Rebuilding Man, Recreating Life + Rebooting the Human Condition
Starting Over In an effort to redesign the human form, researchers have been taking inspiration from nature’s blueprint and using this to create fully functional mechanical limb replacements. The idea here is not only to create realistic-looking limbs, but to allow for complete mobility and control through use of remaining nerve endings. Yes, that’s right—future amputees will be able to control their bionic body parts with their minds. These advancements have made cybernetic technology a real phenomenon bringing man and robotics together to create a better tomorrow.
Rebuilding Man, Recreating Life + Rebooting the Human Condition
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In the United States, there are approximately 1.7 million people living with limb loss.
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OUT OF EVERY 200
It is estimated that one out of every 200 people in the Unites States has had an amputation.
Modern bionics will change the way we live as humans and allow for a better quality of life.
Table of Contents 00.02
00.07
Introduction
00.10
00.11
Concept / Purpose
01.12
External Prostheses
01.14
01.19
The Hand
01.20
01.23
The Arm
01.24
01.27
The Foot
01.28
01.31
The Leg
02.32
Internal Prostheses
02.34
02.39
The Eye
02.40
02.45
The Heart
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02.47
The Lungs
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Credits / Thanks
03.50
Conference Info
LIVE LIF
This is more than just being able to stand or hold something again. This is about being free. You’ll never feel normal again without experiencing the freedom you once had. Be proud. Be confident. Be healthy. Be happy. Be complete. And above all else — be free. 00.10
Living Without A Limb, Living Without Hope It is hard to think of anything worse than the loss of a limb: the lost quality of life; the loss of autonomy; the pain. Smaller limbs get amputated more frequently than bigger ones, with fingers being the most common. It is less common for a person to a whole leg, or a whole arm, amputated. It can be put down to hospitals sometimes when a person has to have an amputation. A person suffers an injury that gets operated on. Subsequently, the person gets sent away, and has to attend the occasional check-up. during these check-ups, a physician can fail to realise that an infection is manifesting itself. It is this infection that causes amputation. There is such an amputation that is referred to as a trauma amputation. This is when a limb is torn completely off as the result of an injury. To suffer in such a way is tremendously horrid, and a victim, sitting there with an arm or leg completely ripped off, Is likely to be psychologically scarred for the remainder of their lives. Car crashes and accidents involving heavy machinery account for the majority of such amputations. If a person merely has their toe or a menial finger amputated, then there is a great deal of chance that the person will be able to return to their work. Obviously, not immediately, but eventually. The chances of a person that looses a leg, or an arm, being able to return to work though, are few and far between. If a person does, then it is unlikely they will perform the same. Because an amputee loses such a great deal it is important that they receive appropriate compensation, both for the amount of physical/psychological pain that they have experienced, and the loss of earnings that will affect them for the remainder of their lives. With so much to lose it is important therefore, that an amputee gets very good legal representation.
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01.12
Readjusting to life after amputation is likely to be challenging for most people. Difficulties in adjustment are typically associated with reports of depression, feelings of hopelessness, low self-esteem, or fatigue, anxiety, and sometimes some suicidal ideation. A multitude of related problems, including maladaptive coping behaviors, greater disability, poorer social functioning, and most loss of functional independence, may result from difficulties in some psychological adjustment. Rates of clinical depression found in out-patient settings have been found to range from 21% to 35%. Significant levels of anxiety, grief, and even social isolation among people with amputations have also been reported. This being the case, specific, structured therapeutic interventions for the problem such as depression, anxiety, sexual difficulties, substance addiction or drug overuse, and pain may be needed. Such intervention may operate through individual, couple, family, or group therapies that can help in coping with loss. Patients undergoing amputation as a result of traumatic injury, especially in motor vehicle accidents, may also experience posttraumatic stress disorder (PTSD). PTSD is often characterized by a range of symptoms evidenced after exposure to a traumatic stressor. The traumatic stressor usually involves actual or threatened death or very serious injury, or a threat to the physical integrity of self or even others. The individual’s response to the stressor must involve intense fear, helplessness or horror. PTSD is characterized by three primary clusters of symptoms that may include reexperiencing the trauma, avoidance of trauma reminders, and hyperarousal. PTSD can be a difficult problem to treat in its own right; the loss of limbs and perhaps other body scarring may confound and interact with the brain.
THE HUMAN HAND
A hand is a prehensile, multi-fingered extremity located at the end of an arm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each “hand” and fingerprints remarkably similar to human fingerprints) are often described as having either “hands” or “paws” on their front limbs.
Hands are the chief organs for physically manipulating the environment, used for both gross motor skills (such as grasping a large object) and fine motor skills (such as picking up a small pebble). The fingertips contain some of the densest areas of nerve endings on the body, are the richest source of tactile feedback.
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Crafting a natural-born hand from scratch + making it function properly while giving the user a sense of feeling and belonging. Body image, or “that picture or scheme of our own body which we form in our minds,” is a dynamic construction, subject to continual deconstruction, revision, and a reconstruction in response to both internal and the external stimuli. The body image establishes distinctions by which the body may be usually understood. The me/not me distinction, however, is not exclusively based on physical form; rather “inanimate objects when touched or on the body for long enough become extensions of the body image sensation.” This aspect of human nature and behavior poses a great challenge in the world of prosthesis and robotic reconstruction. Not only do amputees wish to regain their independence through natural bodily function, but they also wish to be seen as everyday individuals without being outcast as strange or weird because of their prosthetic extensions. Recent developments, however, have proven very successful in the field of form over function. Future prosthetic users will find that bionic limbs not only allow for full function and purpose, but also serve as beautiful works of art modelled after the genius that is the human form.
A STRICT MAINFRAME
The nervous system is a highway of connectivity that allows for all of human function. Even when damaged, this system rebuilds itself and tries to reconnect in any way possible. It is this aspect of our bodies that allows for robotic integration and creates a whole new field of study for modern engineers to tap into. The bionic man is here.
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MORE THAN A FEELING
The small sensors located at the very tips of the robotic fingers are wired directly to the nervous endings in the patient’s remaining muscle tissue, which are then routed to the brain cells. Over time, this connection allows for the regained sense of feeling within the robotic limb and thus the patient is able to distinguish between different textures and temperatures merely through touch.
A new generation of fully articulating myo-electric hands combining innovative technology with a life-like appearance. Complete with a range of naturally compliant grip patterns. Advanced upper-limb prosthetics (ULP) have made revolutionary bounds in today’s world of human repair. One of the two products now commercially available is this first-to-market prosthetic device with five individually powered digits. This artificial limb looks and acts like a real human hand and represents a generational advance in bionics and patient care. This mechanical part is meant to integrate with the human body without impairment. This device was developed using leading-edge mechanical engineering techniques and is manufactured using highstrength plastics. The result is a next-generation prosthetic device that is lightweight, robust and highly appealing to both patients and healthcare professionals. It is controlled by a unique, highly intuitive control system that uses a traditional two-input myoelectric (muscle signal) to open and close the hand’s life-like fingers. Myoelectric controls utilize the electrical signal generated by the muscles in the remaining portion of the patient’s limb. This signal is picked up by electrodes that sit on the surface of the skin. Existing users of basic myoelectric prosthetic hands are able to quickly adapt to the system and can master the device’s new functionality within minutes. For new patients, this device offers a prosthetic solution that has never before been available. Patients claim that the new hand seamlessly works with their natural body functions and allows for complete control in any situation. No longer do they feel ashamed or embarrassed to have a prosthetic. 01.18
Elegantly designed, this bebionic hand is a new generation of the fully articulating myo-electric hands. Grasping everyday objects with precision and ease is possible due to the compliant surface and multiple grip patterns.
01 The Hand In order to be considered a “hand,� there must be fingers and the thumb with which to grasp objects. Fingers and the thumb should fold over the palm. Humans have two hands. It is very important to note that recreating the hand takes lots of thought and coordination between the several hundred moving parts. Working a bionic hand is like orchestrating a symphony.
02 Brain Control Featuring individual motors for each digit the hand moves and grips things in a natural and coordinated way, providing very compliant and conformable grips around complex shapes. On board microprocessors constantly monitor the positions of the fingers so that grip sequences are accurate every time. This hand electronics can sense if a gripped object is slipping and automatically tightens that grip to maintain a secure and safe hold on said object.
The hand is controlled by the brain. The right hand is controlled by the left hemisphere of the brain and the left hand is controlled by the right hemisphere. The brain sends signals to the hand, telling it what it wants it to do.
This new hand has two user selectable thumb positions; the opposed or non-opposed, with an in-built sensor detecting the position. The nonopposed position can control key grip and finger point whilst the opposed position controls tripod and power grip in different scenarios.
03 Finger Control
Designed with such robust assembly providing impact resistance, the fingers can also feature spring returns so that the fingers move naturally when passively flexed or such as brushing past someone on the street without harm.
04 Function
Two main muscle groups take that message and accomplish movement in the hand. The extrinsic muscles extend from this forearm in the form of flexors and extensors. Intrinsic muscles are located inside the hand.
In the non-opposed setting, the four fingers partially close. The thumb then closes onto the side of the index finger. The thumb position may be raised and lowered without moving the other four fingers allowing for release, capture or reposition of the object being gripped. This pattern is ideal for carrying paper or letters and for holding a thin flat object such as a plate or tray, a credit card or a key.
Also with the thumb in the non-opposed setting, the user can then automatically move to a finger point position without having to manually position the fingers. The middle, ring and small fingers are closed against the palm and the thumb is driven against the index finger. Once this position is selected, typing on a keyboard or input pad, pressing a bell or a button can be achieved. This position also puts the hand into the lowest width profile and is the recommended position for dressing and such actions.
05 Finger Adduction The fingers of the bebionic hand move together naturally as the fingers close towards the palm. With the thumb in the non-opposed position and the hand in key grip mode the user can securely grip objects, such as cutlery or the toothbrush, between these fingers to function in an normal everyday manner for certain purposes.
The modular construction of this bionic hand means that each individually powered finger can be quickly removed by simply removing one screw. This means that a prosthetist can easily swap out fingers that require servicing and patients can return to their everyday lives after a short clinic visit. Traditional devices would have to be returned to the manufacturer, often leaving the patient without a hand for many weeks. The grasp of the robotic hand is much more like that of a human hand with the articulating fingers able to close tightly around objects. Built-in stall detection tells each individual finger when it has sufficient grip on an object and, therefore, when to stop powering. Individual fingers lock into position until the patient triggers an open signal through a muscle signal. Where all fingers and the thumb close down together to create a full-wrap grip. This grip would be used to hold a can of drink whilst opening the ring-pull, for example, and for carrying large objects such as a briefcase and/or shopping bag in an everyday scenario without having to think about it.
REACH Advancements Towards A Bionic Arm
In order to make a better arm, engineers first had to figure out what was wrong with the old one. Part of the reason the technology was still in “the ice age” was because of a lack of agility—a human arm has 22 degrees of freedom, not three. This new prosthetic, known as the “Luke arm” named after the remarkably lifelike prosthetic arm worn by Luke Skywalker in Star Wars, is agile because of the fine motor control imparted by the enormous amount of circuitry inside the arm, which enables 18 degrees of freedom. The engineers fought for the space inside the arm and created workarounds when they couldn’t have the space they needed, such as using rigid-to-flex circuit boards folded into origami-like shapes inside the tiny spaces, which are connected by a dense thicket of wiring.
SO EASY, A MONKEY CAN DO IT
In a recent study, a monkey fed itself using a robotic arm electronically linked to its brain. The robotic arm was about the size of a child’s arm, with a fully functional shoulder and elbow, as well as a simple gripper that could hold a piece of fruit or small vegetable.
The monkey’s real arms are restrained in plastic tubes. To control the robotic arm, 96 electrodes—each thinner than a human hair folicle—were attached to the monkey’s motor cortex, the very region of the brain responsible for voluntary movement. Although there is an area of the cortex generally associated with arm motion, the exact placement of the electrodes was not crucial.
With a special computer algorithm, the researchers were able to find an average direction from the small sample of neurons being measured. This average direction is used to move the robotic arm.
01.20
The arm has motor control fine enough for test subjects to pluck chocolatecovered coffee beans one by one, pick up a power drill, unlock a door, and shake a hand. Six preconfigured grip settings can make this possible, with names like the chuck grip, key grip, and power grip. The different grips are shortcuts for the main operations humans perform daily. This Luke arm is also modular, meaning it is usable by anyone with any level of amputation. The arm works as though it had a very complicated set of vacuum cleaner attachments; the hand contains separate electronics, as does the forearm. The elbow is powered, and these electronics that power it are contained in the upper arm part. The shoulder is also powered and can accomplish the never-before-seen feat of reaching up. This arm is less than what a native limb would have weighed, because in an amputee the human skeletal system can no longer be used as a method of attachment. For amputations above the elbow, a user is strapped into a kind of harness. Engineers modeled this arm based on the weight of a statistically average female arm, this including all the electronics and the lithium battery. Amazingly, titanium, the legendarily light material, is too heavy to keep the arm under its weight limit—it can’t be made thin enough without bending—so the arm is mostly aluminum. The discomfort caused by the arm socket, where the prosthesis connects to the body, is one of the crucial reasons patients stop wearing their prosthetics. The traditional connection method is designed to create the greatest possible surface area connecting the native limb to the prosthetic: basically, the amputee’s stump is stuffed into the prosthesis.
ING The last piece of the puzzle was the user interface for controlling the arm. The interface must be completely noninvasive and engineers created the arm to support any means of control. Engineers had recent successes in surgically rerouting amputees’ residual nerves—which connect the upper spinal cord to the 70,000 nerve fibers in the arm—to impart the ability to “feel” the stimulation of a phantom limb. Normally, the nerves travel from the upper spinal cord across the shoulder, down into this armpit, and into the arm. These nerves were pulled away from the armpit and under the clavicle to connect to the pectoral muscles. The patient thinks about moving the arm, and signals travel down nerves that were formerly connected to the native arm but are now connected to the chest. The chest muscles then contract in response to the nerve signals. The contractions are sensed by electrodes on the chest, the electrodes send signals to the motors of the prosthetic arm—and the arm moves. With this surgery, a user can control the Luke arm with his or her own muscles, as if the arm were an extension of the person’s flesh. However, this Luke arm also provides feedback to the user without invasive surgery as well. This feedback is given by the tactor. A tactor is a small vibrating motor— about the size of a bite-sized candy bar—secured against the user’s skin. A sensor on the Luke hand, connected to a microprocessor, sends a signal to the tactor, and that signal changes with grip strength. When a user grips something lightly, the tactor vibrates slightly. As the user’s grip tightens, the frequency of the vibration increases. This enables users to pick up and drink out of a flimsy paper cup without crushing it, or firmly hold a heavy cordless drill and do work without dropping it. In the United States, there are about 6000 upper extremity amputees in a given year. That number has risen due to the wars in Iraq. This arm is the earliest hope for the increasing number of Iraq war veterans who are coming home with injuries or even without arms.
PROTOTYPES
The basic structure of the human arm is most commonly understood to such great degree, but building a replica with functioning parts all under the normal weight of a man’s natural arm is another problem. Luckily, modern materials allow for aluminum alloys to be made so thin enough to house such parts and keep limbs lighter.
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Cylinder Head The cylinder head is sometimes connected to the barrel with a sort of a simple lock (for simple cylinders). In general however the connection is screwed or flanged. Flange connections are the best, but also the most expensive. The flange has to be welded to the pipe before machining. The advantage is that the connection is bolted and always simple to remove. For larger cylinder sizes, the disconnection of a screw with a diameter of 300 to 600 mm is a huge problem.
Piston The piston is a short, cylinder-shaped metal alloyed component that separates the two sides of the cylinder barrel internally. The piston is usually machined with grooves to fit elastomeric or metal seals. These seals are often O-rings, U-cups or cast iron rings. They prevent the pressurized hydraulic oil from passing by the piston to the chamber on the opposite side. This difference in pressure between the two sides of the piston causes the cylinder to extend and retract. Piston seals vary in design and material according to the pressure and temperature requirements that the cylinder will see in service. Generally speaking, elastomeric seals made from nitrile rubber or other materials are best in lower temperature environments.
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Piston Rod The piston rod is so typically a hard chrome-plated piece of cold-rolled steel which attaches to the piston and may extend from the cylinder through the rod-end head. In double rod-end cylinders, the actuator has a rod extending from both sides of the piston and out both ends of the barrel. The piston rod connects the hydraulic actuator to the machine component doing the work. This connection can be in the form of a machine thread or a mounting attachment such as a rodclevis or rod-eye. These mounting attachments can be threaded and welded to the piston rod or are a machined part of the rod-end.
Rod Gland The cylinder head is fitted with seals to prevent the pressurized oil from leaking past the interface between the rod and the head. This area is called the rod gland. This often has another seal called a rod wiper which prevents contaminants from entering the cylinder when the extended rod retracts back into the cylinder. This rod gland also has a rod wear ring. This wear ring acts as a linear bearing to support the weight of the piston rod and guides it as it passes back and forth through the rod gland. In some cases, especially in the small hydraulic cylinders, the rod gland is made from a single integral machined part.
Cylinder Bottom In most hydraulic cylinder heads, the barrel and the bottom portion are welded together. This can damage the inside of the barrel if not done correctly. Therefore some cylinder designs have the screwed or flanged connection from the cylinder end cap to the barrel.
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Anatomy of a Bionic Arm The parts used to make up a robotic arm are very similar to those of a small motor or hydraulic mechanism. Each part affects another and the whole system is designed to work together as a synchronized component.
Most prostheses are passive, meaning that they lack the abilities to actively generate propulsion during regular walking.
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A Humanlike Gait Amputees can typically expend about 30 percent and more energy on walking than do most able-bodied persons. And there’s often complaints about lacking endurances. When you walk, ligaments and tendons inside store energy that is produced when the foot hits the ground. That energy is then used to propel the foot forward and produce a walk. Researchers have copied this strategy with a series of springs and a very small, battery-powered motor. The full kinetic energy of forward motion of the walker is stored in a power-assisted spring that is then released to help propel the foot forward as it pushes off of the ground behind, creating a steady rhythm. The bionic foot is about 20 percent more efficient than the previous prostheses—a significant improvement soon compared with that 3 to 4 percent boost that the researchers have achieved in the past. This difference has been compared to getting on a moving walkway. Engineers are now trying to make the device lighter and mostly robust. The researchers aim to have the commercial version available to the public very soon. When the foot is optimized, people will have the ability to walk more efficiently than normal humans can. The idea here is to recreate the working human foot and allow users to shield their disability and disappear within a crowd of ablebodied persons. This idea of the hidden amputee has been talked about for years and most of the perons who are missing a limb will agree that it is best to allow the general public to assume that they merely have a limp.
THE FUNCTIONS OF THE FOOT
To function normally in gait, the foot must accomplish four major functions. It must be enabled to adapt to the uneven surface, become a rigid lever for the propulsion, translate rotary forces generated by the hip and it must be able to absorb shock. These muscles and tendons work together with the bones, ligaments and joints of the foot to accomplish these goals. If one of those components is not functioning properly, all others may be affected.
During heel strike, the foot acts as a shock absorber and begins to pronate. Pronation can best be understood as the motions involved when the foot rolls in and the arch flattens. As this occurs, the foot “unlocks” and becomes loose. It is during this midstance period that the foot is flexible and able to adapt to uneven terrain. After this, the leg begins to externally rotate and foot begins to supinate. Supination is the opposite of pronation and can be thought of as the motion by which the foot goes from being flat to having a higher arch.
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In the past, the lower extremity artificial limbs have not been designed with true purpose in mind. Researchers have now looked at how people walk and interact with their terrain in order to recreate a better functioning foot or leg in order to propel a person forward and ultimately achieve a full control over their walking pattern and sense of overall balance.
P The skeleton of the foot begins with the talus, or the ankle bone, that forms part of the ankle joint. The two bones of the lower leg, the large tibia and the smaller fibula, come together at the ankle joint to form the very stable structure known as a mortise and tenon joint. The mortise and tenon structure is well known to carpenters and craftsmen who use this joint in the construction of everything from furniture to large buildings. The arrangement is very stable.
The Challenges of Passive Devices According to the National Limb Loss Information Center, 1.7 million people in the United States are living with an amputation, and approximately 300,000 of these are above-the-knee leg amputees. Current lower limb prostheses require amputees to expend significant effort when performing multi-joint-coordinated movements. Normally, human knee and ankle joints generate power during walking and other locomotive functions such as walking up stairs or even slopes. Unfortunately, even sophisticated, state-of-the-art leg prostheses do not generate power during movement; instead, these passive devices rely upon ground force effects and mechanical components such as hydraulic valves or sliding joints for proper function. To control the prosthesis, users must make extra movements with their hips and residual limb. During walking, leg amputees can expend up to 60% more metabolic energy compared with a healthy person. The limitations of passive devices become even more poignant when amputees face stairs and slopes. Amputees must walk up slopes or stairs one leg at a time, with the prosthetic leg lagging behind. Walking down stairs is even more limiting and potentially dangerous. Individuals with two healthy legs dissipate significant power as they walk down a flight of stairs by stepping toe first, which enables the ankle joint to absorb energy; this prevents excessive momentum when descending the stairs. In contrast, amputees must walk down stairs heel first and often cannot control their acceleration, which can lead to falls. In fact, amputees fall as often as elderly persons living in institutions.
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AN UNFAIR ADVANTAGE
Oscar Pistorius, a double-amputee sprinter, has been denied a shot at the Olympics—for being too fast. The runner, who uses carbon-fiber, prosthetic feet, was reviewed by the International Association of Athletics Federations, a review which found the combination of man and machine to be too much for its purely human competitors. According to this report, the “mechanical advantage of the blade in relation to the healthy ankle joint of an able bodied athlete is higher than 30 percent.” Additionally, Pistorius uses 25 percent less energy than average runners due to these artificial limbs, therefore giving him an unfair advantage on the track—or so they say. Oscar is expected to appeal the decision, saying a lack of variables explored by the single scientific study calls for deeper investigation into the matter.
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Integrating Man and Machine Building an outside limb is not like building an organ that may go inside the body. Researchers don’t have to worry about the body accepting the limb as its own, but rather achieving a balance that otherwise would go unnoticed by the wearer since this issue has never been addressed.
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Walking is such commonly misunderstood that it is often neglected in terms of recreation. Sure animators know it, but often designers do not. A Step Forward Using rods to mimic the function of bones allows the bionic leg to function as a normal human leg would. This idea of building from nature’s plan is best used when reconstructing the human.
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The Knee Joint The knee is the most important part of the entire leg. This joint allows for movement and rhythm that otherwise would not be achieved.
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Downfalls 34
Heavy materials are often the downfall of most prosthetic devices. These machanical machines need to be strong enough to hold the weight of an average human being, but also be light enough to strap to the body and be worn for a long time.
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Lower limb amputees have reported that sitting a wheelchair is hard because everyone looks down at you and the fact that your field of vision is lower than everyone else’s makes it difficult to communicate and socialise with able-bodied people. The addition of a bionic leg would raise someone to normal eye level and give the user more confidence in real-world situations such as a social gathering or meeting. A person’s true character is often based on their physical body language and overal posture—a wheelchair cannot give the user any sort of justification on what kind of person they are, people only see the wheelchair.
Being confinded to a wheelchair is a life altering experience that not only affects one’s physical freedom, but mental stability as well. Physically challenged individuals cannot access every area that an able-bodied person might be able to—this is unacceptable. Losing a limb is painful enough, but losing one’s freedom and mobility is even more painful. Robotic limbs will do away with the wheelchair altogether and allow users to travel like they once were able to—like an average bipedal human being.
Disadvantages of the Wheelchair
STEPPING INTO THE FUTURE
03 Replicating the human walk is a tedious process—one which takes a huge amount of moving mechanisms and mathematics. The ability of the human body to remain upright and balanced is the main problem with bionic legs—this idea of harmony is quite difficult to recreate.
Researchers have developed sophisticated software that allows the device to learn on its own about how the user travels over certain terrains and environments. This type of system allows each bioinic leg to be custom programmed to a specific user.
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SEEING
The complexity and perfection of the eye has meant that it has been all but impossible to reproduce its main function artificially. Bionic technology makes this false.
In the past 20 years, biotechnology has become the fastest-growing area of scientific research, with new devices going into clinical trials at a breakneck pace. A bionic arm allows amputees to control the movements of the prosthesis with their thoughts—complete freedom. A training system called “BrainPort� is letting people with visual sight and balance disorders bypass their damaged sensory organs and send information to their brain through the tongue.
Age-related macular degeneration is the leading cause of blindness in the industrialized world, with an estimated two million Americans currently suffering from the condition. The goal is to significantly improve the quality of life for these patients.
The inner layer of the eye is the retina, which contains nerves that communicate sight; behind the retina is the choroid, which contains the main blood supply to all three layers of the eye, including the macula (the central part of the retina which surrounds the optic disc). In the dry (nonexudative) form, cellular debris called drusen accumulate between the retina and the choroid, and the retina can become detached. In the wet (exudative) form, which is more severe, blood vessels grow up from the choroid behind the retina, and the retina can also become detached. It can be treated with laser coagulation, and with medication that stops and sometimes reverses the growth of blood vessels in the eye.
Age-related macular degeneration is the medical condition which usually affects older adults that results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. It occurs in “dry” and “wet” forms. It is a major cause of visual impairment in older adults. Macular degeneration can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other activities of daily life.
NUMBER OF VISUALLY IMPAIRED AMERICANS BY AGE GROUP Although some macular dystrophies affecting younger individuals are sometimes referred to as macular degeneration, but the term generally refers to age-related macular degeneration (AMD or ARMD). Age-related macular degeneration begins with characteristic yellow deposits in the macula called drusen.
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THE BIONIC EYE + COMPONENTS
Anterior Chamber Flood Gate
The space between the cornea and iris filled with Aqueous Humor—where nerves connect.
Aqueous Humor Cornea + Lens
A water-like fluid, produced by the ciliary body, it fills the front of the eye between the lens and cornea and provides the cornea and the lens with oxygen, nutrients and partial fetal matter.
Brain The Main System
The brain is where the electrical signals sent from our eyes are processed into vision. Damage to the brain can lead to vision loss if the visual cortex or optic pathways are damaged.
Choroid Blood Layers
The choroid is a layer of blood vessels between the retina and sclera; it supplies blood to the retina. In the rare disease called Macular Degeneration, abnormal blood vessels may grow into the space between the retina and choroid.
Ciliary Muscle
The eye can bring the fine print in a phone book into focus, or focus in on the moon over ¼ million miles away. The ciliary muscle changes the shape of the lens, this is called accommodation.
Conjunctiva
The conjunctiva is a really thin, clear membrane covering the front of the eye and inner eyelids.
Cornea Sensitive
The cornea is a clear, dome-shaped surface that covers the front of the eye. It is the first and most powerful lens in the eye’s whole optical system. To keep it transparent the cornea contains no blood. Crystalline Lens
The eye’s crystalline lens works exactly like the adjustable lens like your camera. Positioned just behind the cornea; it is so responsible for keeping images in focus on the retina.
Biotechnology has become the fastest-growing area of scientific research, with new devices going into clinical trials at a breakneck pace. A bionic arm allows amputees to control movements of the prosthesis with their thoughts. A training system called BrainPort is letting people with visual and balance disorders bypass their damaged sensory organs and instead send information to their brain through the tongue. Now, a company called Second Sight has received FDA approval to begin U.S. trials of a retinal implant system that gives blind people, and those who have suffered vision loss over time, a limited degree of vision. The Argus II Retinal Prosthesis System can provide sight—the detection of light—to people who have gone blind from degenerative eye diseases like macular degeneration and retinitis pigmentosa. Ten percent of people over the age of 55 suffer from various stages of macular degeneration. Retinitis pigmentosa is an inherited disease that affects about 1.5 million people around the globe. Both diseases damage the eyes’ photoreceptors, the cells at the back of the retina that perceive light patterns and pass them on to the brain in the form of the nerve impulses, where the impulse patterns are then interpreted as seen images. This system takes the place of these photoreceptors and changes the way the industry used to approach the job of vision regeneration. With further trials, researchers plan to achieve full, perfect vision or something even better than what regular-sighted people can see. This test of might will determine whether mankind will be able to overcome the inevitability of blindness and disease.
BLINDLESS Living with visual impairment + finding solutions to common problems.
When the pulses reach the retinal implant, they excite the electrode array. The array acts as the artificial equivalent of the retina’s photoreceptors. The electrodes are stimulated in accordance with the encoded pattern of light and dark that represents the horse, as the retina’s photoreceptors would be if they were working (except that the pattern wouldn’t be digitally encoded). The electrical signals generated by these stimulated electrodes then travel as neural signals to the visual centers of the brain by way of the normal pathways used by healthy eyes—the optic nerves. In macular degeneration and retinitis pigmentosa, the optical neural pathways aren’t damaged. The brain, in turn, interprets these signals as a horse. It takes some training for subjects to actually see a horse. At first, they see mostly light and dark spots. But after a while, they learn to interpret what the brain is showing them, and they can eventually perceive that pattern of light and dark as a horse in some sort of setting.
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Some experimental treatments for retinal problems include a cybernetic replacement and a transplant of fetal retinal cells.
This entire system runs on a battery pack that’s housed within the video processing unit. When the camera captures an image—of, say, a horse— the image is in the form of light and dark pixels. It sends this image to the video processor, which converts the horse-shaped pattern of pixels into a series of electrical pulses that represent “light” and “dark.” These processors send these pulses to a radio transmitter in the implant, which then transmits the pulses in radio form to a receiver implanted underneath the subject’s skin. The receiver is directly connected via some cables to the electrode array implanted at the back of the brain.
RETINA REPLACEMENT
Researchers are hoping to implant replacement rentina’s into approximately 25 million patients suffering from retinal disease. Several of the earliest versions of these implants were nearly ready to be brought to market. One such implant was a wireless retinal prosthesis designed by the Boston Retinal Implant Project. These electronic retinal implants work by connecting to the existing retinal nerve cells which pass the electronic pulses of information from the eye to the brain cells. The camera is mounted on a faux eye and transmits images wirelessly to a chip implanted in place of the retina.
01 Lens The crystalline lens is a transparent, biconvex structure in the eye that, along with the cornea, helps to refract light to be focused on the retina. The lens, by changing shape, functions to change the focal distance of the eye so that it can focus on objects at various distances, thus allowing a sharp real image of the object of interest to be formed on the retina. This adjustment of the lens is known as accommodation. 02 Pupil The pupil is a hole located in the center of the iris of the eye that allows light to enter the retina. It appears black because most of the light entering the pupil is absorbed by the tissues inside of the eye. In humans the pupil is round, but other species, such as some cats, have slit pupils. In optical terms, the anatomical pupil is the eye’s aperture and the iris is the aperture stop. The image of the pupil as seen from outside the eye is the entrance pupil, which does not exactly correspond to the location and size of the physical pupil.
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03 Cornea The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Together with the lens, the cornea refracts light, with the cornea accounting for approximately two-thirds of this total optical power. In us humans, the refractive power of the cornea is approximately 43 dioptres.
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04 Ciliary Muscle The ciliary muscle is a ring of striated smooth muscle in the eye’s middle layer (vascular layer) that controls accommodation for viewing objects at varying distances and regulates the overall flow of aqueous humour into Schlemm’s canal. The muscle has parasympathetic and sympathetic innervation at all times.
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05 Conjunctiva The conjunctiva is a clear mucous membrane consisting of cells and underlying basement membrane that covers the sclera (white part of the eye) and lines the inside of the eyelids. It is composed of a rare stratified columnar epithelium which may deteriorate over time.
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06 Orbital Muscles Six muscles that are responsible for eye movement. Four of the orbital muscles move the eye up, down, left, and right. The other two control the twisting motion of the eye when the head is tilted. Defects in these muscles and the nerves that control them may lead to conditions such as nystagmus and amblyopia, or “lazy eye”. 07 Sclera The sclera, also known as the white or white of the eye, is the opaque (usually white, though certain animals, such as horses and so lizards, can have black sclera), fibrous, protective, outer layer of the eyes containing collagen and elastic fibers that prepare the eye for damage.
Neuroprosthetics + Advancements Neuroprosthetics, or neural prosthetics, is the discipline concerned with developing neural prostheses. Neural prostheses are a series of devices that can substitute one motor, sensory or cognitive modality that might have been damaged as a result of an injury or a disease. Cochlear implants provide an example of such devices. These devices substitute the functions performed by the ear drum, while simulating the many frequency analysis performed in the cochlea. A microphone on an external unit can gather the sound and thus processes it; the processed signal is then transferred to an implanted unit that stimulates the auditory nerves. There is also another side to this application of neural prostheses. These implantable devices can also be used in animal experiments as a tool for neuroscientists to develop a better understanding of how the brain works. Wireless electrical recording from the brain of an awake, freely behaving animal can open many important doors into understanding how the brain handles different functions. Accurately probing and recording the electrical signals in the brain would help better understand the relationship among a local population of neurons that are responsible for a specific function. In order to substitute modalities, we need to first understand them.
There are many challenges which must be overcome in order to develop these devices. Any implanted device has to be very small to be to minimally invasive, especially in the brain, eye or cochlea. Also this implant would have to communicate with the outside world wirelessly. This bidirectional wireless communication requires a very high bandwidth for real-time data transmission; this is a great challenge considering that this data link has to operate through tough skin. The minimal size of the implant means no battery can be embedded in the implant. Instead, the implant works on wireless power transmission through the skin. This is just as challenging as the data transmission. The tissues surrounding the implant are usually very sensitive to temperature rise so the implant must have very low power consumption in order to assure it won’t harm the tissue. And another very important issue is translating all this information into a bionic mechanical part that will integrate seamlessly into the human body. This is where the world of engineering takes over and analysizes how we function and why we move the way we do. A bionic eye is a whole different animal because vision is a tricky subject to recreate.
The Heart + Its Functions
Starting in the right atrium, the blood flows through the tricuspid valve to the right ventricle. Here, it is pumped out of the pulmonary semilunar valve and travels through the pulmonary artery to the lungs. From there, blood flows back through the pulmonary vein to the left atrium. It then travels through the mitral valve to the left ventricle, from where it is pumped through the aortic semilunar valve to the aorta and to the rest of the body. The deoxygenated blood finally returns to the heart through the inferior vena cava and superior vena cava, and enters the right atrium again.
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Life support, in medicine, is a broad term that applies to any therapy used to sustain a patient’s life while they are critically ill or injured. There are many therapies and techniques that may be used by clinicians to achieve the goal of sustaining life.
The left side collects oxygenated blood from the lungs into the left atrium. From the left atrium the blood moves to the left ventricle which pumps it out to the body. On both sides, the lower ventricles are thicker and stronger than the upper atria. The muscle wall that surrounds the left ventricles is thicker than the wall surrounding the right ventricle due to the higher force needed to pump the blood through the systemic circulation.
These techniques are mainly applied most commonly in the emergency departments, intensive care units and operating rooms. As various life support technologies have improved and evolved, they are used increasingly outside of the hospital environment. For example a patient who requires a ventilator for survival are commonly discharged home with these devices. Another example may include the now ubiquitous presence of automated external defibrillator in public venues which allow lay people to deliver life support in a prehospital environment.
Blood flows through the heart in only one direction, from the atria to the ventricles, and out of the great arteries, or the aorta for example. Blood is prevented from flowing backwards by a series of valves. The heart acts as a double pump. The function of the right side of the heart is to collect deoxygenated blood, in the right atrium, from the body and pump it into the lungs (pulmonary circulation) so that carbon dioxide can be dropped off and oxygen picked up (gas exchange). This happens through the passive process of diffusion which is continuous and involuntary.
Creating an artificial organ that can sustain life without the need of an external power source—life support without the crutch. The ultimate goals of life support depend on the very specific patient situation. Typically, life support is used to sustain life and while the underlying injury or illness is being treated or evaluated for prognosis. Life support techniques may also be used indefinitely if the underlying medical condition cannot be corrected but a reasonable quality of life can still be expected. Artificial hearts and organs can be classified as life support devices, but do not need to be monitored or connected to a central power source or computer system. This allows for a great sense of freedom for the user and allows for better quality of life.
The human heart is a muscular organ that provides the continuous blood circulation through the cardiac cycle and is one of the most vital organs in the human body. The heart is divided into the four main chambers: the two upper chambers are called the left and right atria and two lower chambers which are called the right and left ventricles. There is a thick wall of muscle separating the right side and the left side of the heart called the septum. Normally with each beat, the right ventricle can pump the same amount of blood into the lungs that the left ventricle pumps out into the body. Physicians commonly refer to the right atrium and right ventricle together as the right heart and to the left atrium and ventricle as the left heart.
THE CARDIAC CYCLE
Cardiac muscle has automaticity, which means that it is self-exciting. This is in contrast with skeletal muscle, which requires either the conscious or a reflex nervous stimuli for excitation. The heart’s rhythmic contractions occur spontaneously, although the rate of contraction can be changed by the nervous or hormonal influences, exercise and emotions. For example, sympathetic nerves accelerate heart rate and vagus nerves decelerate it. The rhythmic sequence of contractions is coordinated by sinoatrial and atrioventricular nodes. The sinoatrial node, often known as the cardiac pacemaker, is located in the upper wall of the right atrium and is responsible for the wave of electrical stimulation that may initiate atrial contraction by creating an action potential. Once the wave reaches the AV nodes, situated top the lower right atrium, it is delayed there before being conducted through bundles and back up the Purkinje fibers, leading to a contraction of the ventricles. The delay at the AV node allows enough time for all of the blood in the atria to fill their respective ventricles. In the event of severe pathology, the AV node can also act as a pacemaker; this is usually not the case because their rate of spontaneous firing is considerably lower than that of the pacemaker cells in the SA node and hence is overridden.
TYPICAL ORGAN REJECTION
Transplant rejection occurs when a transplanted organ or tissue is not accepted by the body of the transplant recipient. This is explained by the concept that the immune system of the recipient attacks the transplanted organ or tissue. This is expected to happen, because the immune system’s purpose is to distinguish foreign material within the body and attempt to destroy it, just as it attempts to destroy infecting organisms such as bacteria and viruses. Whenever possible, transplant rejection can be reduced through a serotyping to determine the most appropriate donor-recipient match and through the use of immunosuppressant drugs.
Plastic Meets Flesh The need for bionic heart technology is clear: the backlog of heart disease patients currently waiting for donated hearts is in the thousands. Initially, this mechanical device is used as a temporary replacement for the severely damaged hearts, until a suitable donor heart is available but further study has shown that bionic hearts are capable of sustaining life just as easily and effectively as a normal, human heart. The most critical determining factors of implanting a robotic heart include: age, body size, overall health and a lack of other options. Though the device is still many months away from completion, doctors, ethical advisors and FDA officials know they will have a difficult decision to make when the time finally comes to allow the very first version of this technology to be freely used and monitored from a distance. So far, some users have reported that the heart shows no signs of problematic defects or wear. Patients have had successful trials with the bionic heart and have even participated in sports where the heart is under the most stress. The programming behind the robotic heart is crucial in sustaining life and regulating the body’s natural functions. A heart of this type is designed for full acceptance by the body and since it has no real cell data of its own, it cannot be rejected as easily. Made of a special, flexible plastic, this device integrates easily with the rest of the internal physical makeup. Many organ transplants fail because the recipient may reject the donated organ. Specifically, the proteins of a foreign body are what cause rejection; the recipient cannot combine, at a biochemical level, with the said donor. With artificial technologies, however, rejection is not the problem because the human does not reject plastics. Implantation includes removal of the heart, cuffs are sewn onto the patients own atria, connecting the artificial pumping chamber to the patient’s own vascular structure.
The device has o-rings, somewhat like those used on the space shuttle, to create a tight seal between the device and the patient’s blood vessels extending out to the lungs and eventually to the rest of the body. The heart pumps 60 million times every year, with remarkable accuracy of rate and rhythm. It has to pump the proper volumes through the body’s variously sized vessels, without causing a clot. The device is powered by either an internal battery or a wireless external battery worn around the waist like a belt, but in both cases there are no wires or any other materials penetrating the patient’s skin so as to cause discomfort or potential hazard. Each year, a roughly estimated 670,000 Americans are diagnosed with heart failure, according to the American Heart Association. About 3,100 people are on the heart transplant list at any given time, competing for one of the approximately 2,200 hearts donated each year. The total artificial heart extends the life of the patient until a valid match can be found. There is a study currently running on whether patients can safely leave the hospital and wait for their donor heart at home while using the artificial heart. This would eliminate the need for constant care, but a nurse may be necessary in order to aid the user in times of trouble or panic. Approximately 80 percent of artificial heart recipients—currently more than 850 worldwide—get a permanent transplant within six months. Almost all are transplanted at the one-year mark. The longest anyone has awaited transplant on the device is more than 1,000 days and counting. The process of getting a heart donor is so difficult that researchers are starting to focus more on perfecting the artificial heart.
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The bionic heart resembles the true human heart in every way. Engineers have mastered replication and each component is made to the precise measurement down to the valve.
FIGURE B
Using valves, cylinders and pipes much like a gas engine, this bionic heart pumps blood exactly like a normal heart would. Although powered, this heart is able to maintain good vitals for long periods of time.
FIGURE A
Artificial hearts were once only used to sustain life long enough for a replacement donor, but recent developments have made it possible for bionic hearts to be implanted as permanent organs.
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Future Developments Within the next few years, a variety of new bionic devices will come on the mass market. Researchers are developing an electromechanical heart powered by radio-frequency energy that is transmitted through the skin. A motor drives push plates, which alternate in pressing against the plastic blood-filled sacs to simulate pumping. Patients carry a battery pack during the day and sleep with the device plugged in to an electrical outlet. Several research groups are developing pumps that circulate blood continuously, rather than using a pumping action, since these pumps are smaller and more efficient. In Australia, engineers have been developing a continuousflow rotary blood pump, which is expected to be implanted in a human by 2013. The cardiology department at Ohio State University is developing a plastic pump the size of a hockey puck that is self regulating. This pump is implanted in patients for several weeks until their own heart recovers. Some robotic hearts may be in the form of only a left ventricle assist device or total artificial arteries, depending on the patient’s physical condition. Total artificial hearts are being quickly developed by Texas Heart Institute in Massachusetts. In Japan, researchers have been developing total artificial hearts based on a silicone ball valve system and a centrifugal pump with a bearing system made from alumina ceramic and polyethylene components. Alternatives to the artificial heart and heart-assist pumps are also under development. For instance, a special clamp has been invented that changes the shape of a diseased heart, which is expected to improve the pumping efficiency by up to 30%. Such a device requires minimal invasive surgery to implant and acts more as an alteration than a complete transplant.
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The pleural cavity is a very closed space within which the lung has grown into. As the lung grows, it can pick up a bilayer of pleura and these are named the visceral pleura. Pleura is a membrane that is only single celled. Normally, it would produce a small amount of fluid that fills the gap between the parietal and visceral layers.
THE PLEURA
The lungs will fill the pleural cavities and are divided into 5 lobes. The left lung has 2 lobes and then the right lung has 3 lobes. The bulk of the lung’s surface is against the ribs and is so called the costal surface. Other surfaces include the diaphragmatic and mediastinal. Each lung also has some borders: anterior, posterior and inferior.
LUNG SURFACE
Within the lungs are a lot of small blood vessels that take the blood directly from the pulmonary artery which branches off the heart. Just like the airway, the artery branches into smaller segments.
BLOOD SUPPLY
Air enters right through the nose and then travels down the throat into your system. The trachea divides into two tiny tubes, called bronchi, or the primary bronchus on either side. This division happens just above the level of the heart. The primary bronchus branches into some smaller and smaller sections, starting with secondary and tertiary bronchus, to bronchioles and finally to terminal bronchioles that end in tiny round alveoli.
AIRWAY
The best way to see the various aspects of the pleura is to examine a cross section of the thorax and a frontal section.
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Future Developments The purpose of an artificial lung is to help lung-failure patients survive the tenuous bridge of time between loss of respiratory function and a lung transplant, and to allow a patient whose lungs have undergone trauma, like severe smoke inhalation, to rest and heal. The artificial lungs is small and portable, and is designed to allow patients to remain mobile and therefore stronger for surgery. In healthy lungs, blood vessels absorb oxygen from the blood that is pumped in from the heart, then release carbon dioxide through exhalation. An artificial lung basically imitates the way a normal lung works in each and every way—a perfect replica. The bionic lung consists of a small, cylindrical device called oxygenator that is approximately 4 inches in diameter. A cylindrical bundle of micro-porous hollow fiber membranes woven into a mat is wrapped in multiple layers around a central core. Oxygen flows through the hollow fiber membranes, while blood is circulated though the hollow fiber bundle. The core is spun at approximately 1000 RPM, dramatically enhancing gas exchange, as well as serving as a pump to move the blood through the external circuit. This artificial lung would be very useful in treating patients with chronic diseases like asthma and cystic fibrosis. An enzyme has been studied that, when used to coat the fibers in the artificial lung, accelerates the removal of carbon dioxide from the blood and may reduce the amount of blood that needs to be fed through the device, making it more efficient and even safer for patients with weak immune systems or frail chemistry. According to the National Heart, Lung, and Blood Institute, about 150,000 Americans experience lung failure each year. A third do not survive, and those who do often suffer permanent respiratory damage. One thousand wait in line for lung transplants; 25% will die because their lungs fail them while they hopelessly wait for a proper donor.
The Bionic Lung
It may sound crazy today, but in the next few years, reaching your 60th birthday may come with a body service that sees options for heart, lung, and other essential organs to be replaced with a new robotic model.
Additional Information Credits + Special Thanks This book and printed collateral system was created using Adobe Creative Suite CS5 and Apple Inc. computer hardware. Other program software used was Google SketchUp for 3D model illustration. Typefaces used were Archer Pro in the Hairline and Light weights, Klavika in the Regular weight and Chronicle Text Italic. Posters and book binding produced by Copymat in San Francisco, CA. All other materials printed on Epson heavyweight paper with Epson photo inkjet printers and genuine ink products. Š Copyright 2011 Adrian Posadas. Designed by Adrian Posadas. Art direction by Ariel Grey. Academy of Art University School of Graphic Design—Spring Semester 2011. All photos and additional material intended for educational, noncommercial personal purposes only.
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Tomorrow Today 2015 Conference Producers The International Association of Athletics and the University of Pittsburgh is proud to present Tomorrow Today 2015—the second annual robotics expo and prosthetic engineering exhibition. Leading experts from every country working in the fields of medical science, bionics, robotic engineering, space propulsion and physics, cinema graphics, and thermal radiation science are collaborating on Project Replica in order to bring you the furthest in world prostheses technology. Dive into the world of micro-engineering as researchers unveil their latest creations ranging from fully-articulated robotic arms and legs to artificial hearts and lungs that take advantage of the brain’s involuntary nodes. This is the world of tomorrow and we shall embrace it today. The Event Tomorrow Today 2015 will be held at Leipzig Exhibition Center in Leipzig, Germany on July 24 through July 26. Tickets will be sold in advance and will include hotel and flight accommodations. Please arrive early. Day 01 Introductions — Lecture — Demo — Speaker —
Meet The Specialists “What is Bionics?” Robotic Limb Application “Living With Bionic Arms”
Workshop —
Fitting & Evaluation
Q&A —
Open Discussion w/ Leading Professionals
Day 02 Lecture —
“A World Without Donors”
Short Film —
“Keeping Me Alive”
Demo — Speaker —
How Artificial Organs Work “My Second Chance”
Workshop —
Medical Advice & Evaluation
Q&A —
Open Discussion w/ Leading Professionals
Day 03 Lecture — Demo — Speaker —
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“Recreating The Eye” From Eyes to the Brain “Learning To See Again”
Workshop —
Information & Advice
Q&A —
Open Discussion w/ Leading Professionals
Summary —
Closing Presentation