Our Cyborgian Future

To my cautious, risk-averse self, the concept of rock climbing is beyond the beyond. I am fascinated, however, by those who’ll go where I would never tread.

I’m also fascinated by the amazing world of biotech, which continually presses against the limits of human health and capabilities—and often extends them for the better.

Both fascinations brought me to a documentary titled “Augmented” and a subsequent discussion among people featured in the film. The documentary was produced by STAT, a news website for health information, in collaboration with NOVA, the PBS television show.

Note: I’m attaching a link to “Augmented,” which is lengthy and contains images that some may find unsettling. It will be available on PBS stations until March 23, 2022. The trailer is available on YouTube here.

We’ll start with our flawed hero. Hugh Herr, PhD, is Professor of Media Arts and Sciences at the MIT Media Lab and co-leader of its Center for Bionics.

Herr began rock climbing when he was very young; by the age of 6, he was considered a child prodigy climber. For years, he spent as much time as he could scaling the mossy cliffs near his Pennsylvania home.

In 1982, when he was 17, Herr and his climbing buddy, Jeff Batzer, ventured up New Hampshire’s Mount Washington in wintry weather. They did so with the bravado of youth: no map, no compass—solely dependent on the wind to guide them.

But the wind changed direction, and they made a wrong turn.

Lost in sub-Arctic temperatures, they spent hours hugging each other for warmth. Herr had fallen into icy waters more than once and could no longer walk. As the hours passed, they prepared themselves for death.

“We both gave up fighting to live,” Herr said. “We rationalized that the sooner we died, the better. We actually stopped hugging each other.”

They were saved when a snow-shoeing woman who had heard they were missing happened upon them. She sped to a skiing search party, who raced down the mountain. A helicopter then landed, fortuitously just before dark, and transported them to a hospital.

Tragically, one member of the search party was killed by an avalanche. His death transformed Herr.

Frostbite claimed both Herr’s legs below the knees. Batzer, his friend, lost the fingers on one hand, toes on one leg, and part of the other leg.

Waking in the hospital after surgery, Herr was angry at himself—less for his own misfortune than for his sense of responsibility for the searcher’s death. He determined he’d do something with his life that would help others.

In rehabilitation, Herr asked the rehab physician if he’d eventually be able to do three things: drive a car, ride a bike, and rock climb.

The physician said yes to driving, with hand devices, but no to the other two.

Many people might have sadly accepted this fate; Herr did not. One year later, though barely able to walk with prostheses, he was back on the mountain.

He felt “completely at home,” he said. “He [the rehab doc] didn’t know me, and it would seem he didn’t know technology.”

Herr fashioned his own prostheses for various points in the climbs. Some had tiny, childlike feet that enabled him to stand on a small ledge; others had lengthy extensions so he could propel himself across distances.

Remarkably, he said he was then climbing better than he had before the accident. He recognized “the extraordinary capability of technology to extend physicality beyond natural limits.”

Determined to push forward, he sought an education in math, physics, engineering, and design. At MIT, his work is focused on making artificial limbs that come close to providing a “normal” human experience, overcoming the phantom limb pain and other difficulties that amputees experience.

This is where the fusion of biology and technology that is biotech gloriously meet. Herr and his MIT team are collaborating with Matthew Carty, MD, a surgeon at Brigham & Women’s Hospital in Boston who directs its Lower Extremity Reconstruction Program. Carty is also an associate professor of surgery at Harvard Med and a research scientist with Herr’s MIT lab.

Carty was on call at the hospital when the Boston Marathon bombing occurred in 2013. In addition to three deaths, at least 17 people lost a limb on site or in the hospital. The tragedy spurred Carty to improve the surgical method of limb amputation to facilitate better patient outcomes. And that’s when he met Hugh Herr.

One speaker in the discussion said the amputation method hasn’t been refined since the Civil War. Carty said amputated limbs don’t look very different from those done two thousand years ago.

Why?

“We didn’t have a way to interface with the residual limb.” But due to advances in biology and technology over the last ten years, the picture has changed dramatically.

At this point in the discussion, I learned more fully the significance of the normal human response that drives these efforts.

Proprioception.

In processes most of us take for granted, Carty explained that our muscles are paired and work in tandem. When we bend our knee, for example, the muscles in the front of the leg extend; the ones in the back contract.

Sensory nerves—proprioceptors—provide feedback to the brain. The existing amputation method “leaves wires hanging,” he said.

Proprioception, also called kinesthesia, is so important that it’s sometimes called the “sixth sense.” According to the Encyclopedia of Neuroscience, it “lets us perceive the location, movement, and action of parts of the body…including perception of joint position and movement, muscle force, and effort.”

The sensory receptors are in our muscles, joints, and skin. The above source notes that “Proprioception enables us to judge limb movements and positions, force, heaviness, stiffness, and viscosity…[and in conjunction with our other senses] to locate external objects relative to the body…”

Consider how important all of this is to an amputee whose “wires” have been left hanging.

So the challenge has been two-fold: pinpoint the location and function of the proprioceptors in the nerves, muscles, and tendons that will remain in the stump so that the surgery leaves them intact, and build an artificial limb in which electrodes inserted into the stump can activate the proprioceptors.

The amputee could then be fitted with a device that would provide the sensation of normal movement.

Enter Jim Ewing.

In the documentary, we meet Ewing as he’s in his car heading toward Boston to have his foot amputated. Asked how he feels, he says: “F—ing terrified.”

Ewing is another rock climber who survived a bad accident: he fell 50 feet, was severely injured, and was left with unbearable ankle pain. The choice he faced was either bone fusion, which would have deprived him of the active life he’d led, or amputation. He had known Herr through the climbing community; after talking with him, he decided on the latter.

As Ewing was the first patient to receive the newly designed amputation, the method bears his name. Thirty people have now received Ewing lower limb amputations, two have received upper limb surgery, and one patient has received a revision procedure to improve his functionality.

The procedure has been in clinical trials, but Carty observed that it’s now being done in various locales—including Sierra Leone, where a mobile unit travels the country. He expects it will soon become the standard surgical practice.

Ewing had agreed to be a guinea pig to help refine the prosthesis, which isn’t yet available. It was fascinating to watch him react as the robotic ankle positioned alongside his stump was being refined.

“My brain felt my foot was still there and acted accordingly. My muscles are firing, and there’s nothing there. It’s mildly traumatic.”

He had raised the big toe on the prosthesis beside him.

Ewing guided the engineers as they probed his stump with electrical charges, telling them when the sensation was too strong, too weak, or off target. According to the team members, Ewing’s feedback has been invaluable to the progress they’re making toward developing a device that, as Herr had said earlier, “links to the human nervous system seamlessly” so that it feels like an integral part of the amputee’s body.

One of the concerns the documentary raises is that of accessibility—because of location, insurance, and other stumbling blocks. Carty says that his team’s patients have not been denied insurance. But insurance coverage, another speaker says, is “all over the place,” and none covers prostheses with microchips to date.

Not surprisingly, interesting discussions also arose about athletes’ abilities to compete being enhanced by artificial limbs—prompting some “normal” competitors to cry foul.

Herr is emphatic that the term “normal” should be banished. He teasingly remarks that future Olympics, featuring slews of “augmented” athletes, will render traditional Olympics boring. He pats his mouth with a feigned yawn to stress his point.

The documentary had begun with Hugh Herr saying he welcomes a future in which humans become more like cyborgs—even being able to take off and fly.

What thoughts and feelings does such a Cyborgian future evoke in you?

Annie