[ExI] A Stroke Study Reveals the Future of Human Augmentation

[John Grigg]

"IT BEGAN IN early October 2017, when 108 stroke patients with significant
arm and hand disabilities turned up for a peculiar clinical trial. The
researchers would be surgically implanting a neurostimulator to their vagus
nerve <https://www.medicalnewstoday.com/articles/318128>, the cranial nerve
that runs along the groove in the front of the neck and is responsible for
transmitting signals from the brain to other parts of the body. By the time
the trial concluded, the subjects’ once limited limbs had begun to come
back to life. Somehow, pulses to that nerve combined with rehab therapy had
given the patients improved use of their disabled limb—and done so faster
and more effectively than any treatment before it, even on those who had
responded to nothing else.

This spring, the findings of the trial were published in *The Lancet*
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00475-X/fulltext?rss=yes>.
Reversal of paralysis is, in itself, an astonishing feat. But embedded in
the article was something even more radical. It wasn’t *what* the patients
learned, but *how* they learned it: By stimulating the vagus nerve, they
had compressed years of physical therapy into months. The trial was meant
as a way of repairing damage and restoring motor control. But what if there
had been no damage to begin with? In the hands of the healthy and fit, such
technology could significantly enhance physical performance—the question is
whether humans are ready to contend with it.

It’s only a matter of time before neuromodulation becomes marketable. Once
it’s scalable and affordable, it’s likely to have wide appeal for a public,
and specifically athletes, already interested in optimizing the human body.
But in sports, enhancements come with regulations, and even aside from the
usual controversies over doping, professional competitions already have
their fair share of murkiness and debate in this area. For instance, the
first trans woman ever to compete in the Olympics, Laurel Hubbard
<https://onherturf.nbcsports.com/2021/08/02/laurel-hubbard-weightlifting-transgender-women-not-threat-womens-sports/>,
was eligible to compete in the Tokyo Games only if her total testosterone
level (in serum) was below 10 nanomoles per liter and has been for at least
12 months. But those same rules disqualified two-time Olympic gold medalist
Caster Semenya
<https://www.npr.org/sections/tokyo-olympics-live-updates/2021/07/28/1021503989/women-runners-testosterone-olympics>
 of South Africa because though she has XY chromosomes, she also has
elevated testosterone levels.The potential applications of this technology
aren’t difficult to imagine. As seen in the trial, when the vagus nerve
receives extra stimulation, it causes the brain to release neuromodulators,
which regulate the body’s responses. They come online just as the patient
is attempting a new task, strengthening the motor circuits involved. “When
you practice golf or anything, it’s the same,” explains Charles Liu, the
lead neurosurgeon of the study and director of the USC Neurorestoration
Center. “There isn’t much difference in teaching a stroke victim to use a
fork and teaching an elite athlete to hit a baseball better.” It’s just
repeated action and developing and reinforcing brain-motor circuits. If
that process can be sped up, then we’ve just learned how to optimize the
brain—and how to augment human beings. Currently, biotech approaches such
as stem cells have shown promise for repairing damaged nerves, while
brain-machine interfaces aim to replace the lost function by bypassing the
injury and connecting the brain directly to the muscles. But this stroke
study revealed that neuromodulation plus task-specific practice
enhances Hebbian
learning
<https://link.springer.com/referenceworkentry/10.1007%2F978-1-4614-7320-6_672-1>—or
activity-dependent synaptic plasticity, with all your muscles firing in
sequence. Generally, to acquire a skill, the brain’s neurons need to fire
in the right way at the right time; practice is the usual human course, but
now, stimulation lets us do it faster, and better, too.

Neurostimulation promises to complicate this further. Unlike with steroids
or hormones, there’s no obvious way to monitor it. In a healthy person with
full use of their limbs, it may be impossible to track whether or not the
stimulation of the vagus nerve occurred or how long ago. If the athlete had
an implanted neurotransmitter, that might be suggestive, but not
conclusive. After all, the body is releasing its own neuromodulators;
nothing apart from the electrical stimulation itself is foreign to the
body. Even if the Olympic committee were to announce regulation
requirements as they have for testosterone levels, measuring brain
stimulation would require either that athletes or stimulation providers
document usage, or some form of internal examinations of the implant
device. But requiring surveillance of an athlete’s brain trespasses into
one of the last vestiges of private space; any form of regulation would
need to be accompanied by guidelines to protect against abuse. These
mechanisms of monitoring and enforcement must be addressed—and quickly,
before technology outstrips our ethics."

https://www.wired.com/story/vagus-nerve-stroke-study-human-augmentation/
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