America’s Collision Course With The Debt Ceiling
As the nation counts down to default, Diane talks to longtime Congress watcher Norm Ornstein about the debt limit negotiations, what's at stake and whether he sees a way forward.
An estimated 2 million Americans have had an arm or leg amputated from injury or illness. Many chose to wear prosthetic limbs. Ten years ago, most artificial arms and legs were clunky and fragile. But prosthetic technology has advanced significantly since then. A vast body of research gained from treating American soldiers wounded in Iraq and Afghanistan has led to robotic knees and ankles that adjust to terrain and activity. Leg amputees now run marathons, climb mountains and even skydive. And a new bionic arm powered by the thoughts of the person wearing it can mimic almost all the movements of a real hand.
The Modular Prosthetic Limb (MPL), developed by the Johns Hopkins University Applied Physics Laboratory with funding from the Defense Advanced Research Projects Agency provides 26 degrees of motion, including independent movement of each finger, in a package that weighs about nine pounds and has the dexterity of a natural limb. In 2012, a patient at the University of Pittsburgh Medical Center successfully demonstrated that the arm could be controlled by the user’s thoughts. Several patients, including a decorated Afghanistan war hero, are helping researchers further develop the prosthesis. In 2013, the MPL will continue to be tested and refined in a clinical trial at the California Institute of Technology.
© JHU/APL with funding from DARPA’s Revolutionizing Prosthetics program
On Jan. 24, Air Force Tech Sgt. Joe Delauriers became the first patient at Walter Reed National Military Medical Center to begin using the Modular Prosthetic Limb. With nearly as much dexterity as a natural limb, 22 degrees of motion, and independent movement of fingers, the MPL was developed as part of a four-year program by Johns Hopkins University.
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At Johns Hopkins, Michael McLoughlin demonstrates a robotic arm capable of restoring an amputee’s sense of touch.
The Bimanual Dexterous Robotic Platform (also known as Robo Sally) developed by The Johns Hopkins University Applied Physics Laboratory (APL) in Laurel, Md., is a robotic system designed to replicate human capabilities to safely remove the human performer from life threatening operations.
MS. DIANE REHMThanks 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 REHMOver 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 REHMDo join us, 800-433-8850. Send us your email to email@example.com. 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 MCLOUGHLINGood morning.
MR. JOHNNY MATHENYGood morning.
MR. MIKE CORCORANGood morning.
MS. PEGGY CHENOWITHGood morning.
REHMGood 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.
MCLOUGHLINThat'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?
MCLOUGHLINSo 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.
REHMHow does that differ from the kind of deep brain stimulation activity that doctors are implanting for say Parkinson's patients?
MCLOUGHLINOkay, so there are a couple of differences. One is we're working in a different area of the brain...
MCLOUGHLIN...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.
REHMWhat do you mean listening to what the brain is doing?
MCLOUGHLINSure, 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.
REHMSo how long did it take to develop this robotic arm?
MCLOUGHLINWell, we've been working on this for seven years now.
REHMAnd I gather it has some 100 sensors?
MCLOUGHLINYes, 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.
REHMI 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.
MATHENYWell, 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.
MATHENYAnd 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.
MATHENYAnd 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.
REHMYour stomach, your intestines?
MATHENYYes, once I got it in there, they said you would be -- you'd have probably six months.
REHMSo they said if we take your arm at which joint?
MATHENYWell, 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.
REHMJust 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?
MATHENYWith this arm, you're able to do just about anything you can do with your regular hands, wrists or elbow.
REHMCan you move your fingers?
REHMAnd you can move those fingers by?
MATHENYJust thinking about it.
REHMThinking about it.
MATHENYThe 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.
MATHENYThey 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.
MATHENYWell, 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.
REHMAnd how long did it take you to adjust to that?
MATHENYAh, 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.
MATHENYIn 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.
MATHENYThen 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.
REHMNow, are the muscles in your upper arm working?
MATHENYAh, 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.
REHMSo how do you feel about all this?
MATHENYOh, 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.
REHMWell, it's certainly looks as though it moves well. Could you drive with it?
MATHENYYes, eventually as you get more fluid with it you can actually drive with it.
REHMCan you cook with it?
MATHENYOh 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.
REHMPut 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.
REHMAnd have you tried catching a ball?
MATHENYNo, 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.
MATHENYWhenever 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.
REHMAnd 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.
REHMWe'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.
REHMAnd 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.
REHMAnd 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.
REHMAnd, Mike Corcoran, tell us about what you do and how artificial legs and feet had changed in the last few years?
CORCORANWell, 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.
REHMNow, 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?
CORCORANWell, 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.
CORCORANCurrently, 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...
REHMSo how do they work?
CORCORANThere's like accelerometers, gyroscopes and load sensors.
REHMYeah. But you got to explain to me what those..
CORCORANOkay. So basically an accelerometer is something that measures the velocity of the legs moving forward. The gyroscope measures the angle of the joint itself.
CORCORANAnd the load sensor is how much weight has been put on the joint.
CORCORANAnd 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.
REHMSo 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?
CORCORANCorrect, 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.
REHMSo, the user, him or herself, could calibrate the device or must it be calibrated by a professional?
CORCORANYeah, 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.
REHMMike 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.
CHENOWITHI 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.
REHMSo you had lots of pain in this foot after the computer fell on you?
CHENOWITHCorrect. 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.
REHMSo where exactly was the foot amputated?
CHENOWITHI am below knee. So I have about five or six inches below my knee.
REHMAnd then what?
CHENOWITHSo 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.
CHENOWITHI'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.
REHMMay I see?
CHENOWITHI'm not wearing it today.
CHENOWITHI'm not. I'm not. I'm wearing a different foot today.
REHMWhat are you wearing? A different foot today.
CHENOWITHI 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.
REHMOh, I see.
CHENOWITHSo 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.
REHMI see. And what does this foot allow you to do?
CHENOWITHThe one that I'm wearing now?
CHENOWITHThe 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.
CHENOWITHWhen I'm wearing the computerized foot, I can just kind of put it on and walk.
REHMAnd tell me why you decided to establish the blog, amputeemommy.com.
CHENOWITHWhen 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.
CHENOWITHSo, 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.
REHMAnd, of course, so many veterans coming home and needing these kinds of amputations, Mike.
CORCORANYes. Well, actually there's 1,800 amputees since the start of -- since 9/11.
CHENOWITHAnd there are 500 every day in this country.
CHENOWITHEvery day in this country there are 500 amputations in this country alone.
REHMAnd that has nothing to do with war, Iraq, Afghanistan.
CHENOWITHNothing to do.
CORCORANI 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.
REHMI detect that lovely Irish...
CORCORANYeah, I'm from Dublin.
REHMI thought so. I thought so. And how long have you been here?
CORCORANI've been here 20 years.
REHMAnd why did you initially get into this work?
CORCORANOkay. 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.
REHMI see. All of this cost a lot of money. Michael, how much?
MCLOUGHLINWell, 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$100 million. And Johnny Matheny, what do you think this arm of yours would cost?
MATHENYWell, right now I'm not sure. But one thing I am sure of, it cost me an arm.
REHMIt cost you an arm.
MATHENYAnd 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.
REHMAnd you're listening to "The Diane Rehm Show." But cost in dollars for this prosthetic arm, Michael?
MCLOUGHLINWell, this is still in the research stage.
MCLOUGHLINAnd 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.
REHMAnd how did they occur for the most part?
MCLOUGHLINFor most of lower extremity amputations, it's frequently due to cardiovascular issues, diabetes or other circulatory...
MCLOUGHLIN...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.
REHMBut surely an arm like this would cost what, at least?
MCLOUGHLINWe don't really know. But it's certainly going to be more expensive than what's currently available.
MCLOUGHLINWe expect to get it less than that.
REHMYou want to?
MCLOUGHLINYeah, 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.
REHMGood. All right. We're going to open the phones, take our first call from Dallas, TX. Good morning, Mike, you're on the air.
MIKEGood 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.
MATHENYWell, 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.
REHMTwo hundred pounds?
REHMAnd you could, of course, with your other arm lift that much if you needed to.
MATHENYYeah. 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.
REHMI would surely hope that someone with a prosthesis of this sort would not be going back into battle.
MATHENYWell, you know, we have soldiers that have gone back to the field with lower extremity prosthetics.
MATHENYSo, 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.
CORCORANYeah, 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.
REHMPeggy Chenowith, are you limited in any way by your prosthetic foot?
CHENOWITHI 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.
REHMAnd you did plan ahead.
CHENOWITHI did plan ahead today.
CHENOWITHBut, 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.
REHMA bag full of legs.
CHENOWITHI 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.
REHMI 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.
REHMAnd we've got lots of callers waiting. We'll go first to Layton, Utah. Good morning, George.
GEORGEGood morning, Diane, and thank you for taking my call.
GEORGEI lost my hand in 1964.
REHMOh, I'm sorry.
GEORGEWell, 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.
REHMWhat do you think, Michael?
MCLOUGHLINYeah, 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.
REHMInteresting. Interesting. Why not? What would happen?
MCLOUGHLINWell, it's just -- yeah, it's just not sealed up...
MCLOUGHLIN...as well as it would -- it would need to be.
MCLOUGHLINBut we can put a covering over the arm.
REHMWhat kind of timeframe do you believe will transpire before this is available to the general public?
MCLOUGHLINYeah, 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.
REHMI 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?
CORCORANRight. Well, the hook has less moving parts.
CORCORANSo 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.
CORCORANSee 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.
REHMWell, are you saying that as far as strength is concerned that George is better off with a hook as opposed to a prosthetic hand?
CORCORANNo. 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...
CORCORAN...then we'll be -- we won't see any advancements.
REHMGeorge, you've got to do your part.
GEORGEMay I make a suggestion then?
GEORGEThere'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.
REHMAll right. Have you heard anything about that, Michael?
MCLOUGHLINNo. Actually I'm not familiar with that particular set of work.
REHMYeah. 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.
TOMWell, good morning and thank you for taking my call.
TOMThe 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...
REHMOh, dear. What happened? Did we lose you? All right. Well, I'm sure you were shaking your head, Mike Corcoran.
CORCORANYeah, 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.
CORCORANSo a prosthesis that seem expensive that allows the amputee to be more mobile is actually healthier. It's a healthier lifestyle.
REHMAll 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?
MCLOUGHLINThat'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.
REHMAnd here's another question from Cape Cod, Mass. Hi there, Richard.
RICHARDHi. Thank you for taking my call.
RICHARDI 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.
RICHARDI'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.
CORCORANWell, 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.
MCLOUGHLINYeah, well, we're focused on upper extremity use.
MCLOUGHLINAnd -- 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.
REHMJohnny Matheny, is there something further that you wish to learn to do with this arm that you have not yet learned?
MATHENYWell, 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.
REHMCould you hold a pencil and write with it?
MATHENYYes. 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.
REHMOkay. So if I were to hand you this pen right now, could you grasp it?
MATHENYNot at this time.
MATHENYWhat 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.
REHMAnd you keep adding...
REHM...I gather movements...
REHM...that you are anticipating and would like to do. And then is there a permanent memory of what you've incorporated?
MATHENYAt this time, no, but...
REHMYou have to do it all over again each...
MATHENYEach morning. Each morning.
MATHENYYes. But we've got the smartest techs at APL lab. They'll soon have that problem licked.
REHMSo it's like you, Peggy, sort of figuring out each day.
CHENOWITHIt takes a lot of planning to be an amputee. It really does.
REHMA lot of planning.
CHENOWITHAnd 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.
REHMBut it has sure come a long way.
CHENOWITHBut it's -- if you're going to be an amputee, this is the best time in history to be one.
REHMAnd you're listening to "The Diane Rehm Show." Let's go to Houston, Texas. Good morning, Tom.
TOMGood 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...
REHMI 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?
MATHENYOh, 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...
REHMAfter the amputation.
MATHENYAfter 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...
REHMThe path to pain.
MATHENYIt'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.
REHMHow about you, Peggy? Did you experience phantom pain?
CHENOWITHI 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.
REHMAll right. And finally to Orlando, Fla. Good morning, Robert.
ROBERTHi, 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?
CORCORANYeah, 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...
MCLOUGHLINYeah, 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.
REHMAnd finally a lot of people are wondering about cost, whether insurance covers any of this. Mike Corcoran.
CORCORANInsurance 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.
REHMOh, I see. And what about the development of something as sophisticated as this, Michael?
MCLOUGHLINSo 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.
REHMWell, 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.
REHMMichael McLoughlin, Johnny Matheny, Peggy Chenowith and Mike Corcoran. And thanks to all of you for listening. I'm Diane Rehm.
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