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The marvel of the human machine unavoidably inspires awe. The
coordination within the massive complex of organs that make up our
bodies is nothing short
of miraculous. While each organ performs its individual function, it
also operates in finely tuned concert with the other instruments of
the body to create
the music of life. The nervous system alone, consisting of billions of
neurons, or nerve cells, that allow us to perceive and interact with
the world around
us, makes the finest of humankind's technological developments pale
into insignificance.

Even scientists who devote their entire lives to understanding the
workings of the sensory systems eventually arrive at a gap they've
been unable to bridge
short of taking a leap of faith. Modern technology allows them to
watch an individual's brain waves fluctuate in response to a stimulus
such as sound,
light, or a pinprick. But they still can't look at a spike in waves on
an oscilloscope or changes in images on a brain scan and really
understand how that
stimulus translates into perception. They don't understand how
electrical activity in the brain corresponds to perception, pain,
pleasure, or conscious
awareness.

There's no doubt, however, that electricity is at the root of it all.
Electricity, or the movement of electrons and ions, is such a
fundamental aspect
of nature that it was woven into the fabric of life. A long time
before humankind ever walked the face of the earth, let alone thought
about electronics,
Mother Nature found that electrical signals provide the most efficient
method of transmitting information within the body. No living creature
could survive
without electricity, because the body is, in essence, an electrical
machine. Without electricity, neurons could not communicate the
signals that allow
us to see, hear, touch, smell, taste, and move about, and even think.
We need electricity to interact with the world around us as much as an
electric motor
requires electric power to function. Without it the motor is dead. The
same holds true for human beings. Without electricity there is no
life.

Complete comprehension of how small spikes of electricity lead to
perception and thought still lurks somewhere in the future. But
scientists are making
exponential leaps in understanding the mass of neurons that make up
the brain and the rest of the nervous system that extends from it,
though their task
is akin to counting, categorizing, and understanding the activity of
each star in the universe, as well as its relationship to the whole.
Given this level
of complexity, resulting from the vast number of elements that must
operate perfectly to provide perception, movement, and thought, it is
amazing that
it is not the norm for things to go awry. Yet in the vast majority of
people, the staggering number of components that make up the bodily
systems that
allow us to function in our environment work perfectly, or close to it.
Unfortunately, in some people, the circuitry that generates and
conducts electrical signals goes bad, rendering them unable to fully
partake of the miracle
of the senses, as in the case of the blind, when the rod and cone
photoreceptors inside the eye can no longer translate light into the
electrical signals
that send information to the brain. Or when the hair cells inside the
cochlea of the inner ear, which process sound waves, die off, and a
person loses
the ability to hear. Failure of the body's electrical circuitry is
also responsible for paralysis that occurs when spinal cord injuries
damage the nerve
cells that carry electrical signals from the brain's motor cortex to
the muscles and from the skin's tactile receptors to the somatosensory
portion of
the brain. Until recently, these conditions were deemed irreversible.
Now there is hope.

Through the ability to miniaturize integrated electronic circuitry,
scientists can take concrete steps toward countering the ravages
wrought on those whose
internal circuitry has shorted out, without it being a total act of
hubris. The same methods used to shrink electronic components down to
pocket computer
and digital watch size are now being used to create reliable,
intricate devices small enough to be implanted inside the eye, the
ear, the muscles, and
the brain itself. These manmade, implantable marvels of modern
technology are known as "neural prostheses," devices that directly
interface with some component
of the nervous system. They do so either by feeding electrical
impulses into nerves or muscles or by recording signals from the
nervous system and using
those signals to operate some kind of machine, which itself may be
implanted in the body.

Neural prostheses have the potential to aid the hundreds of thousands,
or perhaps even millions, of individuals with neurological disorders
that disrupt
their ability to move or to communicate. These people have functioning
brains, but because of injury or disease, cannot get the output of
their brains
to the parts of their bodies that should receive the signals or cannot
receive impulses to their brains that would enable them to utilize the
sensory-processing
portions of their brains. Though the idea of mating neural prostheses
to the body has been around for quite some time and a number of early
researchers
did experiments in the field, it is only relatively recently that
scientists have had the knowledge of brain function and the
technological arsenal to
actually create viable neural prostheses.

The first widely used neural prosthesis to be added to the physician's
arsenal against sensory deprivation was the cochlear implant, which
was first embedded
in the inner ears of people with profound deafness in the early 1970s.
Since then, tens of thousands of people have had some measure of
hearing restored
through these devices. Typically, the wearer of a modern cochlear
implant who was completely deaf prior to being implanted, can now
carry on a relatively
normal telephone conversation. The success of cochlear implants helped
pave the way for work on retinal implants designed to give at least
partial sight
to people who are blind and beyond the help of purely medical
ministrations. Utilizing electrodes placed directly on the delicate
retina inside the eye,
retinal implants are intended to replace damaged rod and cone light
receptors that are no longer doing their jobs because of diseases such
as retinitis
pigmentosa and macular degeneration. In addition to feeding signals to
the blinded eye and the deaf ear, researchers are designing systems
that bypass
the primary sensory organs and feed electrical impulses directly into
the visual and auditory cortices of the brain to stimulate sight and
hearing. Such
systems can be used in patients whose eyes and ears cannot process any
signals, even those fed in by means of cochlear and retinal implants
because the
nerves leading from the ears or eyes are too damaged to carry those
signals to the brain. In such cases, bypassing these primary sensory
organs by feeding
signals directly to the brain through electrodes placed on or in the
brain may be the answer.

Another family of electronic implants is currently returning hand
movement to quadriplegics, and the ability to stand and step to
paraplegics. In this
facet of neural prostheses, called functional electrical stimulation,
or FES, scientists are merging humans and machines by implanting
electrodes directly
into the muscles of people with paralysis. Computer-controlled jolts
of electricity stimulate the muscles causing contraction and movement.
This can be
achieved because even though one is paralyzed, one's muscles are
usually intact despite damage to the nerve pathways that feed signals
to them. The first
U.S. Food and Drug Administrationapproved FES device, appropriately
named the Freehand, is giving hundreds of quadriplegics the ability to
feed and groom
themselves, and in some cases implantees can even operate computers
using their hands. Though the Freehand was short-lived as a commercial
product, for
business rather than technical reasons, its developers are still
working to improve the technology. And the FDA-approved Vocare bladder
control system
uses neural prosthetic technology to return bladder and bowel control
to people with paralysis for whom these are major problems. In some
cases, the same
device produces erections in men.

Scientists are also developing technology that may return the sense of
touch to users of FES systems by using electrodes to record signals
from a patient's
own tactile receptors, which along with muscles, remain functional in
spite of paralysis. Early efforts are aimed at improving the grasp
capabilities of
Freehand users, who have only visual feedback, which does not provide
the subtlety of grasp available to the able-bodied. A touch-sensitive
neural prosthetic
system records signals from the tactile receptors in the user's hand
and feeds them directly to the prosthesis's computer, which uses the
information to
adjust the pressure of the grip. Early systems do not enable the
patient to feel what he or she is holding, even though the tactile
feedback system uses
the body's own sensing apparatus to determine the pressure required to
grasp a cup, for example. The hope is to eventually return the sense
of touch directly
to the patient, initially by remote referral. Pressure on the hand
would activate a stimulation device to apply pressure to a part of the
body above the
severed nerves where natural feeling still exists. The ultimate goal
is to record signals from healthy tactile receptors and transmit them
to microelectrodes
implanted directly in the brain's somatosensory cortex, where skin,
muscle, and joint information is processed.

Another twist on the same theme involves sending signals in the
opposite direction. Instead of transmitting them to the brain,
electrodes implanted in
the motor cortex of the brain--where electrical impulses initiating
movement, known as action potentials, are created--can capture
intentions, which would
then be used to activate FES devices. This would be accomplished by
transmitting action potentials recorded by the electrodes in the brain
via a computer
to electrodes implanted in paralyzed muscles, thereby effectively
bypassing the damaged nerves in the spinal cord and allowing wearers
to operate devices,
such as the Freehand, merely by thinking about it, much as able-bodied
people move their limbs. This differs significantly from the current
configuration,
in which the Freehand is operated by a joystick mechanism mounted on a
part of the body unaffected by paralysis, such as the shoulder. The
same brain implants
that send signals to the Freehand via thought could also be used to
operate a robotic arm that would respond to the wishes of the patient,
or to operate
a wheelchair. This technology can also give "locked-in" patients, who
can neither move nor speak because of stroke or disease, such as
advanced amyotrophic
lateral sclerosis (ALS, also known as Lou Gehrig's disease), the
ability to communicate. Though many such patients remain
intellectually astute, they find
themselves in one of the most fearful dilemmas a human can
confront--being totally sentient yet unable to communicate with
anyone. With the neural prosthetic
technology that records their thoughts and allows them to essentially
think a computer into operation, bypassing the need to move a mouse or
type on a
keyboard, locked-in patients can again interact with their fellow human beings.

The same technology that can enhance the lives of people with severe
disabilities also holds the potential to expand the capabilities of
the able-bodied
with as yet undreamed of consequences. The visible wavelength may be
increased, or the ability to hear sounds that only animals with more
sensitive ears
can now perceive may fall within human capability. And learning
capacity and memory may be increased. The U.S. Air Force has looked at
the technology as
a possible way of augmenting the ability of fighter pilots to operate
the highly complex systems in their aircraft. And in what sounds like
science fiction,
but has realistic potential, a leading physician in the study of how
the brain represents tactile information says he believes the brain is
capable of
incorporating a machine into its representation of the body. In other
words, from a sensory standpoint, an autonomous machine could be made
part of a person.
The individual would experience the same sensations as the machine.
This would, for example, enable an earthbound scientist to explore
another planet by
seeing and feeling what a robot actually located on that planet
perceives. By the same token, a safely ensconced individual could have
a machine do all
sorts of nefarious deeds on his or her behalf, essentially without detection.

Though some of the hopes and goals of the scientists involved in
developing neural prosthetic implants may seem far-fetched and perhaps
impossible, experience
has shown that if it can be conceived it can be done, given time,
money, and the tools made available by modern technology. Consider,
for example, the
300-year-old drawing by Isaac Newton of a man on a mountaintop
throwing a ball into a parabolic arc around the earth. During Newton's
time, the idea of
putting a manmade satellite into orbit around our planet would have
undoubtedly been considered the musings of a madman, yet, though it
took hundreds of
years, Newton's dream is today a reality.

It is, therefore, an extremely exciting time for those working in the
field of neural prostheses as well as for those who may benefit from
the fruits of
their labors. But a word of caution is prudent. As is the case with
any emerging field that holds great promise, overzealousness on the
part of some of
those involved can result. Thus, people with disabilities who may, in
fact, someday be aided by developments in this new area of technology
should not
allow their hopes to get unrealistically high. Blind individuals, for
example, should not expect full sight restoration, but instead perhaps
the ability
to see only points of light or shadows that may enhance mobility. And
people with paralysis cannot expect to stand and walk with a normal
gait and without
the assistance of a walker anytime soon. Most researchers in the field
themselves expect only relatively modest gains in the short term.
Neural prosthetic
technology does indeed hold the promise of returning almost normal
functioning to those whose nervous systems are impaired, but that
remains a hope for
future generations. In the meantime, the step-by-step gains will
likely be more modest. Yet as virtually every person who has
volunteered as a test subject
for the research and development currently being conducted has said,
"Something is better than nothing."

But even if some of the loftiest goals of this work are never
achieved, the act of striving toward them will not be for naught. For
it is certain that
neural prosthetic research--especially the facet of it pertaining to
brain implants--will go a long way toward solving the mysteries of
some of biological
science's last frontiers, such as how the brain and sensory systems
function. Through the electrodes implanted in the brains of human
patients, scientists
for the first time have an unobstructed view into the workings of the
brain. "You can tell someone to imagine something, but you can't tell
a monkey to
do that," said Andrew Schwartz, a leading researcher in the field, at
the University of Pittsburgh. "Through the use of language and
comprehension you
can do all sorts of experiments that you could never dream of before,
and the data we could get would be very rich." Through such work,
scientists might
finally be able to understand how perception gets transformed into
consciousness and how a pinprick actually does make you say ouch. In
the meantime, the
quest for better neural prostheses goes on, and though no one is
claiming to be anywhere near bionic nirvana, the pursuit is indeed
electrifying.

Selected Works

Books

Shattered Nerves: How Science Is Solving Modern Medicine's Most
Perplexing Problem
My book is as much about the people involved in this dynamic new field
as it is about the science. In it I tell the stories of the
researchers and of the
patients on whom this technology is being tested, some of whom have
become an intrinsic part of the teams creating these devices.



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