#anencephaly

Basics

So first of all, there are multiple forms of anencephaly. The one I was taught mostly in school (keep in mind I'm not a neuro specialist or a doctor) is the most common type, which is when the entire brain does not form. These babies are often born dead.

Personally I don't know of any cases of any form of anencephaly that have survived more than a few hours post-birth. In no case of anencephaly is it survivable in real life. They all are born dead, or die within the first day of life. Even the "less severe" (as in, some of the brain forms lol) types.

However, since we're talking about magic-y sci-fi brain implants...

How To "Treat" Anencephaly (theoretically)

The reason why I'm struggling to think of how (even with sci-fi magic) this would be treated is because anencephaly occurs super early in pregnancy. I'm talking before you know you're pregnant early. (If you want to learn more about this you can google neural tube and see how it's formed very early on in pregnancy and what it entails.)

To me, in a sci-fi world, the most plausible way to treat anencephaly and make it a survivable condition would be to catch it during the neural tube formation (which is the first 1-4 weeks after conception) and preventing anencephaly - or at least reducing the effects.

However, even then, I find it extremely unlikely that it would work, or if did work, it would "cure" it so to speak and then you wouldn't need the implants/treatment post-birth.

Somewhat Plausible Sci-fi Treatments

What might be interesting to explore is this: maybe in your fancy sci-fi world, they have a way to test pregnancies in the first 2-4 weeks and knew the baby was developing anencephaly. Then maybe there is a New Fancy Research Treatment that they try out, something that could be injected into the womb or bloodstream to reverse the neural tube malformation.

But, maybe with your character, it almost works, but doesn't. This leaves them with almost a full brain and skull, but with one section that never developed around the anterior parietal area. This would lead to the motor deficits you describe.

So, essentially, what I've done here is I've taken sci-fi medicine and made it so your world can attempt to treat anencephaly and reduce the deficits to be something more aligning with real-life cerebral palsy (CP).

PLEASE KEEP IN MIND NONE OF THIS IS EVEN REMOTELY POSSIBLE LMAO

Note: Another option is that the baby has a "less severe" type of anencephaly (aka, they live for a few hours post-birth, so enough time to be left in a trash can) and the cyborg finds them - but that would require not just an implant, but literally an entirely cyborg brain and skull. To me this is a bit too far of a stretch to be real even in sci-fi, and I would not consider this character to be human if they do not have a human brain, they would essentially be AI with an organic body. So I'll be answering this question following the above plan of a treatment that was ineffective at curing anencephaly, essentially turning it into an alt-CP. Another note: Cyborg from DC comics is a situation where he has a half-cyborg brain and skull, so it's not totally out of the realm of possibility to do it that way, however that character was a Normal Human who lost part of the brain in an injury, and tbh he has 0 deficits after becoming Cyborg and wouldn't necessarily recommend that if you want to discuss disability in your work. Or if you want any semblance of realism at all (which DC comics does not lol)

Speech & Brain Development

There is one more thing I want to address because, while I definitely can see motor deficits happening from this fictional form of "survivable anencephaly", language and speech is a bit more complicated (and this is literally my area of specialty in my day job).

Now I don't know when you say "loses the ability to speak/motor control" in your ask, if you mean literally the character loses the ability to move their mouth - which is realistic - or if they lose language, which is not as realistic.

If you are born with a brain that has a piece missing, your brain can adapt. (If you want more info, google neural plasticity.)

So if the person lived their life with this chunk of brain missing, yeah they will definitely have deficits, but as they grow, as their brain develops throughout childhood and adulthood, they will likely be able to adapt and their brain can literally wire itself differently than other brains to accommodate as best it can.

This means that the brain will find a way to acquire language, even if the "language centers" of the brain are damaged or not fully formed. It might not be the best ever, there might be language delay, learning disability, adhd, etc. But they will be able to understand language and - if they have the motor capability - to speak.

Cool Side Story: in my neuro class in grad school, we learned about a teenager who had a fast-growing brain cancer that was taking over half of her brain. But she didn't start to have deficits until it was a HUGE and the ended up surgically removing the entire left hemisphere. This is where language is, along with many functions. However, post-surgery, she had almost no deficits. You may be asking, rightfully so: WTF HOW? Because the brain knew it was being attacked, and had spent the past year while it was being eaten away rewiring itself so that all/most of her functions were now working in the right hemisphere. The brain is amazing and there is SO MUCH we don't know. Obviously this is a rare case, but it's still wild that even one brain can do this.

Now, this case is specifically just the brain, but we're not talking about the skull which would also be impacted for your character. I don't want you to think "oh so this character wouldn't even need an implant?" because 1) there definitely would be deficits and 2) you can't just... not have a chunk of skull and have your brain open to air/scalp/damage.

In terms of the motor deficits you would likely see with this "survivable anencephaly" I would say look at resources regarding cerebral palsy (and to a lesser extent, maybe muscular dystrophy?), and see the kinds of life-long impacts and motor deficits they experience. There are some people with CP who will never be able to walk, there are some who can walk but not speak, there are some you can speak but they drool and their speech is slurred, I even worked with a kid with CP whose only deficit was that his soft palate didn't work so food would go up his nose and his speech sounded nasal -- each person is unique, and there will be some physical limitations that are permanent despite neuroplasticity.

This doesn't mean they can't make progress or learn or adapt in some ways, but essentially I just want to clarify: the deficits are motor. This means the person's language and intelligence is normal, but their motor control - their ability to move their bodies - is essentially disconnected, like a faulty wire. Even if your character had an implant and that implant broke or was taken out, their language and intelligence should be intact. (I say this because it's a common misconception that people with CP are intellectually disabled. This can be true, but it is not always true or even mostly true.)

All that to say: how would a sci-fi implant impact all this? What about disability?

So, you say Baby was picked out the trash by a cyborg surgeon. They would find a baby with part of their head sunken in with a chunk of skull and brain missing. It's definitely plausible that said cyborg would want to save Baby and give them a brain implant.

As someone who does not have CP (or any physical disability) I don't really feel it's my place to say what direction to take here, and how much the implant would "treat/fix" motor deficits caused by a missing brain chunk. At this point, we're talking about something so beyond the realm of real life that there's no way to know what an implant would do for brain damage. This is something we haven't even begun to discuss or research in real life medicine.

Side note: the closest equivalent I cant think of this is cochlear implants. These are implants that are fully inside the head (well, the cochlea specifically) and uses magnets to put an outside piece against the head, which then allows it to work. THESE DO NOT "FIX" SOMEONE'S HEARING. It does not sound like natural sound the way a functioning human ear would hear it. It sounds robotic and mechanical, you probably won't be able to tell the difference between people's voices, or whether what you're hearing is a violin or a cello or guitar. You might not hear someone sneaking up on you, or you might hear water dripping from a faucet and have no idea what that sound is or where it's coming from. These people are still deaf. They still depend on other supports outside of the implant in order to function in a hearing word.

I think you should take this into account when thinking about how this implant will help the character. Maybe the implant can "fix" some motor deficits, but not all of them. Maybe it lets them walk, but with unsteady gait. Maybe it lets them walk and move their arms but their speech is always slurred. Maybe the have shitty grip. Maybe it gives them gross motor but not fine motor skills. Maybe it glitches. Maybe it uses a lot of energy and overheats, or needs to be recharged. Maybe, because of these limitations, this character needs to have canes, walkers, wheelchairs and other supports on hand at any time in case the implant malfunctions, overheats, gets damaged, or needs to be recharged. Maybe the implant does "fix" everything and they seem ~normal~ to an onlooker.

I know there are multiple ways of thinking about sci-fi medicine treating disabilities, and I am limited experience in this area. However I would say: even if the person's motor skills are fully intact with the implant in, it is important to make sure that their disability is discussed and that this does not erase the disability.

I like the idea of exploring how someone who is dependent on a sci-fi implant to then have a different outlook/perspective on how to approach violence or war. Personally I love to see how those who are othered by society and have disabilities navigate fantasy worlds and how they approach violence and problems differently than their privileged and abled counterparts.

As the writer, it will be up to you to do the work, engage with the disability community, do research, and decide all these factors for yourself.

Thanks for the ask, I'm always happy to discuss medicine in fantasy!! Hope this was helpful <3

~ MJ