Youve been in a terrible accident. Everyone says that you are lucky to have survived, and you are. But a severe spinal cord injury means you cant use your hands for the simplest tasks. Your family brushes your teeth and dresses you each day. Youve lost bowel and bladder control. Sex will never be the same. But there is an alternative: a neuroprosthesis (a prosthetic nervous system) could restore function to your body, part by part.

This remarkable technology exists, but you cant have it.

Its all economics, explains Julie Jacono, director of Case Western Reserve Universitys Institute for Functional Restoration (IFR), a nonprofit corporate surrogate that is pushing forward the final stage of testing for a platform of six neuroprostheses. The various implantable devices can each restore function to different parts of the bodyallowing paralyzed patients to do things like stand again or move their hands. Its incredibly promising. But because so few people suffer from spinal cord injuries, it isnt profitable for a company to take the technology to market.

Most of us assume that once discoveries are uncovered in the lab, theyll eventually make their way to patients. Its a field of dreams story, that if you build it they will come, says P. Hunter Peckham, bioengineering professor and executive director of the Institute. But I think we all know that thats not the way any of these things work.

According to the National Spinal Cord Injury Statistical Center, there are about 270,000 people in the U.S. with spinal cord injuries. Compared to the number of people suffering from more common conditions like diabetes or heart disease, says Jacono, we are a decimal point in potential market size.

They may not be hugely profitable, but the devices allow people to move again. Using an implantable pulse generator and series of electrodes, the devices create a parallel nervous system. Electrical stimulation runs through the wires to muscles and organs, thus returning function to the hands, bowels and bladder, restoring trunk control, cough reflex, relieving pressure sores, or even helping people stand again. The team is rolling out a plan to integrate multiple devices and wire them across a network.

Thus far, theyve yet to run across a patient for whom the devices dont restore some function. Peckham describes what hes seen with the upper extremity device: turn it on, and they regain hand function. Turn it off again, theyre paralyzed.

In the world of spinal cord injury theres exactly the kind of technology that people have had access to for decadeswheel chairs, assistive technology. Then theres the hope of a cure, through stem cells or some kind of natural, neurological regeneration. Theres no timetable to that, says Jacono. What we can deliver is a true reversal of spinal cord injury, for select functions, and we can do that in the near term.

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Circumventing the Market to Relieve Paralysis

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