The six month myth

Here's something that doesn't get talked about enough. There's this idea in the literature, and it gets repeated so often it's become received wisdom, that stroke recovery plateaus after six months. That if your hand is still limp and stiff at that point, that's just who you are now. You're kind of fossilised in that state.

I don't believe that. And I don't think the data actually supports it either.

What that data really shows is what happens when therapy stops. When you're in hospital and in the early months after discharge, you're getting high intensity care, constant engagement, people around you pushing your recovery every day. And then, gradually, that dwindles. Physio appointments get further apart. Physios go on holiday. Patients cancel. Life gets in the way. And recovery stalls – not because the brain can't keep going, but because the input stopped.

The brain is plastic. You can learn a language well into old age if you keep at it. You can relearn how to move your hand if you keep stimulating those pathways. That's our fundamental belief, and it's what Myonerv is built on.

So the patients who've been told their time is up? They're not a lost cause. They're just massively underserved.

Why everyone else is fishing in the same pond

Here's the thing about a lot of the existing research in this space. The studies backing up conventional neurostimulators are largely using mildly to moderately paralysed patients, people who've recently had a stroke and are still within that intensive care window. And a lot of them would have recovered anyway, because of everything else going on around them.

That's not a criticism, it's just what it is. But it does mean the device design has never really been pressure tested against the hardest cases. Big sticky electrode pads, long wires, fiddly to put on. That's fine if you've got a physio right there to help. It's not fine if you're at home, years on from your stroke, trying to manage your own recovery with one working hand.

We looked at all of that and thought — there's a huge population of people with chronic, severe paralysis who are desperate for something that actually works for them, and nobody is really building for them. That's where we wanted to go.

Jumping in the deep end, on purpose

Upper limb rehab, specifically the hand and fingers, is objectively the hardest place to start. To target individual finger muscles with any precision, you can't just slap on a big pad and hope for the best. You need a high density array of small, custom electrodes that can get to the right nerves, in the right place, with the right signal. It's a harder engineering problem. It requires more scientific rigour. It would have been much easier to start with the lower limb, put some electrodes on the quads, get the leg moving.

But we made a deliberate decision to go after the hardest thing first, close that chapter completely and definitively, and then move down to the lower limb from a position of strength. If we can do the fingers, we can do anything.

And the patients we're working with — people who've been chronically disabled for years, who've essentially been written off by the system — they're not sceptical. They're not going to push back on a device that's clearly been designed with them in mind, by people who understand what they actually need day to day. The engagement is real, the need is urgent, and that matters enormously when you're trying to build evidence for something new.

The personal logic

There's a personal side to this, I think is worth mentioning too. 

My cousin was my best friend growing up, but one day at school he started complaining about headaches. Within days he was in hospital. Within a week he had been diagnosed with leukemia, found to have multiple tumours in his brain and suffered a brain haemorrhage that left him officially ‘brain dead’ and on life support. 

He survived. And over the following months he began to make faint movements, then sounds, then words and sentences. He got up and moving, but his left hand stayed limp. And I remember bringing him his games console we used to play on, and putting it in his hand, thinking he'd just pick it up and start playing. He couldn't do anything with it. That was the first time I started asking about neurotransmitters and mobility.

Those questions took me into neuroscience and a decade later they took me to Myonerv. The patients we build for are severely paralysed, years post-stroke, told their recovery is over, are people I understand in a way that goes beyond the research. My cousin was one of them. And the idea that the data said he was stuck in that state forever was never something I was willing to accept.

That's ultimately why we jumped in the deep end. Not just because it's the right commercial decision. Because these are the patients who've been waiting the longest, and nobody was coming for them.