From Recovery to Performance. Arun Jayaraman on the Power of Bionics.

00:00:00: From rehabilitation, the word became ability lab.

00:00:03: There's almost a mild negative connotation with it.

00:00:05: We're not rehabbing anyone we are just enhancing your human abilities.

00:00:08: I think that is great distinction to make as well because my incident happened.

00:00:12: It was such life changing moment You go into work and you've got four limbs And then you wake up in hospital have them anymore, you only have two leftovers.

00:00:22: This whole idea of rehabilitation.

00:00:23: I thought that was really scary!

00:00:25: I spent about six weeks in the rehabilitation centre for amputees and literally get taught how to walk again And interestingly because i lost my right arm & leg The focus on the leg more now.

00:00:38: understand why it's your mobility starts with your ability

00:00:42: to walk.

00:00:43: That is your independence outside a wheelchair scenario.

00:00:54: Hi, I'm Sarah Delagarde.

00:00:56: I am eighty percent human and twenty percent bionic.

00:00:59: Welcome to Taste of Bionics!

00:01:02: The podcast that focuses on tech innovation the future of health care AND human potential.

00:01:07: Today's guest is Dr Aaron J Raman one of world leading experts in rehabilitation technology wearable sensors Human performance & mobility science.

00:01:20: He's a scientific chair of technology and innovation at the Shirley Ryan Ability Lab.

00:01:26: And Aaron's work is helping transform how we understand movement, recovery and human potential.

00:01:33: So he joined the Shirley-Ryan ability lab in two thousand eight after completing his PhD At The University Of Florida and he played key role In establishing the Max Nader Center for Rehabilitation Technologies and Outcome Research.

00:01:48: So from AI and wearable technology to prosthetics, robotics and digital health he is at the forefront of innovations that are changing both healthcare and everyday life.

00:02:00: In today's conversations we'll explore the future of human machine collaboration how technology is reshaping rehabilitation and what happens when we start thinking not just about recovery but about unlocking.

00:02:16: Welcome to Taste of Bionics.

00:02:17: Thanks Sarah, thanks for having me here and thank you for that really kind introduction.

00:02:22: You're so welcome!

00:02:23: So your dialing in from Chicago?

00:02:26: Am I right?

00:02:27: Yes i'm dialing-in from Chicago.

00:02:29: Nice one nice one...I was in chicago last year actually first time ever visited the city..i thought it was really nice basically new york but less aggressive.

00:02:38: is that a fair description?

00:02:40: yeah its great city.

00:02:42: infact It's got that kind of a Midwestern vibe to it, but it still gives you the same modern fast-moving effect in New York City or any other big cities.

00:02:55: You can also go pretty slow and take your time.

00:03:00: so yeah I love this city.

00:03:02: I heard that the winters are pretty brutal.

00:03:06: I think...you get used.

00:03:09: It's brutal everywhere with all the changes.

00:03:12: So Chicago winters are not that bad.

00:03:15: In fact, if you dress yourself warm enough You don't feel it at all

00:03:20: well.

00:03:21: I heard from my colleagues that they in the winter day They have Long coats.

00:03:26: they walk around a city as if they were wearing their sleeping bags.

00:03:30: That's how they described to me.

00:03:31: Yeah

00:03:33: But you can get used to it right because when I travel somewhere else and its winter another City where It's not that cold.

00:03:40: You suddenly feel cold because you can probably dress down a little and then in fact, wearing the same clothes you wear on Chicago.

00:03:48: So... The reason why I'm so obsessed with weather will become apparent more-and-more this conversation.

00:03:53: but i have to spend some time talking from London.

00:03:58: being ultra hot!

00:04:00: We've had driest hottest summer for ever or whenever records began.

00:04:08: One of my drawbacks, being a prosthetic wearer is that you do run a lot hotter.

00:04:14: And so for me... My peak temperature is about twenty-two degrees Celsius.

00:04:18: anything above that becomes slightly uncomfortable.

00:04:21: So it's also the reality of having lost I'm thinking twenty percent off body but size of heart hasn't changed you know, that same amount of blood cursing through my body and just it raises the core temperature quite a bit.

00:04:39: But that's my assumption.

00:04:41: is that reality scientifically?

00:04:44: I mean...I wouldn't say the exact numbers are what i know off but It Is True.

00:04:50: When You Are Wearing A Bionic Limb It Takes A Bit Of Time For Your Body To Get Used to It And Any Kind Of Material Change In simple terms material science engineering change in your body.

00:05:06: Your body is not meant to handle that in a very comfortable manner.

00:05:09: it It still might considerate, not part of you body.

00:05:13: and so yes heat and humidity and Temperature fluctuations can make it uncomfortable.

00:05:21: But that's the fun part of science.

00:05:23: We're constantly working to make these small changes So that the human mission interaction is seamless.

00:05:32: I don't think any time we would get to a situation where the human could think that the bionic limb is perfect, right?

00:05:39: Because you kind of adapt.

00:05:42: The goalposts keep moving from.

00:05:45: if you looked at the original videos...I don't know have ever seen it?

00:05:48: there's YouTube videos with guy dancing on a peg leg and just single wooden stick but he dances so well.

00:06:00: The background of that is to say, oh if you want to do it.

00:06:03: You can do it but then you got the simple single axis mechanical knees Then you've got the polycentric knees and then you have a whole world of microprocessor control knees.

00:06:15: And then there are powered limbs which I'm talking about the upper limb as an example But then they're powered knee ankle systems.

00:06:24: Initially, there were big sockets and liners and socks which have to be put in.

00:06:29: Now you have osteointegration where the prosthesis is drilled straight into the bone.

00:06:35: You had what is known as just direct control.

00:06:38: then this pattern recognition came through And now you have implanted technology to move your limbs.

00:06:44: So but if you test science and you read those papers at each of these time points There's a whole large limitation sections it says Yes, there is this these issues and that's why it's fun to be in the science because you're like You said.

00:06:59: now we have to solve this problem.

00:07:01: So The next question Is there?

00:07:02: There's gonna Be a scientific study which looks at humidity limb volume changes And heat and temperature changes how It causes discomfort In a prosthetic user.

00:07:14: so those are critical questions.

00:07:15: what do you brought up?

00:07:17: But the science has to move along with.

00:07:19: yeah That's the thing that I enjoy.

00:07:22: on the medical aspect and then the technology aspects is that there are so many small problems, bigger problem to that surface because of environment we find ourselves in.

00:07:33: but it's encouraging.

00:07:36: But if a problem or something we haven't solved yet encourages us.

00:07:49: we dive straight into the conversation.

00:07:52: But I actually wanted to hear a little bit more about your work, like your career?

00:07:58: How it led you there... Many people in your field will know about your working but fewer will know your story and itself.

00:08:07: so how does someone become one of the world's leading voices in rehabilitation technology innovation?

00:08:13: what triggered this passion of yours?

00:08:16: yeah i've always been thinking And I wanted to come up with a really nice story, which can make it sound really cool.

00:08:23: But unfortunately there's not such a fun story to back-up.

00:08:27: why is this person?

00:08:29: Really good at what...I was just recently talking at an event and said you know i was pretty average student in high school and then took a gigantic leap into becoming below average students college.

00:08:42: You're gonna sure you want to find something to do in life.

00:08:49: Are you going to work on something?

00:08:51: But that's the fun part of life.

00:08:55: Yeah, I don't think i was mature enough To understand what is needed in life and what to do at a certain stage Of my life.

00:09:02: And then great places Bring good things out of people.

00:09:08: I wouldn't say great thing sort of people At least from my sense but In a lot of times bring best out-of-people.

00:09:15: When I did my PhD, um...I learned from a advisor.

00:09:18: Her name was Christa Vandenborn and she's from Belgium.

00:09:21: She had this relentless work ethic This motor which is never going to stop And it just amazing for somebody like me who.. I was very relaxed personality Uh....I would do enough get along in life & work & nothing beyond that To see someone with high motor.

00:09:40: And i asked her once Why do you work so hard?

00:09:45: What is the purpose of doing

00:09:46: this?".

00:09:47: She said, oh I'd do it because they like not there's a purpose behind.

00:09:51: It was really love what i did and took that conversation to understand.

00:09:57: There are lot people in world who loved their job And they worked very hard at it.

00:10:03: So when my postdoc afterwards in Rehabilitation Institute of Chicago which is now Shirley Ryan Ability Lab which is worse and it's still the number one ranked rehabilitation hospital in the country, In United States.

00:10:18: And probably... One of top-ranked hospitals in the world You're now pulled into an environment where all engineers, clinicians just are super excited about their work.

00:10:31: Not that any other place does not but you step up to a league Where everybody comes in.

00:10:43: There's a saying in the US you drink the Kool-Aid I Fell in the tub of the kool aid, which means you slowly become obsessed with her place.

00:10:52: Yeah You were like and My wife and i used to work at same place then And she would say when we get off the train line and walk She was like why are you running?

00:11:00: We're going into the Same Place.

00:11:01: Why can't he just walk?

00:11:03: it was Like.

00:11:03: I don't know I'm obsessed I need To Get Into Work

00:11:06: But I guess it's because you feel that your work has purpose.

00:11:10: You know, whatever you work on actually is going to change people's lives and i think thats what creates the motivation in this drive.

00:11:18: Absolutely!

00:11:18: Impacting human life... And then Adubba came along.

00:11:24: they created the Maxinator Lab To be frank.. That was not my first choice Because as you probably noticed, my line of work was quite different.

00:11:35: I was working with people who had spinal cord injury and stroke... ...I was working on a little bit of robotics and neurophysiology and muscle physiology.. ..and this was prosthetics in orthotics.

00:11:46: so i wasn't the first choice!

00:11:48: I'm sure Todd Geikin trying to hire this position for leadership at Ottobock was not ultra-convinced.

00:11:57: So I think it's an attempt that I brought up.

00:12:01: they gave me a year to kind of kick in and then I think uh, They saw the fire in me.

00:12:10: In terms of the excitement and the passion And it worked out just fine.

00:12:14: So It's interesting that there are people along your way in life who give you an opportunity?

00:12:23: have that lateral vision to take up the opportunity.

00:12:25: Because when I first started this job, it was like am i making a mistake?

00:12:28: Is this is not my line of work or why they're doing?

00:12:31: these are big reputed company who's trusting their position on me with an international collaboration in the top rehab hospital and am going to suck at them because many times but then you kind-of trust your work ethic for what you do.

00:12:50: I feel like it clicks.

00:12:52: So, I'm extremely thankful for Audubonk for doing that.

00:12:56: and Rehabilitation Institute of Chicago eventually became Shirley Ryan Ability Lab And its a brutal combination with an industry partner who is not trying to just make financial gain but also have clinical impact.

00:13:09: In fact i've toured their facility in seeing devices which has taken decades of development.

00:13:14: They never pushed into commercialization.

00:13:17: Why are you not pushing into commercialization?

00:13:20: But they're always like.

00:13:23: We want to be sure it works and is really good.

00:13:26: And the same goes for our hospital.

00:13:27: were very, very careful About what we do where non-for-profit Hospital we have a mission and vision To impact human ability which is why from rehabilitation The word became Ability lab.

00:13:43: because we're not rehabilitation It's there's almost a mild negative connotation with it We're not rehabbing anyone, we are just enhancing your human ability.

00:13:53: So that's why we rebranded ourselves.

00:13:56: I think thats a great distinction to make as well because my own experience by incident happened four years ago since September of twenty-twenty two and it was such life changing moment where you go into work and got four limbs then wake up in hospital have them anymore, you only have two leftovers.

00:14:21: And this whole idea of rehabilitation I thought that was really scary and it sounded like i needed some support to do something taught how to walk again.

00:14:50: And interestingly, because I lost my right arm and my right leg the focus was on the leg more at that point than on the arm...and i couldn't understand exactly why in the moment.

00:15:04: but now i understand why.

00:15:05: it's because your mobility starts with your ability to walk!

00:15:10: That is you know your independence outside of a wheelchair scenario is what the clinicians focus on.

00:15:20: But I've seen that, so you mentioned your work has started predominantly on spinal cord injury research but do whole focuses on restoring ability to walk?

00:15:34: Is it how would describe

00:15:36: this?

00:15:38: My current responsibility is scales beyond spinal cord injury.

00:15:42: I work with newborn babies, with motor delays to stroke, spinal cord injuries, multiple sclerosis, Parkinson's disease, amputees musculoskeletal injuries... I oversee technology and innovation translation for the whole hospital And as part of that i got a golden opportunity.

00:16:04: How do we give everybody who's had a traumatic event or disease, which has put them in the situation of disability to take that next step?

00:16:14: Try and get them what is considered pre-morbid levels for quality life.

00:16:18: Which before this happened.

00:16:20: it was tough but fun as you're trying solve big problem.

00:16:28: so then your knowledge on just not on prosthetics and orthotics but robotics.

00:16:37: Neuromodulation, neurostimulation neural prosthetics brain-computer interface how do you diagnose?

00:16:46: It's called precision medicine which means each of each person needs a certain different thing to give them the best outcome.

00:16:53: global medicine or population level medicine is if you take Tylenol or Advil your headache will get better.

00:17:02: But you have not noticed where somebody says yeah, but I still had that lingering a little bit of headache.

00:17:07: It's gone down to like sixty percent and then some people say oh i'm gonna use A vapor rub or Somebody is going to be like if I drink coffee Or somebody some.

00:17:17: so That's the precision part.

00:17:18: were.

00:17:19: You get somebody about sixty percent And then the rest of The Forty is where everybody has a custom package, or they're adding a few extra things to get that hundred percent of their egg gone.

00:17:30: It's very similar right?

00:17:31: There are enough tools in the toolbox Where you can get everyone to recover at sixty-seventy percent But thats not enough To give them to one hundred percent and that thirty percent Or forty percent is determined on value low Unfortunately, what the social economic status?

00:17:50: What is the state of science in your

00:17:51: country?".

00:17:53: So that diagnostic tool.

00:17:54: The wearable sensors allow you to give their precision diagnostic instead of a genetic diagnostics.

00:17:59: or not only am I focused on interventions and also focussed on early detection monitoring somebody and preventing from it happening or letting someone regress.

00:18:12: so its combination these two.

00:18:14: So I want to talk about wearable senses in a minute as well, but there's something that I wanted share the story with you because...I met a lady who was paralyzed and lost her usage of legs.

00:18:30: And we met Germany at an event!

00:18:34: She was walking next me on a perfect gate.

00:18:39: I know that my gait can be sometimes a bit wobbly, but her gait was so perfect.

00:18:44: And i thought wait hold on... But you are paralyzed!

00:18:48: You lost the usage of your legs?

00:18:50: So how is this

00:18:50: working?".

00:18:51: and she was wearing what i believe it's called The Sea Brace Leg Orphosis.

00:18:57: And ive absolutely blown away because.. Of course they had to ask me questions like if u take off You can't walk at all.

00:19:07: And she's like, no if I take it off then i sit in a wheelchair and i felt that was so absolutely amazing.

00:19:13: you worked on this as well yeah?

00:19:16: Yeah the sea brace is one of a kind microprocessor controlled knee ankle foot orthosis.

00:19:22: It basically gives people with spinal cord injury The ability to walk in more biomechanically normal way which means you walk Like what you would have walked before your process.

00:19:33: historically, he would get these long leg braces.

00:19:36: They will call them lawful embrace and they were just locked in it.

00:19:41: What did gave us the ability to stand?

00:19:44: And if you had a walk You basically had to waltz yourself or pivot.

00:19:48: It's...you can do for sure distances but its not mechanically efficient, and you're fatigued a lot.

00:19:53: You hurt your back or arms are hurting so you reject it.

00:19:57: And the wheelchair still one of the world's best mobility devices right?

00:20:01: It gets you from point A to Point B was the easiest one to use But with the onset of these sea braze.

00:20:08: I've seen So many times people who have chosen a Wheelchair.

00:20:13: not that is a bad thing.

00:20:14: i don't want people in wheelchairs To think its'a Bad Thing.

00:20:17: It is still a great thing, but it puts you in a certain human physiological and mechanical disadvantage.

00:20:22: If we're sitting on wheelchair long there are negative issues with your human physiology because the body's not meant to be sitting for that long like if you were sitting in chair-long all day or neck hurts.

00:20:36: That's just simple person without any impairments.

00:20:38: imagine You're paralyzed and don't feel pressure so the sea breeze gets walking There.

00:20:44: two things it gives And that's one thing we're studying right now, is if you give it very early after a spinal cord injury.

00:20:51: You can also aid your recovery which means most of the times by that... By the time you start to walk in hospital purely because there are not appropriate aids..you don't get to work much So longer better than and do'nt walk ,the lesser chance you gonna ever walk Because nervous system starts shut down into product mechanism.

00:21:11: once have a spinal Cord injury The easiest thing is to then give you a wheelchair, but the tool like a sea brace lets you walk more efficiently really early on which triggers natural recovery.

00:21:22: And I've seen patients who don't need this.

00:21:24: over time they veined off and gotten into an ankle photorethosis or even gone off that.

00:21:29: so That's that there are injuries Which are pretty severe?

00:21:33: Like the person in lady You saw i know Who were talking about.

00:21:37: Is she the one with bilateral sea braces and a little shorter?

00:21:40: Yeah She's brilliant.

00:21:42: yeah The trick with that is it's a functional tool.

00:21:48: You want to get point A-point B, you wanna walk around in your garden and go to work so he gets there in the way where there are physical effects, physiological effect or psychological effect.

00:22:02: It has huge boosts of your system – your brain, psyche, sense of wellness.

00:22:08: Yeah!

00:22:08: That was an element we shouldn't underestimate….

00:22:12: I remember in those early days and rehabilitation that there was a lot of emphasis on the physiological aspect, like learn how to walk again.

00:22:24: But the psychological aspect i felt is just as important...I'm going show you something here!

00:22:30: To illustrate this.

00:22:31: can you see?

00:22:32: This is a photograph.

00:22:35: all of my friends and family, colleagues that have supported me in those early days at the rehabilitation centre.

00:22:44: And I would really say it has helped.

00:22:49: in this, we talked about purpose at the start as being a great driver for you know.

00:22:53: The things that you want to achieve and life?

00:22:55: In that moment my life had reduced to um... A very small environment.

00:23:00: it was literally me in that rehab centre And uh.. That photograph of all of my friends family Was stuck on the wall next to my bed the driver of me getting out-of bed and into the gym, trying and failing again.

00:23:19: And then eventually I was fitted with that first leg—that first prosthetic leg —and it was an incredible moment of victory to just stand up because the whole time I was seated... You're right!

00:23:33: There is.

00:23:34: there's an advantage if that's a possibility for you to leave The Wheelchair.

00:23:41: it was quite a defining moment for me.

00:23:45: But the way that I was thinking about the sea brace aspect is, is that close from an engineering standpoint to development of exoskeletons or are they completely separated?

00:23:57: It's slightly different.

00:23:58: The sea brace is passive and doesn't have motors in it so what he does is uses your inherent capability – your own minimal strength on body.

00:24:10: So, it's under your control.

00:24:14: An exoskeleton can be a passive exoskelton like a sea breeze but in most purposes for science they are powered.

00:24:23: where the exosketlaton does the work...for you!

00:24:26: You're not doing the word.

00:24:28: and there are three types of them-you have therapeutic exoskletons you get out of it after the therapy session, where are trying to regain balance coordination strength learning how to walk.

00:24:43: Where if your paralyzed with a brain injury or stroke or spinal cord injury on any other impairment You almost as he said...you cannot forget How To Do It.

00:24:53: and so the exoskeleton helps you Get Up Stand And Walk!

00:24:57: Then you can slowly reduce how much the exo skeleton does?

00:25:00: and then you vene off it.

00:25:03: A personal mobility exoskeleton is somebody with severe paralysis, after all the best therapy they might still not be able to walk stand-and-walk.

00:25:11: so a personal exoskleton is something which...it's a personal mobility device!

00:25:15: You're not trying to vene of it..you gonna use it like a sea brace to get you from point A to Point B but in the sea braze YOU are doing the work in a bit.

00:25:24: your muscles are activating along with the braze and a personal Exoskeleton robot does all a subsection of people who cannot do anything on their own.

00:25:35: And the last is performance augmentation or wellness and recreational exoskeletons, which has huge market

00:25:42: where if you

00:25:44: are like

00:25:45: me... There's quite a lot commercialization behind the exo-skeleton setup.

00:25:53: I noticed that we went to the mountains over the summer who are of a certain age, we probably need some support on the hips and knees and ankles.

00:26:05: You could hire exoskeletons to go hiking – I felt that was quite striking crossover from being in clinical environment.

00:26:15: then commercialising it like this….

00:26:18: Do you think

00:26:22: it covers two reasons?

00:26:24: to be frank with you, right?

00:26:25: It is extremely hard to get CE mark and FDA approved for medical grade devices.

00:26:31: So performance augmentation robots for people within MS Parkinson's who have what I call mild and moderate impairments or even certain individuals of the amputation who need a hip exoskeleton to help their prosthesis work because they have a passive prosthesis.

00:26:50: Those are medical grade devices, right?

00:26:52: And it's a little harder to go through the approval process.

00:26:56: Well, spin-off of that is what is known as wellness robots or recreational robots where you're wearing the exoskeleton and your loving people with... As I said They are pre-frail, they want to climb a mountain and have the view.

00:27:11: You can wear that or if you're like me... ...you wanna go to the rim of the Grand Canyon.

00:27:16: there's no way I make it past one fourth of the way an exoskeleton can help her.

00:27:21: Can help you?

00:27:22: Yeah!

00:27:22: Or if its your grandmother and she wants to get into the grocery store just has gotten really weak at devices like this.. ..I think we need be careful.

00:27:29: however when there is everything on Instagram Facebook whatever people use there is so much noise in the system, a lot of good gets mixed with a lot bad.

00:27:44: Or not bad I would say mediocre.

00:27:46: and just because you put two motors on frame it can actuate to basic software doesn't mean its safe.

00:27:55: So alot times commercial companies use influencers to push robots & technologies which i think all indexes one or two bad incidents and the whole field will go downhill.

00:28:08: So we have to be a little careful about how you do, some systematic scientific research even if it's recreational or wellness robot make sure its safe then commercialize.

00:28:23: but there is an ecosystem problem which I could spend two hours talking.

00:28:27: why they are doing

00:28:29: what?

00:28:29: Yeah!

00:28:30: The question that i ask myself now whether where technology doesn't just restore the capability, but also enhances it.

00:28:41: So going from rehabilitation towards human augmentation and the reason why I was thinking about this the other day is that apparently there were these Las Vegas enhanced games around May of this year supported people enhancing their own human capability by using chemical stimulants, all the things that usual Olympic games for example would definitely not authorise.

00:29:19: And I just wondered with like the progress we're making in robotics and prosthetics part of that trend.

00:29:32: where we're now looking, you know.

00:29:33: We are not just trying to restore your capabilities but actually making you akin a superhuman?

00:29:40: Absolutely!

00:29:41: I mean one mission and vision statements in our hospital is enhancing human ability.

00:29:47: it's critical piece like anything you do bionics or robotics getting into the field.

00:29:55: ten years ago It's unless you are a professional runner.

00:29:59: You didn't have running shoes.

00:30:01: Now people have walking shoes, running shoes badminton shoes tennis shoes Shoes for every type of thing right?

00:30:10: Comfort shoes inside the house shoes outside.

00:30:13: I mean this...I Have a dog walking shoe and i have a shoe when i play sports And i had to go for other things.

00:30:21: it just Just in shoes, in terms of comfort art support Stability energy return like if you see Nike and a few other companies have powered shoes.

00:30:31: now they returned energy to You.

00:30:33: so that's just shoes.

00:30:35: then think of other things.

00:30:37: robotics and exeskeletons And neuro prosthetics is a part of their brain compute interface.

00:30:43: Is trying To get us do that with our thought to do A lot Of Things.

00:30:46: So absolutely yes we are getting into this future generation or I wouldn't even call it future, current generation of advanced technology to give a human more nuanced and high quality life.

00:31:03: Yeah!

00:31:04: What is the question that i get asked quite a lot?

00:31:07: Is whether my prosthetic arm has any advantages over my biological arm.

00:31:16: So are there any advantages to having a robot arm?

00:31:19: is the question I receive quite often and you know, i do subscribe to realism.

00:31:25: so i do say well it's very good at this but it's not going to replace your actual hand because biology is super complex and it's actually quite difficult to replicate it like for like... But and that is strength.

00:31:44: So the idea that you can modulate your strength to either have a soft grip where you could potentially pick up an egg from the fridge without crushing its shell, but at the same time make it so strong that you would crush a glass of water?

00:32:01: And I wanted show this – this is the abionic hand from manufacturer in New Zealand This hand, if you look at it.

00:32:12: It's actually quite significantly bigger than my natural hand which brings me to a completely different topic about equity of access.

00:32:26: so this hand is waterproof shockproof whatever has got strong grip etc.

00:32:34: but its only available on our public health care system.

00:32:37: in that size.

00:32:39: There is a smaller size available, but it's not available on the public health care system.

00:32:44: So there is this notion of like.

00:32:46: we're making so much progress from allowing people to learn how be mobile again... ...to human augmentation.

00:32:58: But what about access?

00:33:01: because its not accessible for everyone?

00:33:03: Right!

00:33:03: There are many discrepancies between countries and regions where you know, get supported in one way but not another.

00:33:11: And I wondered what the solution to that could be?

00:33:15: It's a great question and...I don't think there is an easy answer but i'm going try it.

00:33:22: for example our hospital rate.

00:33:24: we are non-for-profit hospitals But sixty five percent of patients or medicare medicaid are no insurance patients which means the globe stop care is provided to sixty-five percent of people with no insurance or very minimal insurance.

00:33:41: And then we have, uh... thirty percent of our patient has private insurance like Blue Cross Bill Shield and Aetna and other things..and ...we have a five percent cash population!

00:33:51: A lot of these cash patients are very affluential people what we would call VVIPs ..and a lot of them have special care.

00:34:01: I even have a tech immersion clinic which a specialized cash clinic for people who want advanced care.

00:34:08: We even petitioned the FDA, for compassionate use of technologies which are not even known to a lot of people in world or ninety-five percent of the world.

00:34:18: but that money helps run a lot off things we offer at sixty five percent and it also allows us do a lot R&D whether it's the federal government or department of defense, war in United States.

00:34:36: Or other organizations private foundations fund us to do this research which.

00:34:40: so there are two ways.

00:34:41: equity happens.

00:34:42: when we do research The same cutting edge tool is offered everyone free-of cost.

00:34:47: So these clinical trials everybody who was working on a power prosthetic hand which is extremely advanced gets an opportunity to use it and a lot of times people can get to keep these at the end of study.

00:35:00: that's one way.

00:35:01: The second what our hospital does by being non for profit.

00:35:05: we offer this science, we develop...and thats my job is translate the science into clinical practice.

00:35:10: so were actively translating And then we offer the same knowledge to other parts of the world.

00:35:18: Does it immediately translate into countries which are not in that affordable region?

00:35:23: No, but unless you do the science... Unless you have an industry or a partner like for example Audible where just making money is not the mission helping people high quality care It doesn't have the trickle-down effect.

00:35:40: If you don't do science to take that next step, yes... The first hundred people who get it are extremely affluent people and not in an affordable range.

00:35:48: but unless these first hundreds use it by it there's no return on investment.

00:35:54: then manufacturing goes up because they're a market.

00:35:57: Then they start manufacturing more than NHS or CMS in US.

00:36:03: notices clinical impact And their willing to reimburse.

00:36:07: As they're willing to reimburse, the manufacturing component becomes more affordable for Autobug because right now they probably manually make them and it's very cost prohibitive.

00:36:16: But then once there is a reimbursement pipeline you can create manufacturing chains...you can create supply chains.

00:36:23: Then technology become affordable.

00:36:25: So that whole pipeline into this.

00:36:27: unless do science & clinical impact And have first users & responders You are not going get where everybody use.

00:36:37: Yeah, no I can see how that works.

00:36:41: It's quite important as well to realise if you support patients like that then not only they live a little bit more integrated with their family and friends but also there is an option for individuals go back to work and that in itself is a driver for... You see the government's going to be happy with that because you're contributing actor-in-society, pay your taxes.

00:37:10: And you can feel that fulfillment in those conversations with those patients I'm pretty sure.

00:37:16: Yeah it's called healthcare economics.

00:37:17: It's huge component of lot my work.

00:37:20: what is the economics behind providing this advanced health care?

00:37:24: As Workman's comp is a big insurance provider in the United States.

00:37:28: If a worker gets injured, you have to buy law and cover their cost of livings for rest of your life which is very costly for an industry partner.

00:37:40: but by providing an advanced bionic limb let us say You are now letting workers come back to work Which they want?

00:37:47: The dignity being able working with themselves and not taking freebies from government That's what the majority of the world wants.

00:37:55: Nobody wants a handout, everybody want an equal opportunity to contribute have fair life and help their family live good lives.

00:38:03: so they healthcare economics behind all this has been developed in lot times that some for work would is... For example if you give somebody as said a prosthetic limb or exoskeleton or sea brace to walk it means person can go back.

00:38:20: which mean now pay rent which means they're not dependent on governmental supplements, and there's a trickle down effect.

00:38:27: Which means that you are going to get a pressure ulcer or non-insulin diabetes?

00:38:32: You will go back into the health care system and draw more out of it!

00:38:36: Which mean we won't have an infection and be admitted.

00:38:40: Any of these return to hospital costs the government lot money.

00:38:44: so by investing in something which might be a little bit more expensive.

00:38:47: up front you are reducing the trickle-down effect of all the consequence being immobile and not doing much stuff.

00:38:56: But it's hard for a lot people to see that because unfortunately, governments look at it from snapshot vision.

00:39:03: they're looking at that year budget in time there like twenty years later I'm gonna be even power.

00:39:09: what do i care?

00:39:14: But the country will significantly benefit twenty years down if you are investing in these things up front.

00:39:19: Yeah i totally agree with u and i remember earlier now conversation we're talking about wearables, a trend in itself that my husband wears the whoop wearable.

00:39:37: I've seen those smart watches from Apple being able to track all sorts of biometrics, so what role do you think these wearables are going to play?

00:39:48: In future?

00:39:49: health care specifically?

00:39:51: yeah i mean they have huge impact but it's also a doublet sword.

00:39:55: and we What is known as wellness trackers the whoop, they order ring.

00:40:01: The Apple watch are generically good.

00:40:05: to give you generic information They will say your biological age is getting lesser Your heart rates getting a little better?

00:40:14: You're step counts this and that it works genetically well for those things.

00:40:19: but You can ask your husband to sit on the couch watch TV And then shake his hand as he's watching.

00:40:25: I mean literally

00:40:27: yeah, you can cheat the system that way.

00:40:29: Yeah You totally cheated and you could put on your dog.

00:40:32: Because do dogs stepping is actually much more intense.

00:40:35: The number of steps will go down.

00:40:36: so you feel good?

00:40:38: He took seven thousand steps but he probably only took three thousand.

00:40:41: They're biggest trick with these wellness trackers are the accuracy And their predictive models Are not bad grade.

00:40:48: they're trained usually unhealthy people.

00:40:50: So it works marginally or reasonably good.

00:40:52: i wouldn't say margin pretty good for healthy people.

00:40:55: But if it caters to certain models which are enough to make us feel good about ourselves, but is not clinically highly predictive.

00:41:06: It comes up with its own custom index indices of sleep and all that... But nobody can look into the black box.

00:41:14: because That is, it gets into a borderline dangerous situation when you get that in to clinical populations.

00:41:23: You don't want to say somebody's having a heart attack and they're not having one.

00:41:26: You know what I'm saying?

00:41:27: A Parkinson's patient's tremor is getting better when its' not getting better.

00:41:31: so you start to get into kind of an unsafe area.

00:41:36: the US government did a big review of sensors variables because at once stage there were thinking about providing one for every person.

00:41:46: But the whole review identified two things, right?

00:41:49: What is what are you going to do with heart rate and blood pressure for every person.

00:41:55: Let's say you know your heart rate.

00:41:57: most people in the country wouldn't know what to do when it's good or bad.

00:42:04: You are identifying that a certain number of steps and a certain heart rate.

00:42:14: And the sudden blood pressure or certain sleep quality is equates you to longevity, but who said?

00:42:22: Who did the science on this?

00:42:23: These are influencers sitting in saying these things on X or Twitter and Instagram and convincing us.

00:42:32: This Is The Way To Look.

00:42:34: But I know better than this That In Science What Is Science This Year?

00:42:37: Not Science Next Year.

00:42:39: It's a commercial strategy.

00:42:41: And so you have to be extremely careful about how you read into it.

00:42:46: till two years ago, there was nothing about peptides.

00:42:48: now everybody is doing some kind of peptide and Two years ago nobody believed in Supplements.

00:42:55: Now Everybody Is Taking Some Supplement For They're Using Cortisol Or Some Supplements To Improve Your Sleep?

00:43:01: Some Magnesium Spray On Your Leg And Something On Your Neck And Something on Your Hair To Grow It More or Something to get your eyeballs to feel less heavy.

00:43:09: People know what our vulnerabilities are and they will tap into that To make money.

00:43:15: And we all fall prey to that right words doom-scrolling hand every time something comes up.

00:43:19: It looks exactly like that's what I'm struggling through, and I've done the same mistake.

00:43:23: I'm like whoa.

00:43:24: That's exactly what i'm going Through.

00:43:26: it's not false But it's Not true.

00:43:30: also It is that We're Going Through All This but a lot of These Things Are Do give some benefits, but it doesn't give you the same benefits as they're saying because nobody is systematically studied that the prosthetic limb.

00:43:44: You showed me has gone through relentless amount of scientific studies to prove its efficacy.

00:43:51: The mechanical engineering has gone though.

00:43:53: Engineering testing the controls the software has gone Through extensive software testing which is why?

00:43:58: They don't sell there many Which is why people are moving into the wellness industry.

00:44:02: But you've got to be careful about what these things say.

00:44:06: I'm not saying they're all fake, i think the overhype-what this says.

00:44:10: so

00:44:11: yeah... Yeah?

00:44:12: I guess your right!

00:44:14: The hype element is something that people need to look out for sure.

00:44:18: but are there any devices um do a good job that are measuring the right biometrics as well?

00:44:27: I'll tell you in a minute why i'm asking this question specifically, but are there any devices that do a good job at heart rate or blood pressure?

00:44:37: Or sugar levels oxygen level all of those.

00:44:40: They don't they aren't.

00:44:41: yeah okay.. I

00:44:42: think the trick is... That's Why You Don't See A Lot Of Them FDA Approved For Medical Greed Use!

00:44:47: They're Okay for Wellness

00:44:49: Level!!

00:44:51: That's The Point I'm Trying To Say.... When I Do Variable Sensing Work We Extract extract the raw data from that device and then we do signal processing, machine learning which is a method of artificial intelligence.

00:45:06: We label the data against gold standard ground truth and then create algorithms which will give you numbers at high accuracy anything over eighty-five percent accuracy A lot.

00:45:17: these tools are proprietary algorithm which don't have no idea what what is running the algorithm and what the score.

00:45:26: And we believe it, a lot of times.

00:45:28: I believe I've burned six thousand calories where i just burnt a thousand and am eating a burger which shouldn't be so that's okay.

00:45:33: if you're healthy person its not going to make or break.

00:45:36: as I said It's important.

00:45:37: So A Lot Of Hard Work Is Focused On Taking Medical Grade Information.

00:45:42: There Are Brilliant Sensors Which Can Do That.

00:45:44: The Science Is So Good Right?

00:45:45: A Simple Sensor on Ethro can look at how much You Can Walk By Movement Because You Walk Its Acceleration Profile.

00:45:53: It can look at respiration because it's right there in your lungs.

00:45:56: You could look at heart sounds, you get right on to the heart and listen to speech quality or swallowing capabilities... And fifteen other things!

00:46:05: Then its called feature extraction where we take these features and stretch them out like I take a heart sound.

00:46:10: then I stretch them up so that they start to see WOW!

00:46:13: There is this minute medical changes And this is medical grade wearable work, where now we're taking these things?

00:46:22: stretching them out reading.

00:46:23: Them making sure these numbers match with a gold standard halter monitor or EKG machine would do and then we validate it created which?

00:46:32: why?

00:46:33: but its not big attractive field.

00:46:34: It's small because the medical grade Parkinson monitoring for just Parkinson.

00:46:40: So companies don't enjoy that alot purely becuase doesn't make them lot of money.

00:46:45: so in all fairness If I were them, i would just cater to the person who's sitting on their palaton and say... ...I will now measure this.

00:46:53: And then I'll send you a custom protein drink which you

00:46:56: need.".

00:46:58: We love that because we want it be special.. ..and as more and more wellness becomes precise.... ....we think we're getting custom care which gives us superior edge over our next human.

00:47:10: It is marketing brilliance at its highest level!

00:47:15: And I suspect there's a little bit of a placebo effect as well to that, right?

00:47:19: There was a lot of psychology involved in it.

00:47:22: But the reason why i'm asking you this is because... ...I have a project and I am planning an expedition!

00:47:32: What Im really trying to do is hold up here A lonely planet guide to Antarctica, which made me laugh in the first place Erin because I didn't think that you could lonely-planet it.

00:47:48: Lonely Planet is known for helping structure an expedition or a trip on a shoestring budget where most of your time can end up sleeping in hammock!

00:48:01: But anyway... planning this expedition for hopefully next year.

00:48:08: all things going well and one of the thoughts that I had what could be interesting beyond fact i know that process trauma, I climbed Kilimanjaro two years after my amputations and it really helped on a physical challenge basis.

00:48:33: It was super hard work to get almost six thousand meters in altitude with all of the oxygen lack, but the benefits from psychological aspect were amazing because there is real value in doing these movements, moving your body but also doing the same repetitive movement as you walk for eight hours a day if not more.

00:48:59: And after completing that I've been craving a new challenge to be able to move my body again and use it for psychological support so continued way of processing trauma.

00:49:18: thinking about this as a challenge that could potentially inform scientific research because the team I'm putting together is very diverse teams of individuals, variety different ages.

00:49:35: An age range from eighteen to sixty.

00:49:38: then there's male representation and female.

00:49:43: you have able-bodied me with twenty percent missing And I had this idea of, can we use these wearable technologies to record how our bodies react in preparation for such an adventure?

00:49:58: How they perform under duress?

00:50:01: because Antarctica is the harshest environment in the world.

00:50:06: Arguably at the expedition itinerary that we have says It's quite dry, it's quite windy and there is literally nothing out there but white.

00:50:21: That's a white sky or white ground – it was white everywhere!

00:50:25: And so what would be in your opinion my ideal expedition?

00:50:32: technology stack?

00:50:34: I mean the wearables….

00:50:36: Would it include an exoskeleton?

00:50:39: Would that technology even survive such harsh environment?

00:50:43: What do you think?

00:50:44: First of all, it's brilliant that you're trying to do.

00:50:46: That I think

00:50:47: is crazy?

00:50:48: Yes, I know now

00:50:49: we its critical that as humans mean We have one shot at life and we have to give his best shot right.

00:50:56: It just can't roll over and give up.

00:50:58: And so it's brillant that are doing that.

00:51:00: and uh i've had few other patients of mine who have tried To Do that after small cord surgery.

00:51:07: Uh and It's Just uh.

00:51:11: it's amazing what the human ability and the drive to do this.

00:51:16: And I'm always impressed by people who are super impressed, not impresses us.

00:51:20: undertone a super impressed or extremely impressed with how you can drive yourself right?

00:51:25: If you tell me it'll be like nope!

00:51:30: in my room and probably doom scroll a little bit or watch movie.

00:51:36: I'm always hot.

00:51:37: so this whole summer i've been spending at almost plus forty degree Celsius thinking oh my gosh how awesome would it be?

00:51:43: At minus

00:51:52: fourteen.

00:51:54: yes, oxygen consumption and what does your metabolic do?

00:52:04: You can look at heart rate, blood pressure, PPG which measures other things.

00:52:10: Oxygen saturation lung function cardiac function sweat response and glucose uptake.

00:52:22: a lot of it will give you real-time physiological experience how your body reacts in Antarctica.

00:52:31: The other I'm hoping you do or get to do is pre-simulate before that, and then take the appropriate tools scenarios.

00:53:00: I don't think that makes it any lesser of a success or not, i think its brilliant.

00:53:06: you gotta take the tools needed to succeed in their most extreme environment which is ninety-nine

00:53:14: point nine percent I'm thinking about the exoskeleton in particular is to see like, well would it actually survive or with a battery drain within thirty minutes because its not built for that type of environment?

00:53:28: You know this is the hardest test device ever going to get.

00:53:35: That's one part.

00:53:36: but the other bit i am quite interested in is will it support...I'm no an explorer and professional person who goes out exploring stuff And I'm a disabled person as well.

00:53:52: My question is, can with all the limitations that i have With help of technology and innovative healthcare Can actually achieve something that normally would be beyond my abilities?

00:54:07: That's kind of thinking... ...that this expedition has to hopefully able say on return.

00:54:13: Well yes!

00:54:15: It is worth investing in developing such devices because it does enhance your capabilities, it does augment you in a way that allows you to go on extraordinary adventures.

00:54:26: I think absolutely if anybody can do it... You'll be able to do so!

00:54:30: So i think the fun part which would be thrilled is to custom build those things for units right?

00:54:38: I don't just want them off-the-shelf.

00:54:41: That's why we talked about assimilation where you can create the environment.

00:54:47: And there are labs around the world which do that, it created the temperature of Antarctica, the floating material.

00:54:55: and then you work with bionic companies to customize their existing power orthotics powered robotics To match the needs of this environment Which means?

00:55:07: Material changes like were is waterproof in can handle dirt and dust and it's not finicky.

00:55:14: So the same way I suggest you work with these groups, or i can introduce to some ,to get you the appropriately designed custom design ones for your expedition because rather than going in piloting things will they work?

00:55:28: In Antarctica ?

00:55:29: I would rather custom-designed ones which are meant to work in Antarctica so that you have a successful expedition .

00:55:35: Rather then oh!

00:55:36: I tried fifteen things like thirteen failed and only two survived it !

00:55:40: And I had to change about twenty times.

00:55:43: Then you're not enjoying yourself.

00:55:44: That's a better story as well, I totally agree!

00:55:48: You won't be enjoying yourselves if your rather have the battery which lasts six hours in Antarctica and don't have to carry an old backpack full of batteries?

00:55:56: Yeah no that is true right okay i think now we are just going moving into our next segment my quick fire future questions.

00:56:05: so im gonna ask Your response carefully.

00:56:10: You've got a few questions here, you ready?

00:56:12: Okay yeah

00:56:13: okay.

00:56:14: so biggest health care breakthrough coming this decade

00:56:18: brain computer interface nice

00:56:20: most exciting wearable technology.

00:56:23: uh a longevity sensor which can track human aging and provide the custom precise model for care.

00:56:30: okay are you an AI optimist or an AI realist?

00:56:37: AI, realist.

00:56:39: And what do you think is the most overhyped technology at the moment?

00:56:44: Large language models.

00:56:46: Controversial!

00:56:49: But at the same time, What's your most underestimated technology?

00:56:54: What I underestimated the most... I would also say large-language model ability to learn.

00:57:01: Yeah.

00:57:02: and then which innovation will improve more lives than people currently realize?

00:57:07: variable robots.

00:57:09: And what is the most hopeful thing you've witnessed in a patient?

00:57:16: The relentless fire to get back to premorbid levels of quality-of-life and willing to do whatever it takes to get there.

00:57:23: Yeah, that's very nice answer.

00:57:25: I have seen as well As matter fact.

00:57:28: i realize That seems two categories.

00:57:32: If somebody goes through life changing incident It can actually either completely break them or it could give them extra firepower to return good quality life and live your purpose.

00:57:45: So I've really seen that duality.

00:57:49: Now let me see, i want ask you the final question on this episode.

00:57:59: And is what gives you most optimism about future

00:58:06: In current times, that's a tough question to answer.

00:58:08: But I think when you meet good people like yourself today and others have met through my life... ...I have the optimism they all will work to make the world a better place.

00:58:23: It can sometimes look a lot of doom-and-gloom because the internet does customize your algorithm for making it feel this way but there is lots of optimism.

00:58:34: industry partners, like Autobog.

00:58:36: I've worked with them now for over fifteen years and... ...I don't think they just want to make money.

00:58:43: Anywhere from their owners- I have talked about the owners of people who work in much lower levels There is a certain kindness or passion that can change humankind.

00:58:52: Yes everybody wants to be special Make money live happy.

00:58:56: but there are lots of people around The world A lot Who care about each other.

00:59:02: They work hard to work, make better things because at least that's what I see in my field.

00:59:07: So I always have this limitless optimism for the world and i believe each of us can make it a better place by not giving up and pushing towards betterment.

00:59:20: but you gotta take one step at a time.

00:59:21: You've got to solve little problems before you can solve big problem.

00:59:24: Yeah That is brilliant answer.

00:59:26: Do you know what?

00:59:27: It reminds me an answer that previous guest on show has given.

00:59:34: She was saying that human connection is what's giving quite a lot of hope to us at the moment.

00:59:41: And I echoed that, like i showed you the picture of my friends and family and how I had that picture next to my bed as I was going through rehabilitation.

00:59:50: it Is That Human Connection?

00:59:58: They can only pretend once, but they all cannot show up like this and nobody asks them to.

01:00:04: But that is a clear sign of both you and them.

01:00:07: And yeah A lot times we cant see it.

01:00:09: All We See Is All The Bad Stuff.

01:00:12: It's Saddening To A Lot Of People If We Can Shake It Off And Go To The Basics Of Just Being Happy Humans And Trying Our Best.

01:00:21: What'S The Worst?

01:00:21: You Try Your Best And Didn't Work But A Lotta People Give Up.

01:00:26: They Don'T Try And I'm sure nothing was handed to you on a plate and that is every other human.

01:00:36: To think of somebody's got it better than me, they're lucky in this or that... It's just pathway to disaster but we all can work together!

01:00:44: I am sure we could help eachother.

01:00:45: Yeah i like that.

01:00:47: well thankyou very much Aaron.

01:00:48: its pleasure talking with you.

01:00:51: That's it for this episode of Taste Of Bionics.

01:00:54: Thank you very much all for listening, if you enjoyed as I did please subscribe so that you never miss an episode and maybe even give us a bit of feedback.

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01:01:09: In the meantime feel free to let me know what your think.

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01:01:18: just send an email to podcast at Otobot.com and we're looking forward to hearing from you!

01:01:25: So thank you very much everyone, stay happy Stay safe And see ya next time.