinal cord injury patients who had absolutely no motor or sensory function.
Whoever she chooses to kick the ball will wear a helmet that takes brain signals and sends them to a small computer on the person's back. The computer translates that signal into a command, sending the command to the exoskeleton. So when the patient tells his or her foot to kick the ball, the robotic leg will move the foot.
Some experts say this technology will change the approach for rehabilitation, specifically for spinal cord injury and brain injury patients. Others think it will replace the wheelchair or other assistive equipment.
Sawaki sees it as a training tool for rehabilitation centers.
Joe Springer, professor and vice chair for research in physical medicine and rehabilitation at UK, said Sawaki is working on a "different ball game altogether" than that of other researchers.
Springer said Sawaki's drive and desire to find ways to better the quality of life for spinal cord injury patients are why he recruited her into UK's program in 2008. Sawaki is from Sao Paulo and has taught at Wake Forest University.
Sawaki "is working to facilitate function in ways other than through drug treatment," he said. "I think if you give people even 10 percent of their function back, it makes a huge impact on their daily lives."
Sawaki has traveled to Brazil consistently for 18 months to train patients and evaluate their progress. She needs to know their legs are conditioned and the patients will be able to stand, regardless of the osteoporoses many of them have. She needs to know they can ask the right commands of the technology, especially under pressure. Sawaki will help select one patient to actually kick the ball Thursday, although all of the patients will be on the field.
Miguel Nicolelis, principal investigator of the Walk Again Project, wrote about the promise of new technology to human disease in Scientific American. Nicolelis said the "development will restore mobility, not only to accident and war victims, but also to patients with ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig's disease), Parkinson's and other disorders" that interrupt everyday motion. Sawaki said Nicolelis is an avid soccer fan and pursued the idea of demonstrating the technology at the World Cup.
Also co-director of the Duke University Center for Neuroengineering, Nicolelis has used nonhuman primates during his many years of research in brain-computer interface, and this project will be his first using human subjects.
"Our decade-long experience with brain-machine interfaces suggests that as soon as the kicker starts interacting with this exoskeleton, the brain will start incorporating this robotic body as a true extension of his or her own body image," Nicolelis said in Scientific American.
While the media and Nicolelis have described a future in which disabled individuals use exoskeletons instead of wheelchairs or other assistance to perform daily functions, Sawaki insists that isn't reasonable.
"There are many people in Kentucky who cannot buy a good wheelchair, much less an exoskeleton," she said.
A wheelchair without insurance typically costs about $500 or $5 to $50 for a copay with insurance.
The replacement of wheelchairs isn't a goal Sawaki is working toward. Instead, she thinks the Walk Again Project will provide hope and the idea that there is a huge investment of research to help mobilize a population of people who can't perform everyday tasks.
Sawaki hopes that institutions such as Cardinal Hill Rehabilitation Hospital, where she is the endowed chair of stroke and spinal cord rehabilitation, will gain the technology to use as a training tool for more than 300 patients. At Cardinal Hill, Sawaki focuses her research on patients with the lowest ability to function. Sawaki said she aims to have an effect on the daily lives of patients who need it the most; to help them regain control of their bladders, hands and wrist movements, and other basic human functions.
For now, Sawaki will spend her time in Brazil, preparing for a 40-second scientific demonstration in front of millions of people watching the World Cup.
"This will be a minute demonstration, but my main goals come after that," Sawaki said. "If we don't continue to work on it and do research, we won't benefit other people with spinal cord injuries."