9 ms·

Spinal cord work 'is a breakthrough'

135 points by 51Cards 13y ago

cLeEOGPw 13y ago
Only one downside - someone could hack the implant and gain control over his body.
- deleted 13y ago
  [deleted]
- kbenson 13y ago
  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.
- dfa0 13y ago
  Much easier to just manipulate the brain... It is how a large portion of this country works already.
- coolj 13y ago
  Probably less of a downside than not being able to move your lower body at all, but yeah.
refurb 13y ago
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.
- darrhiggs 13y ago
  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" [0] http://www.bbc.co.uk/news/health-26920521 http://www.bbc.co.uk/news/health-26920521
  - _dark_matter_ 13y ago
    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.
    - gknoy 13y ago
      Being able to control your bladder is probably also a huge benefit.
    - MarkTee 13y ago
      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.
      - serf 13y ago
        Similarly, there are Japanese companies who have monetized a service designed to alleviate such problems. http://www.japantoday.com/category/kuchikomi/view/business-caters-to-sexual-needs-of-disabled http://www.japantoday.com/category/kuchikomi/view/business-c...
  - slowmover 13y ago
    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.
drcode 13y ago
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.
- slowmover 13y ago
  Good point. Many (or most?) people do not understand the wide range of disability associated with SCI. No two injuries are alike.
pavel_lishin 13y ago
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.
- rflrob 13y ago
  I think it's a headline editor feeling just a little too clever. Spine stimulation... 'shocker'... Get it?
  - ryanthejuggler 13y ago
    SO glad I'm not the only one who chuckled.
- Alex_MJ 13y ago
  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.
  - 6cxs2hd6 13y ago
    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.
- forgotAgain 13y ago
  "This is CNN"
- dang 13y ago
  I changed it to take out the sensationalism. If anyone suggests a more accurate title, I can change it again.
mcguire 13y ago
"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] 1. https://dublin.sciencegallery.com/failbetter https://dublin.sciencegallery.com/failbetter 2. https://dublin.sciencegallery.com/failbetter/supermanswheelchair https://dublin.sciencegallery.com/failbetter/supermanswheelc...
- chez17 13y ago
  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.
  - mcguire 13y ago
    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.
DSMan195276 13y ago
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.
- 51Cards 13y ago
  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.
  - DSMan195276 13y ago
    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.
- iandanforth 13y ago
  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.
dfa0 13y ago
Just imagine if we had a few thousand hackers working on this stuff full-time, what could be accomplished. Here's hoping it happens.
- jebus989 13y ago
  An iPhone app and an *.io domain name? I'm content with the thousands of neurobiologists working on this stuff full-time.
  - dfa0 13y ago
    I use hacker here is a broader sense than someone who writes an app for $platform and names it $-er(terminated with r instead of er).
    - hencq 13y ago
      Maybe, but you do realize that there are actually a lot of very smart people working on this stuff full time?
      - dfa0 13y ago
        I know/have-worked-with too many MDs to believe that they are also hackers. I am contending that the hacker is the missing part here.
mrfusion 13y ago
I don't get how this works. Is it letting the nerves communicate across the severed area?
- subb 13y ago
  It's indeed a bit weird, but I think it reenforce the idea that the spinal chord is an extension of the brain, not just a communication channel.
- refurb 13y ago
  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.
aganders3 13y ago
Here's a direct link to the journal article PDF. You probably need institutional access for the link to work: http://brain.oxfordjournals.org/content/early/2014/04/07/brain.awu038.full.pdf http://brain.oxfordjournals.org/content/early/2014/04/07/bra...
yaddayadda 13y ago
> 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!
- egli 13y ago
  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.
  - yaddayadda 13y ago
    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.
tokenadult 13y ago
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. doi:10.1016/S0140-6736(11)60547-3 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60547-3/abstract http://www.thelancet.com/journals/lancet/article/PIIS0140-67... 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. [1] https://en.wikipedia.org/wiki/Spinal_cord_injury https://en.wikipedia.org/wiki/Spinal_cord_injury AFTER EDIT: The link to the current publication http://brain.oxfordjournals.org/content/early/2014/04/07/brain.awu038.full.pdf http://brain.oxfordjournals.org/content/early/2014/04/07/bra... 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.

135 points by 51Cards 13y ago

cLeEOGPw 13y ago

Only one downside - someone could hack the implant and gain control over his body.

deleted 13y ago
[deleted]
kbenson 13y ago
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.
dfa0 13y ago
Much easier to just manipulate the brain... It is how a large portion of this country works already.
coolj 13y ago
Probably less of a downside than not being able to move your lower body at all, but yeah.

refurb 13y ago

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.

darrhiggs 13y ago
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" [0] http://www.bbc.co.uk/news/health-26920521 http://www.bbc.co.uk/news/health-26920521
- _dark_matter_ 13y ago
  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.
  - gknoy 13y ago
    Being able to control your bladder is probably also a huge benefit.
  - MarkTee 13y ago
    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.
    - serf 13y ago
      Similarly, there are Japanese companies who have monetized a service designed to alleviate such problems. http://www.japantoday.com/category/kuchikomi/view/business-caters-to-sexual-needs-of-disabled http://www.japantoday.com/category/kuchikomi/view/business-c...
- slowmover 13y ago
  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.

drcode 13y ago

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.

slowmover 13y ago
Good point. Many (or most?) people do not understand the wide range of disability associated with SCI. No two injuries are alike.

pavel_lishin 13y ago

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.

rflrob 13y ago
I think it's a headline editor feeling just a little too clever. Spine stimulation... 'shocker'... Get it?
- ryanthejuggler 13y ago
  SO glad I'm not the only one who chuckled.
Alex_MJ 13y ago
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.
- 6cxs2hd6 13y ago
  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.
forgotAgain 13y ago
"This is CNN"
dang 13y ago
I changed it to take out the sensationalism. If anyone suggests a more accurate title, I can change it again.

mcguire 13y ago

"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] 1. https://dublin.sciencegallery.com/failbetter https://dublin.sciencegallery.com/failbetter 2. https://dublin.sciencegallery.com/failbetter/supermanswheelchair https://dublin.sciencegallery.com/failbetter/supermanswheelc...

chez17 13y ago
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.
- mcguire 13y ago
  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.

DSMan195276 13y ago

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.

51Cards 13y ago
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.
- DSMan195276 13y ago
  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.
iandanforth 13y ago
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.

dfa0 13y ago

Just imagine if we had a few thousand hackers working on this stuff full-time, what could be accomplished. Here's hoping it happens.

jebus989 13y ago
An iPhone app and an *.io domain name? I'm content with the thousands of neurobiologists working on this stuff full-time.
- dfa0 13y ago
  I use hacker here is a broader sense than someone who writes an app for $platform and names it $-er(terminated with r instead of er).
  - hencq 13y ago
    Maybe, but you do realize that there are actually a lot of very smart people working on this stuff full time?
    - dfa0 13y ago
      I know/have-worked-with too many MDs to believe that they are also hackers. I am contending that the hacker is the missing part here.

mrfusion 13y ago

I don't get how this works. Is it letting the nerves communicate across the severed area?

subb 13y ago
It's indeed a bit weird, but I think it reenforce the idea that the spinal chord is an extension of the brain, not just a communication channel.
refurb 13y ago
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.

aganders3 13y ago

Here's a direct link to the journal article PDF. You probably need institutional access for the link to work: http://brain.oxfordjournals.org/content/early/2014/04/07/brain.awu038.full.pdf http://brain.oxfordjournals.org/content/early/2014/04/07/bra...

yaddayadda 13y ago

> 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!

egli 13y ago
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.
- yaddayadda 13y ago
  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.

tokenadult 13y ago

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. doi:10.1016/S0140-6736(11)60547-3 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60547-3/abstract http://www.thelancet.com/journals/lancet/article/PIIS0140-67... 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. [1] https://en.wikipedia.org/wiki/Spinal_cord_injury https://en.wikipedia.org/wiki/Spinal_cord_injury AFTER EDIT: The link to the current publication http://brain.oxfordjournals.org/content/early/2014/04/07/brain.awu038.full.pdf http://brain.oxfordjournals.org/content/early/2014/04/07/bra... 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.