There’s nothing wrong with a little competition. In the field of research you’re either the first or your a footnote, so we rush to be the first when we know that other labs are on the other labs are not far behind. Our lab knew it was coming, there was already rumblings of something big coming from another lab, but when it finally came, we were both surprised, but not exactly shocked. It’s a pretty impressive paper.
I don’t even want to name the paper, but since it’s all over the news and I’ve had several people, most of whom do not even follow the field, share it with me, I can go ahead and share that I’m discussing this paper. Titled, “Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis” the amount of work that went into this multi-institute and international collaboration must have been staggering.
Seriously this paper must have been a lot of work and I’m still trying to digest everything in it. For those who aren’t familiar with the science, can’t read the paper (thanks nature!), or just prefer the summary version, they designed and built a new type of invasive stimulator paddle design. The paddle is the thing that gets implanted into the epidural space of the spinal cord, or the space between the cord and vertebra. Yes, this requires surgery and, in most cases, removal of part of the bone (called the lamina), to make space for it. It’s a risky surgery, but not as dangerous as you may think.
Then, and this is where things get interesting, they also used MRI/fMRI to determine which motor pools in the spinal cord contribute to a particular task. Motor pool is the fancy way of saying “area,” so they figured out which areas of the cord are firing at particular times to perform particular tasks. This is referred to “spatiotemporal” mapping or mapping in both time and space.
Using that information they triggered their special stimulator, which was implanted into three people, to return function to a person. Some of the applications they showcased were things like kayaking, standing at a bar, walking, things like that. So you set the device to do the task you want to do and using sensors you can trigger the pattern of stimulation to let you do that task.
From an engineering standpoint, this was a ton of work alone, much less building the maps and the custom paddle for stimulation. The end result is nothing short of amazing. The day the paper was released, the head of the department emailed hospital-PI and said he was retiring because of it. It was a joke obviously, but the work the team has done is substantial, multidisciplinary, and connects a lot of neurology ideas together into this Frankenstein’s monster of a paper.
Monday was not a good day and it reminded us we’re on a timeline. Both “big idea” and my “super secret technique” have a shelf life, either we, the lab(s) and myself, get the techniques associated with us, or someone else will come along and get to it first. Which, I will be the first to say that both projects are my babies and I would feel really crappy if we didn’t get to it first.
As for the paper, I’m not too worried about it. Like I said, it’s amazing, I am not trying to take away from that at all. However, there is a limitation, that is the paper is basically “how to remote control a human.” It’s driving a person via electrical stimulation, which isn’t as easy as I’m making it sound, but it’s not exactly restoring function. It’s function adjacent, but not the same thing. I’m hopeful that some of the work I plan to accomplish this year will make a similarly large splash.
After all, there’s nothing wrong with some friendly competition.
Huh. Wow. Is this an open-loop system? They achieved all that without adjusting the stimulation patterns with real-time feedback?
I would’ve thought the person would take a couple steps, position a foot imperfectly, and then fall down because they can’t correct for the difference. So does this suggest that control mechanisms in these people’s spinal cords are still somewhat functional, and the stimulation just facilitates them? Does it still work if they’re, say, walking on an uneven floor (I bet they didn’t try that, but just in case)?
Although I’m surprised it works and I’m sure it’s not ideal, that still sounds like it has tremendous potential for improving quality of life.
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February 8, 2022 at 7:20 pm
Wild, right? The people in the study (n = 3) had thoracic injuries, so above the lumbar enlargement (the thing that controls lower limb movement and probably balance). Theoretically the circuitry is intact, but the signal telling the lumbar enlargement what to do is missing. I’m sure they need walkers/bars, etc. to help them when doing the walking, but yeah it’s somewhat surprising they have it working so well. It really drives home the idea that the spinal cord is what drives the body and the brain just navigates.
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February 9, 2022 at 10:08 am