Scientific Advances In Prosthetic Limbs

MS. DIANE REHM

11:06:56
Thanks for joining us. I'm Diane Rehm. More than 1,600 American soldiers have lost limbs in Iraq or Afghanistan namely due to bombs like the ones that injured hundreds of people in Boston last month.

MS. DIANE REHM

11:07:15
Over the last ten years, research on treating troops with amputated limbs has led to scientific advances in robotic arms and legs that are changing people's lives. Here with me in the studio to talk about bionic limbs, Michael McLoughlin of Johns Hopkins University, John Matheny, an arm amputee patient, Peggy Chenowith, an advocate with the Amputee Coalition and Mike Corcoran, an artificial limb expert who works with veterans.

MS. DIANE REHM

11:07:53
Do join us, 800-433-8850. Send us your email to drshow@wamu.org. Follow us on Facebook or Twitter. And to let you know, this hour of "The Diane Rehm Show" is also being video-streamed so you can see these artificial limbs at work yourselves. Good morning to all of you and welcome.

MR. MICHAEL MCLOUGHLIN

11:08:20
Good morning.

MR. JOHNNY MATHENY

11:08:20
Good morning.

MR. MIKE CORCORAN

11:08:21
Good morning.

MS. PEGGY CHENOWITH

11:08:21
Good morning.

REHM

11:08:24
Good to see you all. Michael McLoughlin, if I could start with you, tell me about this robotic arm. I understand, and correct me if I'm wrong, that it's actually controlled by the mind.

MCLOUGHLIN

11:08:46
That's correct. So the goal here was to create a prosthetic that could be controlled very naturally. And so we made an arm that's able to do virtually everything that your natural arm can do. The challenge then is how do I control that in a way that's very natural?

MCLOUGHLIN

11:09:04
So we do very complex things, we don't really think about them. And so what we've developed is a way of interfacing with the brain, whether that be connecting to the nerves that remain after an amputation or actually doing an implant in the brain with small electrodes that can pick up signals for somebody who, say, has a spinal cord injury that can no longer use their arms because the information doesn't get there anymore.

REHM

11:09:32
How does that differ from the kind of deep brain stimulation activity that doctors are implanting for say Parkinson's patients?

MCLOUGHLIN

11:09:51
Okay, so there are a couple of differences. One is we're working in a different area of the brain...

REHM

11:09:57
Of course.

MCLOUGHLIN

11:09:57
...so we work in what's known as the cortex so this is the area of the brain closest to the surface of the skull. It's associated with our higher level thought and we also are just listening. To move the arm, we're just listening to what the brain is doing as opposed to deep brain stimulation, which is actually stimulating the brain.

REHM

11:10:22
What do you mean listening to what the brain is doing?

MCLOUGHLIN

11:10:27
Sure, so every time you think about moving your arm, there's areas of your brain that are associated with that motion and you basically get little electrical impulses with the nerves in that area. So that we can put in an electrode near those nerves, or actually sets of electrodes, near those nerves so that every time one of those nerves fires one of those little electrical impulses we can hear it.

REHM

11:10:57
So how long did it take to develop this robotic arm?

MCLOUGHLIN

11:11:04
Well, we've been working on this for seven years now.

REHM

11:11:06
Seven years?

MCLOUGHLIN

11:11:07
Seven years.

REHM

11:11:07
And I gather it has some 100 sensors?

MCLOUGHLIN

11:11:16
Yes, so that's the other half of the challenge here. So we take sensors that are on, say, the fingertips, and when the arm touches an object, we can actually then make measurements which then we try to then feed back to the wearer so they actually get some sense of touch.

REHM

11:11:37
I see, all right, and that was the voice of Michael McLoughlin. He's an engineer and the principal investigator at the Johns Hopkins University Applied Physics Lab. And now, turning to you, Johnny Matheny, I gather you had your arm amputated because of cancer. Tell us what happened.

MATHENY

11:12:06
Well, I had a knot that was growing up on my forearm, very close to my wrist and it was not bothering me, but my wife told me I need to have it looked at and just as soon as they cut it open to check out what it was, it was a fast, spreadable cancer.

MATHENY

11:12:21
And it ended up being Fibrosarcoma and it's a muscle that grows on -- a cancer that grows on the muscle. And by doing this, once they opened it, it started spreading up. Well, they ended up doing five surgeries and 39 radiation treatments trying to cut it out and burn it out.

REHM

11:12:40
Wow.

MATHENY

11:12:40
And it didn't slow it down. It just kept progressing up my arm. So the only final thing they had to do was try to take the arm above where the last known place the cancer had been in hopes of getting it so it wouldn't get to my (word?) I mean, my body.

REHM

11:12:55
Your stomach, your intestines?

MATHENY

11:12:56
Yes, once I got it in there, they said you would be -- you'd have probably six months.

REHM

11:13:03
So they said if we take your arm at which joint?

MATHENY

11:13:11
Well, they asked me. They said, you know, what do you feel would be comfortable for you? I said, I don't care. You can take it off at the shoulder if you have to. I just want it above the cancer. And so they did their study and this is the way they found that it would be best to take it just above the elbow.

REHM

11:13:26
Just above the elbow, so now this robotic arm allows you to do what? And you can hold it up so that those who are seeing the program on video-streaming at drshow.org can actually see it. What can you do with that arm?

MATHENY

11:13:52
With this arm, you're able to do just about anything you can do with your regular hands, wrists or elbow.

REHM

11:13:58
Can you move your fingers?

REHM

11:14:06
And you can move those fingers by?

MATHENY

11:14:14
Just thinking about it.

REHM

11:14:16
Thinking about it.

MATHENY

11:14:17
The old style prosthetics, they would tap into your bicep and tricep muscles only and as you worked those, that would tell the arm what to do. But now that they've done the targeted muscle reinnervation surgery that Dr. Albert Chi at Johns Hopkins has taken over in this area, that it taps in.

MATHENY

11:14:39
They take muscles that normally would go down to your hand and they would tap it in different places on your muscles in the upper arm and each time that your brain wants to do something like open the hand, well, you know, it's a mind intellectual impulse that comes down. It will wiggle that muscle.

MATHENY

11:14:57
Well, then the sensor within the padded cell then tells the computer this is what I want to do. And therefore, the hand then operates that way and it's no different than, you know, just like this. The more you use it, the more fluid you're going to get and it grows with you.

REHM

11:15:12
And how long did it take you to adjust to that?

MATHENY

11:15:19
Ah, it comes gradual. You can't do everything at once because like with myself, it's been three years since I lost it. I had my arm before we started doing this and what it needed to do was retrain the brain. But now you can send signals down. It's actually going to work and through visual tells the brain this is moving and you start opening pathways more and more and more.

MATHENY

11:15:49
In the meantime, I took home a computer that has a virtual arm on it and it's based on the same principle as this arm here so that I could work with it at home. This way you can train your muscles, you know, fine tune them down to the point because when you first start, you may have a group of three muscles working to try to do the same thing and it gets confused and, you know, it doesn't work properly.

MATHENY

11:16:14
Then as you fine tune down to the final muscle that you need, then you usually get more fluid and more opening and closing with it.

REHM

11:16:21
Now, are the muscles in your upper arm working?

MATHENY

11:16:26
Ah, they work to a degree. In some aspects, you know, you're just thinking, well, it just, you know, it automatically jiggles. The sensor takes it and goes on with it.

REHM

11:16:36
So how do you feel about all this?

MATHENY

11:16:40
Oh, I love it. I've been threatening the AP Lab I just want to take this thing home with me every time I go down and work with it.

REHM

11:16:46
Well, it's certainly looks as though it moves well. Could you drive with it?

MATHENY

11:16:53
Yes, eventually as you get more fluid with it you can actually drive with it.

REHM

11:16:58
Can you cook with it?

MATHENY

11:17:00
Oh now, this is something you're talking a mile away. ,I am a cook and, yes, we've already tried this on different aspects of cooking and it works out very well.

REHM

11:17:09
Put your arm up again so that people can see it and see it moves and see those fingers flex. It's just remarkable. I congratulate you.

MATHENY

11:17:26
Thank you.

REHM

11:17:27
And have you tried catching a ball?

MATHENY

11:17:33
No, I haven't tried catching a ball yet, but we had a side effect that came on when they did the TMR surgery. In this case, it was a good side effect. I got the sensation on my pointer finger and my pinky finger so that anytime like you put something in my hand, like a softball, I can tell you it's a softball or a hardball.

MATHENY

11:17:55
Whenever you go to reach or shake somebody's hand -- because most of the time, that's the first thing anyone will do, shake my hand. They want to see if you can control it or if you're going to crush their hand or what. And so I reach out and the sensation, I can feel just about when to quit and it shakes their hand and give them a good shake but not being too soft.

REHM

11:18:09
And of course, when you came in this morning, because it's your left arm that has been amputated, I put out my right hand to shake your right hand, but I promise you before you leave, I'll shake your left hand.

MATHENY

11:18:29
Okay.

REHM

11:18:29
We'll take a short break here and when we come back, we'll talk with our other guests, Peggy Chenowith and Mike Corcoran. Stay with us.

REHM

11:20:05
And welcome back. I have four wonderful guests this morning. Michael McLoughlin is an engineering principal investigator at the Johns Hopkins University Applied Physics Lab. Johnny Matheny had his arm amputated because of cancer in 2008. He is certainly helping researchers at Johns Hopkins University develop a robotic arm. And as you have seen, he uses that quite effectively.

REHM

11:20:46
And now to my Mike Corcoran. He's co-founder of the Medical Center Orthotics and Prosthetics. That's a Maryland-based company that works with injured veterans at Walter Reed National Military Medical Center. And Peggy Chenowith. She's an advocate with the Amputee Coalition, a national organization. She blogs about being a parent of an amputee on amputeemommy.com.

REHM

11:21:24
And, Mike Corcoran, tell us about what you do and how artificial legs and feet had changed in the last few years?

CORCORAN

11:21:37
Well, I work primarily at Walter Reed National Military Medical Center. We provide lower extremity prosthetics for injured service members. And over the past eight years, technology has been -- come forward in great leaps and bounds from the first microprocessor or the only one eight, nine years ago to now we have multiple microprocessor knees and ankles, and now powered prosthetics, which is motorized knee joints and ankle joints to propel the user.

REHM

11:22:09
Now, how do they work differently from, say, an individual who has to have a knee, an ordinary knee replacement? How does that prosthetic knee work differently?

CORCORAN

11:22:28
Well, so the amputees that we deal with are combat injured and typically blasted or similar to those in Boston. And so when an amputee loses two joints, say, an ankle and a knee, the knee joint becomes very important for stability and also efficiency in walking. The big difference in lower extremity prosthetics currently to upper extremity prosthetics, let's sat Mike and the people at Johns Hopkins are developing is, they use user intent or the user thought control. Correct, yes.

CORCORAN

11:23:06
Currently, lower extremity prosthetics, all the sensors are actually on board the device. So they're all built in to, say, the knee joint or the ankle joint. And...

REHM

11:23:15
So how do they work?

CORCORAN

11:23:17
There's like accelerometers, gyroscopes and load sensors.

REHM

11:23:23
Yeah. But you got to explain to me what those..

CORCORAN

11:23:25
Okay. So basically an accelerometer is something that measures the velocity of the legs moving forward. The gyroscope measures the angle of the joint itself.

REHM

11:23:36
Okay.

CORCORAN

11:23:36
And the load sensor is how much weight has been put on the joint.

REHM

11:23:39
Okay.

CORCORAN

11:23:40
And what that does is a compute -- onboard computer is programmed to let the knee perform certain things if all these criteria is met. And so essentially it's not thought controlled. You teach the user, the patient how to trigger the device. And it sounds complicated, but it's actually -- it's so well designed. It's actually, with powered knees, we just tell our patients just to get up and walk.

REHM

11:24:11
So what each patient then would have to have these computer calibrated to his or her pace of walking, the weight, the strength and so on?

CORCORAN

11:24:29
Correct, yes. As a process, we fabricated a license to, but we also programmed the knees or the ankles to the individual user. However, technology and the manufacturers of these components have made it fairly simple to program. So the devices are quite intuitive to the user.

REHM

11:24:52
So, the user, him or herself, could calibrate the device or must it be calibrated by a professional?

CORCORAN

11:25:03
Yeah, the process calibrates. Now there are some devices that use artificial intelligence that you the -- actually to walk and then the device learns the gait of the amputee and then it's kind of locked into that knee joint.

REHM

11:25:17
Mike Corcoran, he's co-founder of Medical Center Orthotics and Prosthetics. That's a Maryland-based company working with injured veterans at Walter Reed National Military Center. And now to you, Peggy Chenowith. Talk about how you became part of this community.

CHENOWITH

11:25:45
I was injured in 1988. I was at a conference right out of college, my dream job. And a computer fell on top of my foot and crushed the bones and nerves on the top of my foot. And we tried for five years to try to save my foot, and eventually I opted to amputate so that I could get rid of the pain and crutches.

REHM

11:26:09
So you had lots of pain in this foot after the computer fell on you?

CHENOWITH

11:26:15
Correct. We tried for over 20 surgeries in that five years to try to save the limb. And finally, when I was first injured, I wanted to save it at all costs. And after five years, I just -- I literally was in front of a judge begging to have my foot amputated so I could move on with my life.

REHM

11:26:32
So where exactly was the foot amputated?

CHENOWITH

11:26:37
I am below knee. So I have about five or six inches below my knee.

REHM

11:26:43
And then what?

CHENOWITH

11:26:46
So this was 10 years ago. And I was fit with a prosthetic and went about living my life and thought, okay, I'm walking. And then one day my prosthetist called me into the office and said, I think we can do better. I want you to try this new bionic ankle. And I tried it and everything changed. I realized that all of the little things that I was taken as accepting that I'm an amputee, so my back's going to hurt.

CHENOWITH

11:27:14
I'm an amputee, so my gait is going to be limited. But all of a sudden that was corrected by this device. And it just opened up a whole new world for me.

REHM

11:27:23
May I see?

CHENOWITH

11:27:24
I'm not wearing it today.

REHM

11:27:26
Where?

CHENOWITH

11:27:27
I'm not. I'm not. I'm wearing a different foot today.

REHM

11:27:28
What are you wearing? A different foot today.

CHENOWITH

11:27:31
Yes.

REHM

11:27:32
Why?

CHENOWITH

11:27:33
I chose to not wear the bionic foot today because we were taking the Metro in and I was worried if I was going to have to run between trains. You can't really run in a bionic foot.

REHM

11:27:43
Oh, I see.

CHENOWITH

11:27:44
So that's one of the limitations. Although they're great devices for every day walking, they're not really high-impact devices. So I'm worried that I'm going to be running or jogging or kicking a ball or getting dirty. I have to wear different foot.

REHM

11:27:58
I see. And what does this foot allow you to do?

CHENOWITH

11:28:04
The one that I'm wearing now?

REHM

11:28:05
Yes.

CHENOWITH

11:28:06
The one that I'm wearing now is a basic do-everything foot. I can -- last night I was in the stream catching tadpoles with my little boy wearing it. And today I'm on a radio show. So you can kind of live your whole life with it. It doesn't have the features that the bionic foot offers. So my gait is different when I wear this foot. I'm more cognizant of walking than I am with my bionic foot. I'm thinking a little bit more about the steps and where I'm walking.

CHENOWITH

11:28:36
When I'm wearing the computerized foot, I can just kind of put it on and walk.

REHM

11:28:39
And tell me why you decided to establish the blog, amputeemommy.com.

CHENOWITH

11:28:47
When I was pregnant with my little boy, I tried to find information on how pregnancy was going to be impacted by my amputation and prosthetic and I could find nothing. And I just decided that there was no use to reinventing the wheel. And once I figured it out, I was going to put it out there and see if I could help other parents.

REHM

11:29:07
And?

CHENOWITH

11:29:09
So, and that's how it started. And I've been blogging now for five years. People have seen my little boy grow up and I talk about everyday issues. I write about prosthetic issues. I write about concerns within the community and how my amputation and prosthetic impacts not just me but the family because really it's not just the amputee that's affected by this, it's everybody around them.

REHM

11:29:33
And, of course, so many veterans coming home and needing these kinds of amputations, Mike.

CORCORAN

11:29:43
Yes. Well, actually there's 1,800 amputees since the start of -- since 9/11.

CHENOWITH

11:29:50
And there are 500 every day in this country.

REHM

11:29:54
Every day.

CHENOWITH

11:29:55
Every day in this country there are 500 amputations in this country alone.

REHM

11:29:59
And that has nothing to do with war, Iraq, Afghanistan.

CHENOWITH

11:30:02
Nothing to do.

CORCORAN

11:30:06
I think the visibility of amputees -- it has become more visible because of our service members. And there are actually, you know, they survived life threatening injuries. So it's not a stigma being an amputee. I don't see it as a stigma. So most of these young guys and gals are proud to wearing a prosthesis and they don't want it covered and they want to showcase the technology that's enabling them to live their lives.

REHM

11:30:40
I detect that lovely Irish...

CORCORAN

11:30:47
Yeah, I'm from Dublin.

REHM

11:30:47
I thought so. I thought so. And how long have you been here?

CORCORAN

11:30:52
I've been here 20 years.

REHM

11:30:53
And why did you initially get into this work?

CORCORAN

11:30:58
Okay. I came over here to train for the Olympics. And I kind of got into prosthetics because Olympic athletes don't make any money. And so I did some technical work for a prosthetic prosthetist in Virginia and she asked me if I'd like to, you know, learn this field. And so I said sure. And then after my sporting days are over, I went to Northwestern University in Chicago for prosthetics and orthotics.

REHM

11:31:24
I see. All of this cost a lot of money. Michael, how much?

MCLOUGHLIN

11:31:35
Well, we've spent -- this has mostly been supported by the Department of Defense and it represents an investment by the government, over $100 million in development of this technology.

REHM

11:31:46
$100 million. And Johnny Matheny, what do you think this arm of yours would cost?

MATHENY

11:31:58
Well, right now I'm not sure. But one thing I am sure of, it cost me an arm.

REHM

11:32:01
It cost you an arm.

MATHENY

11:32:03
And I mean, it's -- to see this come about, I mean, this is nice, especially with the servicemen coming back. I got into this because I don't like negatives. I lost my arm, it was a negative. I wanted something positive to come out of this. So I told my prosthetist that I want to do something, some studies or whatever. I said, you know, I'm an old fart, it ain't going to hurt me if you failed, if you cut half my arm off or cut the rest of it off. I'd rather me than the young guys coming back.

REHM

11:32:33
And you're listening to "The Diane Rehm Show." But cost in dollars for this prosthetic arm, Michael?

MCLOUGHLIN

11:32:44
Well, this is still in the research stage.

REHM

11:32:46
Right.

MCLOUGHLIN

11:32:46
And so one of our challenges is really looking at how we move to really a commercially available version of your arm. And one of the challenges that we face is although there are 500 amputations a day in this country, a very small percentage of them are upper extremity. Most of our work, okay.

REHM

11:33:09
And how did they occur for the most part?

MCLOUGHLIN

11:33:12
For most of lower extremity amputations, it's frequently due to cardiovascular issues, diabetes or other circulatory...

REHM

11:33:20
I see.

MCLOUGHLIN

11:33:23
...issues. And so we have something that is very complex and we have very small numbers of potential users of it. So the challenge then is, you know, how do you develop a sustainable business model that makes it -- that supports the long-term usage of the technology.

REHM

11:33:43
But surely an arm like this would cost what, at least?

MCLOUGHLIN

11:33:49
We don't really know. But it's certainly going to be more expensive than what's currently available.

REHM

11:33:53
Like $100,000?

MCLOUGHLIN

11:33:55
We expect to get it less than that.

REHM

11:33:57
You want to?

MCLOUGHLIN

11:33:59
Yeah, maybe half that. So we're looking at options, for example, you know, start working with not-for-profits to enable people to get the technology.

REHM

11:34:09
Good. All right. We're going to open the phones, take our first call from Dallas, TX. Good morning, Mike, you're on the air.

MIKE

11:34:20
Good morning, Diane. I just want to say thanks for taking my call. I have a quick question regarding the relative strength of these prosthetics versus the normal strength of a hand, how they relate, how much you can lift versus how much you can lift before the arm falls of the stub versus how strong the prosthesis, et cetera.

REHM

11:34:46
Johnny Matheny.

MATHENY

11:34:48
Well, with the strength of the arm, it has the same capabilities as your normal hand. It can be as soft as you want to be, crush hands. It can lift. The one that I'm wearing right now is like a military style arm. And it's supposed to be able to pick up 200 pounds.

REHM

11:35:06
Two hundred pounds?

MATHENY

11:35:08
Correct.

REHM

11:35:10
And you could, of course, with your other arm lift that much if you needed to.

MATHENY

11:35:20
Yeah. This one was built so if they were in the field and they were bunkered down and they need to move quick, the machine gun that sits on the ground that has to stay and everything, they'd be able to reach down with the prosthetic, pick it up and walk off with it and never slow down.

REHM

11:35:35
I would surely hope that someone with a prosthesis of this sort would not be going back into battle.

MATHENY

11:35:46
Well, you know, we have soldiers that have gone back to the field with lower extremity prosthetics.

REHM

11:35:51
Really?

MATHENY

11:35:52
So, absolutely. I someday would like to see our military members be able to go back to service if that's what they would like to do.

REHM

11:36:00
Mike Corcoran?

CORCORAN

11:36:01
Yeah, we found a number of lower extremity amputees return to active duty and some in combat. There's also been some upper extremity amputees that have returned and transradial amputees are below elbow amputees. It's not advertised. These -- they're professionals. This is what they're trained to do. And they suffered these injuries. They want to regain the ability to do what they're trained to do.

REHM

11:36:26
Peggy Chenowith, are you limited in any way by your prosthetic foot?

CHENOWITH

11:36:35
I don't think that I'm limited by my amputation. I am limited by activities. I have a foot for different purposes. But there's not really one foot that's great for absolutely everything yet. So I have to plan ahead and I'm not real good at that all the time.

REHM

11:36:54
And you did plan ahead.

CHENOWITH

11:36:55
I did plan ahead today.

REHM

11:36:57
Yes.

CHENOWITH

11:36:57
But, you know, if we're going to the park, I have to really make sure that I have the correct leg with me. If we're going to go on vacation, I have a bag full of legs that I have to pack.

REHM

11:37:06
A bag full of legs.

CHENOWITH

11:37:08
I do. But I'm lucky because I can get a bag full of legs. There are a lot of amputees in this country who can't get one.

REHM

11:37:15
I have to tell you a terrible experience I have. I was flying to Pittsburgh. I picked up my suitcase off the motorized lane, got in hotel, open my suitcase and there was a prosthetic leg. I had picked up the wrong suitcase. And of course that person needed her suitcase. Short break.

REHM

11:40:02
And we've got lots of callers waiting. We'll go first to Layton, Utah. Good morning, George.

GEORGE

11:40:13
Good morning, Diane, and thank you for taking my call.

REHM

11:40:15
Of course.

GEORGE

11:40:17
I lost my hand in 1964.

REHM

11:40:20
Oh, I'm sorry.

GEORGE

11:40:21
Well, it's neither here nor there, but thank you. And I've watched the progress of hands coming along. And I've seen that they've made incredible progress over the years, but they seem to be weak. They seem to be vulnerable. And I wonder if anything is solved yet. Mine is fiberglass and I've been through five of them now that have broken. And I wear a hook, but I don't go with the other ones because they're even more vulnerable.

REHM

11:40:55
What do you think, Michael?

MCLOUGHLIN

11:40:58
Yeah, so one of our challenges in building this arm was to make a limb that would be more robust. And so we've actually used this one quite a bit. Johnny's put it through its paces. We've put a lot of effort into making it function like a human hand. You're still not going to be able to do things like, for example, you can't immerse that in water. It wouldn't like that.

REHM

11:41:27
Interesting. Interesting. Why not? What would happen?

MCLOUGHLIN

11:41:31
Well, it's just -- yeah, it's just not sealed up...

REHM

11:41:34
Right.

MCLOUGHLIN

11:41:35
...as well as it would -- it would need to be.

REHM

11:41:37
Okay.

MCLOUGHLIN

11:41:38
But we can put a covering over the arm.

REHM

11:41:40
What kind of timeframe do you believe will transpire before this is available to the general public?

MCLOUGHLIN

11:41:51
Yeah, so the challenge right now is really just designing this really for commercial use. So I think we could be there in a couple of years.

REHM

11:41:59
I see. And, Mike Corcoran, what about George's concern that the hook he's wearing seems to have more strength than perhaps what is available in a prosthetic hand?

CORCORAN

11:42:19
Right. Well, the hook has less moving parts.

REHM

11:42:22
Of course.

CORCORAN

11:42:22
So you -- and it tends to be -- a lot of amputees say that it's most versatile because they can actually see what they're going to pick up. Sometimes a hand when you go to pick up an object and you can't see through the hand and you don't have sensory feedback, it's hard to -- it's hard to see where the hand is in relation to what you're trying to grasp. So typically, again, when manufacturers develop hands, they want to have as much motion in a hand as possible and then so that's more moving parts. And it's difficult to make robust, you know, a hand with many joints robust.

CORCORAN

11:43:03
See our own hands that we have, we have the -- we have cells that replenish. If we injure ourselves, you know, we heal ourselves. But with a prosthetic hand, it doesn't do that.

REHM

11:43:15
Well, are you saying that as far as strength is concerned that George is better off with a hook as opposed to a prosthetic hand?

CORCORAN

11:43:30
No. I'm saying George and every amputee needs to keep pushing for better technology, make the process talk to wonderful institutions like Johns Hopkins to develop stronger, more mobile joints, better artificial hands. Because the end user is the amputee. And we all here, apart from Johnny, are trying to develop it. But if there's no one pressing us to, you know, continue this development...

REHM

11:44:02
Good point.

CORCORAN

11:44:03
...then we'll be -- we won't see any advancements.

REHM

11:44:06
George, you've got to do your part.

GEORGE

11:44:09
May I make a suggestion then?

REHM

11:44:10
Certainly.

GEORGE

11:44:12
There's a physicist from Arizona, his name is Patrick Flannigan, he developed something called a neuro phone back in the late '50s. He's gone through 16 generations of it now. And it actually reads thoughts by compressing square waves. Now, he was teaching dolphins to put the submarine mines underneath Soviet submarines back in the '80s. And they were learning to do that by the technology that he had. It was a nine year fight to get that out of the hands of the Navy and get it patented.

REHM

11:44:53
All right. Have you heard anything about that, Michael?

MCLOUGHLIN

11:44:56
No. Actually I'm not familiar with that particular set of work.

REHM

11:45:00
Yeah. Well, I urge you, George, to get on this issue and push your own medical center to be developing something a little more sophisticated and user friendly perhaps than that hook. Good morning, Tom, in San Antonio, Texas. You're on the air.

TOM

11:45:32
Well, good morning and thank you for taking my call.

REHM

11:45:34
Of course.

TOM

11:45:36
The thing that I wanted to observe was that in the last year I've been able to take advantage of microprocessors in both my knees and my feet. I am over 60 and typically in a category that the people who make decisions as to who these things are available to would decide he won't benefit from it, he's too old. But what happened to me was, by having these new knees and feet that I now have...

REHM

11:46:02
Oh, dear. What happened? Did we lose you? All right. Well, I'm sure you were shaking your head, Mike Corcoran.

CORCORAN

11:46:10
Yeah, I think that the people that make decisions as well as funding. CMS, Medicare and insurance companies will look at these big ticket items and say, oh, that's awfully expensive and he's not going to -- he doesn't need this, he could get by with something more basic. Well, we've seen is if you provide basic feet and knees that are inadequate, you're going to basically condemn that amputee to a sedentary lifestyle and that's going to lead to more costs for healthcare, because they're going to have a lot more issues cardiovascularly, greater hospitalization. Mobility is vitally important for humans. We have two legs. We have to -- we stand, we walk.

CORCORAN

11:46:58
So a prosthesis that seem expensive that allows the amputee to be more mobile is actually healthier. It's a healthier lifestyle.

REHM

11:47:07
All right. Here's an email from Jeff in Baltimore. What about people who were born without limbs and not able to develop that portion of the brain that controls movements of those limbs? Would they be able to utilize such mechanical limbs?

MCLOUGHLIN

11:47:34
That's a great question. And it's something that we've had an opportunity to do some very limited work with congenial amputees. And we have found that we've been able to give them the ability to control the limb. It's not -- you know, it's not natural for them because they've never done it before, but they are able to do it. And so it's -- there's more of a learning curve involved in it, but we think that this would work for congenial amputees also.

REHM

11:48:09
And here's another question from Cape Cod, Mass. Hi there, Richard.

RICHARD

11:48:16
Hi. Thank you for taking my call.

REHM

11:48:18
Sure.

RICHARD

11:48:18
I wanted to ask your guests whether any of this technology might have some application in the future for those of us who are polio survivors from the epidemics of the '40s and '50s.

REHM

11:48:31
Wow.

RICHARD

11:48:32
I've been walking on crutches for now almost 60 years and leg braces. And, you know, the people like me, we have the limbs, we have the joints, we have the muscles, what we don't have is the original wire that ran from the brain to the muscle telling it to contract. And, you know, obviously we're all getting older at a rapid clip. And I just hope that we're not a forgotten generation and that maybe someday in the not too distant future some of this technology may help us do things that many of us haven't done since our early childhood.

REHM

11:49:06
Mike Corcoran.

CORCORAN

11:49:08
Well, actually the company that developed the powered ankle, iWalk, are developing, it's a motor that generates the power for that ankle. They're using applications on orthotics or orthoses, which this caller probably wears, that would replace -- a motor essentially is a muscle, so there is development taking place for powered orthoses, which would enable post-polio sufferers to be more mobile.

REHM

11:49:35
Michael McLoughlin.

MCLOUGHLIN

11:49:38
Yeah, well, we're focused on upper extremity use.

REHM

11:49:41
I see.

MCLOUGHLIN

11:49:41
And -- but for patients that, due to a spinal cord injury or other neuro degenerative condition, can't use their natural limbs, what this potentially provides is a way for them to use a prosthetic limb in order to interact with their environment and pick things up and do all the activities of daily life.

REHM

11:50:03
Johnny Matheny, is there something further that you wish to learn to do with this arm that you have not yet learned?

MATHENY

11:50:19
Well, there's a lot of possibilities of, like you say, where there's a lot of sensors that you can put on it. You can tell when you brush up against something. You can tell when something's cold or something's hot, all these different things. Sensors that, you know, that goes in the fingers, you know how much pressure you're actually putting on something, whether, you know, you're barely touching something or, you know, you got enough grip on yourself to crush a can, just like snap.

REHM

11:50:44
Could you hold a pencil and write with it?

MATHENY

11:50:48
Yes. With this type hand, you're able to be able to do that. And it has different grasps that you can do, which I have not programmed in right now.

REHM

11:51:00
Okay. So if I were to hand you this pen right now, could you grasp it?

MATHENY

11:51:08
Not at this time.

REHM

11:51:09
Okay.

MATHENY

11:51:10
What we got to do each day is we're going to figure out what we're going to be doing today. And we program into the computer we're going to make -- we will possibly make these moves today, so then as we go through that we can do that. Now, coming here to the show, you know, I wasn't ready to start grasping pens or we would've -- we would've incorporated that in. But the computer, what you do is you do the moves and the computer tells the hand or the wrist this is what I want to do.

REHM

11:51:36
And you keep adding...

MATHENY

11:51:39
Yes.

REHM

11:51:39
...I gather movements...

MATHENY

11:51:41
Correct.

REHM

11:51:42
...that you are anticipating and would like to do. And then is there a permanent memory of what you've incorporated?

MATHENY

11:51:52
At this time, no, but...

REHM

11:51:54
You have to do it all over again each...

MATHENY

11:51:56
Each morning. Each morning.

REHM

11:51:57
...each morning.

MATHENY

11:51:58
Yes. But we've got the smartest techs at APL lab. They'll soon have that problem licked.

REHM

11:52:04
So it's like you, Peggy, sort of figuring out each day.

CHENOWITH

11:52:09
It takes a lot of planning to be an amputee. It really does.

REHM

11:52:11
A lot of planning.

CHENOWITH

11:52:13
And I think what you're seeing is that we're on the verge of some great technology, but I don't think it's really there yet for everyday functional life. It's not -- I don't think the technology is there, especially, in the upper extremity, somewhat in the lower extremity. Certainly not available to every amputee.

REHM

11:52:33
But it has sure come a long way.

CHENOWITH

11:52:36
But it's -- if you're going to be an amputee, this is the best time in history to be one.

REHM

11:52:40
And you're listening to "The Diane Rehm Show." Let's go to Houston, Texas. Good morning, Tom.

TOM

11:52:50
Good morning, Diane. I'm glad I got through to you in time because I know it's short. I'm just wondering why that this has never been addressed before. Apparently a British engineer produced some kind of gadget that prevented a signal of these IEDs from going off. And the Pentagon being bloody minded as they are, they didn't want to use the gadget because it was a British invention and they didn't think of it first and -- but it would've prevented a lot of unnecessary amputees in the last...

REHM

11:53:23
I think you've got the wrong audience to address the military and IEDs, Tom. The fact of the matter is when they go off and they do take limbs, it's pretty awful. Here's an email from Brian in Detroit, Mich. wanting to ask you, Johnny Matheny, whether you've had phantom limb pain before getting the prosthetic and has the prosthetic alleviated that phantom pain?

MATHENY

11:54:04
Oh, yes. Phantom pains, I'm very well aware of it. My hand would just throb. I can tell you exactly how my hand was being at that time. Whether it be a fist like this or like that or like this...

REHM

11:54:17
After the amputation.

MATHENY

11:54:19
After the amputation. Now once we got into the prosthetics where the brain is starting to see things move, it's forgetting about the pains and going more...

REHM

11:54:33
The path to pain.

MATHENY

11:54:34
It's going more into movement. That's what it's wanting. That's what it's searching for. And when you get your arm amputated, what it is, when they cut the nerve endings, it scars over. And that's what causes the phantom pain.

REHM

11:54:47
How about you, Peggy? Did you experience phantom pain?

CHENOWITH

11:54:53
I have phantom sensations at times. When the weather is really changing, I'll have pain. If I switch sockets, I'll feel it. But I don't have a lot of issues like other amputees do.

REHM

11:55:04
All right. And finally to Orlando, Fla. Good morning, Robert.

ROBERT

11:55:11
Hi, guys. I have kind of a two-part question I suppose, but I'll keep it brief I promise. The first part is that I think it kind of goes without saying that we're in the digital age and I wanted to -- I wanted to ask you about your thoughts on whether or not the technology for robotics and autonomous machines that we're trying to make more and more like humans, is that technology perhaps interchangeable with that of prosthetic's technology?

REHM

11:55:42
Mike Corcoran.

CORCORAN

11:55:44
Yeah, I think that actually the motor that drives the powered knee is the same motor that came off the Mars rover that propels that device in Mars. So there's -- yes, there is collaboration between robotics and prosthetics. I think there's...

REHM

11:56:05
Michael.

MCLOUGHLIN

11:56:06
Yeah, absolutely. So some of the technology that we've developed here, we're using on robotic systems for dealing with IEDs. So that ultimately we'd like to send the robot out to deal with an IED, so the robot gets injured as opposed to a human.

REHM

11:56:22
And finally a lot of people are wondering about cost, whether insurance covers any of this. Mike Corcoran.

CORCORAN

11:56:32
Insurance covers most lower extremity advanced prosthetics. Once Medicare recognizes that it is a viable device, they issue it with a code. And then private payers tend to adopt that same policy.

REHM

11:56:48
Oh, I see. And what about the development of something as sophisticated as this, Michael?

MCLOUGHLIN

11:56:56
So the cost reimbursement is a significant issue and hindrance to upper extremity prosthetics. And so we're looking at options for dealing with some private entities, nonprofit foundations that would essentially fill in that gap, so that somebody needs a prosthetic can get it.

REHM

11:57:15
Well, I congratulate you all on your efforts, your endeavors. And I know that this work is going to help thousands, millions of people. Thank you for being here.

MCLOUGHLIN

11:57:33
Thank you.

CORCORAN

11:57:33
Thank you.

MATHENY

11:57:34
Thank you.

CHENOWITH

11:57:34
Thank you.

REHM

11:57:35
Michael McLoughlin, Johnny Matheny, Peggy Chenowith and Mike Corcoran. And thanks to all of you for listening. I'm Diane Rehm.
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