Thank You and a Chapter from Plugged In
I want to take a moment to thank you. Thank you for helping me along the path to completing my book. Thank you for the numerous surveys you filled out when I was at a crossroads between (in my opinion) equally cool options. Thank you for sending me encouraging notes, urging me to press on and sharing my excitement. In the end, my book is pointless if it doesn’t inspire you in some manner. Whether that is by sparking a new curiosity or moving you as you read the marvelous stories of true fighters in my book. Many of you, by now, have read and hopefully many of you will still read my book and when you do, I truly hope that you are left inspired, excited, and hopeful for the future, for what comes next in our scientific world.
In this last post of a 12-part blog series, highlighting what I consider to be the most intriguing portions of the book, I am going to share with you my favorite chapter, in entirety. This chapter was quite difficult to research as many of the mentioned persons are not well-known, some almost nameless, and yet what they have done and what they are contributing to science is medal-worthy. I hope you enjoy this chapter and that you have enjoyed these blog posts as much as I have enjoyed writing them.
Before I begin, one quick note. Some of you struck off with me expecting my book to be a recounting of my journey through my injury and the ensuing recovery, and in that sense were probably a little surprised when you began reading Plugged In. I do apologize if you felt mislead, and I hope that you enjoyed the material of the book nonetheless. However, I will say, you needn’t wait too long for a book fulfilling your desires. A book not about me. But about what I learned. About who I met. And, most importantly, about resilience and where it stems from. Up from the Knee Twitch will be published in the Fall of 2019. This book will take you with me through my time in the hospital, what I learned, what drove me to explore a cure, start an outreach program, and share with others about my experiences.
If you want to connect you can reach me here via email admangan2018@gmail.com or connect with me on social: LinkedIn, Twitter, Facebook, Instagram. Also, you can find my book on Amazon.
And now… Chapter 7 from my book, Plugged In:
Computers as Robots
In ABC’s recently popular show, Marvel’s Agents of S.H.I.E.L.D., the main character, Phil Coulson, suffers a terrible injury in the season 2 finale. Coulson, along with characters Mack and Fitz, is fighting a teleporting “inhuman.” After a gripping battle and consequent victory, the inhuman teleports onto Fitz’s blade, resulting in an unimaginably gruesome death. As he falls, he drops a terrigin crystal from his hand. These crystals, brought from an alien planet, cause certain humans to gain powers but kill all others who touch them. Phil Coulson, in an effort to save Fitz and Mack, lunges forward and grabs the crystal as it falls, preventing it from breaking and killing them all. In a tense moment, the trio recognizes what Coulson did, and a silence settles over them as the poison begins to crawl up his arm. All seems lost for Coulson until, out of nowhere, Mack cuts the affected arm off at the wrist.
Through ensuing episodes and seasons, Fitz, the team scientist, develops a perfect prosthetic for Coulson. In this sci-fi-based TV series, the prosthetic is a perfect robotic replica that provides full sensation for Coulson while building in a number of technical features for battle. Requiring nothing more than a coupling, this entirely lifelike prosthetic is indistinguishable from Coulson’s real hand. How real is this depiction? Could we ever develop a prosthetic so perfect, so complete, that no one, not even the user, could tell the difference?
This level of success with prosthetics has been a dream and goal of many people for years. Neuroprosthetics is a field being entirely transformed by brain-computer interfaces. However, normal prosthetics are also being radically upgraded by BCIs. From war veterans who lost their limbs in battle to IEDs, shrapnel, or bullet wounds, to unlucky children born with a limb missing, these amputees are equipped with the latest in prosthetic devices. Unfortunately, the “latest” wide stream prosthetics are still very low technology, nothing like Phil Coulson’s amazing arm.
Prosthetics have a long history dating back to what is considered one of the first prosthetics in 424 B.C. Herodotus wrote of a Persian seer who was condemned to death but escaped by amputating his own foot, which he replaced with a wooden filler and used to walk 30 miles to the next town. Over the next millennia there weren’t any drastic upgrades to the prosthetic, except for some mildly “fashionable” bronze and copper prostheses designed during the Renaissance. The first major advances came under the supervision of French Army barber/surgeon Ambroise Paré, who is considered by many to be the father of modern amputation surgery and prosthetic design. He was responsible for the designs that allow above-the-knee prostheses to bend efficiently and smoothly. A friend of Paré’s was responsible for switching prosthetic materials from heavy iron to leather, paper, and glue.
During the American Civil War, the number of American amputees rose astronomically. In response to the lack of development in this area, the U.S. government formed the American Orthotic and Prosthetic Association (AOPA). Again, after WWII, the government convinced certain weapons developers to switch to prosthetics to meet the renewed demand. Today, as technology has improved, there’s a transition to robotic prosthetics controlled by electrodes placed on the stump of the limb, providing a veritable treasure trove of possibilities. Most impressively, by stimulating the nerves in the affected limb, scientists are beginning to succeed at something amputees could only dream about: feeling in their prosthetic limbs.[1]
Like Keven Walgamott, introduced in Chapter 4, Nathan Copeland also had his life drastically set on a different course: He was 18 when he broke his neck. Nathan was driving his car in the winter of 2004 on a rainy night in western Pennsylvania when he lost control and crashed into another car. Nathan broke his neck and suffered severe damage to his spinal cord that resulted in complete paralysis and loss of feeling from his neck down. Nathan was a freshman in college studying nanofabrication when he experienced this devastating injury. A high quadriplegic injury occurs to around 2000 people per year in the United States.
Immediately after his injury, Nathan enrolled in a clinical trial asking for volunteers to try out cutting-edge robotic limbs. From my time spent at the Craig Spine Center, I can attest to how the clinical trial process works. I volunteered for a couple of studies, and both of them resulted in delays, lots of unnecessary work, and ultimately no idea where the data I provided went. I have also done a lot of research into clinical trials in the U.S., and across the board, the process is comparably frustrating. Less than 3% of studies proposed to see completion, whether from lack of funding, participants, or interest. So when Nathan put his name down, he probably wasn’t too hopeful about receiving an opportunity to work with this mind-boggling technology. This was in 2004, and he didn’t get the call until 2014–10 years later. But, he did receive that call.
The person who called him was Robert Gaunt. Gaunt is an assistant professor in the department of physical medicine and rehabilitation at the University of Pittsburgh. Dr. Gaunt received his Ph.D. in biomedical engineering at the University of Alberta in 2008 and his postdoctoral training in the laboratory of Dr. Douglas Weber at the University of Pittsburgh. Dr. Gaunt also maintains a secondary appointment with the department of bioengineering at the University of Pittsburgh.
The name of the study that Nathan had been called up for was “Intracortical microstimulation of human somatosensory cortex.” The goal of this study was to make use of Nathan’s brain’s natural abilities. Nathan was brought in for an operation to put an implant on his somatosensory cortex, the part of the brain that registers touch. First, however, he went through a series of scans to try to determine where on this part of the brain were the specific areas responsible for his fingers’ sense of touch. Once he had the Utah array implanted, he was hooked up to a computer and a robotic arm.
Watching a video of Nathan, I feel like I am watching The Matrix: There are two cords attached to metal leads on his head. But what happened next seems even more fictional than any Hollywood movie. Dr. Gaunt blindfolded Nathan and then proceeded to touch the fingers of the robotic arm. Without fail, Nathan responded accordingly to the finger that was being pressed. “I can feel just about every finger,” Nathan said. “Sometimes it feels electrical, and sometimes it’s pressure, but for the most part, I can tell most of the fingers with definite precision. It feels like my fingers are getting touched or pushed.”
As the team experimented further they realized that they may have implanted the electrodes a little too deeply, and as a result, Nathan couldn’t feel pressure on his thumb. Dr. Gaunt recognizes this but is still ecstatic: “The ultimate goal is to create a system which moves and feels just like a natural arm would,” he said. “We have a long way to go to get there, but this is a great start.” His colleague, Professor Andrew Schwartz, said the most important finding was that the system could create a “natural sensation.” But he added, “There is still a lot of research that needs to be carried out to better understand the stimulation patterns needed to help patients make better movements.” To demonstrate this amazing feat and the fruits of the DARPA funding, Nathan was given the honor of meeting with President Barack Obama and fist bumping him with his robotic arm.
This experiment is the result of many years of research. Four years earlier, Jennifer Collinger, another member of the team, was involved in an experiment that served as a kind of stepping stone to Dr. Gaunt’s work with Nathan. Jan Scheuermann, a 36-year-old mother of two, was the volunteer that time. Jan had been diagnosed with spinocerebellar degeneration, a disease that destroys the connections between the brain and muscles. Jan came into the trial with one goal: Eat a piece of chocolate on her own.
Dr. Gaunt and Jennifer’s goal was to be able to control a robotic arm fully with an implant on the motor cortex. Their work paved the way for the team to complete Nathan’s amazing experiment years later. Using a procedure later replicated in Nathan, Dr. Gaunt implanted a Utah array on Jan’s motor cortex and connected her with the robotic arm. It was a slow process to learn to control the arm: first, days of calibration, then slow, deliberate movements, learning how to open and close the hand. But ultimately, in 2012, Jan did eat that chocolate on her own.
One goal of Dr. Gaunt’s team, as well as of researchers around the world, is to connect these technologies — the control of the robotic arm with the sensory feedback — because it would allow for significantly better control of these prosthetics. As Takafumi Yanagisawa at Osaka University in Japan says, “The sensory information should be beneficial for patients to manipulate something with the hand more precisely.” Yanagisawa, like Dr. Gaunt, has worked with brain-computer interfaces to enable paralyzed people to move objects using a prosthetic hand.
I introduced Keven Walgamott back in chapter 4 and again in Nathan’s story, but now I am going to explain just how incredible his story is. Fifteen years ago, when Keven was 43 years old, he suffered an electrical accident that ultimately resulted in his left forearm being amputated. Naturally, he was under the impression that he would never move or feel his phantom arm again. As Keven shared in an interview, “One thing I missed was being able to easily put a pillow case on.” Therefore, 14 years later, when Keven learned of a program that was working with experimental robotic arms that might provide him with that ability again, he signed up.
What Keven was signing up for was part of the DARPA-funded Hand Proprioception and Touch Interfaces (HAPTIX) program. The HAPTIX program, started in 2014, has the seemingly lofty goal of achieving a highly functioning robotic prosthetic that is part of a “closed system,” meaning it would be controlled by the brain but also provide feedback directly to the brain. Now, four years later, a University of Utah team, headed by UU Bioengineering Associate Professor Gregory Clark, seems closer than ever to achieving the DARPA goal. And their patient? Keven.
The prosthetic Professor Clark and his team chose to work with was the “Luke” arm, developed by the company DEKA. The Luke arm, actually called the DEKA arm system, was nicknamed after the advanced robotic hand Luke Skywalker received after his own hand was cut off in Episode IV of the famous film franchise Star Wars. DEKA, the same company that invented the Segway, was one of two recipients of a $100 million DARPA grant and spent eight years perfecting its technology. The robotic prosthetic itself is truly an engineering marvel. The DEKA arm system is capable of sensing and moving, providing the user the ability to both pick up delicate items as well as handle rough power tools. Despite the extreme range of motion and ability available, engineers soon realized that there weren’t enough user inputs to complete particularly complicated tasks. To remedy this, the DEKA team built in switches that can be activated with the users’ feet that allow for the Luke arm to perform the more complicated tasks. Ideal? No, but it is a huge step toward a prosthetic as complete and responsive as the Luke arm’s namesake. The team at DEKA finally saw the fruition of their labor when the Luke arm was approved for commercialization by the FDA. Who were some of the first users? Professor Clark and his team at the University of Utah, which brings us back to Keven.
Dr. Clark and his team are based out of the Center for Neural Interfaces, a 20-person lab at the University of Queensland in Australia. Dr. Clark and his team initially received $1.4 million from DARPA to continue research and development of the Utah Slanted Electrode Array (USEA), which promised better integration of sensory prosthetics. The USEA works by using an electrode implanted into the peripheral nerves (in this case in the arm) responsible for hand and forearm movement. This technology is special, first of all because they are tapping into peripheral nerves and reading the signals, a difficult task that is uncommon as of yet in the BCI world, but they are also positioning the electrodes so that they can stimulate the nerves back to the brain: provide sensory response. “Imagine wiretapping into those nerves, which are like a hotline between the brain and the body,” explained Dr. Clark. “We can pick up the nerve signals, translate them, and relay them to an artificial hand. People wouldn’t have to do anything differently from what they’d already learned how to do their whole life with their real hand. They’ll just think what they normally think, and the prosthetic hand will move.”[2]
The team at University of Utah consists of neuroengineers, material scientists, electrical and computer engineers, surgeons, and rehabilitation specialists. The USEA was first developed by University of Utah bioengineering Professor Emeritus Richard Normann and ultimately will communicate with the prosthetic limb wirelessly. The wireless technology was developed by a local company and collaborator, Ripple, LLC, in Salt Lake City, and the electrodes for the array were manufactured by Blackrock Microsystems in the U’s Research Park.
It was an enormous team effort to get this project off the ground, but initially they were just playing on the computer. The first three of the four funded volunteers were simply connected to a virtual reality hand and proceeded to control it with their thoughts via the USEA. The interesting difference between this and other reinnervation technology is that as the volunteers moved the onscreen hand, they were presented with a virtual wall, and when they touched in with the virtual hand — they felt it.
Keven Walgamott was the fourth person to be implanted with the USEA but the first person to use it with the Luke arm. Keven was enrolled in the program for 14 months, and the results were very promising. He was able to both move the Luke arm and also successfully receive feedback. The latter is so crucial, because without feedback, if he went to pick up a grape vs. a hammer, he would clench them with the same pressure, either dropping the hammer or crushing the grape. The biggest achievement for Keven, however, was what he was able to do as a result. Keven was ecstatic at the ability to be able to hold his wife’s hand again with his left arm. The ability that made him happiest, however, was being able to put a pillowcase on a pillow.
“When you have just one hand, you learn to adapt,” he said, describing the infuriatingly slow process he usually uses for pillowcases, pulling them on inch by inch on each side, rotating the whole time. “To just take a pillow in one hand and put the pillowcase on with the other. I know it sounds simple, but it’s amazing.”[3]
And it really is amazing. As more and more studies take place, the future of prosthetics looks extremely promising, not only for amputees like Keven, but for paralyzed people like Nathan and Jan. Being able to have control of a robotic hand that can grab items and bring them to you when you can’t control any part of your own body is inspiring.
[1] “A Brief History of Prosthetics”. inMotion: A Brief History of Prosthetics. November–December 2007. Retrieved 23 November 2010.
[2] Nutt, Amy Ellis. “In a medical first, brain implant allows paralyzed man to feel again.” The Washington Post. 13 October, 2016. Web.
[3] Wan, William. “New robotic hand named after Luke Skywalker helps amputee touch and feel again.” The Washington Post. 15, November 2017. Web.
