Prosthetics 2009. The goal of RP 2007 was to develop a prosthetics arm that would adapt existing technologies and facilitate numerous, already-existing, non-invasive control methods.

The goal of the RP 2009, on the other hand, was to develop a bionic arm that would mimic a natural human arm as closely as possible, a bionic arm if you will. RP 2009 posed no limitations on possible control methods, these could range from non-invasive methods to implantable nerve-reading sensors.

The RP 2007 contract was given to DEKA research and development corporation headed by Dean Kamen (the inventor of Segway). They created a prosthetic arm dubbed “the Luke arm” in reference to Luke Skywalker, yeah, Luke actually had a hand prosthesis, but you get the idea.

The Luke arm was created in a way that allows numerous control options, like some of the above mentioned artificial arms. Unlike them, the Luke arm has 18 degrees of freedom, which is great because a human arm has 22 degrees of freedom. Also, it weighs 3.6 kilograms, that's approximately 7.9 pounds.

The RP 2009 project, headed by John Hopkins University Applied Physics Laboratory, with numerous other high-profile partners involved, resulted in a bionic arm design dubbed as the MPL arm. MPL stands for Modular Prosthetic Limb.

As the name suggests it is designed with modularity in mind to allow different configurations for different conditions. Although numerous control methods, such as brain-computer interface and others, were looked upon, the above mentioned targeted reinnervation is the most promising.

According to DARPA, at the moment both bionic arms are undergoing testing in human clinical trials. The continuity is crucial as the DARPA funding ends, at the moment it seems that in some extent developments from this DARPA program will carry on and eventually better prostheses will be available to people.

2.13. The future of bionic arm tech

As of 2008, there were nearly 2 million Americans living with some form of limb loss according to statistics collected by the Amputee Coalition. Just over half of all limb amputations are the result of vascular disease, such as diabetes or peripheral arterial disease, while most of the remaining cases are caused by physical trauma; just under two percent of amputations are due to cancer. Every year, there are about 185 000 amputations which take place at medical facilities throughout the United States.

Limb loss is a condition which will likely affect a greater number of Americans in the years to come. A 2008 paper published by the National Institutes of

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Health predicted that the number of U.S. citizens will increase to 3.6 million by the year 2050, although that number could be reduced with advances in vascular disease treatments. Still, the NIH paper pegged the current rate of Americans living with limb loss at one out of every 190 citizens.

As we were contemplating a return to our evolution of technology series we were reminded that last December we published an article on the history of prosthetic limbs as Hugh Herr was about to receive the National Inventor of the year award from the Intellectual Property Owners (IPO). Herr, a double amputee, is the inventor of the world’s first bionic foot and calf system called the BiOM T2

2.14. The Bionic Bladder

The Medical Council Neurological Prostheses Unit in London has been responsible for producing a radio activated stimulator for controlling the paraplegic bladder. Based on research by Professor G.S. Brindley, this unit is now being manufactured on a small scale by Finetech Engineering, at a cost of about $N23 500. In Christchurch we are fortunate to be involved in this project as the first centre outside the U.K. to use the system.

The controller works by stimulating both the bladder muscle and the outlet sphincter muscle simultaneously. This results in a bladder pressure rise, but a blocked outlet. Fortunately the bladder is a mode of slow acting smooth muscle whereas the sphincter is composed of fast acting striated muscle. When stimulation ceases the sphincter muscle relaxes instantly, but the bladder remains contracted for several seconds allowing urine to escape. Thus by applying bursts of stimulation, a pulsing flow of urine can be obtained. Conversely if continuous stimulation is applied the outlet will be held shut and leakage prevented.

The stimulator consists of two parts: an implanted electrode and receiver assembly, and a handheld transmitter and controller. In use it provides an effective means of emptying the bladder at will and achieving a low residual urine. Hence the risk of urinary tract infection is much reduced, and awkward collecting devices are unnecessary. A side benefit from the use of the stimulator enables some male patients with impaired sexual function to achieve erections.

The three criteria determining suitable candidates for the stimulator are that the nerves from the spinal cord to the bladder are intact, the patient can feel no pain below the chest and the patient has sufficient hand function equipment.

2.15. The Implant

The electrode assembly is made up of six components: the electrode “books”, the receiver block, three sleeves for protecting the cable joints, and a grommet for

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sealing the spinal canal to prevent leakage of spinal fluid. The electrode books are fitted inside the sacral region of the spine, which is made up of the five lowest vertebrae. They are attached to three sets of nerve fibres known as the S2, S3 and S4 roots which control the bladder as well as other muscles in the lower part of the body. Three cables connect the receiver block, situated under the skin on the chest, to the electrode books.

Examined in detail the electrodes consist of silicon rubber “troughs” into which the nerves to be stimulated are laid. The principles are fairly similar to laying pieces of string between the pages of a book, and so for this reason the electrodes are called “books”. Each of the troughs contains three U-shaped platinum electrodes, the middle one being the cathode and the two outer ones being anodes. This method of construction is used to confine most of stimulating field within the electrode and so prevent stimulation of other unwanted nerves.

2.16. Lung patients' on-the-move oxygen lifeline

The Novalung is attached via tubes to the leg veins and arteries or directly to the heart, bypassing the patient's own respiratory system.

It removes carbon dioxide from the blood and re-oxygenates it.

The machine can remain 'plumbed in' to the patient indefinitely, during which time he or she will still be able to inhale and exhale normally

Unlike other oxygenators, the Novalung uses the patient's own blood pressure rather than an external 'engine'.

A portable bionic lung that 'breathes' oxygen directly into the bloodstream is being offered to critically ill patients – handing them valuable extra time while they wait for a transplant.

The Novalung is attached via tubes to the leg or directly to the heart, bypassing the patient's own respiratory system.

It removes carbon dioxide from the blood and re-oxygenates it. The machine can remain 'plumbed in' to the patient indefinitely, during which time he or she will still be able to inhale and exhale normally.

Unlike other oxygenators, the Novalung uses the patient's own blood pressure rather than an external 'engine'.

At this point patients still have to stay on the ICU but the device is small enough – about the size and weight of a large book – to allow them to walk and carry out many normal daily activities while it is attached.

The device is being used by transplant experts at Harefield Hospital in northwest London, and has so far saved the lives of 12 patients needing new lungs.

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Until recently, doctors had few options for those desperately sick patients who were waiting for a transplant because of donor shortages.

Andre Simon, director of transplantation at Royal Brompton & Harefield

NHS Foundation Trust, who has brought the device to the UK from Germany where he used to work, said: 'This is a lifeline for the very sick.

'Not long ago we would put patients in intensive care on respirators, but they didn't do very well and you only bought them a few days. Often it wasn't enough.' In contrast, the Novalung has been able to keep patients alive for months.

A lung transplant involves removing and replacing a diseased lung with a healthy organ from a donor – usually a person who has died.

The device is being used by transplant experts at Harefield Hospital in London, and has so far saved the lives of 12 patients needing new lungs.

The operation is not carried out frequently in the UK, mainly due to the lack of available donors. From April 2013 to April 2014, 179 lung transplants were performed in England. As of June this year, there were 332 patients waiting for the operation.

Those in need of donor lungs have advanced lung disease and are failing to respond to other treatment. They have a life expectancy of less than three years.

Conditions that can lead to this state include chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis; cystic fibrosis, a genetic condition that causes the lungs and digestive system to become clogged up with a thick, sticky mucus; and pulmonary hypertension – high blood pressure inside the vessels that carry blood from the heart to the lungs.

2.17. First Fully Bionic Man Walks, Talks and Breathes

The Bionic Man is the world's first robot human made entirely of prosthetic parts.

He walks, he talks and he has a beating heart, but he's not human – he's the world's first fully bionic man.

Like Frankenstein's monster, cobbled together from a hodgepodge of body parts, the bionic man is an amalgam of the most advanced human prostheses – from robotic limbs to artificial organs to a blood-pumping circulatory system.

Roboticists Rich Walker and Matthew Godden of Shadow Robot Co. in England led the assembly of the bionic man from prosthetic body parts and artificial organs donated by laboratories around the world.

“Our job was to take the delivery of a large collection of body parts – organs, limbs, eyes, heads – and over a frantic six weeks, turn those parts into a bionic

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