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Thread: Paralysed patients regain voluntary movement with spinal stimulation

  1. #141
    Quote 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?

  2. #142
    Senior Member NW-Will's Avatar
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    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

  3. #143
    Quote 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?

  4. #144
    Quote 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).

  5. #145
    Quote Originally Posted by Nowhere Man View Post
    ??

    a) what evidence?
    This evidence, as was reported in the paper:
    Quote 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.

    Quote 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.

  6. #146
    Quote 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.

  7. #147
    Quote 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.

  8. #148
    Quote 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 at 10:11 PM.

  9. #149
    Quote 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.

  10. #150
    Quote 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.

    Quote 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.

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