A promising first step for those with spinal cord injury: Further reading on electrical stimulation and how it’s helped rats (and one human!) walk again

Science TEDTalks Gregoire Courtine shares the story behind his work at TEDGlobal 2013. It begins with: an encouraging mentor. Photo: James Duncan Davidson

Grégoire Courtine and the scientists in his lab helped a paralyzed rat learn to walk again, voluntarily, through a treatment that combined drugs, electrical stimulation of the lower spinal cord, the support of a robotic arm and a little bit of chocolate. When their study appeared in the June 2012 issue of Science, it sparked a lot of excitement. Articles in Scientific American (“With Willpower, and a Jolt of Electricity, Paralyzed Rats Learn to Walk Again”) and The New York Times (“In Rat Experiment, New Hope for Spine Injuries”) followed, as did a segment on ABC News (“Paralysed rats on ‘incredible’ road to recovery”).

Grégoire Courtine: The paralyzed rat that walkedToday, Courtine shares the story behind this work. The keys to his breakthroughs: a riveting call to action from Christopher Reeve, and a mentor who encouraged wild experimentation.

“The spinal cord below most injuries contains all the necessary and sufficient neural network to coordinate locomotion. But because input from the brain is inhibited, they are in a non-functional state — kind of dormant. My idea: we awaken this network,” explains Courtine in today’s talk. “After completing my Ph.D in France, where independent thinking was not exactly encouraged, I was afraid to talk to my new boss … [But] he listened to me carefully and responded with, ‘Why don’t you try?’ This was such an important moment in my career, when I realized that great leaders believe in young people and new ideas.”

In this talk, Courtine shares why his lab’s method worked so well — because it encouraged the brain to make new connections to relay information from the brain to areas below the injury. This, of course, raises a big question — could this treatment work in humans? After all, 50,000 people around the world suffer from spinal cord injuries every year.

Naturally, Courtine hopes so. His team is working hard to develop interventions that could potentially be effective in humans. And a recent study suggests that this may, in fact, be possible.

At the University of Louisville, neuroscientist Susan Harkema — who also studied with Courtine’s mentor, V. Reggie Edgerton — used electrical stimulation to successfully “awaken” a 23-year-old man’s lower spinal cord. In a paper published in The Lancet in June 2011, Harkema shared the amazing results of a study on a patient named Rob Summers. On the very first day of his treatment, Summers was able to stand up on his own. Soon, he was able to move his legs. He later was able to control his bladder and bowel movements, and regained sexual function.

“Rob’s is a pioneer recovery,” Courtine said, in a powerful article in IEEE Spectrum last month about this experiment. “What was surprising to me was that his was better than what we’ve seen in rats. It was really exciting for me to see.”

The U.S. Food and Drug Administration has given Harkema the go-ahead to continue the study with four more patients, to begin determining if the first study was a fluke or if this treatment could work for others. In their article, IEEE Spectrum profiled one of the four patients who will participate — Dustin Shillcox, a 26-year-old from Wyoming who was paralyzed after a car accident.

“I don’t want to be too optimistic, and I’m trying to be prepared for no results at all,” he told the magazine. “I hope that whatever they find from this research will at least benefit other people.”

Both Courtine and Herkema’s work builds on that of Edgerton, who long ago demonstrated that directly stimulating the spinal cord could produce movement, even if communication with the brain wasn’t a possibility. “Everyone, including us, was hung up on the idea that you have to stimulate at this high level to induce the movement,” Edgerton told IEEE Spectrum. And yet, it turned out that low-level stimulation produced far better results, allowing the lower spinal cord to receive sensory feedback from the body.

This story beautifully illustrates how a scientist’s finding is a beginning rather than an ending. One insight can spark subtle variations and brand-new ideas as others pick up the torch and carry the research forward. And while the finish line of a well-tested intervention for spinal cord injuries might be a long way off, it’s a race we are eager to watch.

(Note: For the latest from Courtine’s lab, check out the literature review “Personalized Neuroprosthetics,” published today in Science Translational Medicine.)

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Why Africa is booming: Further watching and reading on the economic turnaround of the continent

Global Issues TEDTalks Economic growth in Africa is about to climb off the charts, says Charles Robertson at TEDGlobal 2013. Photo: James Duncan Davidson

In today’s talk, economist Charles Robertson turns up the heat on an idea that’s been simmering for several years: that Africa is seeing rapid economic growth. Charles Robertson: Africa's next boomLooking at statistics and at the precedents set by China and India, Robertson brings this idea to a full boil, saying that economists haven’t been nearly optimistic enough in their predictions for the continent. While Africa is currently a $2 trillion economy, by 2050 it will be a $29 trillion economy, he says — bigger than Europe and America combined. It’s a bold talk, full of inspiring graphs all pointing up, up, up.

Africa has, for a long time, conjured up images of famine, disease, poverty and war. But increasingly, entrepreneurship, technological innovation and investment in education are becoming part of the outsider’s mental picture.

Here, a selection of TED Talks fueling that shift:

Euvin Naidoo: Why invest in AfricaEuvin Naidoo: Why invest in Africa. Kicking off TEDGlobal 2007, themed “Africa: The Next Chapter,” South African investment banker Euvin Naidoo takes a data-driven look at the investment opportunities in Africa. The signs he sees that the economy is in a turnaround: decreasing inflation, currencies stabilizing and a growing middle class.

And below, resources where you can read much more about what’s happening in Africa now:

Charles Robertson is the chief economist of Renaissance Capital and a co-author of the 2012 book, The Fastest Billion: The Story Behind Africa’s Economic Revolution. Written by a panel of African economists, this book is great stop for anyone looking to read more about the economic explosion in Africa. Even better, the book’s regularly-updated website, which has detailed reports on African agriculture, the middle class in Nigeria, and how China is influencing Africa through investment.

In which country does Guinness sell more of its flagship beer than any other? The answer, as of two years ago, is no longer Ireland — it’s Nigeria. Check out this article in The Telegraph about how the multinational alcohol brand has seen compound annual growth of 13 percent on the continent since 2007, and how it is rebranding Guinness as a result.

The Economist first began to notice change in Africa in the 2008 article “Booming Africa,” noting that the Sub-Saharan region was bucking the global trend and appeared unaffected by the U.S. economic slowdown. Three years later, in the story “Africa’s Hopeful Economies: The Sun Shines Bright,” the magazine reversed its infamous diagnosis that Africa was the “hopeless continent” with the revelation that 6 of the world’s 10 fastest-growing economies were in Africa. Most recently, in March of this year, the magazine ran a package titled “Africa Rising: A Hopeful Continent,” and declared, “African lives have already greatly improved over the past decade. The next ten years will be even better.”

The May/June issue of Foreign Affairs took a more tempered look with the article, “Africa’s Economic Boom: Why the Pessimists and Optimists are Both Right.” Authors Shantayanan Devarajan and Wolfgang Fengle write, “At first glance, these two narratives seem irreconcilable. It turns out, however, that both are right, or at least reflect aspects of a more complex reality, which neither fully captures. The skeptics focus so much on the region’s commodity exports that they fail to grasp the extent to which its recent growth is a result of economic reforms (many of which were necessitated by the misguided policies of the past). The optimists, meanwhile, underestimate the degree to which the region’s remaining problems — such as sclerotic institutions, low levels of education, and substandard health care — reflect government failures that will be very difficult to overcome because they are deeply rooted in political conflict.”

Another indication of growth in Africa—a booming travel industry. This summer, Bloomberg News shared that Starwood, Hilton and Marriott hotel groups were all greatly expanding their presence in Africa. (Marriott, for example, increased the number of hotel rooms it planned by 55 percent over the course of a year.) Meanwhile, Skift.com noted that tourism in Thailand grew from non-existent to employing 15 to 20% of the workforce in just a few decades, and predicted that the same would be true in African countries. “In 50 years, Africa will be talked about with the same fervor that global hotel groups and tourism marketers now use to fawn over Asia,” the article predicts.

In July, Yes! Magazine declared an “African economic renaissance” in an article titled “What the US Can Learn from Africa’s Booming Economy.” The lessons here that the West can take, according to the author? Provide local service for local communities, use technology to level the playing field, and consider creativity a major strength.

In January, Jake Bright of The Daily Beast noted a major shift in how Africa was being discussed in global investment circles in the article “Africa is Rising: Inside the Continent’s Great Economic Leap.” The piece begins: “In corporate boardrooms and global-investment seminars, more CEOs and business leaders are talking about Africa. That much was evident at a recent New York Stock Exchange investor conference, where along with references to Africa as the ‘new Asia’ or ‘home of the next Google’ there were forward outlooks by Wall Street analysts, representatives of the continent’s 29 stock exchanges, and presentations on Africa’s tech industry, now claiming mobile-banking innovations outpacing the United States and Europe.”

Others have also noted that Africa is fast becoming a source for technological growth. Check out the Businessweek slideshow, “Digital Innovation is Booming in Africa,” published in May. It looks at the continent’s mobile phone banking technology, cheap solar paneling for villages, and touchscreen tablets’ increasing presence in schools.

Last month, the International Business Times took a look at the latest in Africa and identified “Seven Drivers That Could Transform Africa into the World’s Economic Powerhouse.” Among them: the prevalence of cities on the continent, increased stability, growing trade, the world’s biggest workforce, increased spending on education, the explosion of cell phone use and loads of uncultivated cropland.

And finally, BBC News takes a deep dive look at, “Africa Rising — but Who Benefits?”

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If You Do It Correctly Getting Healthy Can Help You Further Your Career

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Further reading (and watching) on autism

Health TEDx Pianist Derek Paravicini, who has severe autism, processes music in fascinating ways. Here, resources for learning more. Photo: TEDxWarwick

Derek Paravicini is many things: an incredible piano player, a blind man, an excited talker, a musical savant, and a 30-something with severe autism. Derek Paravicini and Adam Ockelford: In the key of geniusIn today’s TED Talk, we get a fascinating peek into how he understands music. Paravicini — who was playing major concert halls at the age of 10 — not only has perfect pitch, that rare ability to recognize and re-create any musical note, but is also able to hear all the individual notes played simultaneously in a piece of music. Paravicini has a memory for an incredible catalogue of songs, and is able to transpose them into any key at will. But while Paravicini has been called “The Human iPod,” his longtime piano teacher Adam Ockelford says that this description misses the point.

“Derek, you are so much more than an iPod,” says Ockelford. “You’re a fantastic, creative musician.”

Today’s talk brings up many questions. Is there a connection between autism and music? How do autistic minds work, and what is the experience of living on the spectrum? And what forms of communication are open to those who have a hard time with traditional conversation?

We asked our own Michael McWatters — who writes the blog ASD Dad, which includes his thoughtful reflections on raising a son on the autism spectrum — to curate a list of resources surrounding this talk. Here are his suggestions, focusing on the parental and personal experience of autism.

Watch: Neurotypical. The word ‘autistic’ covers a huge range of people who fall somewhere on the spectrum. But there is also a word for those who fall off of it: Neurotypical. Filmmaker Adam Larsen adopted this term as the name of his new one-hour documentary, which looks at autism from the perspective of those who live it. The doc boldly turns the lens on what it’s like for three fascinating people — 4-year-old Violet, teenager Nicholas and adult Paula — as they negotiate the world around them. This doc aired as part of PBS’ POV series last week, and will continue to play throughout the month. Check your local listings to see when the documentary airs next in your area or watch online through the end of August.

Temple Grandin: The world needs all kinds of mindsWatch: Temple Grandin: The world needs all kinds of minds. People with autism tend to have specialist minds, explains Temple Grandin in this talk from TED2010 — they’re very good at a specific type of thinking. This highly-specific thinking has led to many innovations — she points out that Einstein, Mozart and Tesla would likely have been diagnosed on the autism spectrum, if it had existed in their time. In this talk, Grandin shows us how she thinks — in images, something she delves deeper into in her book Thinking in Pictures: My Life with Autism. Overall, she shows why society needs all types of thinkers — including autistic ones.

Read: Not Even Wrong: Adventures in Autism. Paul Collins’ son, Morgan, excelled from a very young age in reading, spelling and math — but found negotiating social interactions nearly impossible. In this incredible book, Collins brings us into his son’s world. But while the book is part memoir, it is also a sweeping history — introducing the reader to theories of autism throughout time and pointing to historical figures who were likely autistic. It’s a personal story and yet so much more.

Read: Studies on musical skills in autistic children. This study, published in the journal Autism in January, tested what has been found in surveys before — that children with autism are more likely to have perfect pitch and are better at remembering melodies than their neurotypical counterparts. Observing a focus group of 25 children with autism and 25 without as they performed musical tasks, it confirmed the hypothesis. For example, while eight of the autistic children demonstrated remembered 15 of the 16 melodies they’d heard a week before, only two children in the control group were able to do this. While Derek Paracivini is clearly a musical savant, able to do this to the extreme, this 2009 study published in the Philosophical Transactions of the Royal Society looked at musical skills in autistic children who are not savants. They too appeared to have enhanced musical abilities. The study concludes, “While the phenomenon of the savant syndrome is of considerable theoretical interest, it may have led to an under-consideration of the potential talents and skills of that vast majority of autistic individuals, who do not meet savant criteria.”

Faith Jegede: What I've learned from my autistic brothersWatch: Faith Jegede: What I learned from my autistic brothers. In this passionate talk given at TED@London, Faith Jegede introduces us to two incredible men: Remi, 22, who has never told a lie, and Samuel, 16, who remembers the year of release for every song on her iPod. These are her brothers, both of them autistic. In this talk, she shares what they’ve taught her about individuality … and about how “normal” is highly overrated.

Watch: Loving Lamposts. The subject for his next documentary hit director Todd Drezner in the face when he took his son, diagnosed with autism at just a few months old, to the park and watched his routine of visiting a set of lampposts. Drezner began to wonder: is autism a disease to be cured, or is it simply a different way to be human? In the film, he looks at the “recovery movement”—those who aim to reverse autism—and the “neurodiversity movement”—which aims to accept autism as a variation. The tagline for the movie has stuck in the autistic community: “If you’ve met one autistic person … you’ve met one autistic person.”

Read: Carly’s Voice: Breaking Through Autism. Carly Fleischmann’s life changed with a few clicks of a computer keyboard. At age two, Carly was diagnosed with severe autism. She was uncommunicative and sometimes violent, and her parents and therapists assumed no one was home in her mind. And then at age 10, she typed out three words: “HELP TEETH HURT.” This book, co-written with her father, gives a fascinating view of the interior life of severe autism, which isn’t always visible to outsiders.

Watch: Wretches and Jabberers. According to the two main characters in this documentary, “wretches” are those who have limited abilities of speech. Meanwhile, “jabberers” are … everyone else. In this moving film, two self-declared wretches — Tracy Thresher, 42, and Larry Bissonnette, 52 — tour the world on a two-fold mission. First, the pair — both autistic and excluded from normal schools as kids — aim to interact with people of all sorts and change attitudes about autism. And second, they set out to see parts of the world they feared they never would.

Read: “Presuming competence.” The central idea of this paper, published in Equity & Excellence in Education in 2006, remains a motto to many parents of autistic children: that rather than assuming their child won’t or can’t understand, to act as if they will. Authors Douglas Biklen and Jamie Burke write, “Teaching literacy is carried out with the expectation that most, if not all, children are capable of developing literacy skills. Yet with children classified as autistic, it is not uncommon to link early expressive difficulties to a presumption of incompetence.” Their advice: do not make it a self-fulfilling prophecy.

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Further reading on what makes a good end of life

Culture TEDTalks Judy Macdonald Johnston speaks at TED University, where audience members from TED2013 get the chance to speak.

“What would be a good end of life?” Judy Macdonald Johnston asks in today’s talk, given at TED2013. Her answer — based on her own experience of helping two friends face death in a way that respected the incredible life they’d built — involves five practices, all of which can help maintain a high quality of life even as independence and bodily function decline.

Judy MacDonald Johnston: Prepare for a good end of lifeFirst, make a plan, which means “answering straightforward questions about the end you want.” Second, recruit advocates who have “the time and proximity to do this job well” and can thrive under the unique pressures of this task. Third, prepare important documents — like summaries of your medical history — for the hospital. Fourth, select caregivers who fit your needs and desires, which might take a few tries. And fifth, ponder and discuss last words: “What do you want to hear at the very end and from whom would you like to hear it?”

We talk about how to live the good life all the time. And yet, though we all face death, we’re less willing to talk about what would be a good conclusion to life. Here, some further reading, watching and listening on this hard but important topic.

Read: This Wild Darkness. In the mid-‘90s, Harold Brodkey wrote a series of essays, mostly for The New Yorker, about his experiences and emotions as he died of AIDS. In these essays — subsequently published in a single volume as This Wild Darkness: The Story of My Death — Brodkey reckons with the realities of both his impending death and, through that lens, his life. His style can be self-aggrandizing, but ultimately, the book acts as a case study of how self-reflection through writing can make nearing death a little bit less terrifying. “The obsession with literary power games, with recognition and reputation, gradually subsides and gives way to something like acceptance,” Michiko Kakutani wrote in The New York Times upon the book’s publication.
.Watch: A Will for the Woods. The new documentary A Will for the Woods, featured in our roundup 9 documentaries that you need to see in 2013, follows psychiatrist Clark Wang as he battles lymphoma and arranges his own burial. His resolve for a burial that helps, rather than harms, the environment spawns the first natural burial ground in the state of North Carolina. The film’s website notes that green burials were the norm “before the contemporary funeral industry propagated expensive and elaborate funerals as traditional,” and applauds the growing demand for them now.
.Bookmark: The Hospice Foundation. The Hospice Foundation of America offers several quite lovely pages (and for-sale booklets) about approaching your own, or a loved one’s, death. A page entitled “Signs of Approaching Death” explains what death looks like in a purely practical sense—something we don’t and can’t know the first time we confront it. The unknown tends to frighten us most, so having a bit more advanced warning of what’s to come might serve as a comfort. For example, the site explains that as you near death, fluid can build up in your lungs, casing a rattling as you breathe. “This breathing sound is often distressing to caregivers but it is not an indication of pain or suffering,” the site assures us. (There are also practical sections, as on advance care planning.)
.Bookmark: New Old Age. The New York Times’ “New Old Age” blog, which Johnston links to on her own website, explores what it’s like to care for adults over age 80.  Recent posts are on Vermont’s passage of the ‘Aid in Dying’ measure, a look at a recent study on dementia units, and what millennials need to ask their parents while they can.
.Listen: “When Prolonging Death Seems Worse Than Death.” Last year, Fresh Air’s Terry Gross interviewed Judith Schwarz, of the nonprofit Compassion & Choices, about end-of-life decisions for the terminally ill. In the interview, Schwarz argues that terminally ill patients should have the right to choose to die sooner. Beyond dealing with the realities of what terminal illness means, the interview offers a thoughtful, compassionate way of looking at the multiple and varied desires of the dying. That is: it’s a lesson in empathy and a reminder that though some ideas may frighten us, it behooves us to look at them in depth. In the story, Schwarz also prods us to consider what it really is like to live through a painful end-of-life, and suggests that in some cases, death is not the worst option on the table. And that’s okay.
.Bookmark: Seven Ponds. The website Seven Ponds aims to “promote a healthy attitude towards the process of death by encouraging a meaningful experience that is in harmony with the environment.” Their recommendations: cremation and natural burials (see #2, above!). “We see a world where everyone can experience death in their own personal way and feel it’s all okay,” writes Suzette Sherman, Seven Ponds’ founder. For her blog, go here.
.Watch: “Older, and Unafraid to Talk about It.” This New York Times interactive video gallery presents the stories of three seniors who have recently started therapy to work through the changes they’re facing as they near the ends of their lives. “I’m surrounded by people who are old, and I had to come to grips with that,” an 87-year-old woman says. And, from an 86-year-old man: “You can’t do the things you used to do. You can’t go where you wanted. People look at you differently. What psychiatry does is help you go through the problems and adjust your thinking.”

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Further reading in GitHub

The open-source programming world has a lot to teach democracy, says Clay Shirky.

In this fascinating talk from TEDGlobal 2012, Shirky harkens back to the early days of the printing press. At the time, a group of “natural philosophers” (who would later adopt the term “scientists”) called the Invisible College realized that the press could offer a new way to share and debate their work. However, because printing books would be far too slow for this purpose, they came up with a new invention — the scientific journal.

So what does this mean for us today?

Shirky explains, “If I had to pick a group that I think is our Invisible College — our generation’s collection of people trying to take new tools and press them into the service of, not more arguments, but better arguments — I’d pick the open-source programmers.”

Shirky explains a fact that any programmer knows well — that it is very hard to write instructions computers know how to execute. It’s a problem that’s complicated when more than one programmer is on the case, as it’s easy for them to have different ideas on what will work and to create incompatible instructions.

“The problem of managing a large software project is the problem of keeping this social chaos at bay,” says Shirky.

Software engineer Linus Torvalds saw a solution to this problem—“git,” a system that allows for collaborative development. He created GitHub.com, a hosting site that allows multiple programmers to work on the same source code at the same time, with changes getting unique signatures.

“A programmer in Edinburgh and a programmer in Entebbe can each get a copy of the same piece of software. They both can make changes, and they can merge them after the fact, even if they don’t know of each other’s existence,” says Shirky. “This is cooperation without coordination. This is the big change.”

Shirky believes that this same idea management system could easily be used in democratic governments. In fact, he says, there’s just one big reason this isn’t happening yet — that legal experts rarely know about open-source computer programming.

“The law is another place where there are many opinions in circulation and they need to be resolved into one canonical copy,” says Shirky. “There’s the very interesting possibility that this could be used to further the development of legislation.”

To hear more about how this could work, watch Shirky’s laugh-out-loud talk. And after the jump, Shirky gives more resources for anyone looking to learn more about how GitHub could be used in government.

Shirky writes to the TED Blog:

What’s so interesting to me about GitHub isn’t just that it provides new ways to collaborate — though it does that, beautifully — but that it also helps create new social norms. Because the core operation in GitHub is ‘diff’ — what are the differences between two pieces of text — it elevates “Show me” as a social norm. Expressing, clearly and comparably, where you think a particular piece of text could or should be changed for the better becomes a core operation, and, as I said in the talk, the possibility of those social norms being transplanted into democratic politics would be a remarkable change.

So, for people interested in transplanting what programmers have learned about arguing and collaborating into the political realm, here are some good places to start:

Seminal writings

Political Uses

Related Attempts

Interview

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