But patients shouldn't expect that the stimulator will help them walk -- at least not now and maybe not ever.
It's nice to see a mainstream media outlet report on a significant medical advance without the hype. This result should create a lot of optimism, but not without caution.
Interestingly the analysis on the BBC article[0] states:
"[the patients] are also reported to have regained some control of bladder and sexual function - which many paralysed patients regard as more important than walking"
Paraplegic here, can confirm (for myself anyway). After reading several discussions/polls online on the subject, it seems to me that the general order of importance is:
1. Resolution of neuropathic pain
2. Use of hands
3. Sexual function
4. Bladder and bowel function
5. (a few other things)
6. The ability to walk
I should note that the discussions/polls I've read are mostly from the United States. The U.S. is probably the most accessible country in the world, and as a citizen I don't miss walking so much because I can still do almost anywhere I want to. If the discussion was among people from undeveloped countries, the ability to walk might score much higher.
This article mentioned that as well. I mean a basic drive for humans is sex - but walking, not so much. The movie "The Sessions" talks about the importance of sexual function for a immobilized man and is well worth watching.
In the Netherlands a monthly stipend is given to the disabled to be used on sexual services. The rationale is that not having a way to express this basic human desire can lead to mental anguish.
"Their study, funded in part by the Christopher & Dana Reeve Foundation, is being published Tuesday in the journal Brain."
Weirdly, I was recently in Dublin and went to the Fail Better exhibit at the Science Gallery at Trinity College Dublin.[1] One of the exhibits is Christopher Reeve's wheelchair.[2]
It's great to see the Science Gallery get some press! It's an amazing place. One of my best friends from growing up is the current program manager and I always here about the work they do there. For those that don't know, Science Gallery is sort of a museum 2.0, a modern take on a museum. Interactive exhibits that are around for a few months at a time. For those looking for inspiration when it comes to not only teaching the public about science, but getting them to actually care, check it out.
I was particularly impressed with the Fail Better exhibit. It's not just stupid ideas (although there's at least one of those), but bad ideas that lead to better ideas.
Like how the Reeve Foundation is actually making progress.
Not that I don't think this is great, but this isn't anything new. My Dad works in this same line of work (FES - Functional Electrical Stimulation. Particularly in the area of spinal cord injuries). The biggest thing to note from this article: "... involves surgically implanting a stimulator and giving it directions with an external remote control. ". This is amazing tech, but it's not new by any means, it's been around for a fairly long time and it's been known you can stimulate nerves via electrical stimulation. My Dad as at least a few patients that I know of that have implants for moving their arms and hands, which they've had for at least 5 or so years now (I think one of them is 10 years old, and that was a few years ago).
Now, there is something that does seem to be a bigger breakthrough in this article, specifically the notation of having on-demand function without requiring some type of remote or etc. via a stimulator. This is new as far as I know, from the basics that I know this sounds more like helping a partial spinal cord injury rather then a full injury (My Dad works with full-spinal-cord injury patients only). I'm going to send this over to my Dad and see if he has anything to say on it.
This is a bit different than what your Dad has been doing: here, an electrical stimulation allows the patient to consciously move the appendage (or engage in sexual activity). In your Dad's patients, a box is sending electrical signals to appendages to get them to move. iiuc
While you're right, they definitely talked about doing simple stimulation via a control in the article (They mention they had people lined up to do that in the article - I do recognize that's different then the headline.)
I'm guessing this patient has more of a partial spinal cord injury (So the spinal cord itself was still intact). Stimulation may have then allowed weaker signals to make it all the way though. This is definitely a big deal, but it won't work for every patient. One of the biggest challenges in the area of brain-controlled movement is that brains are so unique to everybody, and stimulating the spinal-cord directly is hard to do without accidentally stimulating other parts of the body (In general, stimulators are past the spinal cord and closer to the appendage they're going to move. Implants for the hand are usually located in the shoulder, and stimulate the nerve going off of the spinal-cord for example). If someone has a completely severed spinal cord, this technique won't make a bridge for the signal so it's not going to be a fix-all type of thing (Though, I'd be happy to be wrong!).
Can you fill us in on what this actually means? "Stimulating" a nerve doesn't imply that you're bridging a severed connection or returning control to a higher center.
In some respects I don't know, as part of this tech is new (The part which allows voluntary movement). I have a feeling the patient only had a partial spinal cord injury (Though, usually with partials there is some movement retained). In a partial, the nerves themselves aren't severed, so it would then seem like the stimulation allowed the normal nerve impulses to travel over the part which was damaged and make it down to the nerve.
Either way, 'stimulating' a nerve means applying an electric current to it to simulate a brain-signal. It's not as complicated as it sounds, it's not much more then sticking an electrode around the nerve and then applying an AC or DC current (Though AC and DC do actually produce slightly different effects). I've had it done to my hand before (Via some simple surface electrodes), depending on the placement and nerves which receive the current different muscles start pulling. If you stimulate the correct nerves, you can have the correct muscles pull and create Ex. a fist, or a clenching motion. Implants right now don't do a ton more then a simple 'open-close' type motion for a hand (Since the intent is not so you can type on a computer, but so you can eat by yourself or pick-up a glass, etc.)
spinal cord injuries are basically an electrical impedance (resistance) problem.
FES works on different levels. For one, many FES systems cycle electricity to various muscle groups in a coordinated fashion to try to get the patients body to 'take over'.
Examples of this would be with electrodes on the glutes, thighs, and around the knees in an effort to get an incomplete spinal cord patient to stand. This exploits the patients natural spasticity, along with the physiology of the body (joints can only go so many ways) to get the patient able to stand with parallel bars or in some other controlled manner.
Nerve stimulation also supposedly reduces the 'trigger energy' of certain muscle sets, thus sidestepping the impedance problem. An overly simplistic example : imagine a knee muscle requires 1mW to trigger into an action, however the circuit leading to this nerve only allows for half of that due to damage adding resistance along the pathway. FES can artificially increase the energy available to that muscle set so that the trigger may be more properly interpreted, hopefully leading to a successful 'firing' of the muscle.
source: i'm a quadriplegic, and FES makes me spasm into a 'stiff as a board' plank.
I think that is the amazing part here. It seems the researcher was doing the same type of work, implanting stimulators to study nerve function below the injury. Something in this case however is allowing on-demand capabilities and that is a mystery.
I would agree. My best guess is that they have a partial injury, so the stimulation allows the action potential to travel past the damaged part of the nerve. The article didn't really say though. They did say he had no movement past the waist, which is more of an indication of a full injury, so I'm not really sure.
A spinal cord stimulator was suggested to me several years ago to help treat the neuropathic pain [1] associated with my (complete) spinal cord injury. I'm currently trialing Prialt [2] for this, but if it doesn't work (or the side-effects are too nasty) I might pursue the stimulator.
Funny enough, spinal cord stimulation for treating chronic pain is something my Dad has been working on/researching. Unfortunately I don't know the completely status of it or what product's have been out, I do however know that it does work (I worked for my Dad for a summer internship and witnessed it first-hand), and that you need to be careful when diving into them. The side-effects vary depending on the type of stimulation (AC or DC) as well the frequency used, but they can result in nerve damage.
Specifically, it's known (At least, it was known among the group I worked with, and I saw this result happen) that extended use of the DC block will damage the nerve (On higher frequencies - IIRC 40hz was the highest we tested). AC doesn't have that issue, but AC has the issue that it actually sends a fairly large signal back up the nerve when it's turned on (So you feel a sharp pain when you turn it on). I couldn't tell you how bad it is since I've never felt it, but obviously it's still useable if Ex. you just turn it on to go to sleep at night.
Now, something unfortunate I feel obligated to tell you is that not to long ago my Dad traveled to go give a talk at a conference relating to a company that's been marketing a pain-relief type stimulator with no side-effects. From what my Dad saw, the block was mostly from nerve damage being created from the stimulation (I apologize, I don't remember all the specific details). Bottom line, I'd research any company you're considering getting a stimulator from.
Note: I'm more knowledgeable then the average person, but I'm no biomedical engineer. Definitely look into this stuff yourself and get other opinions. I do know it's definitely worth looking into.
Sounds very positive. I wish they would give some more details on the types of spinal injury the trial patients are suffering from.
Let's hope it's not just MSM hype based on a lopsided account from an overexcited researcher, as unfortunately is usually the case with these types of news stories.
This is definitely a case where the rule of taking the headline verbatim is annoying - like most of CNN, it seems to communicate very little actual information.
I've basically stopped believing any science headline from a major mainstream news source. CNN? MSNBC? Fox? Huffpo? Don't even bother, they're misinterpreting the science deliberately. Dat clickbait.
At least this article is better than CBS 60 Minutes lately. Their version would be something like, "Jeff Bezos pioneers a way to translate your brain waves into drone deliveries, and there's no need to worry about the NSA viewing your order history." Sponsored by ads for gerontology medications.
My dad was paralyzed from the chin down by a spinal cord injury for the last six years of his life, so I follow news about treatments for such injuries with great interest. The article reports, "But patients shouldn't expect that the stimulator will help them walk -- at least not now and maybe not ever. The stimulator can only make one leg work at a time. Patients have to turn the stimulator off and then back on again to make the other leg work or to make another set of muscles such as their torsos work." That sounds like a rather significant practical limitation, so far. My dad had contemporary (2002-2008) physical therapy and other treatment, including electrical stimulation, after his injury, but he died having never walked and never scratched himself in the years after his injury.
I'm trying to find scientific publications about this now that I've read through the article. I see from 2011 the article "Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study" The Lancet, Volume 377, Issue 9781, Pages 1938 - 1947, 4 June 2011 by Susan Harkema (the doctor quoted in the news story) and several colleagues.
The spinal cord injury reported in that single-patient case study was between the seventh cervical vertebra and first thoracic vertebra,[1] and that location further down from the brain makes for a more favorable prognosis than the second cervical vertebra injury my dad had. Those injuries can be quite devastating, and there are a lot of active research programs on how to treat them.
Spinal cord injuries vary in their severity according to where along the spinal cord the injury occurs and how severe the injury is. (A severed spinal cord is a rare outcome of most commonplace injuries, but there is so far no prospect of healing a severed spinal cord. The patient reported here, and my dad, had bruised but not severed spinal cords.) I imagine quite a few doctors at research hospitals are already attempting to reproduce the results reported by Dr. Harkema's team. I hope they enjoy much success.
kindly shared in another comment in this thread doesn't seem to have a paywall for this article. At least, I appear to be seeing the full text even though I am not accessing the article from a computer with institutional credentials.
They don't know for sure, but this is the hypothesis from the paper: "Anatomical connections may have persisted after the injury that were previously 'silent' because of loss of conduction as a result of disruption of myelin or the ionic channels of the neurons."
Basically, the electrostimulation is allowing damage neurons to function.
> Over the next five years, Harkema's team applied electrical stimulation to three more paralyzed men...
I understand the statistical reasons for having commonality among such a small sample, but I'm willing to bet that it was four Caucasian men, and it'd be really nice to hear about generalizable research being inclusive of minorities (e.g., 4 Chicana women instead of 4 Caucasian men) earlier in the research process.
Regardless, it's pretty amazing research and I hope they can overcome the current limitations soon!
Kentucky is 86% white non-hispanic (the 8th highest percentage in the US), and they still had to pull candidates from outside the state for their initial four subjects. I think it is perfectly reasonable for them to wait until they have a first round of results before expending the effort to expand the inclusiveness of the group.
Now that this is out there, others will start trying to reproduce the results and I'm sure we'll see research extend to other demographics.
I don't disagree. While it may have been the lowest hanging fruit for this particular study, the doctors who conducted heart disease research with overwhelming male subjects didn't even consider that there might be gender-related differences [2].
I'm a guy who had the opportunity to attend a Women's College [1]. As a result I'm more aware then most men of things like only including men in a medical study. Since HN is predominantly male, I feel a personal responsibility to highlight such things, because things like gender and ethnic heritage do matter in medical conditions, even conditions that may look very generic in nature (e.g. heart disease or paralysis).
To be clear, my original comment didn't say this particular study should have been conducted with a different sample, I said simply that "it'd be really nice to hear about generalizable research being inclusive of minorities (e.g., 4 Chicana women instead of 4 Caucasian men) earlier in the research process."
[1] Only women were admitted as residential students. There were a myriad of reasons that guys could attend classes. But we were still very outnumbered!
[2] For more than a decade my grandmother complained of what turned out to be primarily female symptoms of heart disease, but her GPs were only aware of the primarily male symptoms. It was only when she visited a emergency room and was treated by a doctor that was cognizant of the differences that she got a proper diagnosis. In the end she died of heart disease, who knows how much longer she would have been with us if heart disease research had been more inclusive earlier on or her doctors were made aware of more recent research.
Cool. I incorrectly took your statement about “earlier in the research process” to mean this particular research process.
You mention unexplored gender-related differences: an interesting example that came up recently was gender differences in depth perception and how it relates to VR.
No, someone could disable the implant and remove use of limbs. The implant is not controlling the limbs, but providing stimulation that allows normal control to work.
It's nice to see a mainstream media outlet report on a significant medical advance without the hype. This result should create a lot of optimism, but not without caution.