Making Bionics Feel Natural. Dr. Paul Cederna on Touch and Intuitive Control.

00:00:00: When I woke up in hospital, I was told by the doctors there that walking is going to take a long time.

00:00:05: That twenty steps per day initially would be my top limit which will take me from bed and back again.

00:00:13: literally just climbed Kilimanjaro with four limbs.

00:00:17: I felt like i was on top of the world and i'm saying, what?

00:00:20: And then you know by sheer determination in wanting to prove everyone wrong... Of course!

00:00:25: I trained for two years and then I returned to Kilimanjarra.. ..and I climbed at this time with two prosthetics.

00:00:30: so

00:00:30: that was

00:00:32: my victory.

00:00:41: Hi!!

00:00:41: I am Sarah Delagarde & I am eighty percent human and twenty percent bionic.

00:00:46: Welcome To Taste of Bionics, the podcast exploring technology.

00:00:50: The future of health care and human

00:00:52: potential.".

00:00:53: So today's guest has spent his entire career trying to solve a question that is deeply personal to me how do we make a prosthesis respond to the person rather than forcing the person to adapt to the prosthesis?

00:01:07: Dr.

00:01:07: Paul Soderna is a plastic and reconstructive surgeon biomedical engineer NERV interface, known as RPNI.

00:01:20: He's a professor at the University of Michigan and founder & CEO of Blue Arbor Technologies where his team is developing technology designed to translate nerve-and muscle signals into more intuitive prosthetic movement.

00:01:37: Pauls work brings together surgery neuroscience engineering and entrepreneurship but ultimately it is about something very human Restoring agency, reducing effort and helping technology feel less like a tool.

00:01:52: And more like part of the person using

00:01:55: it.".

00:01:55: Paul welcome to Taste Of Bionics!

00:01:58: Yeah thanks so much for having me.

00:02:00: I'm really excited about this conversation today and excited to share with you all the things that we're doing today... ...and the potential in the future.

00:02:07: So thank-you.

00:02:08: Now i am the one excited.

00:02:11: just tell me where are you joining us from?

00:02:13: Are you into US based Michigan at the moment?

00:02:16: Yes, so I work at the University of Michigan and it's an incredible place to work because they have incredible engineering.

00:02:23: An outstanding medical school in an endless population of patients who are referred here from all over to get the most advanced forms of care possible.

00:02:33: So It is a perfect location to be.

00:02:34: Wow Okay!

00:02:46: words, the one that speaks the most to you.

00:02:49: So if I ask you surgeon or engineer what do you choose?

00:02:54: So i have to admit at my core...I think I am an engineer more than anything!

00:02:59: I absolutely love surgery and I love the opportunity to improve the quality of people's lives through the operations I perform.

00:03:08: but I think the thing that engineering has taught me is.

00:03:10: it is a field where you take a few rules, and you apply them to an infinite number of situations.

00:03:21: And you can use that then to troubleshoot—and it gives you a way of thinking about problems —to solve the maybe differently than other people

00:03:29: have.".

00:03:30: But I also think for me being able to bring that engineering into surgery has allowed me to think about surgical issues in different ways –in different perspectives–than surgeons typically do so make some advances in areas where people have not before made those advances.

00:03:50: Okay, okay I understand.

00:03:52: and so if i ask you to choose between restore or enhance what would you choose?

00:03:59: Restore!

00:04:00: Okay excellent...

00:04:01: And restore is when people have lost things all the time in many different forms And having the ability to restore something that somebody has lost is so critically important.

00:04:18: Enhancing is obviously really nice and frequently when we restore, we enhance as well.

00:04:23: So we get both.

00:04:24: Yeah That's true I agree with that one.

00:04:27: Then if i ask you to choose between nerves or algorithms What's your choice?

00:04:34: Because I am not the greatest programmer of all time.

00:04:38: Nerves because I have far more familiarity with nerves.

00:04:44: Uh, I know when I need an algorithm and what it needs to do but i can't create that.

00:04:50: But Nerves?

00:04:51: Know a lot about them And I Can Manage Them In A Lot Of Different Ways.

00:04:55: Okay If I Ask You To Choose Between Movement Or Sensation What's More Important

00:05:02: Well That Is A Tough One Because At Our Very Foundation We Need Movement.

00:05:10: So movement is incredibly important from that standpoint.

00:05:14: But if we achieve the ultimate goal, which is the goal that we have it... Which has actually embodiment where we don't actually have a tool strapped to a body That somebody's using like a hammer but instead We have A limb attached of their body that as part Of them.

00:05:32: If we're gonna get that we need sensation.

00:05:35: yeah and so probably sensation for me is the most important.

00:05:40: Yeah, that's yeah.

00:05:44: I'm excited to delve deeper into that part as well because what currently i feel is missing in my setup is that I do have the movement but don't really have a sensation.

00:05:54: so thats an interesting one.

00:05:55: we can delve in deeper.

00:05:57: now.

00:05:58: if ask you about biology or technology whats your pick there?

00:06:03: Uh, so a lot of these I want to pick both because we need both.

00:06:09: But i think the seamless integration Of those two things has been The biggest challenge of all And I think one of the approaches that We've used particularly in the lab with the regenerative peripheral nerve interface and now applying it To humans.

00:06:21: is we aren't forcing technology on biology?

00:06:25: We are encouraging biology to join Technology.

00:06:30: So we're leveraging the body's own approaches to interface with the technology so it's seamless.

00:06:37: And that what we need more than anything is seamless integration, not just put someone in a fancy car but actually making that part of

00:06:46: them.".

00:06:49: Okay!

00:06:49: We're going talk about all of this at the moment.

00:06:51: and before talking about the sightings I'd love to understand who became fascinated by conversation between nerves muscles or machines?

00:07:01: What first drew you to both surgery and engineering?

00:07:05: Well, so um... To begin with I became an engineer as a college student.

00:07:10: And the thing about the engineering that i loved is..I was huge fan of math!

00:07:16: Um....i love math because if you follow rules your right every single solitary time never wrong.

00:07:22: if you follow the rules and And it's a way to solve some incredibly complex problems.

00:07:28: So I love that.

00:07:30: but along the way, I worked in rehabilitation engineering and in Rehabilitation Engineering we were working with people who had progressive loss of motor function like with multiple sclerosis or ALS things like that and We would develop Adaptive equipment for them to help maintain their function.

00:07:50: And I was really young when i Was working in there and wasn't equipped To do it myself but doing a lot of helping There In realizing how you could apply those engineering Principles, not just build bridges.

00:08:04: We all need bridges and they are amazing But in the space that we wanted to work on which is to help people.

00:08:10: So i was off to med school.

00:08:13: It became a surgeon, absolutely loved the opportunity to help people through surgery and then combining those two things that become just such a natural fit.

00:08:26: I often hear from people who take look at my bionic setup who think this is still somewhere in the realm of science fiction but it isn't really science-fiction anymore.

00:08:38: to that point we're already using right?

00:08:41: But were there any moments where The signs look too difficult or too improbable to get.

00:08:47: Well, it's interesting because one of the biggest issues with prosthetic control as you know is finding ways to be able to control in a naturalistic way and It's incredibly challenging And there have been a lot of incredibly talented engineers working on for decades.

00:09:06: They can build spectacular machines That have so many different degrees of freedom, but then allowing the human to control.

00:09:16: that has always been.

00:09:19: The challenge in along the way there's lots.

00:09:21: people can tell you challenges too great.

00:09:25: Can't be overcome by the collection of people who've had on this podcast with you and past shared a lot advancements things they have done And we're excited to share some of the things that we have done as well, to overcome those barriers.

00:09:42: So does it seem like too much?

00:09:46: Not really but doesn't see.

00:09:48: my kids can be a lot work together.

00:09:50: absolutely yeah

00:09:51: I think you right with that is there are two different Things people don't realize.

00:09:58: on one hand There's so much advancement being made and when i became an amputee realise that this is not a childhood memory of pirates with wooden peg legs and hook for hand.

00:10:16: The technology had advanced so much since, yet as a prosthetic wearer myself there are still Um, frontiers that I think we could explore.

00:10:27: And so touch being one of them.

00:10:28: but also this idea of integration between what?

00:10:32: Integrating the technology and machine inside a human body – as you mentioned is the challenge isn't it?

00:10:40: because there are many variations on whether your body accepts…the um...technology trying to implement.

00:10:49: Yeah, and I agree with that a hundred percent.

00:10:51: So it doesn't seem like its too much to overcome at all.

00:10:56: It's just gonna be a lot of work To get there but we are making i will tell you the last Ten years We have made so much progress And my goal is ultimately to never see another body-powered prosthesis.

00:11:12: Um, and we still see so many of them out there.

00:11:16: So we need

00:11:17: one.

00:11:18: One of my arms is a body-powered prosthetic, it has its place and usage in the sporting environment for example.

00:11:28: It does come in handy but yeah I know what you mean.

00:11:32: We have come along way from there.

00:11:35: so Paul can you explain RP&I as if were speaking to someone who never studied medicine or engineering?

00:11:44: Would you be able to do that?

00:11:45: Just explaining what we're actually talking about for someone who doesn't know anything about prosthetics.

00:11:51: Sure, so it is a really exciting concept... So when somebody loses the limb their brain signals are still coming down from their brain through their spinal cord and down their peripheral nerves into their residual limb.

00:12:06: And even though they don't have a hand The signal's to control there hand or still come in front of your brain.

00:12:14: So we decided to devise a method to connect up with the peripheral nerves so We could hear those electrical signals coming from the brain down.

00:12:24: The nerves Record them feed them to the prosthesis and have the prostheses move like their hand normally moved.

00:12:32: Now, the challenge with it is as the nerve signals themselves are tiny And there's electrical noise in the body that's big.

00:12:40: I mean our bodies very electric electrically active.

00:12:44: So the difference between the signals coming down the nerves from the brain and the electrical noise in the body was tiny, that made it really challenging to be able to understand what the brain's signals were coming down their nerves.

00:12:58: so all we did is design a small piece of muscle when you take that small pieces of muscles then put them on end one of those nerves.

00:13:10: Instead of trying to pick up tiny little nerve signals, we're picking up huge muscle signals and that amplifies the signal's huge.

00:13:18: And now we know exactly what the brain is saying.

00:13:21: We know exactly with a motor intent is it can take those signals feed us the prosthesis in the prostheses moves just as they bring his telling you to move.

00:13:31: well okay so wait though but your growing a small muscle and then you grafted into Right inside your body

00:13:41: right.

00:13:42: so Originally, we were doing exactly that and we're taking small muscle biopsies And we are growing up the muscle in culture In a dish in the lab.

00:13:53: now That's really complicated.

00:13:55: There's all sorts of things that can happen when you grow tissue in The lab.

00:14:00: but then We thought we could actually take this small piece of muscle out of the person themselves.

00:14:06: It's only three centimeters by one point.

00:14:08: five centimeters, zero point.

00:14:10: Five centimeters so it's a small piece of muscle.

00:14:14: we can just take that out from A muscle on the side of their leg and then we wrap it around The end-of-the-nerve.

00:14:21: it survives the transfer in its new home and gets re-innovated by the nerve, and then amplifies those nerve signals.

00:14:30: So it's all done on the exact same operation.

00:14:33: we borrow a tiny piece of muscle that they don't need... That they didn't even know is gone.. And then we amplify their nerve signals and have everything we need.

00:14:43: Wow Okay!

00:14:44: That's blowing my mind kind off because The way I'm using my prosthetic at this moment Is By having every thing outside My body.

00:14:53: so inside the socket, I wear the silicon sock that has the electrodes embedded within.

00:15:00: That sits on top of my residual limb and then when i think about a movement... I move them corresponding muscles inside the sockets.. The electrodes pick up the signal and it feeds the rest with electric signals.

00:15:15: but ...I find challenging sometimes to not misinterpret different movements.

00:15:25: there is sometimes a little bit of a gap in between what I'm thinking and what's actually happening.

00:15:32: So by having this integrated, the signal stronger.

00:15:36: therefore communication is better?

00:15:38: Yes!

00:15:38: And if somebody has an amputation at level middle their forearm... There are lots of muscles that control fingers.

00:15:49: they can record signals from those muscles with electrodes on skin like you have And that works pretty well, but even in that situation the tiny muscles that control your thumb to do this Those are all gone.

00:16:02: None of those are there so you can't do this.

00:16:05: Yeah

00:16:05: But when I connect with the nerves All those signals that move that some like that Are still they're which gives me the ability?

00:16:14: To give Even better Control.

00:16:16: and then if somebody has an amputation up at the mid upper arm

00:16:21: Which is what i have yeah

00:16:22: all Of The Muscles That control the hand are all gone and you just have muscles that control the elbow.

00:16:29: Yeah, so then you have to do a bunch of repurposing in moving of nerves around to try to get more signals out.

00:16:36: but for me when we connect up with the nerves We can get as many signals out as we want And we can give all of that individual finger motion back?

00:16:45: We can give thumb really good thumb motion back everything.

00:16:49: So that gives us more ability to con control things.

00:16:53: The difference is the signals are in the body.

00:16:57: So we do have to take tiny, tiny electrodes and put them on those tiny muscles to get the signals out.

00:17:04: but when we do that they never shift They never move.

00:17:09: no one has to recalibrate anything because you put it on And it records the exact same signals In the exact Same way That It did yesterday Last week last month last year.

00:17:20: And so it's really exciting because then allows people to get great function immediately without a lot of inconvenience.

00:17:29: So how can I imagine this?

00:17:31: It is invasive at the start, you do have an operation that makes sure muscle grafts are implanted in place and does it require any other tech pieces to be integrated.

00:17:47: So then the muscle piece is put on the ends of the nerve and we do as many of those as we need.

00:17:55: And, Then We Put This Tiny Tiny Electrode In That Tiny Piece Of Muscle!

00:18:06: to the system that interprets all of data.

00:18:09: and getting back your question before algorithms.

00:18:11: Those are the algorithms we then use, to interpret what those signals mean and feed them wirelessly into the prosthesis.

00:18:20: What happens if there's a problem with the electrode?

00:18:24: It stops working in a way.

00:18:25: Can you just make an incision and replace it or how does

00:18:29: that work?

00:18:29: Correct, correct.

00:18:31: now we have had very Very few problems with electrodes.

00:18:35: early on We implanted our first person In two thousand seventeen And they are still using the exact same wires Same electrodes same everything as They were in Two thousand seventeen.

00:18:48: Okay, and they have never had to recalibrate a single time.

00:18:52: It works every time.

00:18:54: now one of our other patients They were shaving the hair around The wires one-time and they shaved one of the wires off so we had

00:19:05: That's unfortunate

00:19:07: I know.

00:19:07: So he had to repair a wire.

00:19:09: Yeah Um, so there've been a couple of wire breakages but other than that really not much.

00:19:16: But yeah it it's easy to just go replace the

00:19:18: wire.

00:19:19: Okay, I find this extremely interesting personally obviously

00:19:23: and

00:19:24: do you have to combine that with Osteo integration?

00:19:29: or Do You Have The Option To Still Wear A Socket?

00:19:33: Yeah!

00:19:34: It can be either way.

00:19:36: so we've had a great fortune of being able work with Oscar Aschmann in Vienna Austria And we have implanted two of our systems in patients of Oscars, and both of them have Osis integration.

00:19:52: One has targeted muscle re-intervation which you have talked about here before... ...and one of them has RPNIs.

00:20:02: We've implanted electrodes on both of those so that you can do it with Osis integrations but don't necessarily

00:20:08: need to.

00:20:10: I mean, i am fascinated by the technology and the surgical prowess of doing osteointegration but i do realise it comes with a risk as well particularly if you do it for your leg.

00:20:24: There's the bone density issue that your bone might shatter if there is too much weight on it.

00:20:30: so...I was thinking about that!

00:20:32: So..i can see the advantages of having clearer signals from the brain to the nerves in.

00:20:40: But I was a bit more cautious around osteointegration.

00:20:44: just because of that fragility, your skeleton might have.

00:20:48: So it's good to know this is an either-or that you have the option

00:20:53: basically.".

00:20:54: Yeah?

00:20:55: I think Osteos integration is amazing and for some people particularly who have amputations very close up their shoulder It's so hard for them to get a good fit on a prosthesis, to be stable and to get the motion they want.

00:21:11: But if they have even this shortest length of bone left On their upper arm Aussie integration allows them to attach a prosthesis there And move that.

00:21:23: So it really gives people an opportunity particularly those with Really high-arm amputations?

00:21:30: It gives him an opportunity to have pretty good control over a limb That otherwise they wouldn't have had.

00:21:35: So, it's been a really great advance.

00:21:38: And I guess the other advantage is that you get more freedom of movement because this socket is restrictive isn't it?

00:21:46: Like if for example can't lift my arm above my head because the socket locks my arm into place only one direction down and so Osio integration will give me more freedom.

00:22:02: Yeah, that does make a really big difference.

00:22:04: And so we don't have upper extremity-ostis integration approved yet in the United States We do for lower extremities.

00:22:14: So we're doing lower extremity now.

00:22:17: and even people with low extremity it makes a big difference because many of them can get a prosthesis to fit very well if they have amputation through their thigh particularly if its high up on there.

00:22:31: So this gives them an opportunity to walk.

00:22:33: Um,

00:22:35: so how do I understand it?

00:22:36: If it's not the arm that you do um The implant of the electrodes you can do it in your leg.

00:22:44: does that give you more sensation as To what you work on?

00:22:49: Yeah, so we have the ability too.

00:22:52: for instance There is a nerve In the lag which Is A big Nerve About The Size Of Your Thumb And that nerve controls all of the muscles, everything below the knee.

00:23:03: So if you have an amputation through the thigh- All those muscle that control your ankle... Your foot.. Your toes.... Everything are gone!

00:23:12: But what we do is take those RP&Is and create four or five of them on a big nerve in the thigh.

00:23:19: Then we can control it ankle back, ankle down, ankle out, ankle in and we can give them sensation back over the surface of their foot.

00:23:30: That

00:23:32: is incredible!

00:23:33: Yes, so that's an incredible opportunity because some people know it takes a lot energy to walk particularly if you have amputation through the thigh...

00:23:46: Yeah

00:23:48: And its hard.. If your not fit then you're gonna walk very far.

00:23:52: But if we can get somebody a prosthesis that has a motorized knee and a motorised ankle, And then we can control it with the nerve signals from the brain.

00:24:03: Then they've got power assist walking... ...and their gonna be able to walk alot further.

00:24:10: stand up all-all of things.

00:24:12: we want to improve our quality life.. ..And we also know actually frankly If people don't walk their life expectancy is shorter.

00:24:23: Yeah, I heard that too.

00:24:25: So if we can keep them walking who knows?

00:24:28: maybe we could actually not only improve the quality of our lives but may be even a length of your

00:24:33: life?

00:24:35: And i heard it does good for bone density as well which at risk of loss because if you don't use it, you lose it.

00:24:44: That's kind of my understanding of it.

00:24:46: so I do have a walking pad... So i'm talking to you for my office and- My office is a grand word!

00:24:53: It's just a room in my house but.. But I DO HAVE A WALKING PAD AND I DO USE THAT ON A DAY TODAY JUST BECAUSE WHEN I woke up on hospital ,I was told by the doctors there that walking was going to take a long time, that twenty steps per day initially would be my top limit which will take me from bed and back again.

00:25:16: And I had literally just climbed Kilimanjaro with four limbs!

00:25:22: I felt like i'm on the top of the world at thirty thousand steps vertically you know?

00:25:28: Then all this sudden wake up in hospital after accident I get told twenty steps a day and i was devastated.

00:25:39: And then, you know by sheer determination in wanting to prove everyone wrong of course... ...I trained for two years and then I returned to Kilimanjaro.. ..and I climbed at this time with the two prosthetics.

00:25:49: so that was like my victory but it was based on the fact as well.... ....that I really wanted to have that freedom of movement for as far as possible, so ten thousand steps is something that I aim to achieve on a regular basis rather than just exceptionally.

00:26:11: Yeah well what an incredible story and inspiration.

00:26:15: but i do think almost every single person who experiences limb loss has go through their own challenges.

00:26:23: they come in lots of different forms constantly in lots of different ways also.

00:26:32: But our goal is if we can restore people to where they once were and give them the function back that they once had, oh, that would be a dream- Yeah?

00:26:44: ...to be able do

00:26:45: that.".

00:26:46: For sure.

00:26:47: but then there's the question about like restoring.

00:26:49: so remember we spoke about this at the beginning more and more because of the technology improvements that we're making, the use of AI.

00:27:05: So if you are thinking about okay let's restore what a person has lost then can actually make it better than before?

00:27:13: How realistic is this in real terms?

00:27:16: ?

00:27:16: Because there is fantasy I have when i get fitted with my running blade will be able to run faster.

00:27:27: But how realistic is it really?

00:27:29: So the reality is, today I could fit one of our patients with a prosthetic arm that crushes rocks.

00:27:38: Yeah like

00:27:39: that and i can do that today because all we need... We just need a prosthesis That has a motor strong enough to crush your rock.

00:27:50: Now The challenge With It Is!

00:27:51: The Motor To Crush Your Rock Is Gonna Be Heavy so Then You Would Have To Carry A Heavy arm around.

00:27:58: But as the technology improves, we have to control signals now so we can control anything.

00:28:07: for instance I could imagine Now that We Have The Signals From People's Nerves.

00:28:12: instead of even giving a prosthetic hand?

00:28:15: We Could Give Them A Robotic Arm That Is On Other Side Of The World

00:28:21: Yeah

00:28:21: And They Would Just.

00:28:22: They Would just Control It.

00:28:24: i don't know.

00:28:25: they Could Have a child that is around the world.

00:28:30: They just had a baby, they have a prosthetic hand and it has sensation...they could reach out and touch the baby over Zoom.

00:28:36: we give them sensory feedback in to feel the

00:28:38: baby.".

00:28:39: Okay so let's talk about sensory feedback because that doubted something.

00:28:44: I am very hopeful too..I mean my bionic hand has given me freedom of grasping something holding something pinching.

00:28:56: It also has that strength ability you mentioned, so I can calibrate it.

00:29:01: So its a soft touch and doesn't crush the shell of an egg but at the same time i can increase... ...the force to a point where i can squeeze somebody's hand.. ..and will probably hurt this person!

00:29:15: Its the same for the elbow.

00:29:17: if i flexed the elbow.

00:29:19: we actually had in clinic once when my clinician... accidentally left her finger right at the point where the elbow flexes.

00:29:28: And yeah, that was bruised and we were worried about breakage there.

00:29:32: so I can tell.

00:29:34: but um The touch being able to feel if something's hot or cold Or even If i hold my daughter's hand Being able To Feel That Connection How would that work?

00:29:47: Because currently it's not really There

00:29:50: Right.

00:29:51: So So right now we are using the regenerative peripheral nerve interfaces to also be a way to provide people with sensory feedback.

00:30:04: On the prosthetic hand there would be sensors, they could be whatever sensors you want them to be... They can temperature sensors or pressure sensors anything to detect what ever sensation you want.

00:30:16: The fingers come together and feel just pressure.

00:30:21: That becomes an electrical signal from those sensors.

00:30:25: We then take those electrical signals, we wirelessly feed them back into the body and Then we stimulate The RP&Is that go to the thumb and index finger And they can feel it.

00:30:39: Because

00:30:41: because the thing remember is even if you don't have an arm?

00:30:45: The brain signals are still coming down your peripheral nerves To the arm or hand that you don' t. Those are the signals we can record to control a prosthesis.

00:30:55: But, the sensory nerves that used to go to hand is also there!

00:31:00: And this is why people sometimes have phantom limb pain when the ends of their nerves are being irritated.

00:31:07: and if those nerves use to go through the thumb—and it's being irritated–the brain thinks maybe the thumb has been crushed or the thumb was on fire... Well…we'd leverage these sensory nerve connections by stimulating them through the RPNIs, those signals go all the way back to the brain and they feel that body part.

00:31:28: Wow!

00:31:29: And that makes so much sense?

00:31:31: Yeah Now now... The way you explain it I'm like yeah of course but

00:31:36: still yep.

00:31:37: So then if we have an RPNI that controls the thumb like this and has sensation also what we can do is record the brain signal coming down the nerve for a brief period of time when we know what the brain is trying to do and how it's trying to move the thumb.

00:31:56: The prosthesis feels something here, We take those electrical signals, we feed them back And then we briefly stimulate that same RP&I... ...and we turn in on-and off & ON-AND OFF & ON AND OFF.

00:32:08: So we can be controlling and feeling at the same time But were doing so fast That a person doesn't know where turning it ON-&OFF &

00:32:16: ON & OFF And that works automatically?

00:32:21: That is not something that I would have to control over an app on my phone.

00:32:27: Yes, yes and so that's really exciting too because if we are going You know, if you're on a busy street walking with your child and you're holding your child's hand so they don't run off or disappear.

00:32:58: Or whatever...you want to hold their hand tight enough that there hands stays in your hand but you don't wanna crush their little hand too.

00:33:06: But having the opportunity do that without having look and see how much am I deforming my hand?

00:33:13: Am i holding it tightly enough actually be able feel oh my god!

00:33:17: That would be amazing.

00:33:18: Yeah, and you're confident that this is something we are going to see kind of commercialized anytime soon?

00:33:28: Or were looking like further into the future with that.

00:33:31: Further in to the future but right now We Are Doing It With People Right Now But there will be quite a few steps before we'll start doing sensory feedback.

00:33:43: part of things it's already reality for people in the laboratory.

00:33:50: Wow, that's incredible.

00:33:52: and so if now obviously you got me interested... So if I were to go for an operation like that what would be my downtime?

00:34:05: How fast is that

00:34:07: doable?".

00:34:08: Yeah!

00:34:09: That's a great question.

00:34:11: When we take this small piece of muscle Out of your body and we put it on the ends of a nerve out as many nerves is we need to get as many signals as you want when we move that muscle.

00:34:22: It takes about three months for that muscle, not too bad, but it does take a little bit of time.

00:34:42: But even when I do just a simple revision of somebody's residual limb... ...I tell them they can't be in their prosthesis for six weeks.

00:34:51: so there is enough time for

00:34:52: healing.".

00:34:53: So this is longer than six weeks!

00:34:56: But its'not a

00:34:57: year!".

00:34:58: Yeah yeah and that- I remember like for osteointegration dad is about a year of downtime.

00:35:04: It's a long process.

00:35:06: Yeah,

00:35:06: because you have to allow the bone to attach itself to The metal right?

00:35:12: So that's what.

00:35:12: taking so long but three months I mean That means three months where you can't wear your prosthetic.

00:35:18: You need to allow The healing process to take place first.

00:35:22: No during six weeks for the healing process and then they could wear their old prosthesis And use it the way they were before.

00:35:31: But it would take three months for the signals from the RP&I to be fully online.

00:35:36: Right, okay I see.

00:35:38: Yeah

00:35:39: Wow that is exciting.

00:35:40: and then these types of operations they performed in Europe as well.

00:35:45: or where do you do?

00:35:47: So

00:35:48: yeah so The other thing we discovered along the way when we started doing RP&Is Is That there were no neuromas being formed No phantom pain.

00:36:00: So neuromas, what happens in neuromas is somebody gets an amputation and these nerves get cut during the amputations.

00:36:08: What those nerves want to do?

00:36:09: Is they wanna grow back To where they were before?

00:36:11: so they start sending branches out and branches Out and branches are in branches out And Before you know it You have a ball of raw nerve fibers Yeah, and then They just randomly fire and give paint

00:36:23: yeah,

00:36:24: and and they also Give phantom Pain.

00:36:27: So when we put the small pieces of muscle on the end to the nerve, The nerve grows into a piece of muscle.

00:36:34: It reintervates the muscles which is what it was doing before and then stops sprouting all these branches.

00:36:40: And they don't get neuromas.

00:36:41: Yeah.

00:36:42: so We discovered that!

00:36:45: Now there are RP&I operations being performed All over the world now just To help people with neuroma pain and phantom limb pain.

00:36:56: So that's an operation surgeons already do everywhere.

00:37:00: And so the only difference for the prosthetic control is now we're just going to put a small electrode into that piece of muscle, and that's the only addition.

00:37:09: For surgeon it isn't... It is not difficult thing to learn in any way.

00:37:15: Yeah See I have a neuroma on my leg feel like a ball and your skin.

00:37:27: And it is sensitive to any touch, the way that it sits inside the prosthetic socket... I understand!

00:37:40: So do you surgically remove that?

00:37:43: Mm-hmm.

00:37:44: Yep so then if... You

00:37:44: just cut it off and put the muscle graft

00:37:48: instead?

00:37:49: Yeah yeah and we do that all the time.

00:37:53: And even if somebody is not going to want an advanced prosthetic device, we just do that.

00:37:58: operation Prevents them from even wearing their prosthesis or maybe it keeps them awake at night, and they can't sleep.

00:38:20: Yeah And how horrible.

00:38:22: if you care every I mean everyone loves sleep.

00:38:25: How horrible would be?

00:38:26: If night after night after tonight You are being Awakened with horrible pain?

00:38:33: yeah that will be awful.

00:38:34: so this is made a big difference for people for sure.

00:38:38: See, I'm interested in that as well because the aroma on my leg is something that feels...I try to explain it but when you have an infection and your tooth.

00:38:49: It's this really irritating pain where you just want put your finger on it and press it!

00:38:56: That makes it worse though so its not great But there are those annoying nerve pains which are just there.

00:39:01: So knowing they're possible to avoid..that actually fantastic

00:39:08: For sure, for sure.

00:39:09: So the other bit that I'm interested in is to see how you utilize AI in this process.

00:39:15: because The setup that i currently have as my arm works and tandem with me?

00:39:21: That's the best way I can explain it Is that It learns from me.

00:39:26: so every time that I use the ARM data points get collected gets stored on an external server an AI algorithm sifts through the data set, starts establishing pattern recognition.

00:39:39: It's start seeing which electrodes are being used in what sequence and then when it becomes predictive... ...it starts helping me take off that cognitive load of having to concentrate being single-minded on one gesture.

00:40:02: concentrate quite as much.

00:40:06: How does that work in the way you operate?

00:40:09: Do you use artificial intelligence in a same

00:40:11: way?".

00:40:12: Yeah, so your description was great!

00:40:16: That's exactly what we do because we're recording lots and lots of signals... And we are interpreting all these signals using those for the function people want.

00:40:27: We used machine learning algorithms and their algorithms that they just learned from repetitive actions.

00:40:34: When they know then what motor intent is, when they see a certain combination of things happening simultaneously... ...they know what that means and then do

00:40:43: it.".

00:40:44: Now you can imagine with time as we get better and better.. ..that perhaps maybe every time you reach your arm out!

00:40:53: You're gonna grab something, probably.

00:40:54: That's why you are reaching your arm out.

00:40:57: So maybe as we start reaching our arm-out Maybe already get the hand to open Just a little Even before the brain signals come We do it And then they take over and move their hands.

00:41:13: But by doing those kinds of things Predictive modeling You can make very smooth function And so our goal is to continually increase and improve the quality of those algorithms.

00:41:28: So we smoothed the function out even more because, We don't want you to have to move your arm out then wait Then open your hand then wait then close your hand Because if we can see what's coming next?

00:41:42: we can start the motors of the prosthesis moving and doing that ahead of time.

00:41:49: And then have really nice smoothing functions, so it's just smoothed.

00:41:55: So I'm really excited in that is... AI is scary in a lot ways but AI also absolutely incredible.

00:42:05: We were talking about at other day having AI read x-rays A billion data points in a nanosecond and make diagnosis of what's going on an x-rays.

00:42:23: It never gets tired, it never gets hungry And can be used for lot good.

00:42:31: So I'm excited about the good and certainly AI.

00:42:35: these applications is gonna give people amazing function.

00:42:39: Yeah, I totally agree.

00:42:42: This is a conversation that we have over here as well with my colleagues where we talk about tech for good and how.

00:42:49: AI is extremely powerful for sure but i liken it to nuclear powers in the hands of the right people its cheap power for everyone ill-intentioned, well it could be the end of humanity and I feel like AI is quite similar to that.

00:43:11: And it needs a bit of regulatory frameworks to protect usage but used in healthcare.

00:43:19: i can see all advantages there at the service of humans rather than replacing them right?

00:43:25: For sure for sure yes.

00:43:28: so you know what your thoughts are.

00:43:34: next adventure planned.

00:43:36: it's an expedition and its.

00:43:38: basically I am taking this thinking about using technology for good, AI for good.

00:43:47: And how is most powerful when at the service of humans but also restoring and augmenting human to be able perform in harsh environments, and so the harshest environment that I could think of was Antarctica.

00:44:05: So i am putting a crew together to go ski The Last Degree in Antarctica To The South Pole In December next year And That Is Really To Demonstrate.

00:44:20: is it even possible?

00:44:29: health care and technology as a combo to reach the South Pole.

00:44:33: Do you think that's crazy?

00:44:36: I think it is amazing, I am, absolutely love that.

00:45:02: And i think it is going to be an incredible experience and It will be a great opportunity to share with people To realize there actually aren't limits.

00:45:14: The only limit are the ones we place on ourselves.

00:45:18: If you work hard towards goals We can accomplish those goals.

00:45:24: Thanks,

00:45:26: so watch that space.

00:45:29: We are thinking about what kind of technology wearable devices we can use because the whole point as well is to figure out.

00:45:40: how does that harsh environment change our bodies?

00:45:44: How do we adapt to minus forty degrees Celsius?

00:45:48: it's three thousand meters in altitude you know?

00:45:54: um oxygen level measurement tools, what happens to our core temperature?

00:46:00: What happens to my residual limb which has a well the blood supply is kind of different than the other parts of my body.

00:46:10: so how will that react in those conditions.

00:46:13: Will it freeze?

00:46:14: hopefully not I don't know but we have to figure this out and hopefully by collecting all these data points you know, use them in order to develop more appropriate systems for more people.

00:46:29: To be able to do more exciting things like

00:46:31: that.".

00:46:32: Yeah so I really believe that now we have ways to get the brain signals out of the body and out of peripheral nerves using our PNIs.

00:46:45: We actually then had an opportunity device of any variety on the end of their residual limb.

00:46:55: So if it's a leg, we can attach a sea leg that has power and they can run faster and longer than they could ever run with their original limb If its hand in.

00:47:07: there are rock climber We can get special fingers to allow them to climb like Alex Honnold You know have the tiniest little holds attach a thing and they can become an elite rock climber.

00:47:22: if there are an accountant sitting at the desk typing on computer week make up very small lightweight three d printed hand.

00:47:31: That has monofilament line fishing line that controls it in.

00:47:34: they can type fast just anything.

00:47:39: Because now that we have the signals, We can control anything on end of that.

00:47:44: Yeah You know and um And I think the opportunities are endless It's in.

00:47:49: i really do think That there will be a lot Of uh.

00:47:53: job specific Limbs people Will get.

00:47:57: There will Be ones that they Get for their Their activities that They enjoy doing.

00:48:03: Um and if they're swimmers They are new limbs that allow them to swim faster than they ever did before.

00:48:11: I mean, anything mountain bikers where they just attach right to their pedal?

00:48:17: Just everything.

00:48:18: so...I'm excited about

00:48:22: this because i can see a hand play the piano quite well.

00:48:27: I'm really rubbish at music and never had any talent for it.

00:48:31: But imagine if i could have a hand attachment that can play pre-programmed pretty well, any piece of classical music!

00:48:39: Well

00:48:40: yeah...I suspect you almost do that now except the finger spread but still sure there's no limit.

00:48:52: Well, that keeps me hopeful for the future.

00:48:57: These are a type of things I hope my children and their teenagers now would want to work on as they grow into adults because this is As we said in the beginning, it's not just about replacing if we have to opportunity.

00:49:16: We might as well look at augmenting the technology so that I think is brilliant.

00:49:22: Well any other things you wanted to talk about than i didn't ask today?

00:49:29: One of biggest thing for me when people get injured and cancerous.

00:49:37: humans are incredibly resilient and humans have the ability to accomplish so much.

00:49:44: And I think that we've been working hard in this space following limb loss, to restore people back where they once were before they lost their limb.

00:49:54: I think companies like Autobock are doing an incredible job of helping get them there!

00:50:01: And I think we at Blue Arbor Technologies are also working very hard to get people the quality of control that they need, and have a hand-and-a-leg move like we wanted it.

00:50:14: We're making great progress!

00:50:23: So, it is just so many people that we can help and then help all of the people around them.

00:50:37: That they work with play with love live with everything in it.

00:50:42: It's something the world needs And I couldn't feel more Humble than privileged to be able to work in this space and have the impact that were having so far.

00:50:52: So its exciting.

00:50:53: Yeah, you totally agree?

00:50:57: shocked and surprised when i discovered that this community of people living with limb loss is so much bigger than I thought it was going to be.

00:51:07: It's over sixty million worldwide, that's huge!

00:51:10: That almost the population in France... Not everyone has access And it really is debilitating, right?

00:51:20: If you don't have freedom of movement then it does exclude from society in a way that's devastating not just for yourself but your families and friends.

00:51:30: It has an impact...and its true that lot of these limb loss scenarios aren't because of geopolitical tensions or wars

00:51:41: etc.,

00:51:44: diseases, right?

00:51:45: I mean we're looking at…I've met so many people in hospital who had either motorcycle accidents or car accidents.

00:51:54: And then also sepsis is a growing case of sepses and that's really scary.

00:52:05: thinking about some.

00:52:06: my friends went into a coma with four limbs with no limbs left.

00:52:13: I mean, that is absolutely devastating.

00:52:15: and so yeah knowing that technology can actually restore some of their abilities is quite incredible.

00:52:23: So thank you for doing that work!

00:52:25: Thank You!

00:52:26: Yeah, thank you so much

00:52:28: All right.

00:52:28: well i think thats the end our episode today.

00:52:33: And uh...I have to say Paul's work reminds us that the future of prosthetics is not only about building more sophisticated machines, it is about listening more carefully to the human body and designing technology around a signal's intentions and lives already there.

00:52:51: So that's it for this episode of Taste Of Bionics!

00:52:54: Thank you very much for listening.

00:52:56: if you enjoyed as I did please subscribe so never miss an episode.

00:53:01: And don't forget to rate Taste of Bionics on Spotify and Apple Podcasts.

00:53:06: So, we will be back in two weeks!

00:53:08: In the

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00:53:15: Stay happy stay safe See you next time.