I am Jennifer French, Paralympian, active user of neurotech implants which allow me to stand, and advocate for neurotechnology. AMA!

I have to say that I'm curious about the whole implant deal. How long did it take to adjust to using it? Furthermore, how do you control it, exactly?

When we think about implants, they really are not that unusual. We have thousands of people walking around with heart pacemakers implanted into their bodies. Think of these implants as a pacemaker used for a different application or perhaps a 'next generation'. However, this device did take some time to adjust to it. It is not just flipping the switch and your body performs optimally. In fact, prior to surgery I went thru an exercise protocol to build the muscle tissue. From there I had the implants surgically implanted, went thru a recover period and then started exercising again (for about 3 month) before getting to my first stand using the system.

I control the system using an external control unit called a UECU. The electrodes and receiver are all incapsulated in the body. Externally, I tape a coil over the area on my abdomen that has the receiver. The coil connects to the UECU. When I put an input into the UECU, the UECU then send the power and command using RF to the implanted receiver. The receiver decodes and sends the signal to the electrodes. The electrode stimulate the muscle to take action.

Just gonna ride along on the top comment. But are you allowed or able to use your implants in a Paralympic event?

For the 2012 Paralympic Games, we chose not to use the implants in competition. If I did want to do so, it would need to be reviewed to the medical classifiers. It would have opened a big door of debate (which still needs to happen). We simply chose not to surface since we were so close to competition and it would turn into a mental distraction rather than a competitive advantage.

cool, were you into sailing before your accident or did you get into as an outlet

I was not into competitive sailing before my SCI. Prior to my injury, on our 2nd date with my now-husband he took me windsurfing for the first time. So, I was a windsurfer and a cruiser prior to my accident. I did not start racing until after my injury. I was introduced to competitive sailing over 12 years ago. I caught the bug.

think you are no longer doing this AMA, however, I am curious and it would be great if you or someone could answer this: what is the frequency and does it suffer from interference, loss of frames? easy to control error checks because of type/amount of data? I love RF stuff - and I am all for using technology to improve our lifes and bodies in a safe, healthy way. Thank you for doing this AMA and for being an advocate of this cause.

A simple answer is that there is high level RF to communicate through the coil to the implanted receiver. I, as the user, can adjust the frequency in a small range to help with coupling between the coil and the implanted receiver. It really does not suffer from interference. The coupling range is very small, i.e. if you move the coil away from the receiver (inches) it will decouple. In terms of data and error checks, the control unit does have a limited storage of usage data. Error checks are a program to check each individual electrode. I hope that addresses your questions.

Based on how technology is progressing, how long do you believe it will be until conditions like quadriplegia and paraplegia will be considered as totally curable?

Technology progression is an interesting question. I think that consumer technology tends to progress faster than medical technology due to issues such as regulatory constraints, important safety and efficacy studies, etc. Of course, it is hard to predict the future. Based on the exciting technology that is in the pipeline, I believe that I will witness the 'cure' for paralysis in my lifetime. The important thing is that we need to help science move forward, encourage collaborations and create mechanisms to get the technology into the hands of the people for whom they were intended; out of the laboratory and into the hands of user/consumer/patients.

When you enter commands to move, are you moving single muscles, muscle groups or is there a preset command to, for example, "stand up"?

There are several commands programmed into the UECU or control unit. For instance, there is a 'Leg Lifts' program that only stimulates the quadricep muscles to perform leg lift exercises. There is also a 'Backs Only' program to only stimulate the muscles in the lower back. In addition, we can check each electrode individually. These are examples of singular or muscle group commands. There are also more complex commands that bring in the coordination of muscles. Think about how you stand and how many muscles are involved with this. There is a 'Stand' program which coordinates a variety of muscles to perform the task such as gluts, hamstrings, adductors and quad to name a few. The beauty of the system is that the engineers can program various commands to different tasks. Some are orchestrated from the designers and others are found accidentally. I have a 'Massage' program that massages my lower back which was found accidentally in the lab. How many people can say they have a mobile back massage system!

That is incredibly amazing. That's why I asked: I couldn't think how I could consciously push enough buttons to control the muscles needed to stand up.

I have a 'Massage' program that massages my lower back which was found accidentally in the lab.

An improvement even over those $1 / minute massage chairs you sometimes see in the mall. :)

Yeah, this was going to be my follow-up question: So you're actually pushing buttons on a controller? How far off do you think we are from being able to control the implants directly from your brain?

Yes, I press a button to input a command to the controller. They are prototyping a finger switch now.

In terms of brain control, we are a ways off but not that far. We will be discussing this in our session @ WSF. Scientist are now working on merging the technology that I have with commands from the motor cortex of the brain. They can convert a thought into an action of an external controller now they are working on the link between thought and electrode.

It sounds like this technology could be used to "remotely" exercise muscle groups? Would someone be able to sleep while their muscles are being stimulated, do you think?

I do have an exercise pattern which is focused on building the endurance fibers in the muscles. It is about 1 hour long. So, I can lay in bed watching Jimmy Fallon and exercise the muscles. Yes, I have fallen asleep while exercising. It may sound cool, but I would much rather be able to get back to jogging instead.

You mentioned that you received the implants in 1999, how has the technology changed since then?

Have they had a huge impact on your life? What do they allow you to do?

Yes, I was initially implanted in 1999, 1.5 years after by injury. That system was an 8-channel system; meaning there were 8 electrode channels. I used that system successfully for over 10 years. In 2010, I went thru a 2nd surgery and tripled the capacity of the system; going from 8-channels to 24-channels. The intriguing thing about this type of research is that the consumer/the user is intimately involved with the evolution of the technology. We get to use the technology and give feedback to the research team to help improve it. Yes, the technology has changed. The capacity is better, the electrodes have improved, the user interfaces have become more intuitive. In our session at the WSF, we will also be introducing some of the next generation of the technology and where we are going for the future.

This technology has had a huge impact on my life. Not only does it allow me to stand for functional use, like reaching high objects or going thru narrow doorways, it has also allowed me to stay healthy. What we need to understand is that you may see someone who is paralyzed but that is only one component. Perhaps they can not walk or stand, but we also have daily battled against medical or secondary complications that can be life threatening like infections from pressure ulcers or kidney failure. This technology allows me to easily combat those medical complications. Finally, the technology give a social aspect. I can stand at the 7th inning stretch of a baseball game, at a standing ovation at a concert and even walk down the isle at our wedding. Those are aspects that we don't always think about when developing technology.

Thanks for the detailed reply.

Did you have any sensation or movement below your level of injury before receiving the implants?

Do you think in the future the implants could be used to regain some bladder / bowel function, or would that be a long way away?

Are you able to balance when you stand? Or do you hold onto a rail or something when you stand?

Thanks a lot, i have a SCI but i have never heard of this technology.

Since I am an incomplete spinal cord injury, I only bruised by spinal cord. I do not have voluntary movement below my point of injury but I do have some restored sensation. Yes, my husband can tickle my feet but I can't move them.

There are implants today that address bladder/bowel function. For instance there is the implanted sacral nerve stimulation for bladder and fecal incontinence. There is also an implanted bladder stimulation system called Vocare that is commercially available in Europe. An external system called the tibial nerve stimulation is another device commercially available. There are also active clinical trials using stimulation of various mechanisms for bladder and bowel control such as the pudendal nerve or sphincter stimulation. I think you will see more progress in this area very soon.

The question about balance for the standing system is a question currently being addressed by the researchers. Currently, I need to hold onto something for balance. When I stand about 95% of my weight is on my legs and the other 5% on my arms. Standing with the system is rigid and I am on a balance beam. However, I think we will see improvements in balance soon.

The technology for SCI is evolving. Neurotech Network worked with the NSCIA to build a resource specifically for spinal cord injury, found here http://www.neurotechnetwork.org/education/educate_spinal_cord_injury.php

Do you feel that "basement biohackers" (http://www.theverge.com/2012/8/8/3177438/cyborg-america-biohackers-grinders-body-hackers) are a good development or are these amateur enthusiasts making things seem more frivolous?

In my opinion, that just does not seem safe to me. A surgery in a hospital is risky enough. I can't image doing it this way. I think when it comes to implanted technology safety and efficacy are extremely important.

Hi, French (the country, not the name :) ) med-student here. Based on your opinion and experience, what is/are (if there is/are) the major obstacle(s) of the developpment of a cheap, simple to use, risk-free system that would allow paralized people to make progress and gain function ? (And thanks for AMA, acknowledging I did'nt knew you before but your title and that subject attracted my attention, btw I'm checking your website now)

edit : sorry I wanted to say "not the name". Edit 2 : Thanks Mrs for your answer ! It's always good to have feedback from people who have some perspective.

Hi Med Student, I can address the cheap and simple to use but risk-free is a tough one. As you know in the medical field, nothing is risk free. Let's address 'simple to use' first. When we address the user interface, the current system is pretty simple. The UECU has a few buttons with an LCD screen with the commands. I have 2 coils that I tape to my skin and wear all day and a control box that I can put in a backpack and take with me. But there is definitely room for improvement. I believe the most complicated part of the system is on the 'deployment side'. The surgery is complex and the programming is challenging.

I think the main driver of the cost is volume. The technology is build now is small quantities and prototypes. That drives the cost of medical devices, along with other factors like regulatory, safety, materials.

I tend to think the biggest obstacles are societal. Commercialization of the technology is the biggest challenge. Particularly for devices that address problems in orphan populations like spinal cord injury, multiple sclerosis or cerebral palsy.

what's your ultimate, overwhelming, all consuming goal? Massively in awe of you by the way, you're a total inspiration!

Thanks;) That is not always an easier answer. After my injury, I did a lot of reflection. Why did I survive? Why was I given a second chance? I am fortune to have a fantastic support system. I would like to help improve the human condition. Technology is an exciting avenue for this. Ask yourself: If not me, who? If not now, when?

i'm a complete quad, and i have recurring dreams of recovery, and usually the very first thing i try in my dream is to pee standing up. what was your first functional goal?

I tend to still have dreams as an able-bodied person. Many times, I wake up and think I an just get out of bed like a non-paralyzed person, but then reality kicks in. When I was first injured, my first functional goal was to get some arms movement back to propel a manual wheelchair, then I worked on hands to be able to type and do basic ADLs.

What do you think about Oscar Pistorius as an athlete?

I only know Oscar through the media and I am not that well versed on the sport of Track & Field. That being said, I think he bravely put himself out there to push the limits about how we think of athletes. He challenged big 'institutional' thinking in the world of athletic competition. He also sparked a discussion that truly needs to happen. Unfortunately, his private life has tainted the work he did in the world of sport.

What are the greatest social impacts the technology has on your life?

There are many social impacts, I'm sure I'll miss some but let me give you some examples that surface. There are social events that allow me to leave the wheelchair behind like walking down the isle and standing for our entire wedding ceremony. That is etched in my mind forever. But there are every day events too like being part of a standing ovation, standing to hug a loved one or standing behind a podium to speak. There are also social aspects where the technology integrates with the wheelchair. For instance, because of my level of injury, I do not have voluntary movement of my trunk or core muscles. There is a trunk control pattern that gives me a wider range of function like making it easier to propel my wheelchair or do mundane tasks like folding laundry or washing dishes. It's amazing that I have used the technology for so many years that it is integrated into my lifestyle. I almost become addicted to it or take it for granted

Obviously, this technology is an amazing development for people like you who have sustained major injuries and are now given a new opportunity to regain lost function, but do you have any concerns about how this technology could be used to augment "normal" people? Is this a question that comes up in your advocacy or are we still a long way off from "superhuman cyborgs" or whatever?

This is an interesting question about the merging to humans with technology. At this point, in development I think we are a ways away from the 'superhuman'; however, that does not mean that we ignore the issue. I believe ethics of how we use the technology; how we make it accessible for people who can benefit; how it can impact the way that we treat devastating conditions like Parkinson's disease, Alzheimer's, paralysis and other neurological conditions are the questions currently at hand.

As we look to the future, it is also critical that we keep a pulse on where the technology is going and ask ourselves, are we improving the human condition?

How do you feel sports (in particular the Olympics and it's counterparts) should handle biotechnology such as this? At what point do the implants become an advantage to a person and how can we prevent competitive sports from becoming a competition of "who can build the best person?"

I think we are on the cusp of needing to address these questions. Oscar Pistorius opened the door to this important issue. For the 2012 Games, I chose not to use the implants in competition; asking would turn into a mental distraction rather than a benefit. The question of the threshold of technology in competition should be addressed by the Olympic and Paralympic Committees. There is an event Cybathon 2016 (http://www.cybathlon.com) that may highlight this and potential open this issue for further exploration and discussion.

Neuroscientist/engineer here. What annoys you most about your devices? What could we be doing better and what "feature" aren't nearly as useful as they sounded?

The device that I have is still in an 'early' stage as a research project. There is definitely room for improvement such as simplifying the surgery, reduce muscle fatigue, shrinking the control unit, improve the battery performance and adding interactive stimulation to compensate for balance and minor adjustments. Keep in mind, my commentary is anecdotal; we truly need to better understand human interaction with implanted medical devices.

What are your thoughts, if any, on Kurzweil's (and many other people's) idea of the 'technological singularity' that's meant to be happening in the next 30-40 years.

I'm not sure. I guess that is a common answer to this. I think technology is developing fast and artificial intelligence is expanding. Sure, it can process faster than we can. I think there will be aspects of our lives that will be very different in the future. Think about it. 20 years ago, we couldn't image carrying around the computing power that we do today in our pockets. There is a flip side to this. What about creativity, ingenuity and raw emotion. Those are areas of the human experience and the brain that have not been explored. The question is can technology possibly mimic that?

You are an advocate for the implants. Does that really mean there are people "against it"?

In a way, yes. There are countless stories of people trying to get access to the technology and not being able or aware. Awareness is the #1 issue among people who can benefit. We are advocating for education about this technology and awareness. Let me give you a few brief examples. - Relating to chronic pain, people will be prescribed countless pharmaceuticals to treat pain but never introduced to both external and implanted device to help treat the pain without pharma. - This can also be the case for other conditions like epilepsy, Parkinson's disease, essential tremor, etc. - Relating to foot drop, there are external stimulation systems but people are not aware since they are initially given a brace and cane. - Third party payers tend to look in the short term rather than the long term when it comes to comparing a pharma treatment vs. a technology treatment. Technology has a high upfront cost but economical in the long term. These are just a few examples. Neurotech Network in partner with Neurotech Press will be releasing a collection of technology user short stories and more this fall.

Are you going to get back into the SKUD class? Rio? Tokyo? Another class?

I'm leaving the door open. Right now, I'm dedicating my 'sailing time' to a program we started called the 'Warrior Sailing Program' It is a bootcamp taking active duty and veterans who are ill, injury or disabled from never being on a sailboat to racing in 3-days. Our next event is during Warrior Week in Virginia. http://warriorweek2014.wordpress.com It is so rewarding to share the sport with those who served for us.