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It started in in early October 2017, when 108 stroke patients with significant hand and arm injuries appeared for a kind of clinical trial. Researchers will surgically implant a neurostimulator in their vagus nerve, the cranial nerve that runs through a 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 ordeal was over, the subjects’ once-limited limbs began to come to life. Somehow the impulses to this nerve, combined with rehabilitation therapy, gave patients better use of their injured limb – and made it faster and more effective than any treatment before it, even in those who did not respond to nothing else.
This spring, the results of the process were published in The lancet. Removing paralysis is in itself an amazing feat. But what was built into the article was something even more radical. Was not What patients learned but how they learned it: By stimulating the vagus nerve, they had compressed years of physiotherapy into months. The test was designed as a way to repair damage and restore engine control. But what if there was no damage to begin with? In the hands of healthy and healthy, such technology could significantly improve physical performance – the question is whether people are ready to fight it.
The potential applications of this technology are not difficult to imagine. As seen in the study, when the vagus nerve receives additional stimulation, it causes the brain to release neuromodulators that regulate the body’s responses. They go online just as the patient is trying to do a new task, strengthening the involved motor circuits. “When you practice golf or something, it’s the same thing,” explains Charles Liu, the study’s lead neurosurgeon and director of the USC’s Center for Neurorestoration. “There’s not much difference in teaching a stroke victim to use a fork and teaching an elite athlete to hit baseball better.” It is simply a repetitive action and the development and strengthening of cerebro-motor circuits. If this process can be accelerated, we have just learned how to optimize the brain – and how to increase human beings. Currently, biotechnological approaches such as stem cells show promise to repair damaged nerves, while brain-machine interfaces aim to replace lost function by bypassing the injury and connecting the brain directly to the muscles. But this stroke study reveals that neuromodulation plus task-specific practice improves training in hebby-or activity-dependent synaptic plasticity, with all your muscles firing sequentially. In general, in order to acquire a skill, the neurons in the brain must be activated in the right way at the right time; practice is the usual human course, but now stimulation allows us to do it faster and better.
It is only a matter of time before neuromodulation becomes marketable. Once scalable and accessible, it is likely to be widely available to the public and more specifically to athletes who are already interested in optimizing the human body. But in sports, improvements come with regulations, and even in addition to the usual controversies about doping, professional competitions now have a fair share of turbidity and debate in this area. For example, the first trans woman to ever compete in the Olympics, Laurel Hubbard, was only eligible to participate in the Tokyo Games if her total testosterone level (serum) was below 10 nanomoles per liter and was at least 12 months. But those same rules disqualified two-time Olympic gold medalist Custer Seeds of South Africa because, although she has XY chromosomes, she also has elevated testosterone levels.
Neurostimulation promises to further complicate this. Unlike steroids or hormones, there is no obvious way to monitor it. In a healthy person with full use of the limbs, it may be impossible to trace whether or not the vagus nerve stimulation occurred some time ago. If the athlete has had a neurotransmitter implanted, this may be suggestive, but not definitive. After all, the body releases its own neuromodulators; nothing but the electrical stimulation itself is foreign to the body. Even if the Olympic Committee announces regulatory requirements for testosterone levels, measuring brain stimulation would require either athletes or stimulus providers to document use or some form of internal examination of the implant device. But the requirement to observe an athlete’s brain enters one of the last traces of personal space; any form of regulation must be accompanied by guidelines for protection against abuse. These monitoring and enforcement mechanisms need to be addressed – and quickly, before technology transcends our ethics.
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