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Virtual or Augmented Reality will contribute tremendously in rehab and recovery of SCI. With Incomplete injuries this new tool can make day / night difference.

Referring to Sao Paolo, Brazil trial, it is obvious that virtual Reality component is adding something substantial and important for brain and cord to jump faster with re-wiring in effort to send signals to patient limbs.paraplegic-mobility-brain-machine-interface-12
For complete injured patients scientists had to use cap with special sensors to pick-up signals directly from the brain – as signals can not by-pass injured site.(Note 1 below);
Sao Paolo trial shows amazing results. All 12 complete injured SCI patients in this trial improved a lot and the most of them start to voluntary move their legs.

Incomplete injuries should be even easier to train using VR component with no need to use a cap to pick-up signals.
In lot of cases, Incomplete injured patient have signals by-passing injured site, but they are just too weak to contract muscles and move their limbs.
Sensors (wi-fi) can be attached on the skin should be able to pick up these nerve signals and to supply program that would run VR module with augmented reality showing legs movement.
Depend on level of mobility of incomplete injured person, different modes of support would be applied. In some cases just parallel bars will be enough. Gait support walking (ZeroG or similar) and in some cases Lokomat or even robotic suite (Hal or KeeoGo – suites able to pick up and amplify weak signals) should be adjusted to work in accordance with program and VR module.

This VR component combined with gait supported walking or robotic suite might be the holy grail for future physical rehabilitation.
Even simplified VR program without use of sensors should help incomplete SCI in rehab. Nobody knows without trial.vr-glass
That’s why we need a program with Virtual Reality set of sitting / standing / walking / hand exercises available on google cardboard & smart phone for free massive VR trial. (Note 2)   We need it Yesterday!!!
Z. Komadina

In Brazil complete injuries trial scientist put complex head cap interface to pick-up signals and transfer them to electrodes to lower body. However, this would never be enough to control standing and walking as Spinal Cord Injured person got no balance, which is controlled by corrective actions with more than 100 muscles in our body.
To help patient to walk they had to use Gait supported walking machines as “Locomat”.
After so many sessions with use of Locomat & Head cap and Virtual Reality program that was additional component to help brain to harmonize walking process and make it look more natural and inspirational, this Virtual Reality component shows up as extremely helpful as somehow (they don’t know yet why) helped patient brain to start to make physical nerve connections, and despite seriousness of injury (all 12 participants listed as complete injuries), after removal of head-cap and electrodes interface patients start to move their legs showing neurological connections were established! This amazing twist is showing regenerative ability of human body even beyond plasticity.

My idea is that Incomplete SCI, where some neurological connections are already existing, can be Fortified WITHOUT cap and electrode interface just with Virtual Reality program and constant series of supported walking exercises. Instead of waiting for any official trial, testing of this idea can be done by any volunteers combining their walking exercises and Virtual Reality program that might be crafted (by my opinion) much easier than program done for complete injuries.
We just need to mobilize people involved in creation of similar Virtual Reality programs for SCI or similar disability exercises, to make something that can be downloaded and used by us.

(Sao Paolo Trial) (VR future) (Affordable VR coming) (VR Therapy already) (VRT 2)
(VR help strokers fo move again) (VR strokers) (Scientifically explained) (AR scientific)
(VR Gaming – arm aralysis therapy)



Several articles pop-up on the Net about finding of Duke University researchers.
Checking out genes and proteins of already famous zebrafish and it’s ability to recover totally destroyed spine & cord, they have figure out that protein under code CTGF it’s the main factor of this recovery.

Read more here…-sfk110116.php


Virtual Reality Gait supported walk training’s after 12 months caused all 8 Chronic Paraplegics in Brazil’s Sao Paolo institute trial to recover some sensory or motor functions!

The whole story you can find here:

see more here

How Much is One Step ?!

Story about MacWheelers Gym, last affordable place for gait supported walking exercises in Southern Ontario for many Spinal Cord Injured people or MS impaired victims is shutting down its door of opportunity with up to 10 times higher fee’s than in previous years. MacWheelers Gym became overnight non-affordable / non-accessible place.

About MacWheelers Gym
For people who don’t know much about MacWheelers Gym – If we start from beginning, this place was first created as research “lab” for Kinesiology department and when participants asked to stay and exercise on regular basis, McMaster University had decided to make a Gym for people suffering from SCI and MS as a place to exercise and pay just regular gym membership fee as any able body people in regular gym.
This unique idea brought volunteers, mostly Kinesiology student’s who are helping us and learn through this process preparing at that way for their future profession, made this Gym successfully functioning for the last 15 years helping so many people.
This gym was also built with help of lot of people, companies, organizations, number of fundraising and grants for purchases all specialized equipment and some of the most advanced equipment for gait support training.
For daily operations MacWheelers is managed with help of few staff members, usually more experience students, that are paid minimum wage for their effort.
This place parallel function as Kinesiology department research facility so University from beginning granted it’s space, and also with paid equipment (!),
volunteer’s, minimum staff wages, and 96 active members (x $50 monthly membership fee~ $ 60,000 yearly) MacWheelers Gym should be able to operate as self
sustain facility even after paying staff salaries, maintenance etc.
     However, with all of promising points to run this joint successfully, apparently after years of financial mismanagement, with some added administrative fee’s
 and salaries of people (possibly not needed) to run this place, the gym slipped in deep hole beyond accounting repair with debt of approximately $ 250,000 of debt
(or more as they said) and according to management of Pace program which is organizational and administrative “motherboard ship” for MacWheelers Gym,
the way out of trouble this management see only in increased membership fee’s that would charge 10x more for progressive walking exercises.
As far as I know so far, from 16 patrons of this Gym who were using gait training, half of them already dropped from the gym unable to pay draconian and non-accessible fee’s of up to $ 700 monthly and other half reduced their walking exercises to minimum, already killing envisioned contribution for Gym financial recovery from that source.
In Pace management vision for financial recovery, they have never proposed relaxing administrative ballast or to increase membership base for the Gym and number
of operational hours [Gym is open only 15 hours per week(!)] to allow other people with mobility impairments to come and use benefits of this place.

My Story

I am member of MacWheelers Gym @ McMaster University in Hamilton Ontario for more than 5 years. My previous post about “MacWheelers Dream Gym” jinxed the whole sugar-coated story about this gzm. With new fees, instead of payment of $ 75.00 for previous monthly membership, now, for exactly the same thing  -2 walks per week (x 40 min) on gait supported treadmill I should cash $ 600 per month!!!
With a help of MacWheelers staff, I have carefully tailored my exercise program and after last couple of years of hard work and continuous exercises that includes 2 walk per week on treadmill,
I have finally start to show improvements with my health and mobility. As a matter a fact, last 12 months I was witness of huge success for me after previous 12 years since my injury,  12 long years with almost no any change.
For example, I have dropped down weight support on treadmill from 75 kgs to 10 kgs in last 12 months and also I have improved my stability, core, my transfers, etc. Sensitivity, bladder and bowel control are also two-fold increased in this period. (Btw – My spinal cord injury is C6 Incomplete Asia B/C)

I am pretty sure I was able to achieve all of this only by increasing frequency and intensity of my walking sessions from once to twice weekly and by increasing number of minutes per session from 25 to 40 in the last year.
My idea is to increase level of my workout to 3 walks per week to see if this improvement trend will continue, start slow independent slow walk (I can move my lags from my hips) and eventually start to exercise with ZeroG.

After new fee’s were proposed, I have contacted Pace program Management with
question what to do to preserve my exercise level.
Their answer was basically – to pay.
Oh, btw, they congratulate me on my success!!

They are directing me to find sponsor or try to cover through insurance.
In other words, I should be wheeling around begging for sponsorship.

Insurance company needs confirmation and prescription from doctor that
exercises will help me to recover.
Doctor’s shrugs their shoulders for they believe in an age old health care policy that condemns chronic spinal cord injuries to a crippled life that can not  possibly recover.
So many researcher’s (even from McMaster University) and some live examples tells different story for incomplete injuries.
From my experience, I was witnessing fantastic progress of few people who worked really hard.  They have live examples from MacWheelers Gym of people walking out of the wheelchair after working very hard and with help of special equipment and volunteers.
Dave-MacWheelersAn example of this can be seen in 80 years old member Mr. Dave Cook (former MP) who dismiss concerns of his Doctor specialist that tried to discourage and frighten him with “what if you fall and break a hip”, and regardless of that he kept working hard till he start to get up and walk with
less and less ZeroG machine help !
This Gym, for the most of us, is not only exercise joint but social, health, equipment etc lifeline portal and with new “no-wealth-no-exercise”
policy is making it non-affordable and non-accessible for the most of us and will kill great idea of equality for handicap people.

Few members were trying to move things by writing public petition and meeting with management but no any changes regarding gait exercise high fee’s are considered.

* * *

And finally, the whole story about this unique and inspirational place that is settled in thick Hamilton’s fog and painted with colors from spectrum of mismanagement, University bail-outs, schizophrenic nature of little-bit-gym-little-bit-research-program, hundreds of thousands of dollars of grants to joint accounts, fund-raising efforts from the last century (yes, bring empty beer bottles…), scares from insurance companies “what if something happen and somebody sue you”,  is not really getting any more clear with new “commercial” vision at all.

To preserve classical capitalistic supply & demand scheme even here, management will rather see this advanced equipment collect dust than allow members to use it for regular membership fee – as it was the case for last 15 years.
People who are progressing very slowly due to nature of their injury or health state will be stranded with no access to walking gait supported machines that can help them.
Parody of this situation is when staff members come to position to explain to young students about special equipment on the floor, they would need to jump on Zero-G, Locomat or Gait trainers by themselves and people in wheelchair will be only able to watch.



WALK is possible

How others see standing and continuous walking exercise can help mobility impaired / spinal cord injured people.
In China’s center Kunming for decades they are practicing walking program that last at least 6 months, with 6 hours a day, 6 days a week and they have fantastic results when many people walking out of wheelchair and be independent.

Kunming walking video

In Germany they are using gait training combining with new technology – robotic legs at least 5 hours a day, 5 days a week also for at least 6 months to create some totally “unexpected” results – unexpected for this health care system that is actually promoting big dependability business.

Neurologic-Controlled Exoskeletal Neuro-Rehibilitation by Thomas Schildhauer, MD

Scientists pinpoint molecular signal that drives and enables spinal cord repair

Caption: This is a confocal micrograph taken from the lesion core after a spinal cord injury. Nuclear EdU (red) shows the presence of newly differentiated cells which produce Schwann cell myelin (P0, green). These peripheral-like Schwann cells remyelinate central axons in the injured spinal cord and are important for spontaneous repair and functional recovery after spinal cord injury.
Researchers from King’s College London and the University of Oxford have identified a molecular signal, known as ‘neuregulin-1’, which drives and enables the spinal cord’s natural capacity for repair after injury.
The findings, published today in Brain, could one day lead to new treatments which enhance this spontaneous repair mechanism by manipulating the neuregulin-1 signal.
Every year more than 130,000 people suffer traumatic spinal cord injury (usually from a road traffic accident, fall or sporting injury) and related healthcare costs are among the highest of any medical condition – yet there is still no cure or adequate treatment.
Spinal cord injury has devastating consequences for muscle and limb function, but the central nervous system does possess some limited capacity to repair itself naturally.
Understanding what drives this repair mechanism could aid the development of new treatment strategies aimed at boosting the self-healing capacity of the injured spinal cord by taking advantage of ‘tools’ that the spinal cord already possesses.
For the first time researchers from King’s and Oxford have identified one of these tools, neuregulin-1, which signals from the surface of damaged nerve fibres during a process called ‘spontaneous remyelination.’
Spontaneous remyelination is a period of natural regeneration that happens in the weeks following a spinal cord injury. The process takes place as a result of damage to spinal nerve fibres which have lost their insulating ‘myelin sheath’. This myelin sheath is crucial for efficient communication between the brain and the body.
However, this natural capacity for repair is not sufficient for full recovery and may account for the compromised function of surviving nerve fibres, which can affect balance, coordination and movement.
The researchers found that, in mice lacking the neuregulin-1 gene, spontaneous myelin repair was completely prevented and spinal nerve fibres remained demyelinated (i.e. unable to send nerve signals along the spinal cord).
They also discovered that mice without neuregulin-1 showed worse outcomes after spinal cord injury compared to mice with the gene intact, particularly in walking, balance and coordinated movements.
Not only did neuregulin-1 drive spontaneous remyelination, but it also served as a molecular switch for cells within the spinal cord to transform themselves into cells with remyelinating capacity. This is unusual, according to the researchers, because the ‘Schwann’ cells with new remyelinating capacity normally only myelinate nerve fibres in the peripheral nervous system – not the central nervous system, as observed here.
Elizabeth Bradbury, Professor of Regenerative Medicine & Neuroplasticity at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, and Medical Research Council Senior Fellow, said: ‘Spinal cord injury could happen to anyone, at any time. In an instant your life could change and you could lose all feeling and function below the level of the injury.
‘Existing treatments are largely ineffective, so there is a pressing need for new regenerative therapies to repair tissue damage and restore function after spinal cord injury.
‘These new findings advance our understanding of the molecular mechanisms which may orchestrate the body’s remarkable capacity for natural repair.’

Professor Bradbury added: ‘By enhancing this spontaneous response, we may be able to significantly improve spinal cord function after injury. Our research also has wider implications for other disorders of the central nervous system which share this demyelinating pathology, such as multiple sclerosis.’
Dr Katalin Bartus, also from the IoPPN at King’s College London, said: ‘We hope this work will provide a platform for future research, in which it will be important to test how enhancing levels of neuregulin-1 will improve functional outcome after spinal cord injury.’
This research is a collaboration between scientists at King’s – led by Professor Elizabeth Bradbury – who work on repairing traumatic injuries of the central nervous system, and a group of researchers at Oxford – led by Professor David Bennett – who work on nerve injury and myelination within the peripheral nervous system. The study was funded by the Medical Research Council, Wings for Life Spinal Cord Research Foundation, the Wellcome Trust and the International Spinal Research Trust and Henry Smith Charity.

When Spinal Cord Injury occurs, our body creates a scar in that area of spinal cord. This “crust” forms a solid wall that still sprouting neurons can not overcome. The idea behind Dr. Silver’s work is to find a way to dissolve this scar and help neurons from both sides of injury spot to grow and re-connect again.
In the latest appearance in Cleveland, OH @ Neural Prosthesis seminar (January 16, 2016) Dr. Silver has announced results from research on chronic animal model treated with Chondroitinase (Cha’se) enzyme and Peptide, concluding that “robust breathing function recovery occurred”.
Experiment is repeated several times and possibly  first time in medical history we have significant Central Nervous System Regeneration with certain method / therapy confirmed.
Dr. Silver want to rush his team findings from the lab to human use as soon as possible. One intermediate step, as test on large animal model (primates), is needed before the first people with high level SCI injuries (patients using ventilators for breathing) will be approached.

Dr. Silver is also ready to answer any questions at this Post @ CareCure Forum – Click on the Link.   Some of the questions / answers you an read below.

Dogs are already receiving this Cha’se treatment and healing

Quote Originally Posted by comad View Post
Dr Silver, I have few questions:
– What would be the fastest & safest way to deliver Cha’se + Peptide to humans – I guess with micro-injections ?
– If this therapy (to restore breathing) proven effective on humans, do you expect
accelerated human testing for similar Cha’se + Peptide approach for other levels of chronic SCI.
– Also – realistically – how long large animal testing procedure can take?
Thank you very much for your time and for your work!!!!!


Dr. Silver:
Good questions

Ch’ase is administered via micro-injections to the appropriate levels of the cord depending on which behaviors one is targeting for recovery. For breathing, the target is around C4, for arm/hand function C5-8, for walking L2 (the location of the CPG) and bladder/bowel/ sexual function lower lumbar L4,5 + upper sacral. There is a possibility to target multiple cord levels simultaneously with the enzyme. The ISRT is now working on state of the art controlled AAV vector delivery systems for the enzyme. This will give us a long acting, highly potent and widespread delivery system that can be turned off when behavioral improvements plateau. I am extremely optimistic that they will be successful. They are a wonderful and dedicated group. The peptide (or a small molecule substitute that is now being developed) is delivered systemically either via su-cutaneous injections or maybe in the future via oral administration.

I do believe that the respiratory system is not unique in its ability to sprout slowly after injury. I am very optimistic about improving arm/hand function. We should be able to target other levels of the cord as mentioned above. For those with complete cord lesions we will need to build a bridge across the lesion scar and we are now working on that with with a combination of peripheral nerve grafting, Ch’ase and our peptide. We have had great success using our bridging strategy over the years and we are now focused on repeating this in chronic models. The bridging work is funded by a grant from the NIH.

Large animals are a bit of a hurdle due to cost. I have colleagues who are quite interested in testing our strategy in mini-pigs and primates. I would very much like to move to primates before humans because of their human-like hand function. Unfortunately, they are telling me that the cost is about a million and half bucks (100K per animal, good grief). It should not take too long once the experiments begin.

Quote Originally Posted by comad View Post
Thank you for your answers, Dr Silver!
In above quote you’ve said that you will work on building bridges for complete injury.
Is this mean that INCOMPLETE CHRONIC injuries might have even larger chance for recovery using this method? Also, if 1.5 Million (15 animals x $ 100K needed for primates testing step) is obstacle to achieve this research to become human trial – should this community start screaming around for donations and more media attention??!?

Yes, for certain, incomplete chronic injuries are far more likely to respond best to the enzyme. As for money raising it is always appropriate for the SCI community to help call attention to and help raise funds for scientifically excellent research. One good way of identifying the very best SCI related science is to browse the Unite2Fight Paralysis web site. They do a wonderful job of calling attention to the good stuff.

Quote Originally Posted by 6 Shooter View Post

Dr. Silver–Looking down the road after successful large animal trials, when beginning to test with humans, how do you envision the combined Ch’ase and peptides will be administered into the spinal cord? Surgery, injections, pills, intravenous? Oops, just read above which answers this question.

Would this be a one time and done, or would the procedure require multiple attempts due to the time it takes to degrade the glial scar?

The enzyme is administered through micro-needles but the number of injections per area that would adequately cover the cord still needs to be worked out in a larger animal model. In our rat model we only administer a single injection at C4. When the viral vectors are perfected they spread much farther than regular ch’ase. Thus, perhaps only a single injection will be needed even in a larger animal per targeted area. The peptide is given systemically and can be administered for as long as needed. A critical adjunct to the therapy can be physical rehab or epidural stimulation.

Bionic Spine

Brain Antenna to transfer brain signals to Exo-Skeleton.
This small device will be inserted through the veins into the brain and should pick up and transfer signals from brain to the exo-skeleton bypassing injured place.
see also


SENSOR WALK was developed by Otto Block in conjunction with the Mayo Clinic. The knee-ankle-foot orthotic (KAFO) provides superb stance control for patients who exhibit weak or absent quadriceps, or display knee instability while bearing weight during the stance phase of the gait cycle.

Unique sensors in the footplate know when the patient is in the late stance phase and triggers the knee joint to unlock. Because an extension movement is not required to unlock the joint, the SENSOR WALK helps provide the clinical benefits of a more natural gait. The robust design can handle patients who weigh up to 300 lbs (136 kg) and can accommodate a 15° knee flexion.

Key Features:

Enhanced stability during stance phase.
Stumble recovery due to the ability to block flexion if needed.
The flexion blocking mechanism is activated when needed
during the gait cycle, providing additional stability.
300 lbs (136 kg) weight limit.
Electronic assessment of the relative orientation of the
patient’s limb and utilization of a microprocessor to determine
the appropriate time to engage and disengage the knee joint restraint mechanism.
The SENSOR WALK can be set to function in three ways:
as a locked joint, as a stance control KAF orthotic, and in a free swing mode.

Investment for Cures

NovaGenesis and their Swiss commercial branch Ophiuchus will offer autologous stem cell therapy transplant to investors & family members.
More money in the pocket – closer to the cure folks!!!

Stem cell company tells investors, ‘Make money and save humanity’

A new investment model will see high net worths sponsor ground-breaking research to wipe out the world’s diseases

A small Swiss company has created a novel investment model, where the rewards are far greater than anything financial could bring.

Rather, investors are also paid with technology advancements that could save the lives of their nearest and dearest, or solve their own chronic health issues.

The Novagenesis Foundation and its commercial arm, Ophiuchus Technologies, are pioneers in a niche field of stem cell research. The organisation has created a patented technology that allows bone marrow cells to be taken from an individual, reprogrammed, and reinserted into the body.

The technology is based on the salamander lizard, which can regrow limbs and organs when they are damaged. According to Jørgen Thorball, managing director of Ophiuchus, the company has the capability to heal – and in some cases cure – a variety of health issues.

In Roman mythology, Ophiuchus, also known by his more common name Asclepius, learnt the secrets of keeping death at bay.

The organisations are raising capital through XOventure, which finds funding and support for early-stage life sciences and biotechnology firms.

Ed Cappabianca, senior partner at XOventure, explains that cures are usually avoided by traditional investors, such as venture capitalists, because once someone is cured, the product is no longer required, which limits its scalability.

“What investors want is a single chemical, something like Viagra, that you can scale and sell for a lot of money,” he says. “Once you start taking it, you tend to keep taking it. It doesn’t solve a problem, so you create a customer for life.

Last year Pfizer made $1.7bn from Viagra sales

“The same is true of many treatments for diabetes. The focus is on creating medicines that allow people to lead healthy, happy lives – as long as you keep taking them.”

Novagenesis has been funded by high-net-worth individuals who are motivated by altruistic or personal reasons to further this kind of research. The not-for-profit foundation has already raised “many millions” to take its technology into clinical trials, and Ophiuchus is aiming to close a £7m investment round.

The company could later also go down the crowdfunding route, Cappabianca claimed, allowing armchair investors to invest in the firm. “The early data will help us to secure the next round of funding as we don’t want to IPO too early,” says Cappabianca. “The stock price will be driven up as people hear about us and the last thing you want is to have a steep valuation when you’re looking to raise more money.

“We want to raise money at a lower price, giving early investors a return, but leaving something on the table for the next guy. That way we can keep going back to the well.”

One private investor, Serge Richard, who manages the Swiss branch of a global estate planning business, said he was attracted to the proposition because of its human dimension. “I believe it will create progress for humanity as a whole, not just for a few people,” he says, “Everyone knows somebody who has been hurt in an accident and left disabled or brain damaged and that could all be avoided with this technology.”

Most of Novagenesis’s backing has been provided by a single donor with progressive multiple sclerosis, a form of the disease where symptoms get continually worse over time rather than having relapses and remissions. Cappabianca also got involved with the project because of personal reasons. “A friend has progressive MS,” he says. “I don’t know if we’ll solve the problem in time for Charlie, but it is why I wanted to help raise the money.”

Ophiuchus’s work is currently focused on spinal cord injuries. The foundation’s founder, Jan-Eric Ahlfors, who invented the new technology, chose to target the most severe cases of paraplegics in order to leave no doubt that the science and product concept was robust.

“Most researchers go for the low-hanging fruit,” says Thorball. “But it actually makes sense to try and solve the most difficult problems first because then you know the technology works.”

Ophiuchus has embarked on its first human clinical trials. The trials are being undertaken in Russia, supported by the country’s leading health body, the Federal Research Clinical Centre of Federal Medical & Biological Agency. There will be 30 patients in the current trial.

Ahlfors is working on the core technology in a private lab in Montreal, Canada, and will publish a paper on his research when the current set of clinical trials are complete.

Novagenesis has kept its research under wraps to avoid creating false hope among the paraplegic community, and sufferers of other diseases, who could eventually be helped by the technology. “We didn’t want to create hype before there was a product,” says Thorball. “The science is interesting but it’s not relevant for the patient, only products are relevant. When science says we can cure something and there is no product, what does the patient do?”

Unlike other stem cell methodologies, Ahlfors is focusing on an “autologous” process, which ensures that the cells are not rejected by the patient, unlike experiments using cells harvested from other sources.

One barrier to growth is that different governments have varying laws on whether an individual can have their own cells harvested. This is not currently possible in the UK or US.

“It seems ridiculous to tell people that they cannot have their own cells, but the regulations are very different depending where you are in the world,” says Thorball.

Other companies have allegedly made headway in stem cell research. Last year, the BBC’s Panorama programme followed the treatment of one paralysed man in Poland, who was filmed walking again for the first time after his accident. Thorball warned against taking claims made by stem cell researchers that are based on a single selected patient.

“In that case, the spinal cord was not severed, just damaged,” says Thorball. “He already had some ability, so the regrowth is a matter of discussion.”

Ophiuchus will work hard towards rolling out treatments in private clinics within two years. The company is aiming to create a mass-market product within a decade. Investor Richard said: “All the insurance companies will begin covering the treatment because even though it will be expensive, it will be much less expensive than treating people for the rest of their lives for a disease, or keeping them in a wheelchair.”