The journey from initial consultation in Chicago to full functionality–say, the ability to slice a lemon with the prosthetic hand while holding it with a natural hand–often takes a year or longer. Patients first undergo a two-hour surgery performed by Greg Dumanian, a Chicago plastic and hand surgeon who has worked closely with Kuiken in developing the procedure. Dumanian identifies the surviving portion of the nerves that previously conducted electrical signals from the spinal cord to the lost limb; then he transfers them to muscles in the chest or upper arm. The nerve that would normally trigger the hand to close might be transferred to part of the chest muscle, for example. (The exact procedure varies according to the patient’s injuries.) When the robotic arm is in place, an electrode on the chest detects contractions in this muscle and sends the signal to the prosthesis. The prosthesis is programmed to interpret that signal as a command to close the hand, and the action typically takes place less than half a second after the chest muscle moves.
The experimental bionic arms are also programmed with pattern recognition algorithms to decipher the rapid series of nerve signals that govern hand and wrist motions. The more than 30 patients who have had the procedure report that they are easily able to slice hot peppers, open a bag of flour, put on a belt, operate a tape measure, or remove a new tennis ball from a container.
Among several experimental approaches to improving prosthetic arms, including transferring nerves directly to a prosthesis and decoding movement signals directly from the brain, Kuiken’s technique is the one that has made the most progress. The former has yet to be tested in humans, and the latter is currently considered too dangerous for most patients, since it requires brain surgery. Kuiken says he views targeted reinnervation as a quicker, more practical way of restoring crucial functions. (His approach won’t help quadriplegics, however, because the nerves need to be intact for the procedure to work.) So far, the procedure is performed only at Kuiken’s rehab center; in ongoing studies, the center is offering it to any patient for whom it’s deemed medically appropriate.
Advanced though it is, the experimental prosthetic is still missing a major function: sensation. If Mitchell were to place her bionic hand on a hot pan, she would have no way of knowing its temperature. Giving the prosthetic sensory capabilities similar to those of a real limb is more complicated than restoring movement. But it’s not impossible. While Kuiken’s procedure focuses on moving motor nerves, which conduct nerve signals from the brain to the muscles, it appears that sensory nerves, which carry signals from the skin to the brain, are affected as well. Patients, including Mitchell, have reported that when certain areas of their rewired chest muscles are touched, they feel as if their missing hand is being touched. Place an ice cube on the chest, and a phantom hand gets cold.
Kuiken, Loeb, and others are studying ways for the bionic arm to make use of this sensory information. For starters, they’ll need sensors that can stand up well to moisture, heat, and the other physical eventualities of daily living. They’ll then need to deliver that sensory information to the wearer.
But what’s clear now is that for the first time, a useful prosthetic arm is in sight. “We’re not trying to make a bionic person who can leap tall buildings and pick up cars,” Kuiken says. “We’re trying to make something that restores a fraction of the incredible function and power and efficiency of a human limb.” For arm amputees like Claudia Mitchell, that means getting a chance that leg amputees have had for years.
Michael Rosenwald is a staff writer at the Washington Post.