“I stood up like a normal person for the first time in 18 years. I went home and I just cried.” —Amanda Boxtel. Photo courtesy Ekso Bionics.

On February 27, 1992, 24-year-old Amanda Boxtel took a freak somersault on a downhill ski slope—and as she did, life as she knew it went somersaulting out of her control. A jolt of electric current passed through her legs, and then she realized she could no longer feel them at all. At the hospital her fears were confirmed. She had four shattered vertebrae and a bruised spinal cord and she was paralyzed from the hips down. She assumed she’d be confined to a wheelchair for the rest of her life.

For many years Boxtel, now 44 and living in Basalt, a quaint mountain community near Aspen, Colorado, worked to make the best of her wheelchair-bound existence. She learned to ski again, this time sitting down, and became a ski instructor for people with disabilities. She helped start an organization called Challenge Aspen, which helps disabled athletes participate in sports despite their physical limitations. But she kept hoping, against all odds, that she would walk again.

In July 2010 Boxtel got a phone call from a man who introduced himself as Eythor Bender. He was the CEO of a start-up company called Ekso Bionics, and he explained that his company was developing a metal exoskeleton designed to allow wheelchair users to stand and walk on their own. The device contained four motors and more than a dozen sensors that replicated a natural human gait, and it was particularly well-suited to people with lower limb paralysis. After hearing about Boxtel’s work as a speaker and wheelchair athlete, Bender had decided that he wanted her to be one of the first to test his exoskeleton.

Boxtel took Bender up on his offer, and a week later she was on her way to Ekso headquarters to try out the device. She squared the battery backpack on her shoulders and had the black brace supports strapped onto her legs; what happened next surpassed her wildest expectations. “I stood up like a normal person for the first time in 18 years. Then I took my first steps. I walked with a bent knee, step after step. I felt as if I had springs in my ankles,” remembers Boxtel, who now works for Ekso and demonstrates the exoskeleton to potential users. “I went home and I just cried because it was overwhelming. It was what I had dreamed about.”

Poised to become available for home use by late 2013, the robotic exoskeleton should help thousands of people like Boxtel take their first post-injury steps. But the device isn’t an island unto itself; it’s part of a fast-growing landscape of innovations that promise to make life easier and more fulfilling for paralyzed patients. Not content to simply work around the problem with assistive devices such as exoskeletons, researchers are hot on the trail of actually treating paralysis using brain-machine interface devices. These tools would be able to read brain waves and turn them into controllable arm or leg motions—in effect, translating intent directly into movement. Implantable electrodes would activate muscles when neural connections between limbs and the spinal cord have been severed. Such treatments are not yet within reach, but for the 5.6 million Americans living with paralysis—including 1.3 million with spinal cord injuries—any steps scientists make toward restoring freedom of movement are milestones to be celebrated.

At neuroscientist Chet Moritz’s lab in the University of Washington’s Center for Sensorimotor Neural Engineering, the quest to restore missing connections between the brain and body is underway in a room the size of a walk-in closet bathed entirely in red light. Lining the walls are several rows of clear cages containing rats that have incomplete spinal cord injuries, the most common type seen in human patients. Each animal is wearing a lozenge-sized beanie, a connector attached to electrodes implanted in the brain or spinal cord. Some of these electrodes record signals from the rats’ brains, Moritz explains, and other electrodes run under the skin to enter a part of the spinal cord that controls movement of the upper limbs.

Neuroscientist Chet Moritz: “The goal is to take brain activation and relay it to the spinal cord below the injury.” Photo by Randi Blaisdel.

Moritz’s ultimate goal is to develop a system that will pick up electrical impulses that arise in the brain when a paralyzed person thinks about performing a movement, route them through a small computer, and send electrical stimulation to the body to generate the movement itself. Scientists working on these so-called brain-machine interfaces have demonstrated that brain activity can be harnessed to control computer cursors or robotic arms, and Moritz and other researchers have recently used brain impulses to control artificial stimulation of paralyzed muscles in the arms or legs. One problem with stimulating muscles directly, however, is that movements initiated this way tend to be jerky because artificial electrical stimulation activates the muscles more quickly and abruptly than the brain naturally would. “If you’re trying to pick up a flexible cup, you might crush it,” Moritz says.

To circumvent this issue Moritz and his colleagues are experimenting with sending electrical signals directly to the spinal cord instead of the muscles. His work and that of other scientists demonstrates that when a spinal cord is stimulated electrically, it sends instructions to the limbs to perform complex acts like reaching or grabbing. Although connections between the brain and the spinal cord are damaged after injury, Moritz thinks this technique may help restore some hand and arm function.

His experiments have begun to support this theory: Partially paralyzed rats whose spinal cords are being stimulated are better at grabbing food pellets with their impaired limbs than rats that are not receiving the stimulation. I watch, transfixed, as a lab-coated technician lifts a food pellet with tweezers and places it in front of one of the beanie-clad rats. Although the pellet is on the other side of a small opening in a clear glass panel, the rat easily reaches through to grab it.

Moritz’s team has already demonstrated that by electrically stimulating a single site in an uninjured monkey’s spinal cord, he can coax the monkey to make a pinch-grip movement. He hopes activity from humans’ brains can be sent via a small computer to trigger electrical stimulation of the spinal cord so that paralyzed people will someday be able to grab a cup or turn a doorknob effortlessly. “The goal is to take brain activation and relay it to the spinal cord below the injury.”

Other scientists around the country, including electrical engineer Euisik Yoon at the University of Michigan, are also working on promising brain-machine interface devices. Yoon’s BioBolt, about the size of a penny, sits on top of the brain and contains microcircuits that record neuronal activity and transmit it wirelessly to an external computer. Such a computer could then send out electrical signals to reactivate paralyzed limbs—or potentially to do things like display words on a computer screen for patients whose paralysis impairs their ability to speak. “Brain-machine interfaces have the potential to restore communication, movement, and sensation,” Moritz says. “For paralyzed individuals, this could allow them to once again interact with their outside world.”

Hundreds of miles away at the California Institute of Technology, mechanical engineer Joel Burdick shares Moritz’s belief that sending electrical stimulation to selected sites on the spinal cord may be the ideal way to help paralyzed patients make controlled limb movements. After a spinal cord injury, Burdick says, the connection between the spinal cord and the brain may be severed, but “the [spinal cord] circuitry’s all down there, and it doesn’t degenerate.”

Although Moritz’s work is still largely in the theoretical stages, Burdick and his collaborators V. Reggie Edgerton, Yury Gerasimenko, and Susan Harkema have gotten government approval to test their theories on a small group of paralyzed human patients. Burdick’s system bypasses the complications of implanting electrodes in the brain by stimulating the spinal cord directly, reawakening connections between the spinal cord and the lower limbs. When you walk, Burdick explains, there’s a special circuitry in your lower spinal cord that helps to control your strides, and his electrical-stimulation system takes advantage of this natural circuitry. To install the system the team implants an array of electrodes next to the dura, the thick protective sheath that surrounds the spinal cord. “We pop off half of a vertebra and insert the electrodes. Then the neurosurgeons put sutures in place and we close everything up,” Burdick says.

After the electrodes—16 of them, each in a different location—are placed, a computer can send currents through the attached wires to the spinal cord, adjusting the voltage or the frequency of the electrical stimulation to restore the missing signals that move the legs. “We get the circuits down there excited again,” Burdick says. “What happens is [the circuits] get the input and they already know how to compute the muscle movements, so they apply those movements.” This shortcut approach works because certain basic movements such as stepping are controlled primarily by the spinal cord not the brain.

The first patient to test Burdick’s system was Rob Summers, a 20-something former pitcher for Oregon State’s baseball team who was paralyzed from the chest down in a 2006 hit-and-run accident. Near the end of 2009 surgeons implanted electrodes into Summers’ spinal cord, which are attached to a wire that runs down to a device on his hip containing the electrical stimulation hardware. After weeks of intensive physical training, Summers is now able to stay standing for about 20 minutes at a time and can make stepping movements on a treadmill while his spinal cord is being stimulated. (He still can’t make voluntary movements after the stimulation stops.)

Paralyzed in a hit-and-run accident, Rob Summers is now able to stand and voluntarily move his toes, ankles, knees, and hips on command with the aid of electrical stimulation. Photo Courtesy Rob Summers.

The first time Summers was able to wiggle his toes, Burdick remembers, was a red-letter day. Summers was joking around with Claudia Angeli, one of his doctors, during a procedure where she was measuring his muscle activity with sensors. “He said, ‘Let me see if I can move my toe,’ and he did. She just about dropped on the floor.”

But Burdick and his colleagues see Summers’ remarkable improvements as just a preliminary step. Burdick describes his current system as a “crude hammer” because the electrodes excite whole groups of spinal cord neurons at a time. The team plans to take a more targeted approach in the future, stimulating neurons more precisely to produce more distinct kinds of movement. In addition, Burdick thinks spinal cord stimulation may prove a key adjunct to biological therapies still in the works such as stem cell infusions and tissue transplants. Even if these approaches come to fruition, he says, “it’s naïve to think people are going to get up and walk away. You’re going to have to retrain the spinal cord anyway.”

Before invasive technologies such as brain-machine interfaces and customized spinal cord stimulation arrays can become widely available, however, they will have to prove their mettle in long-term clinical trials involving large numbers of patients—trials that will likely cost millions of dollars. So, although these targeted-stimulation systems offer perhaps the best hope for paralyzed people to regain their former mobility, potential users may have to wait years—possibly decades—to reap their benefits.

The advantage of an exoskeleton, by contrast, is that it’s nearly ready for widespread rollout. Ekso plans to complete trials at rehabilitation centers nationwide and have the device ready for home use by the end of 2013. Even though the exoskeleton doesn’t allow paralyzed patients to move their limbs with the same degree of fine motor control brain-machine interfaces aim to provide, it does give them freedom of movement most haven’t enjoyed since their pre-injury days. In a round of testing last fall at the Kessler Institute in West Orange, New Jersey, six patients with spinal cord injuries of varying severity were able to use the device to walk using walkers or canes to stay balanced.

One tester, Mike Rhode, had resigned himself to life in a wheelchair after a 2010 skiing accident left him with paralyzed arms and legs, but Kessler staff told him the exoskeleton might let him stand up and move on his own. “They said, ‘You’re going to lean forward like you’re getting up out of a chair, and the unit will assist you in standing up,’” he says, recalling the first day he got to use the device. “One, two, three—I pushed up. It was an unbelievable feeling. After I was up walking for an hour, I had this euphoric tingling feeling in my body for a few days.”

Boxtel, too, says the exoskeleton’s benefits go beyond helping her get from one place to another. When she’s in a standing position, she says, “I’m no longer prone to edema—my ankles are no longer cankles—and my bladder works more efficiently.” And although the device might seem a little clunky at first, Boxtel says the exoskeleton feels natural now; she thinks it’s the next best thing to being restored to a physically able state. “The robot encases my frame like an outer shell. The metal is like my bone structure, and the motor is like my muscles.” While scientists continue to work at reviving dormant connections between the brain, spinal cord, and muscles, this bionic pinch-hitter is allowing paralyzed people to take huge steps forward.

“Watch Me Walk” The Saturday Evening Post

Although the qualities that make a great innovator can’t be measured by standardized tests, they’re exemplified in the life stories of the foremost innovators in this country—inventors, composers, policymakers, and others who have beaten the odds to break new ground. The innovators we profile here hail from a wide variety of fields, but they have a few key attributes in common: a burning curiosity about the world; an unusual willingness to implement new concepts and ideas; and an unrelenting work ethic that enables them to turn mistakes into successes.

David Baker

David Baker knows a little something about thinking outside the box. As a high school student, he fell so deeply in love with music that he resolved to learn how to play the sousaphone, even though his school music department didn’t own one. “I took a cigar box, made holes in the top, put some springs and pieces of wood inside, and used that to learn the fingering for the tuba,” says Baker, now chair of the jazz department at Indiana University’s Jacobs School of Music. “When the sousaphone finally became available, my band teacher, Russell Brown, was enamored that I was so serious about it.” Still, Baker remembers butting heads with Brown from time to time. “We were playing ‘Begin the Beguine,’ and I tried to play a boogie-woogie line. Mr. Brown said, ‘That’s not the way the line goes.’ I played the line again, and he was really getting angry. He said, ‘Boy, I don’t understand you. You run into a wall, and your solution is to run faster and hit harder.’ ”

Those early philosophies—pursue improvement at all costs and refuse to concede to an obstacle—would come to define Baker’s career as a musical innovator. An up-and-coming trombonist as a young man, he dreamed of achieving fame as a performer until a jaw injury sustained in an auto accident left him unable to play the instrument. “I thought it was the calamity of all calamities,” Baker says. But he now views this tragedy as a triumph: It forced him to find other ways to be creative, to give birth to the images in his mind. Following the injury, he learned to play a variety of other instruments and began experimenting with writing his own music. “If that [injury] hadn’t happened,” he says, “I wouldn’t have become a composer. No way.”

Baker’s professional reorientation jump-started a wild ride through the world of music, one that hasn’t yet come to a halt. In addition to writing scores for the New York Philharmonic and the St. Paul Chamber Orchestra, Baker directs the Smithsonian Jazz Masterworks

Orchestra and has won an Emmy Award. Part of his success comes from his willingness to entertain ideas that others may think are a little nutty. In his “Concertino for Cell Phones and Orchestra,” for instance, he incorporated ringtones into the score to harmonize with the orchestra, transforming orchestra-goers’ ultimate annoyance—a ringing cell phone—into an integral part of the music.

Although Baker’s original premieres have made a splash on many stages worldwide, he considers himself a teacher first and foremost. Interacting with students feeds his musical innovation, he says, because they encourage him to keep seeking out new ideas and new approaches. “To find something original, you take what you are and expand it to include all the new things that you know,” he says. “When I teach, I’m forever having to solve new problems. I’m so thrilled to be around young ideas.”

Peter Pronovost, M.D.

Dr. Peter Pronovost. Photo © Chris Hartlove.

Dr. Peter Pronovost has long been haunted by the story of a little girl named Josie King, who died at Johns Hopkins Hospital in 2001 from dehydration and an overdose of pain medicine. After Josie’s death, Pronovost, a professor at the Johns Hopkins University School of Medicine, worked with her mother, Sorrel, to implement better safety programs at the hospital. “At one point,” recalls Pronovost, “she said, ‘Peter, can you tell me that Josie would be less likely to die today than she was four years ago? I want to know if care is safer.’ ”

Josie’s mother’s words have stayed with Pronovost, he says, because he believes all the well-meaning safety programs in the world mean nothing if they don’t make a measurable impact.

“The tragedy that befell Josie King had a devastating effect on our institution and was, and still is, a reminder of how
important patient safety and quality work is for Johns Hopkins and for every hospital in the world,” says Dr. Pronovost.

This keen focus on practicality, on quantifying and achieving results, has been the hallmark of Pronovost’s career. Determined to save patient lives that were being needlessly lost because of negligence and human error, he devised a concrete series of safety checklists for doctors and nurses to follow. To prevent a common cause of illness—bloodstream infections related to catheters inserted into a blood vessel with a direct line to the heart—doctors had to:

Wash hands using soap or alcohol prior to placing the catheter.

The system was simple enough, but to implement it, Pronovost had to upend some of the prevailing tenets of health care culture. “I said, ‘Nurses, I want you to supervise the doctors to make sure they’re using the checklist.’ You would have thought it was World War III. The doctors said, ‘There’s no way you can have a nurse second-guess me in public.’ ” In hopes of forging a consensus, Pronovost brainstormed a way to appeal to the doctors’ and nurses’ shared interests. “I pulled everyone together and I said, ‘Is it tenable that we can harm patients in health care?’ They said, ‘No.’ I said to the doctors, ‘Unless it’s an emergency, the nurse is going to correct you.’ When it was framed that way, as a common goal, the conflict just melted away.” Pronovost’s unifying efforts paid off. When Michigan hospitals put his checklists in place, central line infection rates plummeted nearly 66 percent, saving about $175 million in health care costs. Other doctors and hospitals began following Pronovost’s example, and in 2008, he was named to Time magazine’s list of the 100 most influential people in the world.

As impressive as his accolades are, Pronovost has never lost sight of the importance of getting other people on board to create a lasting transformation—a policy he’s put into practice in his own family as well. “I went to my kids and said, ‘How am I doing as a dad? What could I do better?’ ” he says. “Their insights were spot-on. My son said, ‘Dad, get on my level. Just put your BlackBerry away and play with me.’ ”

Dean Kamen

Dean Kamen. Photo © 2007 Nathaniel Wlech/Redux.

Dean Kamen may be best known as the inventor of the Segway—the two-wheeled human transporter—but he’s far from a one-hit wonder in the world of innovation. The New Hampshire entrepreneur has amassed a formidable oeuvre of technological advances, from an all-terrain electric wheelchair to a water purification system for Third World villages that runs on a Stirling engine. But Kamen doesn’t invent just for the sake of creating new things. All of his ventures spring from his desire to make people’s lives better in a concrete way. “In order for an invention to become an innovation,” he says, “you have to have such a compelling story that people are willing to say, ‘Yesterday, this is what I did and how I did it, but this represents such a big improvement that I am willing to change.’ ”

Kamen’s obsession with change and innovation came gradually. He wasn’t a tinkerer as a child, but he did have one standout trait: an insatiable curiosity about the natural world. “I asked myself things like, ‘Why does hot chocolate cool off if you don’t drink it quickly?’ There were so many things that seemed so predictable and yet so inexplicable, and I wondered how all of this happened.”

Once Kamen realized that inventing new products involved understanding these laws of nature and applying them through engineering, he was off and running. He derived special pleasure in finding unexpected uses for existing technology. When his older brother was in medical school and designing drugs to help babies with leukemia, Kamen realized available drug delivery systems were too large and began devising a solution. “I went down to the basement and built him the equipment he needed: tiny pumps that would deliver a very small amount of drug,” he remembers. “Then one of the professors my brother was dealing with said, ‘That little pump is so small you could put it on your belt or put it in your pocket.’ ” Inspired, Kamen used the mini-pump technology he’d developed to create the first portable insulin pump—now used by diabetics around the world.

Aspiring innovators, Kamen believes, would do well to adopt this kind of flexible mind-set. It’s important for ambitious creators to get comfortable with end-arounds, unexpected eurekas, and periodic failures, he says, because the ride is bound to be a bumpy one. To that end, Kamen founded FIRST, a high school robotics competition designed to give students a firsthand taste of what the innovation process is like. “I think the public has this perception that inventors run around with great ideas, get the parts, and make the product. But the process of inventing couldn’t be further from that—it’s not a linear, straightforward process. You have to be willing to adapt your ideas quickly, no matter how passionate you are about them, and just keep chipping away.”

Esther Takeuchi

Esther TakeuchiPhoto © Doug Levere/University of Buffalo

From an early age, Esther Takeuchi liked to get into just about everything—whether that meant peeling apart golf balls or exploring inside the walls. “My father was an electrical engineer, and I would follow him around the house,” she remembers. “Whatever he did, I would do.”

Takeuchi, now an engineer at the State University of New York at Buffalo, has parlayed her penchant for figuring out how things work into a wildly successful career. She holds over 120 patents—more than any other woman alive—and has received multiple regional Inventor of the Year awards. While working at the technology company Greatbatch, she developed the Lilliputian battery that powers implantable cardiac defibrillators, a scientific leap forward that has improved the lives of thousands of patients.

Perfecting her most famous invention, Takeuchi says, proved a long, slow slog. “The battery didn’t leap forward fully formed—a lot of steps led to the development and improvement of the technology.” She doesn’t discount the importance of split-second inspiration, but emphasizes that innovators need to lay an extensive groundwork of knowledge to pave the way for that eureka moment. “What was important was spending time thinking about the problem and reading about it. Sometimes I would set the problem aside, and at the strangest moment it would occur to me, ‘Hey, we could do it this way.’ But being diligent in exploring the problem—that part is a disciplined process.”

After a successful career in the industry, Takeuchi returned to academia in 2007 for two reasons: to pursue more freewheeling research on ways to improve battery performance and to help equip the next generation of innovators in a time of increasing global competitiveness. “The United States is just an unbelievable country—there’s such a tradition of innovation and great thought. But I do have concerns about how the United States is going to remain competitive, and I thought, ‘Well, maybe I can contribute to that.’ ”

Although Takeuchi believes inspiring teachers can help spur youthful creativity, she also thinks the government needs to pitch in by delivering sustained funding for science to help the country shift its focus toward innovation. “We have bright, diligent, motivated young people, but what fields are they
attracted to? We need to value, as a society, the contributions that scientists, engineers, and technical educators make.”

Van Jones

Van Jones. Photo courtesy Richard Hume/Experience Life Magazine.

Several years ago, Oakland, California, lawyer Van Jones found himself at a career crossroads. “As an attorney, I was focused on trying to keep kids out of trouble, and I just burned out,” he says. Discouraged and not knowing exactly what he was going to do next, Jones set out to learn more about cutting-edge environmental business. “I discovered a lot of really cool technology—solar companies, organic food companies. I said, ‘This is great stuff, but none of it’s happening in the neighborhoods where I’m doing my work.’ ”

That initial epiphany—that residents of cash-strapped urban areas could form the foundation of a future green-collar economy—launched Jones on a quest to make his vision come true. “It’s a tremendous asset, the pent-up desire for positive change in urban communities,” he says. “You have all these people that need work and all this work that needs to be done.” To that end, Jones founded Green for All, a non-profit organization designed to combat poverty and build a green economy at the same time. Word about Jones’ grassroots venture spread among national movers and shakers, and thanks in part to Green for All’s inspiring example, President Obama budgeted more than $4 billion for green job creation and training as part of his 2009 economic stimulus plan. In March, Obama also named Jones the White House Council on Environmental Quality’s special advisor on green jobs. In addition to providing urban residents with a much-needed livelihood, Jones says, Obama’s new program will help enable the United States to compete with the rest of the world in the green-jobs sector. “This is one of those moments where the United States gets to choose: Do we want to have these jobs in our country, or only see them in other countries?”

The experience of turning his career crisis into a national-scale coup has steeled Jones’ determination not to let negativity block his future path, a philosophy he’ll adhere closely to as the Obama administration attempts to turn its green-jobs plans into reality. “My biggest asset is my innocence, and I treasure it. I went down that whole cynical pathway—too cool for school—and it didn’t make a difference for anybody I cared about,” he says. “So I had to reclaim that innocence. When I started working in politics, it was because I thought we could make a better society. You’ll never get me to give up on what I want this country to be.”

Profiles in Creativity The Saturday Evening Post