&#8216;Thought-Control&#8217; Prostheses &#8211; Soon a Reality

In the movie The Empire Strikes Back, hero and Jedi knight Luke Skywalker found himself locked in mortal combat with Darth Vader. Beaten and wounded, Luke was pressed back by the Dark Lord. Suddenly, Vader's light saber sliced upwards, severing the young Jedi's right hand - sending it and Skywalker's light saber spinning into the abyss below. Luke survived and was fitted with a prosthetic hand. Detailing the drama, a website continues with a description of Luke's prosthesis: "Luke's prosthetic hand took advantage of the latest biomechanical technology to create a life-like appendage that worked just as well as the original. The frame of the hand was made up of artificial bones crossed with wires and connectors. The prosthetic replacement joined to Luke's living tissue via a complex synthenet neural interface, allowing the young Jedi to feel through his mechanical hand. Finally, a layer of synth-flesh covered the mechanisms within, making the hand appear completely organic on the outside. The medical droid 2-1B fitted Luke's artificial hand, and tested its effectiveness once in place. When pricked with a small needle, each of Luke's mechanical fingers responded, and Luke registered the pain. He found he could clench his fist, waggle his fingers...just as well as he had always done. Though Luke initially felt a throbbing sensation when he thought of the circumstances which had necessitated his replacement hand, 2-1B assured him it was only a phantom limb pain, and would soon ease." For soldiers injured in nitty-gritty warfare here on planet earth, a similar prosthetic hand may become a reality in as soon as two years. This is the time frame planned for clinical trials to begin on a brain-machine interface prosthetic hand, according to 1 st Lieutenant Joe Miller, CP, MEd, Medical Service Corps, US Army Reserve. Miller is a clinical/research prosthetist at the Armed Forces Amputee Patient Care Program at Walter Reed Army Medical Center, Washington, DC. A formidable array of brainpower from several disciplines, including neurosurgeons, neurologists, theoretical physicists, biocomputer scientists, mechanical engineers, informatics specialists, and others, have been brought to bear on the project. A high-level meeting brought together personnel from the Amputee Care Program, the Department of Defense (DoD) Advanced Research Project Administration (DARPA), and the Telemedicine and Advanced Tactical Research Center (TATRC) to structure a plan for developing high-level brain-machine interfacing for the advancement of prosthetics, commonly known as "thought-control" prosthetics, Miller explains. "We are working with researchers who are engaged in brain-machine interfacing on animals and a few things with humans." Groundwork has already been laid with monkeys, who through tiny probes inserted in their brains, have been able to move robotic arms by thought. Designing such advanced prosthetic technology requires a complexity of effort. A separate group is researching materials, such as special alloys being developed for the space industry, and another group is working on prosthetic design, Miller says. Different techniques of interfacing a thought-control prosthesis are being studied. The challenge: the brain has to interface with something and so does the prosthesis. At the moment, Miller can't discuss specifics, but notes, "We're waiting for funding on sealing projects." Possibilities lie with "bioskins" that can actually have sensory receptors in them, Miller says. "We are looking at coating the prosthesis with receptor material that will provide feeling and perception." Miller continues, "The question now is whether we can tap into the cortical part of the brain or the peripheral nerves. There is no prosthetic device on the market that can do what we want to do. There are some experimental prosthetic hands with multi-dexterous fingers, but there is no way to control each of those fingers right now - there is no brain or peripheral nerve interfacing. "We now have to design a device that can do that function," Miller sums up. Simultaneous Research Simultaneous research is currently involving a group working on actual devices, a group working on the brain-machine interface, and another team working on integration of the system to the body. Initial funding is currently about $25-30 million, with the Walter Reed side of the project being headed by Col. Geoffery Ling, MD. "If we can use the brain, we eliminate a lot of the electronics, and if we use synthetic muscles as actuators, we eliminate a lot of the gears and motors, and it becomes a very lightweight prosthesis," Miller adds. A power source is vital, and the researchers are going beyond batteries and studying alternate types of fuel sources. The materials side of the project is looking at stabilized fuel cells which are the size of a lighter or a CO 2 cartridge. The fuel being considered is a combination that includes liquid hydrogen. Research Categories The Military Amputee Research Program at WRAMC basically has four different classifications, Miller explains: (1) database management and development; (2) clinical management; (3) rehabilitation strategies; and (4) neurological studies. "When we call for requests for proposals, we ask for which of these areas the researcher is requesting funding." Since there also are prosthetic researchers in the Walter Reed O&P facility, this group submits proposals of its own as well, Miller said. Funding can be either intramural - from the DoD through the Military Amputee Research Program - or extramural, with funding from outside sources. An example of extramural funding for a project with a primary investigator outside the DoD would be developing a technologically advanced component. Impact statements of patient involvement must be submitted to prevent confounding effects on the outcomes. The research at Walter Reed involves outcomes measurements, specific prosthetic components, crossover designs and interrelated reliability studies, measurements as to how patients are evaluated, and physical therapy rehabilitation strategies, among other areas. Miller adds, "We have a couple of studies working through the Human Use Committee looking at how technologies affect the function of the patient, more than looking at the specific socket or foot." "Hardening" of prosthetic technologies is also part of the task: locating and fixing problems such as a microprocessor emitting signals that can be detected by the enemy; coping with the effects of hard use, heat, and dirt on componentry, and other tasks to make prosthetic componentry battle-ready. Exciting Breakthrough But it's the technological breakthrough of a thought-controlled arm and hand that excites the imagination as to what possibilities would then open up for upperlimb amputees. Both transhumeral and transradial prostheses with a terminal device are being considered - and even a shoulder disarticulation prosthesis may be possible, Miller says. With brain-machine interface, he notes, "You move like you normally do. You move your arm because you want to - you don't think, 'Okay, now open hand to grasp cup, close hand on cup.' You just do it." He continues, "We're looking at different types of robotic systems; we're looking at actuators that may or may not be biosynthetic muscles; we're looking at materials milestones such as carbon nanotubes [which can be 1/1,000 of the thickness of a human hair]." More powerful computers, more in-depth research on the brain and nervous system, better power sources - all of these are contributing to the complete package. Farther down the road, although not yet in the works, is the possibility of pseudo limb regeneration, with a prosthesis placed inside the body and muscle and skin tissue re-grown around it, Miller says. "I'm on the team from the clinical end - what we need to do on a day-to-day basis to work with our patients," Miller continues. "I'm involved with component size, shape, function, repairs - what we need to do to bring it out of the science lab and make it applicable clinically." Part of the program's mission is to develop new technology for everyone, not just soldiers, he adds. This current research could even in time help other disabled persons as well as amputees. "Once you've mapped the brain and know how it interfaces with the body, there could be other developments in that direction," he says, but adds with a smile, "At this point, though, that's looking at a bigger picture than we are."

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