Todd Kuiken: A prosthetic arm that "feels"

174,094 views ・ 2011-10-20

TED


Please double-click on the English subtitles below to play the video.

00:15
So today, I would like to talk with you
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about bionics,
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which is the popular term
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for the science of replacing part of a living organism
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with a mechatronic device, or a robot.
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It is essentially
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the stuff of life meets machine.
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And specifically, I'd like to talk with you
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about how bionics is evolving
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for people with arm amputations.
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This is our motivation.
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Arm amputation causes a huge disability.
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I mean, the functional impairment is clear.
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Our hands are amazing instruments.
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And when you lose one, far less both,
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it's a lot harder to do the things
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we physically need to do.
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There's also a huge emotional impact.
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01:00
And actually, I spend as much of my time in clinic
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dealing with the emotional adjustment of patients
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as with the physical disability.
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01:07
And finally, there's a profound social impact.
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01:10
We talk with our hands.
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01:12
We greet with our hands.
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And we interact with the physical world with our hands.
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01:17
And when they're missing,
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it's a barrier.
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01:21
Arm amputation is usually caused by trauma,
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with things like industrial accidents,
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motor vehicle collisions
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or, very poignantly, war.
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There are also some children who are born without arms,
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called congenital limb deficiency.
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01:36
Unfortunately, we don't do great
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with upper-limb prosthetics.
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There are two general types.
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They're called body-powered prostheses,
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which were invented just after the Civil War,
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refined in World War I and World War II.
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Here you see a patent
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for an arm in 1912.
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It's not a lot different
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than the one you see on my patient.
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They work by harnessing shoulder power.
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So when you squish your shoulders, they pull on a bicycle cable.
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And that bicycle cable can open or close a hand or a hook
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or bend an elbow.
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And we still use them commonly,
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because they're very robust
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and relatively simple devices.
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The state of the art
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is what we call myoelectric prostheses.
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02:18
These are motorized devices
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that are controlled
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by little electrical signals from your muscle.
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Every time you contract a muscle,
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it emits a little electricity
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that you can record with antennae or electrodes
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and use that to operate the motorized prosthesis.
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They work pretty well
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for people who have just lost their hand,
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because your hand muscles are still there.
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You squeeze your hand, these muscles contract.
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You open it, these muscles contract.
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So it's intuitive, and it works pretty well.
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Well how about with higher levels of amputation?
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Now you've lost your arm above the elbow.
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You're missing not only these muscles,
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but your hand and your elbow too.
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02:54
What do you do?
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Well our patients have to use
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very code-y systems
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of using just their arm muscles
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to operate robotic limbs.
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We have robotic limbs.
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03:08
There are several available on the market, and here you see a few.
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They contain just a hand that will open and close,
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a wrist rotator and an elbow.
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There's no other functions.
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03:18
If they did, how would we tell them what to do?
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We built our own arm at the Rehab Institute of Chicago
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where we've added some wrist flexion and shoulder joints
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to get up to six motors, or six degrees of freedom.
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And we've had the opportunity to work with some very advanced arms
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that were funded by the U.S. military, using these prototypes,
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that had up to 10 different degrees of freedom
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including movable hands.
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But at the end of the day,
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how do we tell these robotic arms what to do?
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How do we control them?
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Well we need a neural interface,
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a way to connect to our nervous system
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or our thought processes
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so that it's intuitive, it's natural,
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like for you and I.
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Well the body works by starting a motor command in your brain,
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going down your spinal cord,
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out the nerves and to your periphery.
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And your sensation's the exact opposite.
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You touch yourself, there's a stimulus
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that comes up those very same nerves back up to your brain.
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When you lose your arm, that nervous system still works.
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Those nerves can put out command signals.
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And if I tap the nerve ending
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on a World War II vet,
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he'll still feel his missing hand.
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So you might say,
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let's go to the brain
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and put something in the brain to record signals,
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or in the end of the peripheral nerve and record them there.
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And these are very exciting research areas,
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but it's really, really hard.
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You have to put in
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hundreds of microscopic wires
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to record from little tiny individual neurons -- ordinary fibers
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that put out tiny signals
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that are microvolts.
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And it's just too hard
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to use now and for my patients today.
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So we developed a different approach.
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We're using a biological amplifier
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to amplify these nerve signals -- muscles.
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Muscles will amplify the nerve signals
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about a thousand-fold,
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so that we can record them from on top of the skin,
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like you saw earlier.
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So our approach is something we call targeted reinnervation.
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Imagine, with somebody who's lost their whole arm,
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we still have four major nerves
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that go down your arm.
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And we take the nerve away from your chest muscle
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and let these nerves grow into it.
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Now you think, "Close hand," and a little section of your chest contracts.
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You think, "Bend elbow,"
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a different section contracts.
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And we can use electrodes or antennae
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to pick that up and tell the arm to move.
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That's the idea.
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So this is the first man that we tried it on.
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His name is Jesse Sullivan.
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He's just a saint of a man --
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54-year-old lineman who touched the wrong wire
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and had both of his arms burnt so badly
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they had to be amputated at the shoulder.
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Jesse came to us at the RIC
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to be fit with these state-of-the-art devices, and here you see them.
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I'm still using that old technology
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with a bicycle cable on his right side.
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And he picks which joint he wants to move with those chin switches.
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On the left side he's got a modern motorized prosthesis
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with those three joints,
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and he operates little pads in his shoulder
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that he touches to make the arm go.
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And Jesse's a good crane operator,
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and he did okay by our standards.
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He also required a revision surgery on his chest.
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And that gave us the opportunity
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to do targeted reinnervation.
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So my colleague, Dr. Greg Dumanian, did the surgery.
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First, we cut away the nerve to his own muscle,
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then we took the arm nerves
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and just kind of had them shift down onto his chest
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and closed him up.
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And after about three months,
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the nerves grew in a little bit and we could get a twitch.
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And after six months, the nerves grew in well,
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and you could see strong contractions.
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And this is what it looks like.
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This is what happens when Jesse thinks
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open and close his hand,
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or bend or straighten your elbow.
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You can see the movements on his chest,
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and those little hash marks
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are where we put our antennae, or electrodes.
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And I challenge anybody in the room
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to make their chest go like this.
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His brain is thinking about his arm.
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He has not learned how to do this with the chest.
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There is not a learning process.
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That's why it's intuitive.
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So here's Jesse in our first little test with him.
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On the left-hand side, you see his original prosthesis,
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and he's using those switches
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to move little blocks from one box to the other.
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He's had that arm for about 20 months, so he's pretty good with it.
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On the right side,
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two months after we fit him with his targeted reinnervation prosthesis --
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which, by the way, is the same physical arm,
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just programmed a little different --
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you can see that he's much faster
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and much smoother as he moves these little blocks.
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And we're only able to use three of the signals at this time.
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Then we had one of those little surprises in science.
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So we're all motivated to get motor commands
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to drive robotic arms.
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And after a few months,
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you touch Jesse on his chest,
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and he felt his missing hand.
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His hand sensation grew into his chest again
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probably because we had also taken away a lot of fat,
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so the skin was right down to the muscle
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and deinnervated, if you would, his skin.
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So you touch Jesse here, he feels his thumb;
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you touch it here, he feels his pinky.
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He feels light touch
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down to one gram of force.
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He feels hot, cold, sharp, dull,
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all in his missing hand,
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or both his hand and his chest,
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but he can attend to either.
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So this is really exciting for us,
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because now we have a portal,
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a portal, or a way to potentially give back sensation,
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so that he might feel what he touches
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with his prosthetic hand.
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Imagine sensors in the hand
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coming up and pressing on this new hand skin.
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So it was very exciting.
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We've also gone on
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with what was initially our primary population
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of people with above-the-elbow amputations.
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And here we deinnervate, or cut the nerve away,
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just from little segments of muscle
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and leave others alone
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that give us our up-down signals
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and two others that will give us a hand open and close signal.
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This was one of our first patients, Chris.
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09:13
You see him with his original device
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on the left there after eight months of use,
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and on the right, it is two months.
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He's about four or five times as fast
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with this simple little performance metric.
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All right.
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So one of the best parts of my job
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is working with really great patients
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who are also our research collaborators.
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And we're fortunate today
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to have Amanda Kitts come and join us.
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Please welcome Amanda Kitts.
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(Applause)
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So Amanda, would you please tell us how you lost your arm?
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Amanda Kitts: Sure. In 2006, I had a car accident.
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And I was driving home from work,
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and a truck was coming the opposite direction,
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came over into my lane,
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ran over the top of my car and his axle tore my arm off.
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Todd Kuiken: Okay, so after your amputation, you healed up.
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And you've got one of these conventional arms.
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Can you tell us how it worked?
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AK: Well, it was a little difficult,
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because all I had to work with was a bicep and a tricep.
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So for the simple little things like picking something up,
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I would have to bend my elbow,
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and then I would have to cocontract
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to get it to change modes.
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When I did that,
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I had to use my bicep
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to get the hand to close,
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use my tricep to get it to open,
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cocontract again
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to get the elbow to work again.
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TK: So it was a little slow?
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AK: A little slow, and it was just hard to work.
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You had to concentrate a whole lot.
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TK: Okay, so I think about nine months later
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that you had the targeted reinnervation surgery,
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took six more months to have all the reinnervation.
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Then we fit her with a prosthesis.
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And how did that work for you?
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AK: It works good.
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I was able to use my elbow
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and my hand simultaneously.
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I could work them just by my thoughts.
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So I didn't have to do any of the cocontracting and all that.
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TK: A little faster?
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AK: A little faster. And much more easy, much more natural.
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TK: Okay, this was my goal.
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For 20 years, my goal was to let somebody
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[be] able to use their elbow and hand in an intuitive way
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and at the same time.
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And we now have over 50 patients around the world who have had this surgery,
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including over a dozen of our wounded warriors
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in the U.S. armed services.
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The success rate of the nerve transfers is very high.
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It's like 96 percent.
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Because we're putting a big fat nerve onto a little piece of muscle.
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And it provides intuitive control.
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Our functional testing, those little tests,
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all show that they're a lot quicker and a lot easier.
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And the most important thing
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is our patients have appreciated it.
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So that was all very exciting.
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But we want to do better.
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There's a lot of information in those nerve signals,
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and we wanted to get more.
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You can move each finger. You can move your thumb, your wrist.
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Can we get more out of it?
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So we did some experiments
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where we saturated our poor patients with zillions of electrodes
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and then had them try to do two dozen different tasks --
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from wiggling a finger to moving a whole arm
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to reaching for something --
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and recorded this data.
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And then we used some algorithms
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that are a lot like speech recognition algorithms,
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called pattern recognition.
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See.
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(Laughter)
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And here you can see, on Jesse's chest,
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when he just tried to do three different things,
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you can see three different patterns.
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But I can't put in an electrode
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and say, "Go there."
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So we collaborated with our colleagues in University of New Brunswick,
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came up with this algorithm control,
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which Amanda can now demonstrate.
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AK: So I have the elbow that goes up and down.
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I have the wrist rotation
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that goes -- and it can go all the way around.
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And I have the wrist flexion and extension.
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And I also have the hand closed and open.
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TK: Thank you, Amanda.
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Now this is a research arm,
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but it's made out of commercial components from here down
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and a few that I've borrowed from around the world.
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It's about seven pounds,
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which is probably about what my arm would weigh
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if I lost it right here.
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Obviously, that's heavy for Amanda.
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And in fact, it feels even heavier,
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because it's not glued on the same.
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She's carrying all the weight through harnesses.
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So the exciting part isn't so much the mechatronics,
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but the control.
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So we've developed a small microcomputer
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that is blinking somewhere behind her back
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and is operating this
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all by the way she trains it
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to use her individual muscle signals.
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So Amanda, when you first started using this arm,
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how long did it take to use it?
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AK: It took just about probably three to four hours
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to get it to train.
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I had to hook it up to a computer,
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so I couldn't just train it anywhere.
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So if it stopped working, I just had to take it off.
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So now it's able to train
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with just this little piece on the back.
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I can wear it around.
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If it stops working for some reason, I can retrain it.
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Takes about a minute.
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TK: So we're really excited,
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because now we're getting to a clinically practical device.
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And that's where our goal is --
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to have something clinically pragmatic to wear.
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We've also had Amanda able to use
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some of our more advanced arms that I showed you earlier.
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Here's Amanda using an arm made by DEKA Research Corporation.
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And I believe Dean Kamen presented it at TED a few years ago.
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So Amanda, you can see,
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has really good control.
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It's all the pattern recognition.
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And it now has a hand that can do different grasps.
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What we do is have the patient go all the way open
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and think, "What hand grasp pattern do I want?"
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It goes into that mode,
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and then you can do up to five or six different hand grasps with this hand.
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Amanda, how many were you able to do with the DEKA arm?
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AK: I was able to get four.
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I had the key grip, I had a chuck grip,
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I had a power grasp
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and I had a fine pinch.
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But my favorite one was just when the hand was open,
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because I work with kids,
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and so all the time you're clapping and singing,
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so I was able to do that again, which was really good.
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TK: That hand's not so good for clapping.
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AK: Can't clap with this one.
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TK: All right. So that's exciting
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on where we may go with the better mechatronics,
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if we make them good enough
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to put out on the market and use in a field trial.
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I want you to watch closely.
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(Video) Claudia: Oooooh!
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TK: That's Claudia,
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and that was the first time
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she got to feel sensation through her prosthetic.
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She had a little sensor at the end of her prosthesis
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that then she rubbed over different surfaces,
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and she could feel different textures
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of sandpaper, different grits, ribbon cable,
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as it pushed on her reinnervated hand skin.
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She said that when she just ran it across the table,
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it felt like her finger was rocking.
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So that's an exciting laboratory experiment
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on how to give back, potentially, some skin sensation.
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But here's another video that shows some of our challenges.
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This is Jesse, and he's squeezing a foam toy.
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And the harder he squeezes -- you see a little black thing in the middle
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that's pushing on his skin proportional to how hard he squeezes.
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But look at all the electrodes around it.
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I've got a real estate problem.
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You're supposed to put a bunch of these things on there,
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but our little motor's making all kinds of noise
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right next to my electrodes.
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So we're really challenged on what we're doing there.
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The future is bright.
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We're excited about where we are and a lot of things we want to do.
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So for example,
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one is to get rid of my real estate problem
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and get better signals.
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We want to develop these little tiny capsules
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about the size of a piece of risotto
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that we can put into the muscles
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and telemeter out the EMG signals,
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so that it's not worrying about electrode contact.
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And we can have the real estate open
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to try more sensation feedback.
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We want to build a better arm.
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This arm -- they're always made for the 50th percentile male --
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which means they're too big for five-eighths of the world.
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So rather than a super strong or super fast arm,
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we're making an arm that is --
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we're starting with,
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the 25th percentile female --
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that will have a hand that wraps around,
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opens all the way,
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two degrees of freedom in the wrist and an elbow.
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So it'll be the smallest and lightest
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and the smartest arm ever made.
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Once we can do it that small,
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it's a lot easier making them bigger.
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So those are just some of our goals.
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And we really appreciate you all being here today.
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I'd like to tell you a little bit about the dark side,
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with yesterday's theme.
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So Amanda came jet-lagged,
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she's using the arm,
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and everything goes wrong.
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There was a computer spook,
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a broken wire,
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a converter that sparked.
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We took out a whole circuit in the hotel
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and just about put on the fire alarm.
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And none of those problems could I have dealt with,
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but I have a really bright research team.
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And thankfully Dr. Annie Simon was with us
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and worked really hard yesterday to fix it.
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That's science.
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And fortunately, it worked today.
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So thank you very much.
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(Applause)
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