
Nerve transfer restores hand function, elbow extension in paralyzed patients - Someone
https://www.sciencedaily.com/releases/2019/07/190704191425.htm
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TaupeRanger
Whenever I see a post like this I am struck by the huge disparity in our grasp
of (and ability to treat) different types of human ailments. Are you a
tetraplegic? Don't worry, we will just literally rewire your nervous system to
give you functioning limbs again. Do you have tiny tumor in your pancreas?
Sorry, you won't know about it for a while, and when you do your only recourse
is for a surgeon to cut out half of your digestive system and then we'll
inject literal poison into your body with the hope that you die in 1 year
instead of 3 months.

I know, there are plenty of reasons that certain diseases have been harder to
crack, but the disparity always seems so striking. This nerve transfer study
seems so incredible and futuristic, and yet there is still so far to go.

~~~
disabled
The autonomic dysfunction (including the super-horrible autonomic dysreflexia
events) would still occur in higher level spinal cord injuries, including in
people with higher level paraplegia and more commonly in quadraplegia, in the
case of nerve transfer. It is not as good as it sounds, as autonomic
dysreflexia occurs in up to 90% of people with injures above T6, to varying
degrees. The autonomic ganglia (which runs adjacent to the spinal cord, and
consists of a different type of nerve) controls this, not the spinal cord. You
simply cannot do a nerve transfer for the autonomic nervous system without
just about dying. By the way, trust me, autonomic dysreflexia is actually one
of the worst feelings in the world.

[https://en.wikipedia.org/wiki/Autonomic_dysreflexia](https://en.wikipedia.org/wiki/Autonomic_dysreflexia)

~~~
joncrane
Is this the phenomenon that paralyzed athletes exploit to increase
performance?

~~~
serf
Yes.

I had a friend who broke his toes repeatedly to do so before track events. I
had another friend in physical rehab that used to purposely sit on his own
testicles to trigger an AD fit for the same purpose.

It's a pretty terrible feeling, but I guess if there is a strong enough desire
to win you can put yourself through whatever you need to. I've gone through a
lot of shit medically, but AD and the accompanying loss of blood pressure and
uptick in heart-rate is one of the closest to "feeling like i'm going to die"
i've ever been.

~~~
disabled
Agreed. Same here.

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disabled
Frankly, as somebody with 2 rare autoimmune nerve diseases (affecting my
peripheral nervous system), who is disabled, I am not excited about this news.

Do they have any sort of residual neuropathic pain, either from their injury
or the procedure? What sort of functional limitations do they have? Did their
autonomic dysfunction improve (extremely unlikely to improve with a nerve
transfer procedure, as described above)? Etc., etc.

I am sure this is more heartwarming than anything else. I am perfectly OK with
being disabled, and I just wish society would accept us for who we are (as
disabled people). I am tired of people in tech posting "inspirational" stories
in general about "overcoming disabilities" or "making our lives better"
(because "we suffer so much"), without any sort of interview or input from the
disabled person. We are always portrayed as objects, and are never at the
center of the story, and if we are, we are still the object because it is
about making a gerry-rigged mobility device with a high school robotics team
with Home Depot materials because our insurance refused to pay for something
medically necessary.

The most famous example of a "heartwarming story" about the disabled is
wheelchairs that climb stairs (that probably are not safe to use in the rain
or on carpeted stairs), that cost tens of thousands of dollars and have huge
design constraints (which are almost never mentioned). Plus, if you knew how
US insurance reimbursed wheelchairs (which should be classified as a
prosthetic device, versus an orthotic device), you would be absolutely
appalled. I would not hold my breath on insurance reimbursement for a
procedure like nerve transfer anytime soon, either.

To me, this is another variant of techno-ableism:
[https://techanddisability.com/2017/11/11/technoableism-
cybor...](https://techanddisability.com/2017/11/11/technoableism-cyborg-
bodies-and-mars/)

~~~
nsajko
> They can now perform everyday tasks independently such as feeding
> themselves, brushing teeth and hair, putting on make-up, writing, handling
> money and credit cards, and using tools and electronic devices.

Would that not be worth it?

~~~
disabled
The way this news is portrayed, as "heartwarming", does nobody favors.

The autonomic dysreflexia, which people with tetraplegia are almost guaranteed
to have, is literally one of the worst feelings in the world. I promise you,
and I have experienced it firsthand. This cannot be resolved by the nerve
transfer.

It's not about worth or function-It's about perspective and how things have
changed for them. That is what really matters. Nobody ever interviews the
disabled people who participate in these sorts of things, and limitations are
almost never honestly described in these circumstances. If you do not
recognize the hypocrisy, then I do not know what to say.

By just portraying it as heartwarming news, it does no favors for people who
are actually going through things like this. By the way, it is not at all
heartwarming for us. We also cannot make informed decisions off of articles
like this, and it is harmful because the bar is either set really high for us
--or really low.

Our lives are tied more to "what we are worth" far more than the abled-bodied.
I could go into it more but I don't want to write a really long winded post.

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Epholys
It's really heartwarming to have progress in this field of medicine! I feel
anxious just imagining being unable to move my arms.

But there's a catch:

> Despite these achievements, nerve transfer surgery still has some
> limitations. For the best results nerve transfers should ideally be
> performed within 6-12 months of injury.

I hope this method will progress to have a much longer span of time allowing
this surgery.

~~~
dsfyu404ed
>I hope this method will progress to have a much longer span of time allowing
this surgery.

I think it becoming cheap/common enough that 6-12mo is not a limitation in
practice would be a far better outcome.

~~~
Filligree
The problem isn't with treating new injuries. There are a lot of paraplegics
in the world today who were injured a long time ago, and it would be nice to
fix them...

A much harder problem, I'm afraid.

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FigBug
When I was injured in 1991, they transplanted nerve sheaths from my leg to my
arm with the hope nerves would regrow. Some actually did an I regained some
sensation and movement.

That was considered pretty good at the time. I wonder how much better off I'd
be if I'd been injured today instead.

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grenoire
How exactly does a nerve transfer work? I always imagined that certain control
and reception signals would have their dedicated nerve connections, such that
rewiring from a transplanted nerve would jumble up the wiring and give
'incorrect' results.

~~~
zaarn
Even if the result is incorrect at first, the brain is adaptable and will
simply remap to correct the bad wiring.

There are videos on youtube of people who put on googles that invert the view
of the world upside down. After a few weeks/months of adaption, they can live
in that condition as normal.

~~~
yomly
I seem to have awareness that people have redirected the auditory and visual
cortexes as an experiment and found that sight and hearing were recovered
eventually?

Unfortunately I can't find a source to verify this so hoping someone with
better knowledge could confirm that this is just how plastic the brain can be?

~~~
DavidSJ
You may be thinking of this experiment on ferrets:
[https://www.ncbi.nlm.nih.gov/m/pubmed/1527604/](https://www.ncbi.nlm.nih.gov/m/pubmed/1527604/)

~~~
yomly
Yes this is along the right lines - thank you!

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Causality1
"Australian surgeons attached functioning nerves above the spinal injury to
paralysed nerves below the injury."

How was that done, exactly? Were they just sort of clamped together? Some sort
of special bonding device that encouraged synapse formation?

~~~
porpoisemonkey
Might have been a neuragen tube.

I had one of these placed in my hand after I severed the nerves in one of my
fingers... It took about 1 year before I regained any feeling and 2 before I
regained maximum nerve use.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920394/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920394/)

~~~
hanniabu
Roughly how close was max nerve use to how it was before the accident? 60%?
80%?

~~~
porpoisemonkey
It's hard to gauge, but...

* Before the accident the nerve was 100% (undamaged)

* Immediately after it was 0% (could not feel anything - including the sensation of heat)

* 1 year after ~20% (could feel the sensation of heat and firm presses)

* 2 years to now ~70% (could feel heat and soft presses)

I still only type with 7 of 8 fingers on the keyboard because I have a hard
time determining the location of that one finger.

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ajcarpy2005
Good reference book is The Body Electric. Except it's about regrowing limbs.

~~~
carapace
Seconded, awesome book about human tissue regeneration.

Michael Levin's lab is doing mindblowing stuff: "What Bodies Think About:
Bioelectric Computation Outside the Nervous System"

[https://news.ycombinator.com/item?id=18736698](https://news.ycombinator.com/item?id=18736698)

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icefo
What I remember from biology class is that nerve cells are very long (up to ~1
meter) and when they are cut they die.

I wonder how they transferred nerves given that.

If someone know and can explain I'd be very thankful !

~~~
Vrondi
Not all types of nerve cells are the same size. Some are several feet long,
but some are only millimeters long. I assume this technique must make use of
the shorter ones that survive?

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malka
Probably the most uplifting news I read these last times. I cant imagine what
these people must have felt when they got this new arm.

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RocketSyntax
Woah, like transfer learning in neural nets.

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buraequete
This is magical, science shall cure all ills.

