Spinal implants allow paralysed people to walk, swim and cycle again
economist.com
economist.com
Here is the actual paper: https://www.nature.com/articles/s41591-021-01663-5 (paywall)
For most of us, I do want to suggest being careful when and how you mention research and articles like this to people in wheelchairs. Just be aware there are lots of different reasons why someone might be in a wheelchair and what can and can't be done for a given illness. It can be really taxing to get suggestions or shares of articles like this from well-meaning friends and family that don't actually understand the realities of living with an injury or medical issue that puts someone in a wheelchair.
Obviously people should know work is being done. And obviously people might be excited to hear about breakthrough research. If you're inspired by articles like this, consider donating to the institutions funding the research. But, be aware that articles like this come out every year and for the vast majority of spinal cord injury patients it won't be available to them soon or ever.
If you really want to support those in the accessibility needs community, support local building code changes and adaptive sports and outdoors programs. Making buildings, sports, and wilderness accessible will impact more people positively in the near term. The science is cool and amazing, but 100k people are limited by a few stairs to enjoy life and experiences with family.
The most impactful thing you can do to help people with paralysis is push for better wheelchair accessibility where you live. It's amazing how much of the world is not accessible to someone in a wheelchair.
Obviously "average american" is not intended to reflect the 'typical american', but instead be an average across all people, including those with mobility requirements.
I don't discount the promise or effect of such research, but the utilitarian in me says that this can make a tangible improvement now, and to more people and not at an indeterminate point in the future.
I assume governments have models to make decisions about utility now vs utility later, and the way that trades off with cost now vs cost later.
I don't see why this decision shouldn't just use those models and spend the money on whatever the models say makes sense.
I'm curious where this assumption comes from. It seems more likely that it would be made on intuition of what story will seem most defensible to voters or avoid the angry scrutiny of a legislator.
If decisions were made with the high level of rationality you point to, it seems unlikely that the US would have problems like this:
- https://pittsburgh.cbslocal.com/2022/02/07/pittsburgh-warnin...
- https://www.marketwatch.com/story/it-is-a-challenge-the-irs-...
- https://www.irs.gov/newsroom/irs-announces-transition-away-f...
----------------
Looking at your username lets consider a question such as "Should we pay additional money to design London's new Elizabeth Line with step-free access at all stations?"
for such a model to answer such questions, we would need a way to accurately count costs. If could do that, then the line would already be open.
Yes, I don’t know why this is even a question. Ramps support people who will never need spinal nerve repair. They support strollers, wheeled luggage, canes, crutches, fall risk folks, furniture movers, bike/scooters, etc.
Both are 'obviously' better than the other, depending on what you look at. Therefore the decision really should be made with more data.
I think you make a good point here. Likewise, making software accessible, e.g. to blind people, requires effort for every GUI toolkit and non-trivial application. In the short term, that work has to be done, because it would be wrong to just leave blind people without a way to independently access software that might be critical to jobs, education, etc. But if we started funding research into curing or preventing all of the various causes of blindness now, then we could eventually solve the problem permanently. I'd have to find a different problem domain to work in, but I might be retired by then anyway.
> curing or preventing all of the various causes of blindness
All of them? Got a list?
There is so much wrong with what you say. Just look at the person in the very article. He doesn't walk with a hippity-hoppity bouncy gait. He walks with the help of a wheeled walking frame. He needs the ramps and the handholds to get to places. Do you have a proposal on how to spend all the ramp money to "medical research" that away?
Look at any person who broke their leg and walks with a crutch, or a mother-to-be who is wobbly from all the extra weight of the baby, or an old person who needs a walking frame. Do you think if we just spend more money on medical research these conditions will go away?
How are you proposing to medical research away the need for a baby stroller?
And what you are omitting is the very high cost to people needing accessibility right now.
Those discoveries are:
Not a sure thing
Not on an easy to quantify timeline
Not broadly applicable.
And this is not zero sum. Every dollar spent on accessibility pays off right now. Starts paying the moment access is improved.
We can always, and should always, be advancing medicine.
There is nothing in the way of better accessibility. We can do it now and it pays us well when we do.
There are things in the way of, "let's just fix the people!" and the fact that we do not know how, do not know when we will know how, is in our way solid, like we can't miss it.
Finally, treatments can be used, until they can't. And "can't" comes up an awful lot. Ramps and other devices just work.
They work even when people do not need them to work, or people do not expect to need them. The world is just easier, and new moms, old people, and many others get the benefit.
So, when "we can't" comes up, what is the answer for those people?
I propose:
Boy those accessibility spends are really helping a lot of people! Sure glad we did that work.
And remember, YOU yourself, right there reading this, very well could be one of those people. You don't know.
None of us does, which is why the work is being done.
By the time you're finished fixing the reasons people encounter mobility issues, we'll be darn near immortal - and you still won't have magicked away the reasons that able-bodied people benefit from universal design.
Ideally you would build the infrastructure /while/ allowing things like stem cell research but we live in a puritanical theocracy that opposes both for ideological reasons
A standard issue wheelchair is very efficient on reasonably smooth and flat surfaces. Beyond the obvious problems with e.g. stairs, you can get around ok using just arm muscle power in lots of places.
This efficiency helps also if you can't use your arms or the slopes are more challenging. Reasonably sized and weighted batteries can extend your scope a huge amount in very practical ways.
As soon as you get away from wheeled locomotion though, the power needs become much more problematic. Not to mention the system complexity is orders of magnitude higher than a basic chair, with all that entails.
So short story, I wouldn't expect any significant impact in the next few years. It's possible that for some very specific use cases you'll see a bit more robotics in assistive technology. It's also possible that we'll learn some good tricks from robots about negotiating particular obstacles (e.g. curbs) which can be retrofitted to "dumb" conveyances and improve things...
The reason they don't work is because the mobility she misses the most is the ability to transport a cup of coffee from the coffee maker to her desk, or the ability to go for a jog. It's the little things that have the biggest impact, and no one is going to don an exoskeleton to wear around the house.
Furthermore, the drive to overengineer mobility solutions crashes headlong into the world of manual wheelchairs. Manual wheelchairs are like road bikes: the best ones are the smallest, lightest-weight ones (often made from the same parts and materials). They have as few parts as possible, can turn on a dime, and can be lifted one-handed into the passenger seat of a car.
A walking device of some sort might be a better equivalent to an electric wheelchair for someone with quadriplegia, hemiplegia, muscle spasms, or generalized weakness, but here you have the problem that many electric wheelchair users are at high risk of pressure sores. There's a reason that electric wheelchairs have all sorts of fancy recliner features: sit in any chair for 16 hours a day without the ability to shift around and you're going to do some pretty serious damage to whatever your weight is resting on. An exoskeleton necessarily holds you in a more upright position, putting more weight on fewer body parts.
The solution to the access problem is to build ramps and lifts.
That is not very much. People who are not limited in some way are very unlikely to appreciate those hard facts. I didn't, until some professional work brought me into awareness.
https://medium.com/incerto/the-most-intolerant-wins-the-dict...
(I'd take universal health care over improved building codes any day, but both would be nice.)
_This_ is infinitely more amazing than any crypto shit, saving-the-world with Lomi blah blah blah and senseless techno-garbage some wanna-be-rich-thanks-to-an-exit-strategy creeps propagate on HN.
1. Hook up said implant, convert analog impulse to digital 2. Chemically induce paralysis of the peripheral motor neurons (??) 3. Truly immersive VR experience where participant controls embodied avatar
Wonder if you use your mind vs. a display, then are the visuals as good as real life. Or maybe you feed the image and your mind upscales it.
You need an incredibly high density of electrodes arranged around the spinal column. Then you need to construct in real time an image of the internal spinal column down to the level of fibre bundles, in real time. Then when you want to stimulate something you can apply the correct voltages to the huge numbers of electrodes and induce firing in the target neuron bundles.
Oh and you need to understand how neurons relay information - not actually a solved problem.
It's all possible. Just good luck getting this to work before the year 2100.
But in the back of my mind I have a plan involving flex pcbs...
https://www.roadtovr.com/neuralink-brain-interface-limb-trac...
As a disabled (legally blind) person myself, I had mixed feelings about this. On the one hand, it felt like we (well, the disabled people in the fictional world) were being used as means to an end. On the other hand, one of my unanswered questions from the first book was what the rise of a VR like the OASIS would mean for people like us; I felt that the second book provided a satisfying answer (in the fictional world, if not in the real one).
To be clear, the sequel was panned, for good reasons IMO. I chose to read it before looking at the reviews. I don't recommend it, but this comment reminded me of it.
Who and how would I contact, if I wanted to know more about these kinds of clinical trials and participation?
Just another example of how I slowly ended up living in the future without fully realizing it. Now, where's my flying car and Rosie, my robot maid?
I'm all for innovation, but I do think it's easy to get the wrong end of the stick with scifi and focus on the aesthetic over the social conditions.
I don't really see a straight path to improving upon cars for arbitrary point-to-point transportation.
https://12ft.io/proxy?q=https%3A%2F%2Fwww.economist.com%2Fsc...
> For those who are not able to access this
Quote from article: "Dr Courtine and Dr Bloch have developed a wafer-thin device with electrodes that could target the dormant nerves. Once implanted into Mr Roccati’s back, the device sent in pulses of electricity that mimicked those normally present in the nerves of an uninjured person as they walk.
By doing this, the device acted like an amplifier for any electrical signals coming from Mr Roccati’s brain. Those brain signals would normally be blocked by his damaged spinal tissue and be incapable of activating the nerves in his lower back. But with the stimulation device in place, Mr Roccati was able to voluntarily control those once-dormant nerves, allowing him to move his legs and walk."
It's his brain, the device is only used as amplifier. The fact that article talks about "Walk, swim, cycle" in its title is only a part of what people fitted with devices can do. It said he can also sit and talk to friends at bar.
Muscles are controlled through the software, with pattern of activation uploaded from an iPad via Bluetooth and generally managed by am accompanying person. The patients absolutely do NOT control the muscles with their brain.
(1) https://en.wikipedia.org/wiki/Transcutaneous_electrical_nerv...
Read the Nature article linked at one of top comments. It is also mentioned in every interview the researchers gave recently. The muscles are controlled with the software only, the brain doesn't participate at all.
"... the first implant specifically designed to control movement by mimicking the signals the lower body usually receives from the brain and upper spinal cord."
It's described in the Nature article linked from another comment - https://www.nature.com/articles/d41586-022-00367-1
Also I heard authors give an interview on the radio and they mention that while walking is impressive, a more practical outcome is an ability to control muscles on the back, because these allow for bending and controlling the balance while sitting on a chair.
I think a lot of people don't really see past the wheelchair, I certainly didn't for a long time. Some people try as an educational experience to live for a day in a wheelchair, but that's easy, spending a whole day sitting down is something desk workers do anyway. It's a completely different thing if you don't get to use any core muscles. I wanted to try that, but couldn't go even ten seconds without cheating. Even with all kinds of assistive technology it's extremely hard. Also the lack of bowel control must be a total nightmare.
The whole "paraplegics can do anything, they're just like you and me" schtick that normal people are fed is a nice coping mechanism, but I think it may be holding back funding for research into real solutions.
> Once the implant was in place, each person could control the pattern of electrical stimulation, using buttons and a tablet to raise or lower each leg, for example [...] using the device to guide their muscles through preprogrammed movements.
I would be ecstatic if there was a cure for occipital pain (other than cutting the lower occipital nerves; that too just based on mere guess; or having regular nerve blocker injections) and a clear way to properly diagnose and image the region.
But I guess things like this will eventually trickle down to general and widespread availability, just technological advancements like cochlear implants and pacemakers did.
Sorry if that came off as antagonistic. I think I actually agree with the overall sentiment that luck and popularity shouldn't be barriers to healthcare, but experimentation is a necessary part of the process. And at the very least, luck is inherent to experimentation.
And as an engineer it brings attention to me that there are companies solving these problems that I could work for to speed up the effort.
What these people did is nothing short of amazing.
Yet, here we are - a completely generic and trivial "critique" comment is the highest upvoted sentiment. On the HN of all places. Jesus.
The same "complaint" can be lodged against ANY novel treatment before it's fully productized for mass adoption.
And 26 minutes later it's now downvoted. HN is working as intended, you just have to wait and let the community do it's job.
I agree with you and always have to think about "Everything is amazing and nobody is happy": https://youtu.be/nUBtKNzoKZ4
-- and I don't care it's Louis C.K. saying it. Like I don't care if a songs from Michael Jackson is playing. Still true.
However, I am yet to see a single service or product or improvement that all humanity took at the same instant. It simply does not or won't ever exist.
These things need work, feedback, improvement. It is literally impossible to deliver things at the same time to everyone. Besides that, if that happened, but cannot, you would also make exactly the same mistakes with almost everyone. So tak e for granted that people that come later are granted to take improved versions of these techniques.
Economy in the sense of scarcity and availability, was, is and will be always like this. If you wanted everyone to have this at the same time the only reality is these people would have to wait until general availability, things would probably be slower bc of the loop feedback and noone would get this benefit, just these three people would not get ir. So noone wins this way, except your feeling of fairness. But it is notba rational choice.
What we need is massification and learning of these tecniques as they are certified as safe and to lower its price as much as it is possible to spread its availability.
I think your negativity comes from the frustration that you cannot accept reality as it is. We all want what you say. It is just not how things work, unfortunately.