An Athlete and Innovator with a Drive to Discover the Future
By ONWARD
Miro isn’t afraid to try something completely new – like taking people with spinal cord injury (SCI) out for a paddle on Lake Geneva. As a recent graduate from the EPFL, he dove straight into the startup world, developing a new technology based on his masters’ research on neurostimulation. That brought him to the attention of ONWARD co-founder Vincent Delattre, who persuaded him to join the company as its first employee. Since then, Miro has contributed to dozens of patents, earning an ONWARD Innovator of the Year Award in 2021. For this competitive hockey player and keen outdoor athlete, the future of neuro-engineering is ripe for discovery.
I’ve spent a lot of time in the clinic over the years, and I’ve got to know many of the participants in our mobility study. These are incredibly motivated people. You see how much they're pushing themselves, and it motivates you to push yourself harder too.
What was your path to working at ONWARD?
I came to Switzerland to do a master's in quantum physics at EPFL. For my thesis, I decided to apply my skills to neuro-engineering, by studying the interaction between electricity and how to stimulate different neural pathways in the body to restore some of the functions that are lost after an injury. My supervisor then suggested we try to spin something out of my research. I spent the next 10 months investigating opportunities for developing a technology that would optimize spinal cord stimulation for pain management, which is the main use today. But it wasn’t working out as I had hoped. My supervisor got me talking to Vincent Delattre, one of the co-founders of ONWARD. He told me, “If you want to continue trying, go ahead, but I think you could apply your knowledge to what we're doing. We don’t have funding yet, but we’re working on it.” I went to work for him as the first employee, in October 2015.
What exactly does a system and clinical engineer do?
Being at ONWARD since day one, I've worn many different hats! One constant has been that my work takes place between the teams developing the device and our academic research partners at the University Hospital in Lausanne and the EPFL. My current job consists of building use-cases for our ARC-IM technology. I collect feedback from trial participants and clinicians’ observations, filter through it, and ask, how does this impact our product? What new features should we implement? How can we modify the existing features to make rehabilitation more effective? Then I coordinate with the development team to determine how to feed this information into shaping the ARC-IM system. The next step is to work with our research partners to evaluate the new features through clinical studies.
How much does feedback from end-users shape the design of the device?
Our approach is very user-centric, which is something I really like about ONWARD. I can give you an example from our mobility study. For neural reconnection to happen, the person with the implant needs to engage their volition to move at the same time as the stimulation is happening. But some participants couldn’t feel when the stimulation was being turned on. That made it hard for them to time the movement. The solution we came up with was to add an audio signal when the machine is going to kick in. A beep lets the user knows when they need to focus on doing the movement.
The blood-pressure study we’ve just started in June is another good example. The first participant we’re working with has impaired hand function due to a high-level spinal cord lesion. We set up a session to observe how he handles the main controller that allows him to turn on stimulation. Can he move it easily on and off his lap? Is it too heavy? We were pleasantly surprised to find that he was able to handle it well using two hands. But he remarked that if he wants to use the device at night when lying in bed, he needs to be able to grab it with one hand. That got us thinking: should we change the design of the controller by adding a hook? As for control of stimulation itself, our future users have repeatedly asked for voice command; and we may add this feature to the system we eventually commercialize.
There are many potential applications of the ARC-IM device, from mobility to blood pressure to bladder control. How do you determined which ones to investigate first?
By working closely with clinicians to better understand the current state-of-the-art and how our device could make rehabilitation more effective. What medications or therapies are they using today? What is the standard rehabilitation process? Then we explain the solution we're thinking of and ask them for their take on it. What solutions don’t exist today that they would like to see? What would our device need to do to fill the gap?
Sport plays a big part in your life; you’ve even shared your passion by taking some of the ONWARD study participants along for the ride! Can you tell us about that?
Playing hockey competitively for 25 years has defined who I am today. It helps me stay calm and focused, and to persevere when things get challenging. I’ve spent a lot of time in the clinic over the years, and I’ve got to know many of the participants in our mobility study. These are incredibly motivated people. You see how much they're pushing themselves, and it motivates you to push yourself harder too. We thought we could try something different with them, like skiing or paddle-boarding or going for a ride with an assisted bike. The response was “Yes, I would love to be able to do this!” The whole team jumped on board to make it possible. Taking the rehab outside of a clinical setting is an opportunity to explore how to tune the stimulation parameters for new conditions and spice up the rehab training. For paddle-boarding, for instance, the participant first practiced the movements with the physiotherapist in the clinic. That gave us a chance to optimize the stimulation to improve his trunk stability. Once the team and the patient were confident, we took him out on the lake. When it all came together, it was an incredible feeling!
You’re completing a PhD based on the research you’ve been conducting at ONWARD. What do you see yourself doing in the future?
The therapy we’re working on is truly novel, which means there's a lot of research behind it that is worth exploring. For my PhD, I’ve looked at how our therapy integrates with current standard of care. I can honestly say that at ONWARD, you never look at the clock. It’s such a dynamic team and there’s always something exciting ahead. And at the back of your mind, you always know exactly what you’re trying to achieve, and you can see the effects immediately. I'm happy to have ended up in this field and look forward to evolving in it: there's so much more to do, so much to discover, and the discoveries have such high impact to people's lives.
It sounds like ONWARD has set the bar high! What are two words that best describe the culture?
Passionate and innovative. Passionate, because our proximity to the end-users makes it easy to stay motivated; you get to see exactly what you can bring to people with SCI. And there’s such an innovative mindset here. We have a whole pipeline of potential new indications we are working on. We're not scared to try something completely new.
