Human Body Shop
February 17th, 2004
Narrator: A new era in medical science is dawning. Scientists are using bionic technology to rebuild the body -- connecting artificial devices to people in ways previously unimagined.
Miguel Nicolelis, M.D., Ph.D.: We are perhaps witnessing the birth of a new area of scientific endeavor ... we are learning that it is possible to replace what biology gave us with something we manufacture.
Narrator: The convergence of miniature electronics with precision surgical techniques, and an ever-increasing understanding of the human body, are allowing doctors to reach new heights in healing. Some work with limbs.
Rickard Brånemark, M.D., Ph.D.: We are rebuilding the patient's body. We are doing something that is not considered possible.
Narrator: Others are attempting to interface electronics with the brain.
Miguel Nicolelis, M.D., Ph.D.: The brain allows us to extend our self to dimensions that you know -- we basically could not even imagine
Narrator: It is uncharted territory for all involved.
Atul Gawande, M.D.: These are scientists who have a reputation, maybe a career, maybe some income at risk. But it doesn't matter as much as having your life on the line the way that the patients do.
Karen Grisdale: We're at the pioneer stage and that's where I like to be ... right at the beginning of something.
Narrator: To regain what they've lost, patients will go to extraordinary lengths -- pushing the limits of safety.
Atul Gawande, M.D.: Patients are perfectly willing to make themselves the guinea pigs. When you're got nothing, people are willing to take unusual chances.
Narrator: Karen Grisdale works as a meals delivery coordinator for the senior center in her hometown of Duxbury, Massachusetts. She hasn't seen anything for almost three decades. And she has never seen her husband Todd.
Karen Grisdale: Have I seen Todd? Never, no. Never. I haven't seen my own face in 27 years.
Narrator: As a diabetic, Karen was susceptible to a condition called diabetic retinopathy.
Karen Grisdale: When I was about twenty-seven, I was driving home from work, and I was approximately a hundred miles away from home and I had a hemorrhage, which basically blocked most of the vision out of my eyes, so I was working with very limited vision.
Narrator: Though she could barely see, Karen pressed on towards home.
Karen Grisdale: The thing that helped me the most was I was following a truck and his lights in the back of the truck you know when he put his breaks on, bingo, you know I could see that very clearly so that was my cue to step on the brake and so that's how I carefully crawled all the way home. It was very frightening.
Narrator: Karen never recovered from the damage to her eyes. Within months of her harrowing drive home, she had gone completely blind.
Karen Grisdale: I have a view of very bland gray, anonymous gray, I like to call it because it's just like being this close to, to a battleship. Whoops, excuse, 'scuse, 'scuse, 'scuse ...
Narrator: Since she lost her sight, Karen has been searching for a way to regain some vision. Now, for the first time, she holds out real hope of overcoming her perpetual darkness. She is putting her faith in an innovative form of artificial vision. It is a groundbreaking system that bypasses the eye and connects camera, computer and brain, to provide wearers with a rudimentary dot outline of objects in front of them.
Karen Grisdale: Just to be able to walk free, to hope for the future. Put somebody in a cave for 27 years and let them come out, and I think they'd get an understanding.
Narrator: The system is still considered experimental and has not yet been approved by the US Food and Drug Administration. So Karen must travel to Lisbon Portugal, to meet with artificial vision pioneer William Dobelle. For over 30 years, Dobelle has been working on ways to restore sight to the blind.
William Dobelle, Ph.D.: My entire adult life, almost 35 years, has been spent investigating artificial vision. I truly think that Braille, the long cane, the guide dog, all will be museum pieces by the end of the century. We are clearly at the beginning of the end of blindness.
Narrator: Though considered a renegade by some, Dobelle is the only person who currently offers a brain-integrated artificial vision system for human use. Karen is one of the pioneers who will now be given a life-altering second chance at sight with Dobelle's system. But first, Karen and Todd enjoy some time exploring this old European city. They have their own unique way of sight seeing.
Todd Grisdale: That's the, umm, statue over here. Very very ornate, columns going over, big Greek columns ending in this in this arch. These buildings all forming these, these sides of this big plaza. It is beautiful. It is absolutely beautiful.
Karen Grisdale: All glassed in or ...
Todd Grisdale: Oh no, the arches are all open.
Karen Grisdale: No, no I know.
Todd Grisdale: And the ... Oh no, it's all open.
Karen Grisdale: It's just what we do. You know I form a picture in my head of what he's describing and then I get my own picture whether it's exactly like it or totally, totally off.
Narrator: Karen hopes that once she is outfitted with the artificial vision system, she can do some sightseeing of her own.
Karen Grisdale: I'd be able to see that monument in the background. Definitely, that, yeah, yeah. Yeah, anything that huge yeah. And I'd be able to see the skyline over there. And buses going by. It's not going to be 20-20 -- it's gonna be a dot matrix. Like looking up in the sky and seeing the stars twinkle into a picture.
Narrator: At Dobelle's offices, Karen meets up with Jens Newman, a patient who has already had the system implanted. He talks her through the equipment.
Jens Newman: So the best thing is to just not look at the size, to look at this as just the very beginning prototype ... .it's a vacation from blindness. It's not something you wear everyday. So here are the glasses ... see the camera on the one side? On the right side? You probably would want more lady-like glasses, wouldn't you?
Karen Grisdale: I'm putting my fingers all over it. Does that mean you'll see my fingerprints?
Jens Newman: I'm afraid you don't see that well with this.
Narrator: Dr. Timothy Deyer tries to make sure that Dobelle's patients understand the limitations of the system.
Timothy Deyer, M.D.: Blindness is such a terrible condition that, patients have so much stock in trying to get some vision back that often they'll hear what I say but won't really understand what I say or won't want to understand what I say. They always believe that they're the one person who it's going to work better for. The one person who they'll be able to see more.
Where we see a building full of windows, pipes, antenna, the patient who's implanted with the device might only see an edge on the front, where the white and black contrasts, an edge on the top where the blue sky and the roof contrast, as well as a line along the back of the building. So it's really sufficient information for them to realize where the road goes, where the building is, and allows them to navigate through the street successfully.
Narrator: The system works by combining several components. A miniature TV camera mounted on a pair of sunglasses sends an image into a set of computers.
These computers simplify the picture and convert its outline into electrical pulses. The pulses run through 144 wires to electrodes that get permanently implanted on the patient's visual cortex. When stimulated, each electrode is designed to create one point of light, called a phosphene. Together, these phosphenes generate a crude shape of the object in the patient's visual field. Ultimately, the accuracy of the image will depend on how many of the 144 electrodes are working as designed. And this depends in part on the success of the surgery to implant them. During the operation, the ends of the implants, called the pedestals, are screwed into the patient's skull. The other ends, the arrays with the electrodes, are placed on the visual cortex -- the vision center of the brain. Concerns about infection at this interface, between the inside of the body and the outside world, caused the United States FDA to ban human testing of such implants in 1978. Dobelle, however, did not share the FDA's concerns. After years of animal testing, he felt that his system was safe enough to use in human trials -- regardless of FDA regulations. So in 1983, he set up shop outside the United States.
Atul Gawande, M.D.: To push ahead and to succeed I -inventing something that's truly new. To make a leap--It means pursuing something that everybody else is ignoring. And often they're constantly saying it's the wrong direction to go. You can't get funding, you can't get the FDA to go along with what you want to do. And then you go offshore or you come up with private money and you try it anyway.
Narrator: Karen has followed Dobelle across the world for a chance at even limited vision. But she has had to weigh her decision on both medical and financial levels. She and Todd have made some hard choices to cover the $100,000 price-tag.
Karen Grisdale: It's a very costly operation. I've had to mortgage my whole life, but, ah, I -- I think it's worth it. I have great expectations of being able to see.
Todd Grisdale: I know how much this means to Karen. If Karen thinks it worth the risk then I'm 100% behind Karen.
Narrator: Unfortunately, Karen faces more risk than Dobelle's other patients because of her diabetes.
Karen Grisdale: I'm hoping that there's no infection. Being a diabetic you don't often heal as well.
Narrator: Diabetes is a condition Dobelle is all too familiar with. He lost his leg to it in 2001.
William Dobelle, Ph.D.: Karen understands the risks of undergoing this procedure as a diabetic, which is greater. In fact, we don't know how to calibrate it. Nobody knows for sure what will happen with this pedestal coming out of her scalp.
Narrator: Nonetheless, both Karen and Dobelle are willing to take the risk.
Atul Gawande, M.D.: The difference between daring and recklessness is almost nonexistent. So, it all depends on whether you get it right or not. If you are wrong, and you're just going down the wrong alley here and you're hurting people, then we call it reckless. And if you succeed, then we say you were daring.
Narrator: William Dobelle is just one among many daring innovators who are willing to push the limits of science to break new ground and help patients with disabilities. Swedish orthopedic surgeon Rickard Brånemark has devoted his career to improving the lives of amputees. He is revolutionizing orthopedics with a surgical technique called osseointegration. In this cutting-edge procedure, he implants a titanium fixture into the patient's femur -- melding inert metal with living bone. This connection vastly improves the way artificial limbs work with the body.
Rickard Brånemark, M.D., Ph.D.: The implant is in the bone working as an extension of the bone. From a functional perspective, we are rebuilding the patient's body.
Narrator: Traditionally, prosthetic legs are connected to the body via a socket system in which a plastic sleeve fits over the residual limb. But this approach can cause grave difficulties for amputees. In addition to poor mobility and discomfort, the airtight vacuum-sealed connection between prosthetic and flesh often causes sores and infection.
Rickard Brånemark, M.D., Ph.D.: I think that osseointegration is better for the amputee because it takes away all the problems related to the socket. I think this is by far the biggest step during the last 500 years.
Narrator: Titanium's ability to adhere with living bone cells is the key to the procedure. The man responsible for discovering the outstanding bio-compatibility between bone and titanium is someone close to Rickard -- his father, Per-Ingvar Brånemark. In the 1950s, Per-Ingvar was studying blood circulation in bone tissue. As part of his research, he placed titanium cylinders in the leg bones of rabbits. But at the end of the experiment he couldn't remove the cylinders as planned. The bone had bonded to the metal.
Rickard Brånemark, M.D., Ph.D.: It was sort of an accident. And it was an offspring from something completely different. Which is kind of fascinating.
Narrator: The elder Brånemark's groundbreaking discovery had its first real impact in the world of dentistry. Approximately one million people worldwide have been treated with osseointegrated dental implants since 1965. But it wasn't until 1990 that Per-Ingvar performed the first operation to connect a residual limb to a prosthetic leg using osseointegration. Rickard assisted in the surgery, and has picked up the charge from there. To date, he has performed over 60 osseointegration procedures.
Rickard Brånemark, M.D., Ph.D.: Titanium seems to be the best material so far because there's been a lot of research and a lot of different hypotheses, but we can say that it works in clinical reality and that might be good enough to start with.
Narrator: The complete process for lower limb amputees involves two surgeries.
Rickard Brånemark, M.D., Ph.D: So inside this titanium container is the fixture. And it's packed in a way to minimize risk of contamination to the surface.
Narrator: First the titanium rod is implanted into the patient's femur. A fluoroscope allows the surgeons to see the inner part of the cavity and steer clear of the bone shell. Six months after the first surgery, the soft tissue around the titanium implant is trimmed away and a fixture called an abutment, is added. This is the piece that will protrude through the skin and directly attach to the artificial limb.
Rickard Brånemark, M.D., Ph.D: As an orthopedic surgeon I've been taught that it's impossible to have something sticking into the bone and permanently penetrating the skin. There must be infections and it will come loose. And of course this is not happening with our osseointegration procedure. We're doing something that's not considered possible.
Narrator: In fact, they have managed to keep infections to a minimum and the procedure has a success rate of over 90%. However there are still risks. If the leg does become infected or if the fixture loosens, Brånemark may have to remove the implant, and with it, more of the leg. This can leave the amputee worse off than before the procedure. After suffering with painful socket prosthetics, Norwegian amputee Erik Ax decided the risk was worth taking.
Erik Ax: The reason I lost my leg was that I was up in the Norwegian mountain with my son hunting. And unfortunately I got shot in my knee. And I had my leg for 14 days. Then they had to amputate it.
Narrator: Following his amputation, Erik struggled with various socket shapes and configurations for eight years, but never managed to find one that fit his residual limb.
Erik Ax: I heard about osseointegration from Dr. Brånemark. And I said then, I want one like that. I applied for this and I got approval from Dr. Brånemark that I was a good patient to do this
Rickard Brånemark, M.D., Ph.D: It's easy for me to introduce this technology, because I really don't take the risk. It's the patients that dare to go for it, try it, take the risk ... I think those are really the persons that made this a good procedure.
Atul Gawande, M.D.: The pioneers have to be both the innovators themselves and the patients ... because the patient is without question the pioneer for putting their lives on the line.
Narrator: Karen Grisdale remains confident with her decision as she heads into brain surgery.
Karen Grisdale: I knew there was an answer out there. I mean I just knew it. Don't know why, but I just knew it.
Todd Grisdale: One of the first things you ever said to me when we met was that you knew you'd be seeing again.
Karen Grisdale: Yeah I knew it.
Karen Grisdale: There's no making a getaway, huh?
Todd Grisdale: Ah, not now.
Todd Grisdale: We'll be praying.... Well, the fun begins.
Narrator: Once anesthetized, Karen is prepped for surgery. Two neurosurgeons, Joao Antunes and Domingos Coitiero bring their operating skills to the table.
Domingos Coitiero, M.D.: We're delivering the system, I mean we're not part of the concept, but we're basically delivering the system to the patient. Somebody has to place the electrodes.
Narrator: The doctors cut and peel her scalp to expose Karen's skull. Two holes are then drilled into her head just above and behind her ears. This is where the pedestals will be placed. Each of the two pedestals is attached to its electrode array via 72 individual wires. Next, in a procedure called a craniotomy, a four-inch wide section of her skull bone is removed. The brain is now accessible and the surgeons can implant the electrodes onto her visual cortex.
Domingos Coitiero, M.D.: So, we slide the electrode array into the visual cortex and the array has a shape that conforms with the occipital lobe so that we know it is exactly in place. We insert the electrodes exactly on the mid-line on each side of the visual cortex.
Joao Antunes, M.D.: We have to keep the cells intact. So any maneuver that can injure the cortical surface, the surface of the brain of course will absolutely jeopardize the result of the surgery
Narrator: Once the surgeons feel the placement of both plates is correct, and are confident there is no internal bleeding, they prepare to close. They use biologic glue to minimize leakage and reduce the risk of infection. Then they put Karen's skull and scalp back into place, suture and staple. With the electrodes and wires tucked into her head, the only outside reminders of the procedure are the two plugs protruding from her skull. The surgery has taken over 4 hours and Todd is eager for some news.
Domingos Coiteiro, M.D.: Hi. Long wait? Things are going well. She's awake, and she's talking and moving everything, so we're all very happy.
Todd Grisdale: Thank you.
Domingos Coiteiro, M.D.: You're very welcome.
Todd Grisdale: Relief. Excuse me, I didn't think I was gonna do that that, but, yeah, relief.
Narrator: Two days after her surgery, Karen is recovering well.
Todd Grisdale: She's talking now, so it's, I think... The pain I think now is manageable. But she definitely still is in pain. Can we come in?
Timothy Deyer, M.D.: How are you feeling?
Karen Grisdale: Well, I mean, I don't think the pain is, on a scale of one to ten, I would say it's probably about a four. It's tolerable.
Todd Grisdale: If you move your head around ...
Karen Grisdale: Oh, yeah, if I quickly move my head then it jumps up to ten
Todd Grisdale: -plus
Karen Grisdale: Ten plus. (Laughs). My head is kind of in one place, so if I'm not looking at you please don't think I'm rude.
Timothy Deyer, M.D.: No problem. No problem... She's doing great. I mean, the level of headaches that she has are significantly better than a lot of the other patients we've had.
William Dobelle, Ph.D.: On her second post-operative day she has a limited amount of pain, the drainage is drying up, so far she's fine.
Narrator: Only four days later, Karen is strong enough to undergo the first big test that will determine whether the implants are working.
William Dobelle, Ph.D.: The first thing we do with any patient is to find out the minimal amount of electricity that is necessary to elicit a phosphene.
Technician: Ready. Now. See anything?
Karen Grisdale: No. See I got all these other things clouding around.
Todd Grisdale: Don't worry about it.
Narrator: Dobelle and his team stimulate a single electrode. Karen should see a phosphene -- a point of light.
Karen Grisdale: No.
Narrator: At first, she sees nothing, so the voltage is increased.
William Dobelle, Ph.D.: Hit it at a higher amplitude.
Karen Grisdale: I see like something down there. I don't know. I can't differentiate
Todd: Is it a dot? A big dot? A little dot?
Karen Grisdale: It's like a twinkling and then it goes away.
William Dobelle, Ph.D.: Try it at a little higher amplitude.
Karen Grisdale: Oh yeah. Like a little twinkle. Yeah. That's exactly what it is. A twinkle.
Technician: Number 41.
Narrator: This is what the team calls first light. It is an important milestone post-surgery.
Karen Grisdale: Indeed. (Laughing). That was definitely a phosphene. Does it matter if I cry? I think I'm going to cry.
Narrator: For Karen, it is a moment of joy and relief. Her visual cortex is functional -- the implant is working.
Karen Grisdale: Oh My God
Narrator: Dobelle is happy with the initial results.
William Dobelle, Ph.D.: So you saw all five of them?
Karen Grisdale: I did!
Narrator: This is a significant step, but it is just the first of many. Six more months of healing are required before the implants can be connected to the camera. Only then will Karen know if the system really works.
Erik Ax is further along on his journey. Both his stage one and stage two osseointegration operations were successful, but it takes more than surgery to get patients back on their feet. The bone anchored implant needs to be trained to accept the patient's full body weight.
Erik Ax: I start training with putting on weight on this scale from 20 kilo and I increase it ten kilo per week until I reach my own body-weight.
Narrator: This can take months of painful and tedious physical therapy. When he started, Erik trained on a bathroom scale balanced atop a chair. But Erik, an engineer by trade and an inventor by nature, improved on this method by combining a digital scale and foot pedestal into one piece of equipment.
Erik Ax: I found that standing looking down to the scale was not as convenient as to have a scale away. And it was most convenient to stay and have support.
Narrator: He calls his device the Axometer -- and hopes it will help future patients with their rehabilitation.
Erik Ax: So I found it was necessary to make something, and -- I made it adjustable for everyone. It can be used every way, and so on, and they liked it here so they took it over and bought it from me.
Narrator: Erik enjoys the freedom his new leg affords him. What once took twenty minutes to attach, now takes twenty seconds.
Erik Ax: The osseointegrated leg is of course, a much much better way of fixing it to the body because it's fixed right on to the femur, to the bone. And it's quite a new feeling than it was with the old socket leg.
Narrator: Erik is nearly as active as he was before his amputation.
Erik Ax: It felt like it had it forever. Like my old leg because this is like my old leg. It's just mechanical. Which is beautiful. Which is for me a new way of living even. A new way of biking ...
Narrator: And he is not the only one showing successful results.
Rickard Brånemark, M.D., Ph.D: What I learned from the amputees is great improvements, like being able to sit in a sofa, being able to play with the kids on the floor that they couldn't really do that with a socket, and now they can.
Narrator: To quantify the improvement, osseointegration patients take part in scientific evaluations that include gait analysis. This hi-tech learning tool combines sensors and 3-D computer systems that allow technicians to analyze a patient's walk before and after surgery.
Lab Tech: The purpose of this is to see how well this person can perform the gait. We have a pre-op session, and then we compare it with a post-op session. So we can see what the difference is in the gait pattern walking with this type of prosthesis, compared to a socket prosthesis.
Narrator: This data will help Brånemark and his team refine the procedure for future patients. The computers and sensors provide useful information. But in the end, only patients can truly testify to the advantages of osseointegration. It is more than just a matter of mobility.
Erik Ax: I'm feeling like in my old leg. It's part of me, this here now, so when you touch it down there I feel it all the way up here.
Narrator: Erik is referring to a phenomenon called osseo-perception. Patients report that they actually have feeling in their artificial limbs.
Erik Ax: You feel if you're walking on hard surfaces, carpets, or lawn, whatever.
Narrator: One patient even claimed he could feel raindrops on his prosthetic foot.
Rickard Brånemark, M.D., Ph.D: What is happening with an osseointegrated implant is that the brain can feel through the implant.
Narrator: Scientists speculate that osseointegrated prosthetics communicate with the brain via neural pathways originating in the bone.
Rickard Brånemark, M.D., Ph.D: When you become an amputee, the areas in the brain that are controlling the limb start to shrink, so the neurons, they don't get any information anymore. Then if you start to put more information into the brain, maybe there is a change in this area again. It's wakening up.
Narrator: Because the number of patients is still small, much remains to be learned about osseo-perception. Currently the procedure is offered in England, Australia and Sweden, where Brånemark and his colleagues have treated only one hundred people. This is a tiny number compared to the 133,000 plus amputations performed worldwide each year.
Rickard Brånemark, M.D., Ph.D: It's not good enough just to come up with an invention and perhaps implement it on a few patients. You should continue to spread that know-how, worldwide
Narrator: Brånemark is on a crusade to offer osseointegration to as many amputees as possible. But it is a mission that involves sacrifice and trade-offs. He has taken valuable time away from surgery to start a company in the hopes of increasing the reach of his procedure -- a choice frowned upon by many of his colleagues.
Rickard Brånemark, M.D., Ph.D: It's been a hard time with all of those around you ... Sometimes colleagues looking at you in a special way, trying that you're not really doing any good clinical work because you dedicate a lot of time to -- to setting up a business.
The problem is that this is a must. Otherwise we will just treat 5 or 10 amputees a year. But it's much tougher than I thought. I didn't see my two oldest grow up because I was working like hell.
Narrator: Erik, for one, is grateful.
Erik Ax: Well, I have one fellow which I really appreciate and that is Richard Brånemark, He has given me a new life, so that's why I want to give him back--as much as I can to tell everyone how great this is.
Rickard Brånemark, M.D., Ph.D: The greatest thing with this is when you have a bad day, you have a patient who says thank you. You gave me a new life.
Narrator: For Erik Axe and Richard Brånemark, the patient/innovator collaboration has been a success story. But the outcome of the partnership between Karen Grisdale and William Dobelle remains to be seen. Nearly six months have passed since Karen's implant surgery, and other than occasional headaches, her recovery has been uneventful. Even with the complicating factor of diabetes, her head has healed without infection, and she is preparing for her trip back to Portugal. If all goes well, she will return home with her artificial vision system up and running. But first Dobelle's team must map her field of vision.
Don: Put your thumb right there. Feel the button in the center of the board. You're gonna hold that thumb on there and when Tony stimulates, you're going to take this hand, and point where you see it. Just hold that finger so that I have time to get the coordinates.
Todd Grisdale: Are you ready Karen?
Karen Grisdale: Something way down there very dim.
Narrator: One by one, each electrode is stimulated.
Karen Grisdale: That's better.
Technician: Positive two. Negative 7.5.
Narrator: The team records each phosphene Karen sees. This allows them to set up the system so that the shapes in her brain correspond to shapes in the real world. Without the mapping, the dots would appear randomly in her field of vision. But the process is not entirely straight-forward, and can be dangerous. The phosphenes are produced by electrical stimulation, and too much voltage can lead to a seizure. This is a risk German patient Klaus Faron knows all too well.
William Dobelle, Ph.D.: Klaus had a minor seizure. It's no big deal, you send him home. You learn from experience. Klaus will come back, he'll be fine, I hope, I trust.
Narrator: Klaus was ok following his seizure, and much to everyone's relief, Karen's mapping session goes off without any complications.
Technician: 2.25 ... , negative 6.
Narrator: However once each electrode has been calibrated, the team determines that only 90 of the 144 are actually working. Since the electrodes are placed on, not in the brain, veins and blood vessels can block the impulses. But 90 phosphenes should still be sufficient to provide Karen with the outline vision promised by Dobelle's system.
Todd Grisdale: Now we've got the mapping done, we know we've got a good grouping of dots. I think close to 90 something out of 144 dots. Which is a pretty good number of dots to be playing with. So now I don't think there's anywhere to go but up.
Narrator: After nearly three decades in the dark, Karen straps 25 pounds of equipment to her body, and flips the switch on what she hopes will be a new life.
Karen Grisdale: I thought I saw something down there.
Technician: Okay. Now, come forward, very easy. You saw something there.
How about ...
Karen Grisdale: A chair! Right there, I saw the edge. Right there.
Narrator: She picks out the corner of a picture frame on the wall. Simple, but successful.
Karen Grisdale: I'm walking around seeing...
Todd Grisdale: Fantastic. This is a hell of a big step. A wonderful step. A long time in the coming and it's wonderful.
William Dobelle, Ph.D.: I don't advocate at this point just throwing away their cane. But, it's tremendously rewarding to see, you know, people that can actually use the system.
Todd Grisdale: Can you see me?
Karen: No ...
Todd Grisdale: I'm over here. Can you see me?
Karen Grisdale: No. I see no phosphenes.
Todd Grisdale: I've been reduced to a couple of pinpoints of light.
Narrator: It is a bittersweet moment.
Karen Grisdale: I'm kind of disappointed. It is not what I expected it to be. I thought after I had the phosphenes you know all twinkling in my eyes that I would see like Bill Dobelle as a shadow of a man draped in diamonds. But it is it is not it is not like that at all.
Narrator: Karen's vision may improve somewhat as she learns how to better interpret the phosphenes. And Dobelle is working on ways to upgrade the equipment. But the system is still far from perfect. Richard Normann, a professor at the University of Utah, has created a competing device to Dobelle's that may end up being more effective -- though it is not yet in human trials. Normann uses much smaller electrodes that actually penetrate the visual cortex, instead of lying on its surface.
Richard Normann: There are strong advantages to putting electrodes that penetrate into the brain the tips of the micro-electrodes are sitting right next to the neurons you're trying to stimulate. And it takes very small currents to stimulate those neurons.
Narrator: This means Normann's electrodes can produce much higher resolution images, and because they use a thousand times less electricity, they should reduce the risk of seizures. While there is always concern about penetrating brain tissue, Normann has demonstrated that his micro-needles can be inserted without causing damage. The penetrating electrodes have another advantage. In addition to sending messages into the brain, they can export signals out of it -- vastly increasing the potential medical applications of the brain-machine connection.
Richard Normann: Once we figured out how this could be done, now that enables other people to come up with even better ideas. So this could be regarded as the new frontier of neuroprosthetics.
Narrator: Miguel Nicolelis, a neuroscientist at Duke University, is using electrodes like these, to create mind-controlled machines that could replace lost limbs, and eventually help people with such conditions as Lou Gering's Disease, strokes, paralysis and more.
Miguel Nicolelis, M.D., Ph.D.: I think that is the pinnacle of brain research, because you would basically mimic brain functions in artificial devices and allow people that have lost these functions to regain their capability to communicate, to interact with their families, to interact with the world, and move.
Narrator: His work requires that he tap directly into the brain and harness the signals it produces.
Miguel Nicolelis, M.D., Ph.D.: It amazes you -- that not only it can be done, that we can listen to the brain, but that now, after 20 years of work, we are starting to have a chance to actually understand what is the language that the brain is using.
Narrator: Like Normann, Nicolelis is still in the animal testing phase, but studies show that his concept is sound.
Miguel Nicolelis, M.D., Ph.D.: We discovered that we could connect living brain tissue in animals to artificial devices like a robotic arm and have these animals control these devices as if they were their own arms.
Narrator: The breakthrough experiment involved a monkey and a video game. Nicolelis's team inserted a small electrode array into the monkey's cerebral cortex, the seat of perception and volition -- the intention to act. The array was connected to a computer system that recorded the monkey's brain waves. Next, the team trained the monkey to play a simple game. Using a joystick, the monkey had to navigate a cursor into a circle that would appear at random places on the screen. Cameras are not allowed in the primate labs, so Nicolelis's colleague demonstrates the game. Once the cursor was in the target, the monkey squeezed the joystick with the correct amount of force to make the dot expand and fill the circle. When she completed her task within 5 seconds, she received a sip of apple juice -- high incentive for a monkey.
Miguel Nicolelis, M.D., Ph.D.: They love juice, so we give them a lot of juice. So the monkey learns slowly that -- to get a, a reward he has to move the cursor into the target, and then when he gets there, he has to squeeze the joy stick and produce enough force to hold that virtual object for a few milliseconds.
Narrator: Nicolelis then had to make sense of the patterns coming out of the monkey's brain as she performed her task.
Miguel Nicolelis, M.D., Ph.D.: Throughout the period the animal is enjoying and learning the video game we are recording the brain activity from many areas in the brain and trying to extract from these areas the information that is needed to make these cursor movements.
Narrator: In other words, Nicolelis was recording the specific brain signals that instructed the monkey's arm to move the cursor.
Miguel Nicolelis, M.D., Ph.D.: So I am going to show you now how a brain cell sounds.
Narrator: This is the sound of electrical impulses firing between neurons.
Miguel Nicolelis, M.D., Ph.D.: So basically what you are listening to is the intention of the monkey to move his arm.
Narrator: Nicolelis can hear miniscule differences in the firing patterns -- the instructions in the brain that tell the monkey's body what to do.
Miguel Nicolelis, M.D., Ph.D.: She's quiet now. Now she is moving. More quiet again. Taking her time. Enjoying life. She is a Brazilian monkey after all. OK, here she goes.
Narrator: The spikes on the display indicate an increase in brain activity as the monkey prompts the muscles in her arm and hand to move in specific directions and with specific force.
Miguel Nicolelis, M.D., Ph.D.: Now there is a moment where they are doing that really well -- they're enjoying the video game a lot -- that we do a little trick.
Narrator: Nicolelis switches off the joystick, making it impossible for the monkey to move the cursor with her arm. Although the joystick is no longer functional, the electrode array in her brain still picks up the electrical signals that she is sending to her arm. The computer converts the signals directly into instructions for the cursor.
Miguel Nicolelis, M.D., Ph.D.: She will continue to play the game, and we say, "Oh my goodness, it's doing the whole thing just by thinking."
Narrator: The monkey quickly learns that she only has to think about moving the cursor to make it move -- and get her juice. So she stops using her arm.
Miguel Nicolelis, M.D., Ph.D.: You can grab that electrical storm coming from the brain, and you can reproduce the movements because the animal continues to imagine his hand movement without making an actual movement of the hand. We are basically simply translating a thought into action
Narrator: Nicolelis then adds one final, all-important step to the experiment. He processes the monkey's brain signals through another computer, and feeds them to a robotic arm, which moves exactly as the monkey's real arm would. The monkey's brain is now controlling the mechanical arm.
Miguel Nicolelis, M.D., Ph.D.: He didn't need to make an arm movement. He had acquired a new arm -- he had acquired an artificial device as an arm.
Narrator: Nicolelis's experiment demonstrates that signals from the brain can be utilized to directly operate an artificial device -- without any help from the rest of the body. The implications are enormous.
Miguel Nicolelis, M.D., Ph.D.: The dream here is to basically one day get a very sophisticated robotic arm reproducing in every detail the movements that a human is capable of making by thinking about it. People that do not have an arm will be able for the first time to experience what it is to have an arm.
Narrator: It is small steps like these that will eventually make the dream of helping people with all kinds of disabilities a reality. But with each new success, there are also setbacks. For Karen Grisdale, progress with her new vision system has slowed, although she continues to practice with the equipment each day. The electrodes are producing phosphenes, but Karen is having real trouble making sense of them.
Karen Grisdale: There's of something going on down here. I don't know what it is.
Narrator: Her daughter Felicia is lending a hand.
Felicia Grisdale: Tell me what you're seeing.
Karen Grisdale: I'm seeing dots and then more dots and then more dots.
Narrator: Though the phosphenes break up the incessant darkness, Karen still needs help learning how to interpret them. And the system itself requires further refinement.
Karen Grisdale: Back and forth. I look back and forth. But the phosphenes definitely are not in the right place. This thing is heavy after a while.
My expectations have changed -- what I first thought I was going to see a perfect matrix of just perfect outlines of people and doors and windows and just everything. But I'm just seeing a lot of phosphenes that may or may not have anything to do with what I'm looking at
Narrator: The system is not providing Karen with the sight she expected. But she still has hope for herself, and for patients who will follow.
Karen Grisdale: It's just the thought of me as an individual helping others -- maybe 10 years, maybe 20 years down the line, that -- that's very important to me. I'm the guinea pig. I'm ground zero here. Its only gonna get better and better and better.
Narrator: The optimism of people like Karen is what will ultimately push technology forward. For at the end of the day, it is up to the patients and innovative scientists, who are willing to take the risks that will determine what is truly possible.
Miguel Nicolelis, M.D., Ph.D.: You may not see in your lifetime the end result of your lifetime work, but you know that someone will take that banner from your hand and will continue and will take that further. And one day down the road ... they'll say that was the dreamer and we are only here now because he did have a dream that was perhaps beyond his time, but he pursue it his whole life, and that's the only reason we can accomplish something today.
Produced and Directed by
Co-Producer and Editor
GERALD BECK, DDS, MS
KERSTIN BERGSTROM, CDT, MDhc, ANAPLASTOLOGIST, SAHLGREN UNIVERSITY
BRÅNEMARK OSSEOINTEGRATION CENTER
ROBERT C. COGHILL, PhD, WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE
THE DOBELLE INSTITUTE (PORTUGAL) LDA.
JAMES H. DOUNDOULAKIS, DMD, MS, FACD
HANGER PROSTHETICS AND ORTHOTICS
S. WILLIAM LEVY, MD
MKMEDIA PRODUKTION AB
JOHN A. MORAN EYE CENTER, UNIVERSITY OF UTAH
NATIONAL MUSEUM OF HEALTH AND MEDICINE
PROSTHETICS OUTREACH FOUNDATION
PAULA SAUERBORN, MA, ANAPLASTOLOGIST, CENTER FOR PROSTHETIC RESTORATION, INC.
THE SEEING EYE
SPECIAL COLLECTIONS DEPT., J. WILLARD MARRIOT LIBRARY, UNIVERSITY OF UTAH
THE WHEELCHAIR FOUNDATION, DANVILLE, CALIFORNIA
WORLD REHABILITATION FUND
BRIGHAM AND WOMEN'S HOSPITAL
CBC (AMERICA) CORP.
CENTER FOR NEUROENGINEERING, DUKE UNIVERSITY MEDICAL CENTER
DEPARTMENT OF BIOENGINEERING, UNIVERSITY OF UTAH
DUXBURY SENIOR CENTER
HARVARD SCHOOL OF PUBLIC HEALTH
ROBERT R. MYERS, PhD, UNIVERSITY OF CALIFORNIA, SAN DIEGO
SAHLGREN UNIVERSITY HOSPITAL
Series Open and Additional Graphics
Series Open and Additional Graphics
LANDON VAN SOEST
Series Production Assistant
SUSAN K. LEE
JULIE SCHAPIRO THORMAN
Executive Producers, Engel Brothers Media
Executive in Charge
WILLIAM R. GRANT
An Engel Brothers Media production for Thirteen/WNET New York in association with Carlton International
© 2004 Educational Broadcasting Corporation and Carlton International
INNOVATION was produced by Thirteen/WNET New York, which is solely responsible for its content.