As a partner of a person with a complete spinal cord injury, I appreciate these articles and the science being done by these researchers, it is truly a big and complex and worthwhile problem to solve.
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.
To your last point, it's worth pointing out that making your built environment more easily traversible and usable for people with accessibility needs will pretty much always make it more easily traversible and usable for everyone. It's hard to appreciate this until you visit a country where they haven't spent decades making sure their elevators and hallways are wide enough, there are no unnecessary stupid steps, the sidewalks don't have curbs at crossing points, etc. etc. This is just general societal progress, it makes all of our lives easier and we're so used to it we don't even notice it anymore.
I only truly appreciated this once I had was a pedestrian in a big city with a baby stroller. If a wheelchair can get somewhere, generally the stroller can do it as well. (At least a single wide stroller). Making places more accessible can have a positive impact on large parts of the population.
I've learned to take this approach with software as well. It just makes sense. While he's not universally accepted, Nassim Taleb makes compelling behavioral arguments for why this is better overall (in the context things like kosher salt and such)
Canada is unexpectedly one of those countries. Accessibility here is a nightmare, especially in big cities. As another partner of a person with limited mobility, I always notice and appreciate the difference that 40 years of ADA has brought to construction in the US.
(I'd take universal health care over improved building codes any day, but both would be nice.)
Indeed, Canada is a laggard in this area. I work on a university campus where they've gone beyond the bare minimum that's legislated, and it's quite a stark difference from the rest of the city. Another important part of that is sidewalk snow removal. Only within the last 5 years has the city slowly started doing this somewhat right on some streets, whereas campus sidewalks are always plowed and salted.
I'm blind with a retinal disease and it's a similar dynamic. Not all breakthroughs will help a given person. Additionally, most breakthroughs seem to be some version of vaporware, and it might be 10 or 15 years, or never, for most people in that category to benefit. I go through phases of catching up on research, but mostly try not to think about it.
I used to read physorg and other publications and would get really excited by all the new discoveries. But then decades go by and you sadly never see most of them realize.
I completely agree. My mother has been a partial quadriplegic since 1992 after a car accident. The moment there are broad cures for injury related paralysis, it'll be front page news.
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.
I guess the real question is, will a dollar spent on wheelchair ramps in buildings across the USA give a greater quality of life improvement to the average american than a dollar spent on medical research that tries to repair spinal nerves?
Obviously "average american" is not intended to reflect the 'typical american', but instead be an average across all people, including those with mobility requirements.
Given perfect hindsight that we have now, at any point in the 20th century you would have to respond "yes, you should also fund accessibility right away" . The answer today is almost certainly the same. Never mind that there are reasons to need accessibility beyond spinal injuries.
The distinction is that the quality of life improvement can be done now, and can make peoples' lives better immediately. It's not just wheelchair users that can make use of accessible infrastructure, the elderly, and young children can more readily make use of it too.
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.
There are plenty of such tradeoffs... For example, the government could start a helicopter service to help people cross a river today, or they could build a bridge across the river, which will help far more people, but won't be ready for 5 years.
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 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'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:
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.
> will a dollar spent on wheelchair ramps in buildings across the USA give a greater quality of life improvement to the average american than a dollar spent on medical research that tries to repair spinal nerves?
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.
But medical research leads to treatments which may have far better quality of life improvements than ramps. And when discovered, those treatments can be used forever, whereas ramps require constant spending for every new or renovated building.
Both are 'obviously' better than the other, depending on what you look at. Therefore the decision really should be made with more data.
> But medical research leads to treatments which may have far better quality of life improvements than ramps.
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.
> But medical research leads to treatments which may have far better quality of life improvements than ramps. And when discovered, those treatments can be used forever, whereas ramps require constant spending for every new or renovated building.
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.
Just like universal design in the physical world, universal design in software has knock-on benefits for everyone. A website that can be properly parsed by a screen reader can be scraped by search engines and archived efficiently. An application with proper tab indexes can be easily navigated by someone with a laptop rather than forcing them to reach for the trackpad.
> curing or preventing all of the various causes of blindness
It’s not obviously better because you’re solving for one case when a ramp solves for multiple. At no point does solving nerve damage fix the fact a baby in a stroller has a better time on a ramp, unless you’re proposing a new technology that obviates wheels. But that just makes it the new ramp in its utility.
I don't know why this has to be framed as an either/or. The US doesn't invest in infrastructure but leads in medical patents, so the low hanging fruit is being ignored. It is cheaper to build ramps than fund good longitudinal scientific research. Also you can have perfect spinal nerves and benefit from accessible infrastructure. Parents with infants in strollers, for example.
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
And spina bifida, and cerebral palsy, and strokes, and diabetes, and broken bones, and arthritis, and being pregnant, and just getting old, and literally hundreds of other disorders that cause temporary or permanent impairment.
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.
Whenever I come across an article about walking robots for the military, I am asking myself: What about walking-chairs as a replacement for wheelchairs? Could that be a realistic solution to the access problematic? I am an absolute layperson regarding robotics. Can perhaps anybody with some background explain, what to expect here in the next few years?
No. My wife is paraplegic and we did in fact test a rudimentary exoskeleton at one point.
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.
Anything more than a couple PSI over a couple hours comes with tissue damage risk.
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.
It's not exactly my area but I have some related experience. I suspect the big problem with this is power use.
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...
You may be happy to learn that a lot of recent stem cell work does not actually use foetal tissue. Instead, there are methods for reverting adult cells from a blood sample back into stem cells (IPSCs, or induced pluripotent stem cells). This is exciting for a number of reasons: not only does it sidestep ethical concerns, but it introduces the possibility of making stem cells--and thus, other cells--that precisely match an individual patient!
On the other hand, I'd encourage you to think about the motivations of medical researchers. Nobody is actually looking for any excuse to work with embryonic tissues (or animals, placebo-controlled trials, etc): it's slow, annoying and expensive and everyone I've ever met would vastly prefer to use yeast + computational models. People do actually want to help the sick and helpless, but the tools aren't there yet to do so with nothing but yeast and computational models.
Ok - things change. It was an similar example of the point is that with articles like these we are being 'tenderised' into acceptance of the generally unacceptable. It is a type of manipulative engineering of consent. It is not a fair presentation of the issue.
The 'sales job' suggests there is a (degenerative) agenda already in play with a desired end.
I'm honestly baffled as to what might be the generally unacceptable or "degenerative" agenda here. They stuck needles into consenting volunteers' spines and injected current. I don't think there's like...a big conspiracy to convince people to get epidurals or something.
Unless I've misread the articles about this story this is about a company using electrical stimulation to try to get people with spinal injuries to walk again. Not government using foetuses for some deeper purpose.
I think I would cry tears of joy even seeing _anyone_ even just wiggle their toes after not being able to do so. How awesome that most be to witness somebody who could only recently dream of doing this, really accomplish this?
_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.
Or the ad industry that keeps peddling more material shit on all of humanity. They ensure that the brightest minds are occupied by only one thought: how to maximise clicks.
I wonder if this could be used for a truly immersive vr experience.
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
The sequel to the novel Ready Player One, predictably called Ready Player Two, begins by introducing an OASIS Neural Interface (ONI) headset, which paralyzes the body and directly connects the brain to the OASIS VR. To develop this technology in secret, the creator of the OASIS set up an "Accessibility Research Lab" to develop implants for various categories of disabled people, then moved on to develop the headset.
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.
The number of bits needed for visual input far outweigh that needed for motor output so I’m not optimistic that it can improve the immersiveness of the experience.
Sword Art Online. An anime about players trapped inside a virtual reality online game. As jcun4128 described, the in-universe headset is much more advanced than what we have now.
It's an older RPG anime about people laying in bed playing a game in a virtual world via a BCI head set. It wasn't like today's VR, their eyes were closed.
yeah, I've been thinking about this for a while. You can do a kind of tomographic reconstruction of neural impulses in the spinal column. By the same token you can induce electric fields within the spinal column.
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...
I have a colleague who could benefit from this type of new treatment.
Since HN is a wonderful place with a multitude of experts in various fields, I'll throw a question in the air:
Who and how would I contact, if I wanted to know more about these kinds of clinical trials and participation?
As a sibling comment noted, the vast majority of "breakthroughs" are hot air and your discovery of a way to "fix" your colleague may not be received as warmly as you expect. I don't know anything about your colleague or your relationship with them, but I strongly advise careful consideration before broaching the subject. (In fact, I strongly advise against bringing it up at all. "I found a cure for you" is up there with "what's wrong with you" and "I'll just push your wheelchair without your consent" on the list of ways to really, really piss off someone with a disability.)
Growing up, this sort of thing was speculated about with almost the same level of "sci fi" around it as things like stopping aging, instant cures for new diseases, and video phones.
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?
Flying cars, despite being a symbol of a scifi future, are actually a pretty bad idea. Driving on wheels is much more energy efficient than flying, and without the risk of acting like a kinetic weapon if the battery cuts out.
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.
Yes, small aircraft already account for most of the unscheduled rapid disassembly of planes each year. I don't think that masses of flying cars would improve on that.
I don't really see a straight path to improving upon cars for arbitrary point-to-point transportation.
This builds upon some solid research in rodents and humans, which had showed very promising results. It is very likely to become a therapeutic option within the next 10 years, in my opinion.
We are now at the technological level where the paralyzed can walk, but still at the legal level where information regarding such achievements is best shared surreptitiously.
Walk, swim, cycle?
Are we talking about pre-recorded neural commands, "modes" in implant?
Or they actually managed to restore connectivity in nerves, bypassing damaged part?
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.
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."
The methods used in this study sound almost exactly like a TENS unit (1). As someone with a spinal cord injury that almost left me a quadriplegic, and who has serious neuropathy as a result, I have found that TENS units do very little to help me. I hope this can help people though,
Yes, it is inaccurate to the point of being the reverse.
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.
They hooked up trodes to the bottom section of the nerves, enabling patients to activate, selectively, respective muscles. Chain those activations together in sequence and you got a walk.
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.
As the partner of a complete paraplegic, sitting up and providing trunk control would be a huge benefit to newly injured patients. My partner had titanium rods but in their back 20+ years ago and the connections and bones are now wearing down. Allowing the muscles to provide trunk control would likely improve quality of life, increase mobility, and remove the challenges with arthritis from implants they put in spinal cord injury patients currently.
Reading in detail what it actually entails to be completely paraplegic is quite an eye-opening experience.
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.
Probably pre-recorded, according to the nature article:
> 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.
Seems incredibly risky. If a muscle is stimulated too greatly without the user's ability to feel it cramp or be overworked, it could potentially rip, rupture, etc.. and now the user will be dealing with rhabdomyolysis without even having any notice.
True risk. My partner is a paraplegic and their are things to watch out for all the time. Hot items on paralyzed skin, bed sores, muscle atrophy. I don't know if this is common, but my partner has developed a heightened sense of awareness for many of these things. Not to say that muscle tears couldn't happen, but there are other senses that do kick in with practice and awareness to keep people safe.
You don't need to do crossfit to get injured. You're perfectly capable of injury by pushing your arm back, walking too slowly, and many other "normal" movements if you ignore the pain or are not able to feel it. This is basically a one-way interface and as far as I understand it, the patients don't get the sensations coming back.
Excellent news. For someone working from chair and dealing with a lingering mild sensation kind of feeling (sometimes faint pain like) in the lower back any new development in the spine region gives hope for the future if things go wrong. (I’ve mild lower spine bulging that doctors say nothing to worry about though).
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.
Better hope you have insurance or are a part of a study. Spinal Cord injuries are among the most expensive injuries to treat. Totals up into the millions pretty quick.
My main criticism and cynicism from articles like these (related: prosthetics) is that they help the few people that are lucky, popular, or rich; lucky to have a doctor or to find a program and get into it; popular because they end up in social media 'feel good' posts and articles; rich because it's experimental, low-volume tech or treatments that require going abroad. Popular can also translate to being able to afford it, but it's shameful that people have to post their stories online to raise money. (shameful to society that is, not the people who are driven by desperation).
But I guess things like this will eventually trickle down to general and widespread availability, just technological advancements like cochlear implants and pacemakers did.
That's generally how things with new tech. Initially expensive; it gets cheaper over time. Eventually patents run out and everybody gets in on the action.
We all want the biggest amount of people have something that improves their life.
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.
I see it differently, I think articles like are important by making people aware of solutions like these which will speed up the time needed to get them to people not as fortunate to have access to them now. More awareness means more people will work towards making the solution, lowering their cost.
I'd agree with this sentiment. These articles make people excited and bring awareness plus, if you allow me to speculate, I bet someone with paralysis who at least sees these articles and realizes they might have a chance to walk in the future will feel better than someone who doesn't see them. Knowing there is a chance makes it easier to cope with problems. Or maybe I'm wrong, tell me if I am, I fully understand my perspective may be skewed.
I have a few medical problems that aren't solvable with current technology, seeing articles like these related to my issue gets me excited and hopeful that I'll be cured one day.
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.
Do you have any ideas or advice on how these products should be developed instead?
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.
Obviously, medical experiments should only be done on the poorest and neediest segment of the population. There's no way to spin THAT as exploitative. ;D
Please this is public research from a public University, what do you expect? That they can scale it to 1000 of people?
This is research as intended, now commercial products may be built out of this but it will take time again.
You don’t have to worry about that. If it’s possible, the market will solve that. Think of this as a proof of concept that viable tech and a potential market exists.
Here is the actual paper: https://www.nature.com/articles/s41591-021-01663-5 (paywall)