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Thread: Paralysed patients regain voluntary movement with spinal stimulation

  1. #151
    Quote Originally Posted by taymas View Post
    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.



    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.
    I'm just not convinced sensory information wasn't reaching the brain. This is a direct excerpt from the paper:
    "Both participants [the two ASIA A subjects] were able to have a greater modulation of the flexor groups as compared to the extensors. This is consistent with their voluntary activity practice as all participants regained the ability to perform flexion tasks with a greater difficulty performing active extension. This ability to modulate EMG with intent during stepping was only seen in two of three individuals." [The first subject, Rob Summers, had a vastly different timeline for implantation and training than the other 3 subjects and thus they couldn't get comparable data for him.]

    When the subjects were putting forth greater effort in stepping, how could it just be coincidence that the hip flexors are what saw the biggest increase in activity? There is a lot going on during locomotor training, when your body is being moved for you/you are being assisted in a walking motion by three different people. In my own experience, when someone undergoing locomotor training tries harder to contribute to the walking, the number one go-to motion is pulling the legs forward (which involves the flexor muscle groups). The only way I can venture that these subjects were voluntarily able to increase the effort in the flexor muscle groups, provided the locomotor technicians provided consistent locomotor training, is that the subjects could feel the flexor muscles in their legs. It has nothing to do with b,b,&s function, but as I have said I can't in good judgement assume there was no sensory information going to the brain.

    I also didn't mean to imply that you personally, taymas, were calling the investigators liars. I don't see any derogatory language in my post, but regardless, I apologize. I didn't want or mean to come off as derogatory. I was just trying to get my point across, which I could have done more clearly.

  2. #152
    Quote Originally Posted by tomsonite View Post
    I'm just not convinced sensory information wasn't reaching the brain. This is a direct excerpt from the paper:
    "Both participants [the two ASIA A subjects] were able to have a greater modulation of the flexor groups as compared to the extensors. This is consistent with their voluntary activity practice as all participants regained the ability to perform flexion tasks with a greater difficulty performing active extension. This ability to modulate EMG with intent during stepping was only seen in two of three individuals." [The first subject, Rob Summers, had a vastly different timeline for implantation and training than the other 3 subjects and thus they couldn't get comparable data for him.]

    When the subjects were putting forth greater effort in stepping, how could it just be coincidence that the hip flexors are what saw the biggest increase in activity? There is a lot going on during locomotor training, when your body is being moved for you/you are being assisted in a walking motion by three different people. In my own experience, when someone undergoing locomotor training tries harder to contribute to the walking, the number one go-to motion is pulling the legs forward (which involves the flexor muscle groups). The only way I can venture that these subjects were voluntarily able to increase the effort in the flexor muscle groups, provided the locomotor technicians provided consistent locomotor training, is that the subjects could feel the flexor muscles in their legs. It has nothing to do with b,b,&s function, but as I have said I can't in good judgement assume there was no sensory information going to the brain.

    I also didn't mean to imply that you personally, taymas, were calling the investigators liars. I don't see any derogatory language in my post, but regardless, I apologize. I didn't want or mean to come off as derogatory. I was just trying to get my point across, which I could have done more clearly.
    I fail to comprehend your coincidence. They said the patients were better able to perform flexion tasks. So why is it odd that they had greater muscle EMG in their flexor muscles? In your experience, when someone tries to walk their go to motion involves the flexor muscle groups, so why is it odd that that they had greater EMG in their flexor muscles?

  3. #153
    Quote Originally Posted by Nowhere Man View Post
    I fail to comprehend your coincidence. They said the patients were better able to perform flexion tasks. So why is it odd that they had greater muscle EMG in their flexor muscles? In your experience, when someone tries to walk their go to motion involves the flexor muscle groups, so why is it odd that that they had greater EMG in their flexor muscles?
    I never said anything was odd about that...I just think that the flexor muscle EMG increasing when the subjects increased their effort may have something to do with sensation.

    The study also talks about the subjects' ability to correlate their volitional efforts with visual and auditory cues, and about how that ability increased with training. That sounds to me like something that would take sensation to do.

  4. #154
    Super Moderator Sue Pendleton's Avatar
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    Tomsonite, yes, they were EMGs and I've had both surface and intramuscular and neither are exactly painful tests even for an incomplete. But I'm not the only one who has reported feeling nauseous afterwards. Not much makes me feel like that so I find it very peculiar.

    I agree. Your descriptions of both tests are great. Thanks.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  5. #155
    Quote Originally Posted by tomsonite View Post
    When the subjects were putting forth greater effort in stepping, how could it just be coincidence that the hip flexors are what saw the biggest increase in activity?
    No one ever said it was just a coincidence. It makes perfect sense. The patients had better voluntary control over their flexor muscles as compared to extensor muscles, and when trying to step, they were voluntarily trying to use their flexor muscles to step forward (as you said). It seems like a direct causation.

    Quote Originally Posted by tomsonite View Post
    I never said anything was odd about that...I just think that the flexor muscle EMG increasing when the subjects increased their effort may have something to do with sensation.
    I thought EMG tests voluntary control of muscle? In the study they used EMG to test voluntary control of muscle...not sensation. So WHY do think that the flexor muscle EMG increasing when the subjects increased their effort may have something to do with sensation? That?s what I'm having trouble understanding. The why.

    Quote Originally Posted by tomsonite View Post
    The study also talks about the subjects' ability to correlate their volitional efforts with visual and auditory cues, and about how that ability increased with training. That sounds to me like something that would take sensation to do.
    I did not read that section. But the visual and audio systems do not use the spinal cord. As the eyes and ears are obviously on the head. So I don?t understand why that sounds like something that would take sensation (ability to feel) to do.

  6. #156
    Senior Member lunasicc42's Avatar
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    Quote Originally Posted by Moe View Post
    At least it's not a bad word... In fact Clowns are quite entertaining and kids love them...

    .....those loveable scamps
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  7. #157
    Senior Member lunasicc42's Avatar
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    back to topic ...I have long suspected that the whole Epidural stimulation thing is attention grab with little scientific subtance or might ,but of course I am reserving my final judgement for the real publication .right now it's all talks and speculation.
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


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  8. #158
    Quote Originally Posted by Sue Pendleton View Post
    Tomsonite, yes, they were EMGs and I've had both surface and intramuscular and neither are exactly painful tests even for an incomplete. But I'm not the only one who has reported feeling nauseous afterwards. Not much makes me feel like that so I find it very peculiar.

    I agree. Your descriptions of both tests are great. Thanks.
    I've never heard of an EMG test causing nausea. That is very peculiar indeed.

    Quote Originally Posted by Nowhere Man View Post
    No one ever said it was just a coincidence. It makes perfect sense. The patients had better voluntary control over their flexor muscles as compared to extensor muscles, and when trying to step, they were voluntarily trying to use their flexor muscles to step forward (as you said). It seems like a direct causation.

    I thought EMG tests voluntary control of muscle? In the study they used EMG to test voluntary control of muscle...not sensation. So WHY do think that the flexor muscle EMG increasing when the subjects increased their effort may have something to do with sensation? That?s what I'm having trouble understanding. The why.
    When doing locomotor training, the patient is up in a harness while three people move their body in a walking motion - there is a ton going on and it can be hard to focus on one thing. I've even gotten in a harness myself to have new trainers/aides at my facility learn how to do LT, and its quite overwhelming. Its much tougher to focus on one movement when your body is being moved over a treadmill then when lying on a table. That's why I would guess that the subjects could feel their hip flexors when they were trying harder on the treadmill. Rather than trying harder with every single complex movement involved in walking, they resorted to the movement that was strongest and easiest to pinpoint, because they could feel it.
    EMG doesn't test voluntary control of a muscle, simply the electrical activity going through it. If a muscle is on, whether from voluntary movement or external stimulation, you will get a result on EMG. Its why complete SCIs with no volition can still get EMG responses when going through locomotor training.
    Another thing to remember is how limited ASIA exams are when it comes to sensory and motor function. I work with people every day who can't feel x, y, or z when lying on a table, but if you get them on the treadmill or overground in a walker, they can tell you all about whats going on below their injury because of the extra sensory information coming in. Its very possible that the subjects might have felt what was going on up on the treadmill while walking, but not gotten any sensory return when off the TM and the epi-stim turned off. Is this practical or useful to most people with SCI? Not really. But it is a factor in why I believe the subjects might have felt their hip flexors when up on the TM.
    Quote Originally Posted by Nowhere Man View Post
    I did not read that section. But the visual and audio systems do not use the spinal cord. As the eyes and ears are obviously on the head. So I don?t understand why that sounds like something that would take sensation (ability to feel) to do.
    Think about it this way...The eyes and ears are on the head, and information gets from those organs to the brain through the cranial nerves...so you are correct, they don't use the spinal cord, the way skeletal muscles do (the muscles that move your skeleton). But, sensory information from the eyes, ears, muscle and skin all go back to the brain for processing, and they all intertwine. In fact, the visual and auditory systems play massive roles in balance when standing or moving.
    Anyway, the subjects in the study were asked to increase or decrease effort during volition strength tests according to a visual cue on a computer screen, or an auditory cue while wearing headphones (the louder the sound, the stronger the muscle contraction had to be). All subjects displayed a very limited ability to do so at first, yet over time improved their abilities. They appropriately adjusted the strength of their muscle contractions depending on what the computer screen or headphones told them to do (this was confirmed by EMG). Adjusting how strong a muscle contraction is while focusing on other sensory information coming in sounds like something that's hard to do if you can't feel the muscle contraction. So that's where I'm coming from on that one.

    Quote Originally Posted by quadfather View Post
    Plus, their posses are often insane
    Nice.

  9. #159
    Quote Originally Posted by 2drwhofans View Post
    The complete article from today's online edition of the Neurology journal Brain.


    http://brain.oxfordjournals.org/cont...in.awu038.full
    Quote Originally Posted by lunasicc42 View Post
    back to topic ...I have long suspected that the whole Epidural stimulation thing is attention grab with little scientific subtance or might ,but of course I am reserving my final judgement for the real publication .right now it's all talks and speculation.
    See the quote above yours. Its not all talks and speculation. The published paper this thread is based on is available online (at least it was when this thread started). If the link doesn't work I can send you a copy.

  10. #160
    Senior Member ChesBay's Avatar
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    Quote Originally Posted by SCIfor55yrs. View Post
    And bowel, bladder function, and sexual functioning too!
    would be heavenly after all these years.

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