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Can't speak to palsy but I had a friend with muscular dystrophy who passed in his late 20's. He couldn't swallow his own spit, and every 10 minutes or so I (or

Can't speak to palsy but I had a friend with muscular dystrophy who passed in his late 20's. He couldn't swallow his own spit, and every 10 minutes or so I (or his attending nurse, or whoever he was spending time with) would need to help him drain it. He had the same sort of little vacuum that your dentist uses to get water out of your mouth during a cleaning or filling. I moved out of my hometown a few years before he passed so I don't know all the details, but I'm pretty sure his death had to do with respitory issues caused by his weakened muscles.

trhway 5y ago
speaking as total layman wrt. medicine, i wonder whether it is possible to at least improve the condition a bit by implanting electrodes and triggering the needed muscle(s) similar to say pacemakers.
- 1adam1200 5y ago
  In diseases like muscular dystrophy there are no muscles to stimulate.
  - HideousKojima 5y ago
    There are still muscles, they slowly deteriorate over time though. When my friend was in 2nd grade or so he could still run and play with the other kids. For a few years after that he could still use a controller to play video games. As he deteriorated further, he couldn't even do that, and got most of his enjoyment from watching other people play games. Heartbreakingly his nephew, who was named after my friend, also suffers from muscular dystrophy since it's a genetic illness.
    - 1adam1200 5y ago
      I'm sorry you're friend went through that. I'm also sorry because I should have been more succinct. You are correct. I, too, have a form of muscular dystrophy called Spinal Muscular Atrophy, type II. I deal with a lot of what's being discussed here, i.e. aspiration pneumonia. That said, there is, at least in my mind, almost no functional difference between not having a muscle and having muscle so deteriorated that it no longer works. Electrical stimuli such as through a TENS unit does nothing. Back to OPs suggestion though. You might be able to make a case for early onset muscle assist? Dunno, just spit-ballin'. There
- Calavar 5y ago
  I am a physician, though not a specialist in that particular area (otolaryngology). A healthy heart contracts exactly the same way (nearly) every time. There is a single electrical tree that coordinates the entire heart, so if you shock the tree at the right point, it will propagate down the entire tree in a predictable pattern and you get normal heart contraction "for free" The throat is orders of magnitude more complicated. There are several major muscles involved in swallowing, each of which can have tens to hundreds of thousands of individual fibers, each with their own innervation. Coordinating all these fibers to produce a single coherent motion is complex and is not fire and forget - it involves some pretty intricate feedback loops between processing centers in the brain and stretch receptors in the muscle, with the brain refining and redirecting movements based on updated data from the stretch receptors. It's like the sending a single strong electrical pulse to your lightbulb versus a CPU. It will probably do what you expect for the lightbulb (heart), but not for the CPU (throat).
  - im3w1l 5y ago
    > sending a single strong electrical pulse Technology is way further along than that though, e.g. https://www.bbc.com/news/science-environment-60258620 https://www.bbc.com/news/science-environment-60258620
    - Calavar 5y ago
      That press release links to a journal article in Nature. I can't read the Nature article because it's paywalled, but the same group published an article in Brain in 2014 where they said "We propose that the functional state of... motor neurons was modulated by the epidural stimulation, presumably driving them closer to their appropriate activation threshold, enabling intentional movement." [1] Basically, they're saying that the spinal cord was a bit blunted after the injury. Movement signals were fizzling out as they travelled through the injured area. The stimulator is giving the injured region of the spinal cord some extra juice so that it propagates motor signals further down the body. However, it isn't actually creating a signal de novo - that's still coming from the brain. As for the latest Nature article, based on what I can see from the abstract, it seems like it is an update where they used a computational method to decide where to place the stimulators and with which strength to stimulate. But it's still the same basic idea. Another thing to note here. In the 2014 article, they mention that they only tried this treatment in patients who had an intact sensory pathway and an injured motor pathway. Kind of speaks to what I was mentioning earlier - the brain can't coordinate movement unless it gets feedback from the muscle. I would presume that this stimulator therapy can't help with the sensory component, which is why the researchers limited the study to patients with sensation. [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999714/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999714/
- stuffuru 5y ago
  there's the inspire implant[1] for sleep apnea which sounds like what you're describing, but I'm not sure how much help it'd be in the case of muscular dystrophy. [1] https://www.uhhospitals.org/services/Ear-Nose-and-Throat-Services/conditions-and-treatments/inspire-therapy-for-obstructive-sleep-apnea/how-it-works https://www.uhhospitals.org/services/Ear-Nose-and-Throat-Ser...

trhway 5y ago

speaking as total layman wrt. medicine, i wonder whether it is possible to at least improve the condition a bit by implanting electrodes and triggering the needed muscle(s) similar to say pacemakers.

1adam1200 5y ago
In diseases like muscular dystrophy there are no muscles to stimulate.
- HideousKojima 5y ago
  There are still muscles, they slowly deteriorate over time though. When my friend was in 2nd grade or so he could still run and play with the other kids. For a few years after that he could still use a controller to play video games. As he deteriorated further, he couldn't even do that, and got most of his enjoyment from watching other people play games. Heartbreakingly his nephew, who was named after my friend, also suffers from muscular dystrophy since it's a genetic illness.
  - 1adam1200 5y ago
    I'm sorry you're friend went through that. I'm also sorry because I should have been more succinct. You are correct. I, too, have a form of muscular dystrophy called Spinal Muscular Atrophy, type II. I deal with a lot of what's being discussed here, i.e. aspiration pneumonia. That said, there is, at least in my mind, almost no functional difference between not having a muscle and having muscle so deteriorated that it no longer works. Electrical stimuli such as through a TENS unit does nothing. Back to OPs suggestion though. You might be able to make a case for early onset muscle assist? Dunno, just spit-ballin'. There
Calavar 5y ago
I am a physician, though not a specialist in that particular area (otolaryngology). A healthy heart contracts exactly the same way (nearly) every time. There is a single electrical tree that coordinates the entire heart, so if you shock the tree at the right point, it will propagate down the entire tree in a predictable pattern and you get normal heart contraction "for free" The throat is orders of magnitude more complicated. There are several major muscles involved in swallowing, each of which can have tens to hundreds of thousands of individual fibers, each with their own innervation. Coordinating all these fibers to produce a single coherent motion is complex and is not fire and forget - it involves some pretty intricate feedback loops between processing centers in the brain and stretch receptors in the muscle, with the brain refining and redirecting movements based on updated data from the stretch receptors. It's like the sending a single strong electrical pulse to your lightbulb versus a CPU. It will probably do what you expect for the lightbulb (heart), but not for the CPU (throat).
- im3w1l 5y ago
  > sending a single strong electrical pulse Technology is way further along than that though, e.g. https://www.bbc.com/news/science-environment-60258620 https://www.bbc.com/news/science-environment-60258620
  - Calavar 5y ago
    That press release links to a journal article in Nature. I can't read the Nature article because it's paywalled, but the same group published an article in Brain in 2014 where they said "We propose that the functional state of... motor neurons was modulated by the epidural stimulation, presumably driving them closer to their appropriate activation threshold, enabling intentional movement." [1] Basically, they're saying that the spinal cord was a bit blunted after the injury. Movement signals were fizzling out as they travelled through the injured area. The stimulator is giving the injured region of the spinal cord some extra juice so that it propagates motor signals further down the body. However, it isn't actually creating a signal de novo - that's still coming from the brain. As for the latest Nature article, based on what I can see from the abstract, it seems like it is an update where they used a computational method to decide where to place the stimulators and with which strength to stimulate. But it's still the same basic idea. Another thing to note here. In the 2014 article, they mention that they only tried this treatment in patients who had an intact sensory pathway and an injured motor pathway. Kind of speaks to what I was mentioning earlier - the brain can't coordinate movement unless it gets feedback from the muscle. I would presume that this stimulator therapy can't help with the sensory component, which is why the researchers limited the study to patients with sensation. [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999714/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999714/
stuffuru 5y ago
there's the inspire implant[1] for sleep apnea which sounds like what you're describing, but I'm not sure how much help it'd be in the case of muscular dystrophy. [1] https://www.uhhospitals.org/services/Ear-Nose-and-Throat-Services/conditions-and-treatments/inspire-therapy-for-obstructive-sleep-apnea/how-it-works https://www.uhhospitals.org/services/Ear-Nose-and-Throat-Ser...