Top Doctors 2013

Rejoining Brains to Limbs with Robot Rehab

Dr. Gerard Francisco sees robotic rehabilitation as a way to make a rough road to recovery smoother.

By Peter Holley September 3, 2013 Published in the September 2013 issue of Houstonia Magazine

Dr. Gerard Francisco

One day, Dr. Gerard Francisco was reading a medical journal when he came across a study involving a monkey trained to use his thoughts to make a robot move, which wouldn’t have been so impressive had the robot not been in Japan and the monkey in Brazil. Researchers accomplished the feat by implanting electrodes in those parts of the monkey’s brain that send impulses when it decides to move, and transferred the target of those impulses to the robot.

For Francisco, this was more than an idle demonstration. As the chief medical officer of TIRR Memorial Hermann, and chairman of physical medicine and rehabilitation at UT Health, he had seen more than his fair share of patients severely impaired by post-stroke paralysis. Which is to say brains and limbs so out of touch they might as well have been on different continents.   

“I was always curious,” says Francisco, reflecting on the monkey study.  “Can we do that? Implant electrodes into someone’s brain and then connect those electrodes to a robot who would help them move and rehabilitate?” 

The answer to that question may well come courtesy of a $1.7 million grant from the National Institutes of Health (NIH) and a multidisciplinary team that includes a robotics expert from Rice University; a computer engineer from the University of Houston; dozens of graduate student guinea pigs; and Francisco. (Aside to graduate students: participants will not have holes drilled into their heads; researchers will use non-invasive brain stimulation.) 

As of now, Francisco still refers to robotics as a “hobby”; it’s for his clinical work in the fields of brain injury and stroke rehab that the 48-year-old Manila native is mainly known. But the goal is to marry the two, “to include more technology in rehabilitation, to use robots and machines and similar technology to really enhance what we’re doing on the clinical side. Houston is the perfect place to do this.”

In the meantime, Francisco will have to settle for being one of the nation’s leading physicians in his field, and enjoy the occasional stint in the spotlight afforded thereby. When congresswoman Gabrielle Giffords came to Houston for treatment after the assassination attempt on her life in 2011, Francisco was her primary caretaker. He also assumed the role of the even-keeled clinician, never failing to temper the media’s unreasonable expectations for a speedy recovery.

“Somebody has to ground you,” he says, explaining that incremental goals are crucial if a patient undergoing brain rehabilitation is to stay positive. “Ironically, I’m the one who is pulling for my patient’s recovery, but I am also the one who is pushing on the brakes.”

Calling a recovery process “rehabilitation” implies that a person can be all that he was pre-injury, a complete restoration of self. And yet, as Francisco explains to his patients and their families, having a traumatic brain injury means never fully recovering from it. His aim is to help patients achieve a “new normal,” and since even that can take years, Francisco often tells them he will be with them forever, that theirs is an arranged medical marriage brokered by freak accidents, gunshots, and car wrecks. Some patients have been coming to see him since he first arrived in 1977.

“I always tell my patients there’s no such thing as a smooth recovery. The road to recovery is bumpy.”

In technology Francisco sees the potential to make that road smoother, improving the lives of the injured in ways that conventional rehab can’t. Next month, he’ll oversee the opening of the TIRR Memorial Hermann Research Institute, a research center devoted to brain and spinal cord injuries, disabilities, and robotics. For Francisco, it’s appropriate that the institute and the adjacent hospital will be linked by a bridge.

 “To me that is more than a physical connection,” he says. “It’s a symbolic connection. We want to send the message that research and clinical operations are not exclusive of each other. Our research center focuses on what we can do better to help our patients recover even more.” 

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