Walking Around the Obstacles

The effort to build and market a neural prosthesis that restores walking to individuals paralyzed by spinal cord injury has never been easy. In case it’s not difficult enough to solve the engineering problems involved with designing a multichannel, multisite stimulation system that replicates physiological processes that are still not fully understood, research teams and commercial ventures must confront naysayers within their own ranks and unbelievers within the clinical communities and the public at large.

But as we discuss in our article on FES locomotion this month [see p1], sometimes controversy and disagreement can be helpful if it’s used in a constructive way to formulate the proper goal and make progress toward that goal. As tempting as it might be for proponents of FES locomotion systems to dismiss doubters like USC’s Gerald Loeb as irrelevant, this is not a wise course of action.

To begin with, even if theirs is a minority viewpoint within the FES community, Loeb—and those who concur with him—have too much expertise and experience developing neural prostheses to ignore. More important, whatever arguments these opponents make concerning the viability of FES locomotion systems are likely to surface again at various stages of the funding process, clinical testing, or venture capital investment. Far better to be prepared in advance for every possible objection that can be thrown out later down the line.

Also, an objective, dispassionate discussion of the technical and market factors contributing to the project’s success can often lead to new insights on both sides as participants look for common ground in their points of view. This was the case at the recent Neurotech Leaders Forum, where both Loeb and those who disagreed with him voiced their support for exercise and FES rehabilitation systems that will help alleviate problems such as diminished bone density and muscle mass and pressure sores in individuals with spinal cord injury. If these systems prove instrumental in restoring locomotion to paraplegics, as many in the field of locomotor training believe, so much the better. But even if they fail, or if some other therapy beats FES to the punch, the side benefits of these rehabilitation and exercise systems will have been well worth the cost.

In the end, perhaps the greatest value of opponents like Gerald Loeb to those working on a walking prosthesis—and to their users that stand to benefit—is the motivation they can provide to overcome obstacles, be they intellectual, economic, or political. Just about every significant engineering achievement of the last 100 years—including the Wright brothers’ first powered flight, the television, the laser, and the cardiac pacemaker—has benefited in a perverse way from the people who said it couldn’t be done.

Considering the obstacles that their users have had to overcome along the way, a little bit of doubt should not be too much for engineers.

James Cavuoto
Editor and Publisher