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Paralysed patients regain voluntary movement with spinal stimulation

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  • Originally posted by tomsonite View Post
    How can you be so sure there isn't ANY sensation at all? Just because it wasn't reported in the paper or has only been reported anecdotally doesn't mean none of them got any sensory return.

    I posted earlier in the thread about how in the paper, the two ASIA B's had a decrease in the delay of the response of their somatosensory evoked potentials (and yes, I know there were no more details or numbers presented, and I am critical of that, and yes I realize this does not confirm any sensory return.)
    The fact that all subjects had no EMG activity in the legs before transplantation, even on the treadmill after multiple bouts of training, yet instantly got EMG activity on the treadmill after implantation, shows that at least the spinal cord was able to receive and process sensory input. The paper also talks in the discussion section about how two of the subjects (the two ASIA As) were able to modulate their EMG responses on the treadmill depending on how much effort they contributed, suggesting some kind of connection between input from the brain and afferent input from the periphery.

    Again, I realize no sensory return was formally reported, and I realize everything I just said does NOT confirm any sensory return. However, I think it is at least enough evidence that you can't conclude with certainty there was no sensory return.
    I never said that I conclude with certainty. I said "With the information that has been made public". Asia A's have NO sensation. Until the lab proves that their device restores any sensation, the assumption is that the patients still have no sensation. The burden of proof is on them. The scientists don't even claim to have restored any sensation. So with info that I know right now, there is absolutely no claims or evidence of ANY sensation, I would not get one of those devices implanted in my body; nor do I have any hope that this device will ever restore any sensation for me (although ever so slightly possible that it could).

    Comment


    • Originally posted by taymas View Post
      Hey GRAMMY, are you behind the spinal research and advocacy site? (Sorry I'm new) I've learnt so much from your site, especially your posts and threads here, and absolutely appreciate it. Would it be OK if I update my original post with links to your site and threads here? It would help the newbies here. I'll also link some more articles and videos if allowed.
      Regards,
      TM
      Thank you taymas. I do update the community via the Spinal Cord Injury Research and Advocacy blog site. If you wish you can also receive new blog posts via email when I put them up by clicking on the right side "follow" button or you can follow along on Twitter. The blog posts automatically appear on the U2FP/Working2Walk Facebook page as well. U2FP stands for Unite 2 Fight Paralysis and Working 2 Walk is the name of an annual spinal cord injury conference the organization hosts each year. You're welcomed to link to any posts on the blog. I'm glad you're able to get value from the blog.
      Last edited by GRAMMY; 04-22-2014, 01:37 PM.
      http://spinalcordresearchandadvocacy.wordpress.com/

      Comment


      • Originally posted by GRAMMY View Post
        @Tomsonite, would you be so kind as to give a brief explanation of what these two acronyms mean? TMS and EMG in relation to the paper or in general? Many people aren't really familiar with some of this and what it's capabilities are..
        I didn't give an explanation initially because I didn't want to do any unnecessary writing if Curt already knew all about TMS and EMG.
        TMS = Transcranial Magnetic Stimulation. It is a non-invasive way of activating neurons in the brain and sending electric currents down those neurons using electromagnetic fields. TMS can be used so precisely that by placing the magnetic wand over a certain part of the brain, people can be made to involuntarily perform very specific movements or move specific muscles. Rather than you voluntarily deciding to move a muscle, someone flips a switch in the magnetic controller, an electromagnetic field is created, and a movement is generated in your body, because one specific neuron/neurons that control specific muscles was turned on for you.
        EMG = Electromyography. EMG can be use to record and analyze the electric activity of muscles in the body. There are two ways to do EMG. One is with surface electrodes which are sticky little pads that you put on the skin over a specific muscle you want to measure the electrical activity of. Some muscles, however, are not right under the skin, or are too thin or small to be measured by surface electrodes. In this case, intramuscular EMG is used, where a minuscule electrode is actually injected into the target muscle. One you have an electrode in/on a muscle, you are then able to measure the amplitude of the electric current going to that muscle. The more electricity that the nervous system pumps into a muscle, the stronger the muscle fibers contract. Surface EMG does have some reliability issues, but if done properly, surface EMG can tell you reliably if a muscle is working or not.

        Therefore, these are two very useful tools in assessing how complete someone's SCI is. There are people with SCIs who demonstrate no voluntary control of a muscle, yet when they are given TMS, those muscles contract. If you use TMS to stimulate neurons in the brain, as long as there is a connection to the target muscle, some activity should be able to be picked up with an EMG. If, on the other hand, TMS is used to stimulate the brain to try to elicit a certain movement, and literally nothing shows up on the EMG, then the connection is lost. I.e. if TMS produces no visible muscle contraction or EMG activity in the target muscle, you have the most complete SCI possible, which according to the data presented, is what these four subjects had.

        Originally posted by Sue Pendleton View Post
        And how EMG has improved over at least the last 20 years I've been injured. Now if I just didn't feel nauseous after that test that would be a great improvement.
        I couldn't comment on EMG 20 years ago...are you sure it was an EMG test that made you nauseous? EMG doesn't actually do anything to your body, it just measures activity within it.

        Originally posted by Curt Leatherbee View Post
        Oh yes I read all that, but who knows, machines will be machines and humans will be humans. Maybe there were calibration problems, maybe something else was amiss, who knows. What it's going to take is time and more people involved and hopefully this thing is as good as it seems to be according to papers that were written. I do have the feeling though this is not going to help everyone who is SCI, only a certain percentage of people. Those who it does work can hopefully advance through more technological changes to make their gained movement more functional.

        Here's a interview, fascinating stuff http://www.sciencefriday.com/playlis...y/segment/9397
        Yes, we need more research on more subjects before we can conclude anything. But any experienced scientist can take care of calibration problems with EMG and/or TMS and get reliable readings properly from the equipment. Frankly, I trust this team of researcher's abilities to do TMS and EMG. They presented data showing that TMS produced no muscle activity at all in the four subjects. This means one of two things:
        1. The subjects had the most motor-complete spinal cord injuries that can possibly be shown with current instrumentation, or
        2. The researchers are liars and knowingly and purposefully gave false data.

        I believe number 1.

        Originally posted by taymas View Post
        ...

        I am also beggining to think that completes weren't quite as complete. And as a complete I'm anxious in that regard as it depends on the extent of our injuries. Guess we've got to start somewhere as it may be very useful for incompletes.

        ...
        See my above post to Curt. These guys were as motor complete as you can get, unless you believe the investigators are liars. The researchers chose the most complete subjects possible to make sure they could reliably investigate if epidural stim produced activity in a human spinal cord. You can't fool TMS + EMG.

        Originally posted by Nowhere Man View Post
        I never said that I conclude with certainty. I said "With the information that has been made public". Asia A's have NO sensation. Until the lab proves that their device restores any sensation, the assumption is that the patients still have no sensation. The burden of proof is on them. The scientists don't even claim to have restored any sensation. So with info that I know right now, there is absolutely no claims or evidence of ANY sensation, I would not get one of those devices implanted in my body; nor do I have any hope that this device will ever restore any sensation for me (although ever so slightly possible that it could).
        The burden of proof isn't really on anybody right now, since sensation was never reported on or investigated, as the researchers never sought to increase sensation in the first place. From day 1 these studies were always about seeing if epidural stim can produce activity in an injured spinal cord for the sake of locomotion. I believe that what I said to you in my original post to you IS evidence for sensory function return. We're just going to have to wait and see in further investigations if there is indeed sensory return or not.

        Comment


        • Originally posted by tomsonite View Post
          TMS = Transcranial Magnetic Stimulation. It is a non-invasive way of activating neurons in the brain and sending electric currents down those neurons using electromagnetic fields. TMS can be used so precisely that by placing the magnetic wand over a certain part of the brain, people can be made to involuntarily perform very specific movements or move specific muscles. Rather than you voluntarily deciding to move a muscle, someone flips a switch in the magnetic controller, an electromagnetic field is created, and a movement is generated in your body, because one specific neuron/neurons that control specific muscles was turned on for you.
          EMG = Electromyography. EMG can be use to record and analyze the electric activity of muscles in the body. There are two ways to do EMG. One is with surface electrodes which are sticky little pads that you put on the skin over a specific muscle you want to measure the electrical activity of. Some muscles, however, are not right under the skin, or are too thin or small to be measured by surface electrodes. In this case, intramuscular EMG is used, where a minuscule electrode is actually injected into the target muscle. One you have an electrode in/on a muscle, you are then able to measure the amplitude of the electric current going to that muscle. The more electricity that the nervous system pumps into a muscle, the stronger the muscle fibers contract. Surface EMG does have some reliability issues, but if done properly, surface EMG can tell you reliably if a muscle is working or not.

          Therefore, these are two very useful tools in assessing how complete someone's SCI is. There are people with SCIs who demonstrate no voluntary control of a muscle, yet when they are given TMS, those muscles contract. If you use TMS to stimulate neurons in the brain, as long as there is a connection to the target muscle, some activity should be able to be picked up with an EMG. If, on the other hand, TMS is used to stimulate the brain to try to elicit a certain movement, and literally nothing shows up on the EMG, then the connection is lost. I.e. if TMS produces no visible muscle contraction or EMG activity in the target muscle, you have the most complete SCI possible, which according to the data presented, is what these four subjects had.
          Thank you so much for giving us such a detailed explanation of the acronyms. That's very helpful.
          http://spinalcordresearchandadvocacy.wordpress.com/

          Comment


          • thanks, tomsonite.
            T5/6, ASIA A, injured 30 Nov 08
            Future SCI Alumnus.
            I don't want to dance in the rain, I want to soar above the storm.

            Comment


            • Originally posted by tomsonite View Post
              I didn't give an explanation initially because I didn't want to do any unnecessary writing if Curt already knew all about TMS and EMG.
              TMS = Transcranial Magnetic Stimulation. It is a non-invasive way of activating neurons in the brain and sending electric currents down those neurons using electromagnetic fields. TMS can be used so precisely that by placing the magnetic wand over a certain part of the brain, people can be made to involuntarily perform very specific movements or move specific muscles. Rather than you voluntarily deciding to move a muscle, someone flips a switch in the magnetic controller, an electromagnetic field is created, and a movement is generated in your body, because one specific neuron/neurons that control specific muscles was turned on for you.
              EMG = Electromyography. EMG can be use to record and analyze the electric activity of muscles in the body. There are two ways to do EMG. One is with surface electrodes which are sticky little pads that you put on the skin over a specific muscle you want to measure the electrical activity of. Some muscles, however, are not right under the skin, or are too thin or small to be measured by surface electrodes. In this case, intramuscular EMG is used, where a minuscule electrode is actually injected into the target muscle. One you have an electrode in/on a muscle, you are then able to measure the amplitude of the electric current going to that muscle. The more electricity that the nervous system pumps into a muscle, the stronger the muscle fibers contract. Surface EMG does have some reliability issues, but if done properly, surface EMG can tell you reliably if a muscle is working or not.

              Therefore, these are two very useful tools in assessing how complete someone's SCI is. There are people with SCIs who demonstrate no voluntary control of a muscle, yet when they are given TMS, those muscles contract. If you use TMS to stimulate neurons in the brain, as long as there is a connection to the target muscle, some activity should be able to be picked up with an EMG. If, on the other hand, TMS is used to stimulate the brain to try to elicit a certain movement, and literally nothing shows up on the EMG, then the connection is lost. I.e. if TMS produces no visible muscle contraction or EMG activity in the target muscle, you have the most complete SCI possible, which according to the data presented, is what these four subjects had.


              I couldn't comment on EMG 20 years ago...are you sure it was an EMG test that made you nauseous? EMG doesn't actually do anything to your body, it just measures activity within it.


              Yes, we need more research on more subjects before we can conclude anything. But any experienced scientist can take care of calibration problems with EMG and/or TMS and get reliable readings properly from the equipment. Frankly, I trust this team of researcher's abilities to do TMS and EMG. They presented data showing that TMS produced no muscle activity at all in the four subjects. This means one of two things:
              1. The subjects had the most motor-complete spinal cord injuries that can possibly be shown with current instrumentation, or
              2. The researchers are liars and knowingly and purposefully gave false data.

              I believe number 1.


              See my above post to Curt. These guys were as motor complete as you can get, unless you believe the investigators are liars. The researchers chose the most complete subjects possible to make sure they could reliably investigate if epidural stim produced activity in a human spinal cord. You can't fool TMS + EMG.


              The burden of proof isn't really on anybody right now, since sensation was never reported on or investigated, as the researchers never sought to increase sensation in the first place. From day 1 these studies were always about seeing if epidural stim can produce activity in an injured spinal cord for the sake of locomotion. I believe that what I said to you in my original post to you IS evidence for sensory function return. We're just going to have to wait and see in further investigations if there is indeed sensory return or not.
              What about utilizing SSEP?

              Comment


              • apologizes if this was already posted but couldn't find it.

                Science Friday Radio Program 17:33 minutes long.

                cool interview with the scientists involved.

                Quote:
                Reawakening Limbs After Years of Paralysis
                Reporting in the journal Brain, researchers write of reawakening the legs of four men paralyzed from the waist down. They did so by implanting electronic devices in the men’s spines. The devices send out electrical stimulation that re-trains the nerves to listen more carefully for signals, allowing voluntary movements after years of paralysis. Study author Susan Harkema of the University of Louisville and Roderic Pettigrew, director of the National Institute of Bioimaging and Bioengineering, discuss the device and the path towards commercially available treatments.



                http://www.sciencefriday.com/segment...paralysis.html

                Comment


                • Originally posted by tomsonite View Post
                  The burden of proof isn't really on anybody right now, since sensation was never reported on or investigated, as the researchers never sought to increase sensation in the first place. From day 1 these studies were always about seeing if epidural stim can produce activity in an injured spinal cord for the sake of locomotion. I believe that what I said to you in my original post to you IS evidence for sensory function return. We're just going to have to wait and see in further investigations if there is indeed sensory return or not.
                  ??

                  a) what evidence?

                  b) if there IS evidence for sensory return in Asia A, why would we then have to wait and see in further investigations if there is sensory return or not?

                  Comment


                  • Originally posted by PaidMyDues View Post
                    What about utilizing SSEP?
                    SSEPs were also used in this study, but all they reported were the pre-implantation SSEP data. No follow up data was reported (which I find a little odd, and annoys me).

                    Comment


                    • Originally posted by Nowhere Man View Post
                      ??

                      a) what evidence?
                      This evidence, as was reported in the paper:
                      Originally posted by tomsonite View Post
                      ...
                      I posted earlier in the thread about how in the paper, the two ASIA B's had a decrease in the delay of the response of their somatosensory evoked potentials (and yes, I know there were no more details or numbers presented, and I am critical of that, and yes I realize this does not confirm any sensory return.)
                      The fact that all subjects had no EMG activity in the legs before transplantation, even on the treadmill after multiple bouts of training, yet instantly got EMG activity on the treadmill after implantation, shows that at least the spinal cord was able to receive and process sensory input. The paper also talks in the discussion section about how two of the subjects (the two ASIA As) were able to modulate their EMG responses on the treadmill depending on how much effort they contributed, suggesting some kind of connection between input from the brain and afferent input from the periphery.

                      Again, I realize no sensory return was formally reported, and I realize everything I just said does NOT confirm any sensory return. However, I think it is at least enough evidence that you can't conclude with certainty there was no sensory return.
                      How could the legs suddenly activate and show EMG activity if there was no sensory information coming in from the periphery? Just because sensory information might not have made it all the way to the brain doesn't mean the spinal cord wasn't taking it in and processing it.

                      Originally posted by Nowhere Man View Post
                      b) if there IS evidence for sensory return in Asia A, why would we then have to wait and see in further investigations if there is sensory return or not?
                      How the hell should I know?? I didn't write the study. I did not choose what data to collect, and what data to report on. Ask Susan Harkema, Reggie Edgerton, Yury Gerasimenko, or Claudia Angeli this question. They're the ones who decided what data to collect, analyze, and report.

                      Comment


                      • Originally posted by tomsonite View Post
                        This evidence, as was reported in the paper:


                        How could the legs suddenly activate and show EMG activity if there was no sensory information coming in from the periphery? Just because sensory information might not have made it all the way to the brain doesn't mean the spinal cord wasn't taking it in and processing it.
                        When I say sensation, I mean the ability to FEEL...by the brain. You know..like the ability to feel when your bladder is full, rectum is full, or feel penis. There is nothing in this paper that says the Asia A patients regained any sensation (in brain). They did Asia exams on them..so if they recovered ability to feel anus, it would have been noted in the Asia exam.

                        The spinal cord is always taking in sensory information below the injury site.

                        Comment


                        • Originally posted by Nowhere Man View Post
                          When I say sensation, I mean the ability to FEEL...by the brain. You know..like the ability to feel when your bladder is full, rectum is full, or feel penis. There is nothing in this paper that says the Asia A patients regained any sensation (in brain). They did Asia exams on them..so if they recovered ability to feel anus, it would have been noted in the Asia exam.

                          The spinal cord is always taking in sensory information below the injury site.
                          Did they even report post-implantation or treatment ASIA scores? If they did I missed it. That's what is annoying about this paper, all the unanswered questions.

                          Comment


                          • Originally posted by tomsonite View Post
                            Did they even report post-implantation or treatment ASIA scores? If they did I missed it. That's what is annoying about this paper, all the unanswered questions.
                            No, but they said they gave the Asia exam post implantation & post training. So if new sensation were found, the paper would have said so. That would be groundbreaking news. The SCI community doesn't need false hope by playing these "you cant know for sure they didn't" games. I think it is completely logical to assume/presume? that the Asia A patients did not recover any sensation. Nor did the authors ever claim they did!
                            Last edited by Nowhere Man; 04-22-2014, 10:11 PM.

                            Comment


                            • Originally posted by Nowhere Man View Post
                              No, but they said they gave the Asia exam post implantation & post training. So if new sensation were found, the paper would have said so. That would be groundbreaking news. The SCI community doesn't need false hope by playing these "you cant know for sure they didn't" games. I think it is completely logical to assume/presume? that the Asia A patients did not recover any sensation. Nor did the authors ever claim they did!
                              If new sensation wasn't found, it would/should have been reported in the paper too. That's what really irks me, they reported that they collected a whole bunch of data (ASIA scores, TMS, EMG, and SSEP information) before transplantation, then gave no follow up data on any of those parameters.

                              Given the discussion section of the paper and anecdotal reports from the subjects, I personally don't assume the subjects got no sensation return. I don't think I'm spreading false hope by simply stating what I believe based off what I've read.

                              Comment


                              • Originally posted by tomsonite View Post
                                See my above post to Curt. These guys were as motor complete as you can get, unless you believe the investigators are liars. The researchers chose the most complete subjects possible to make sure they could reliably investigate if epidural stim produced activity in a human spinal cord. You can't fool TMS + EMG.
                                No I didn't call them liars - don't assume that. I wasn't aware of TMS and EMG, so thanks - that was helpful, aside from the unnecessary derogatory language.

                                Originally posted by tomsonite View Post
                                How could the legs suddenly activate and show EMG activity if there was no sensory information coming in from the periphery? Just because sensory information might not have made it all the way to the brain doesn't mean the spinal cord wasn't taking it in and processing it.
                                This on the other hand isn't quite as useful. Just like Nowhere Man has said, if our brain cannot receive the sensory input, (bladder etc) it's useless - and that sensory information was recorded below the level of injury.

                                Comment

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