A wheelchair-mounted robotic arm controlled by thought alone has been created by scientists at the University of South Florida.

The device could give people with amytrophic lateral sclerosis (ALS) or full body paralysis the ability to perform simple day to day functions that would otherwise be impossible.

“We aren’t reading people’s thoughts,” said Redwan Alqasemi, a scientist at the University of South Florida who, along with Rajiv Dubey and Emanuel Donchin of USF, helped develop the software and hardware. “This is the first time a person with severe disabilities like ALS can perform daily activities for themselves.”

Over time, patients with ALS slowly lose control over their muscle movement, losing the ability to move their arms, legs and eventually all muscles except those around the eye. Patients with ALS have fully functional brains, but have no way to express their thoughts.

EEG scans offer one way for patients with ALS to communicate with the outside world. By fitting patients with a head cap equipped with electrodes and filled with an electrically conductive gel, scientists can monitor particular kinds of electrical impulses coursing through the brain.

In this case, the scientists monitor a particular brain wave called P300, so-called because it lasts about one-third of a second. Reading P300 waves is basically like reading a person’s thoughts, but only in the most coarse kind of way.

For the wheelchair-mounted robotic arm, the person in the wheelchair looks at directional arrows flashing across a small screen. When the arrow points in the direction that they want to go, their brain lights up on the EEG, and the wheelchair or robotic arm moves accordingly.

This doesn’t happen at the speed of thought, however. Turning the wheelchair or moving the robotic arm takes about seven seconds as the arrows cycle across the screen. The wheel chair or arm continues in that direction until it receives a new command.

The wheelchair or arm could move faster, but it might not move as accurately, said Alaqsemi. The next step for the USF scientists is to refine the model’s hardware and software, to increase speed and reliability while cutting down on weight.

“Every pound you take off the robotic arm is another pound of payload that can be lifted,” said Alqasemi.

Right now the robotic arm can lift about four pounds, about the weight of a gallon of milk. In the next version Alqasemi hopes to double the payload.

Lifting a door handle or moving a gallon of milk may seem like simple tasks, but according to Jonathan Wolpaw, who builds brain computer interfaces at the Wadsworth Center in New York, using thought-controlled devices is harder than simply just thinking.

“Our normal muscle movements require practiced skill and control,” said Walpaw. “Controlling brain activity is also a skill that requires practice.”

Reading P300 brain waves is a good system, argues Walpaw, because it doesn’t take a lot of practice to train the brain. With only one WMRA built so far and no current plans to commercialize the design, not many people will get the chance for their brain to learn the new skill. But when commercial models appear in several years, even slow brain computer interfaces could make the impossible, possible.

“It would allow patients with severe disabilities the ability to control their own environment and have some form of independent mobility,” said William Heetderks, Director of the National Institute of Biomedical Imaging and Bioengineering. “It would be very valuable to these individuals.”

Wheelchair arm controlled by thought alone

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Two of the babies were still receiving supplemental oxygen but were inhaling and exhaling on their own.

“They’re doing amazingly well,” said Socorro Serrano, spokeswoman for Kaiser Permanente’s Bellflower Medical Center, where the babies were born nine weeks premature.

The mother, whose identity remains a secret, had not yet been able to hold any of the delicate babies — six boys and two girls — who were born weighing between 1 pound, 8 ounces and 3 pounds, 4 ounces. However, she was able to see them in their incubators Tuesday night.

In lieu of names, the babies have been assigned letters A through H, in the order of their birth Monday morning. The babies’ incubators were being kept near one another in the same room for bonding, said Miriam Khoury, clinical director of inpatient obstetrical nursing at the hospital.

Four of the babies were receiving tube-feedings of donated breast milk, said Khoury.

The stomach of a fifth baby didn’t absorb the milk he was given Wednesday and now was being fed intravenously, said Khoury. Two of the babies that were receiving milk also were being fed through a vein.

The mother has begun pumping breast milk in anticipation of eight hungry babies, said Serrano.

Doctors were surprised by the birth of the eighth baby, because they were only anticipating seven, said Dr. Harold Henry, one of 46 staff members who delivered the babies by cesarean section.

Khoury said the addition of eight babies to the neonatal unit had not stressed the hospital.

“This is history for us, so of course we’re happy,” said Khoury, who helped coordinate the materials needed for the labor.

Details about how the octuplets were conceived have not been released, but doctors not involved in the delivery believe the mother was likely on fertility treatment.

Dr. Daniel Mishell, professor of obstetrics and gynecology at the University of Southern California’s Keck School of Medicine, recommends carefully monitoring pregnancies involving fertility drugs by ultrasound.

Multiple births can be dangerous for babies and their mother, and in some cases, may result in lasting health problems. However, in cases where a woman insists on having multiple births, there’s a limit to a doctor’s role.

“You can’t mandate a reduction of pregnancies,” Mishell said. “You can advise them, but you can’t mandate them.”

The babies were expected to remain hospitalized for several weeks and could face serious developmental delays because of their small size.

The nation’s first live-birth octuplets were born three months premature in Houston in 1998. The tiniest baby, who was born at 10.3 ounces, died of heart and lung failure a week after being born. The others survived.

Mother Nkem Chukwu and father Iyke Louis Udobi had used fertility drugs in the pregnancy.

The Associated Press: Hospital: Calif. octuplets doing ‘amazingly well

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Siemionow and CNN chief medical correspondent Sanjay Gupta talked with CNN’s Larry King about the reconstructive procedure and the prognosis for the patient. The following is an edited transcript of the interview.

Larry King: Dr. Siemionow, what caused the patient to need a new face?

Dr. Maria Siemionow: The patient has a severe deformity of the face after trauma and was missing a nose and missing cheekbones and a large part of the skin and the front of the face, upper lip, lower eyelids. There was a large part of the skin and bone components which were missing, and practically the patient was missing the front of the face.

King: Did you have to find the perfect donor?

Siemionow: No. That’s not what were looking for. We were looking for a possibility of reconstructing this patient’s face in a way that it would replace the missing components and that we would be able, also, to give back this patient’s function, which is probably the most important idea behind this procedure.

Siemionow: Well, the transplant was the transfer of the transplanted face, which included (a) large amount — about 80 percent of the entire face of the patient. It included skin components, bone components, the entire nose, cheekbones, a palette and upper lip and also included the eyelids — the lower eyelids.

King: From another doctor’s standpoint, Dr. Gupta — and I know that you’re not a plastic surgeon, but a brain surgeon — what was the most amazing thing about this to you?

Sanjay Gupta: The face is one of the most complicated areas of the body. I mean, it’s responsible for your facial expression, your ability to eat, your ability to breathe, your ability to speak, obviously. Being able to take all those really, really functional areas that are made up of so many nerves, so many blood vessels — not to mention the cosmetic aspects of it — and making it all come together and work in some sort of functional form is pretty remarkable.

King: Doctor, has the patient seen her new face?

Siemionow: No, the patient has not seen her face, but she touched her face, and she was very happy. She, for the first time a few days ago, just went with her fingers over her face. She felt that she has a nose. She was feeling her lip, and she was very happy.

King: How long did it take (to do the surgery)?

Siemionow: It took 22 hours — 22 hours of many team members of different subspecialties working together, from one afternoon one day into the late afternoon the second day.

Gupta: It strikes me that you found the perfect recipient, someone who’s a good candidate for this operation. Four years, though, it took, Dr. Siemionow. Is that how rare this type of procedure will be?

Siemionow: Yes. Well, you know, we discussed it very extensively, that you want to be sure that in our approach we were looking only at potential candidates who would be a patient who had already exhausted all conventional means of reconstruction. I think it’s very important because you would like to be sure that the patient is not undergoing such a serious procedure without being helped in conventional means before.

However, it is very difficult to reconstruct certain parts of the face, including, for example, lips or including eyelids. Even reconstruction of the entire nose is difficult.

There are plastic surgeons who are doing wonderful reconstructive procedures, but they are also done in several attempts. This takes time and patients suffering and the results not always are presentable.

CNN.com

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It was the world’s first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date.

theage.com.au

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The patient’s name and age were not released, and the hospital said her family wanted the reason for her transplant to remain confidential. The hospital plans a news conference Wednesday and would not give details until then.

The transplant was the fourth worldwide; two have been done in France, and one was performed in China.

Surgeons not connected to the Cleveland case reacted cautiously since little is known about the circumstances, but generally praised the operation.

“There are patients who can benefit tremendously from this. It’s great that it happened,” said Dr. Bohdan Pomahac, a surgeon at Harvard-affiliated Brigham and Women’s Hospital in Boston who plans to offer face transplants, too.

Dr. Laurent Lantieri, a plastic surgeon at Henri Mondor-Albert Chenevier Hospital, near Paris, who did a face transplant on a man disfigured by a rare genetic disease, said: “This is very good news for all of us that doctors in the U.S. have done this.”

Unlike operations involving vital organs like hearts and livers, transplants of faces or hands are done to improve quality of life — not extend it. Recipients run the risk of deadly complications and must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer and many other problems.

Arthur Caplan, a leading bioethicist who has expressed grave concerns in the past about such surgery, withheld judgment on the Cleveland case but said the woman’s doctors should give her the option of assisted suicide if they wind up making her life worse.

“The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell,” said Caplan, bioethics chief at the University of Pennsylvania. “If your face is falling off and you can’t eat and you can’t breathe and you’re suffering in a terrible manner that can’t be reversed, you need to put on the table assistance in dying.”

Siemionow’s long and careful preparation should help prevent such a horrific outcome, those familiar with her said. Siemionow, (pronounced SIM-en-now), 58, a noted hand microsurgeon, has been testing the surgical approach and ways to temper the immune system’s response in experiments for more than a decade.

She has considered dozens of potential candidates over the past four years, ever since the clinic’s internal review board gave permission for her to attempt the operation, and has said she would choose someone severely disfigured as her first case.

“She’s a leader in this field. She’s been investigating this for a long time. She has done the most amount of research in small animals looking at this,” said Dr. Warren Breidenbach, a surgeon at Jewish Hospital in Louisville, Ky., who did the nation’s first hand transplant, in 1999. Siemionow trained with him in Louisville.

The world’s first partial face transplant was performed in France in 2005 on a 38-year-old woman who had been mauled by her dog. Isabelle Dinoire received a new nose, chin and lips from a brain-dead donor. She has done so astoundingly well that surgeons have become more comfortable with a radical operation considered unthinkable a decade ago.

Two others have received partial face transplants since then — a Chinese farmer attacked by a bear and a European man disfigured by a genetic condition. Both are believed to be doing well, though details, especially of the Chinese case, have been scant.

In the Cleveland case, “it is very important what kind of recipient they selected,” and how great the need was, Pomahac (POE-ma-hawk) said. “Hopefully it will open the door both to the public and to other centers” wanting to do these operations.

Details of the Cleveland surgery are not known, but surgeons generally transplant skin, facial nerves and muscle, and often other deep tissue. That is done so the new face will actually function and not just be a mask.

In an interview at the Cleveland Clinic in 2005, Siemionow spoke of the terrible need she saw in people horribly disfigured, and how badly it scarred their social and emotional lives, not just their bodies.

“There are no really good alternative therapies for the severely burned or patients with a facial injury or damage,” she said.

Her task now is to prevent organ rejection while managing the risk of infection from taking strong immune-suppressing drugs.

Rejection is a possibility whenever someone receives an organ or cells from someone else because the body regards this as foreign tissue. Two types of problems can result.

The first is graft-versus-host disease, which could happen if the new facial tissue were to attack the recipient’s body. The second is if the patient’s body were to attack the transplanted face, causing inflammation and other problems at the site of the new tissue.

Either of these can be life-threatening. They can come on suddenly, within days or weeks of the operation, or set in slowly.

The Associated Press:

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Differences in metabolism can make some people more susceptible to diseases such as diabetes and explain why response to diet, exercise and drugs to treat certain conditions varies from person to person.

Knowing right away how a person’s body will break down molecules in the blood that build up muscle and cells and provide energy could lead to better care, said Karsten Suhre, a researcher at the Helmholtz Center in Munich.

The researchers scanned the genes of 284 people and found four — FADS1, LIPC, SCAD and MCAD — linked to determining metabolic rates.

“These genes appear to be involved or play a key role in metabolism,” Suhre said in a telephone interview.

This potentially paves the way for more personalized health care in which doctors could use knowledge of a patient’s metabolism gleaned from their genetic make-up to determine treatment, he said.

This could prove particularly useful for treating conditions strongly linked to metabolism such as coronary artery disease and obesity, he added.

“These findings could result in a step toward personalized healthcare and nutrition based on a combination of genoytyping and metabolic characterization,” Suhre and colleagues wrote in the Public Library of Science Journal PLoS Genetics.

Reuters

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The groundbreaking technology also means for the first time tissue transplants can be carried out without the need for anti-rejection drugs.

Five months on the patient, 30-year-old mother-of-two Claudia Castillo, is in perfect health, The Lancet reports.

She needed the transplant to save a lung after contracting tuberculosis.

The disease had damaged her airways.

Scientists from Bristol helped grow the cells for the transplant and the European team believes such tailor-made organs could become the norm.

To make the new airway, the doctors took a donor windpipe, or trachea, from a patient who had recently died.

Then they used strong chemicals and enzymes to wash away all of the cells from the donor trachea, leaving only a tissue scaffold made of the fibrous protein collagen.

This gave them a structure to repopulate with cells from Ms Castillo herself, which could then be used in an operation to repair her damaged left bronchus – a branch of the windpipe.

By using Ms Castillo’s own cells the doctors were able to trick her body into thinking the donated trachea was part of it, thus avoiding rejection.

Advanced science

Two types of cell were taken from Ms Castillo: cells lining her windpipe, and adult stem cells – very immature cells from the bone marrow – which could be encouraged to grow into the cells that normally surround the windpipe.

After four days of growth in the lab in a special rotating bioreactor, the newly-coated donor windpipe was ready to be transplanted into Ms Castillo.

Her surgeon, Professor Paolo Macchiarini of the Hospital Clínic of Barcelona, Spain, carried out the operation in June

He said: “I was very much afraid. Before this, we had been doing this work only on pigs.

“But as soon as the donor trachea came out of the bioreactor it was a very positive surprise.”

He said it looked and behaved identically to a normal human donor trachea.

The operation was a great success and just four days after transplantation the hybrid windpipe was almost indistinguishable from adjacent normal airways.

After a month, a biopsy of the site proved that the transplant had developed its own blood supply.

And with no signs of rejection four months on, Professor Macchiarini says the future chance of rejection is practically zero.

“We are terribly excited by these results,” he said.

“She is enjoying a normal life, which for us clinicians is the most beautiful gift.”

Today Ms Castillo is living an active, normal life, and once again able to look after her children Johan, 15, and Isabella, four. She can walk up two flights of stairs without getting breathless.

Professor Martin Birchall, professor of surgery at the University of Bristol who helped grow the cells for the transplant, said: “This will represent a huge step change in surgery.

“Surgeons can now start to see and understand the potential for adult stem cells and tissue engineering to radically improve their ability to treat patients with serious diseases.”

He said that in 20 years time, virtually any transplant organ could be made in this way.

US scientists have already successfully implanted bladder patches grown in the laboratory from patients’ own cells into people with bladder disease.

The European research team, which also includes experts from the University of Padua and the Polytechnic of Milan in Italy, is applying for funding to do windpipe and voice box transplants in cancer patients.

Clinical trials could begin five years from now, they said.

Between 50,000 and 60,000 people are diagnosed with cancer of the larynx each year in Europe, and scientists say about half them may be suitable candidates for tissue engineering transplants.

BBC NEWS

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It is hoped their micro-needle array sensors, which are around the size of a matchstick head, will help amputees move artificial limbs with brain power.

The sensors, which were developed and manufactured by Cardiff University firm MicroBridge Services, comprise of 100 needles just thicker than a human hair.

They sit on the brain and send out nerve impulses to prosthetics.

MicroBridge Services was asked by researchers at Utah university in the United States to develop the micro-needle array sensors in tungsten carbide, an extremely hard material which conducts electricity.

The American team has been leading research in the area and has already been successful in developing an implant which can be used to manipulate computers and prosthetic appendages.

They need the needles, each of which can be up to several millimetres long, to penetrate into the brain to such a depth that they pick up electrical brain activity.

The electrical signals that are detected are amplified and then transmitted and interpreted to produce movements in the prosthetic limbs.

Patients using the implants must learn how to generate the correct mental activity to get responses from the system, but tests have already shown encouraging results, says Dr Robert Hoyle, from MicroBridge Services.

“The researchers in Utah have had patients controlling simple mechanical operations like gripping objects with the prosthetic limbs or operating a mouse,” said Dr Hoyle.

“They came to us because we can make these needles in tungsten carbide which is very strong and robust but extremely difficult to cut to such a small size.

“The more needles you can get on a sensor in the smallest possible area, the better control a patient will get over his or her prosthetic limb.

“The challenge for us now is to make the needles smaller so that we can pack more onto a sensor.”

Dr Hoyle said the researchers’ long term goal was to develop a sensor which would sit on the spinal column of someone who had broken their neck or back.

They could then learn how to move their limbs again.

“There is a lot of research and testing that needs to be done before this becomes a reality,” said Dr Hoyle.

“The research that goes on here is never ending.”

MicroBridge Services was formed to exploit the commercial potential of the research into micro and nano engineering undertaken at Cardiff university.

Already their expertise has been used in the manufacture of tiny components for the instruments used in keyhole surgery.

The firm is part of the XGEN consortium, a Welsh Assembly Government initiative which has united three of Wales’ leading micro engineering organisations.

All three members are commercialising micro nano technology and each are funded by the assembly government and the Technology Strategy Board.

BBC NEWS

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The 38-year-old was rendered infertile when her ovaries failed at the age of 15, causing her to suffer an early menopause. After receiving an ovary transplanted from her twin sister, the woman, who lives in London, is expected to give birth this week.

The pioneering surgery will give hope not only to more than 100,000 British women who suffer an early menopause, but also to those undergoing chemotherapy or radiotherapy for cancer. They could now freeze an ovary before beginning the treatment.

The success also raises the possibility of women freezing ovarian tissue to postpone motherhood for social reasons, such as delaying marriage or not wishing to interrupt their careers.

Unlike IVF, the conventional infertility treatment, an ovary transplant not only allows a woman to conceive “naturally” but also restores hormone levels in women who have suffered an early menopause. The hormones produced in the ovaries – oestrogen, progesterone and testosterone – affect the female body in many ways, including prompting monthly periods and protecting the bones from osteoporosis.

After the ovary transplant, the previously sterile woman had periods for the first time in 22 years. In addition to the joy of becoming pregnant, the osteoporosis she had previously suffered showed signs of improvement as a result of restored hormone levels. The woman’s twin, who already has two children, was prepared to sacrifice one of her ovaries to give her sister the chance of becoming a mother. The baby will, genetically, be the twin sister’s child.

The transplant was carried out in America early last year by Dr Sherman Silber, the microsurgery pioneer of the Infertility Center of St Louis in Missouri.

Silber removed the ovary, which is the size of a walnut, from the donor twin using keyhole surgery. He implanted the ovary into the recipient and had to connect tiny blood vessels, one only a third of a millimetre in diameter, to establish blood flow to the organ.

Three months after the transplant the woman began to ovulate normally and her hormone levels were equal to those of her healthy twin after five months. The woman discovered she was pregnant about a year after the transplant.

Silber, who will discuss the pregnancy at a meeting of the American Society for Reproductive Medicine tomorrow, described the reconnection of the arteries and veins in the transplant as “extremely delicate”.

“Reconnecting these blood vessels deep inside the pelvis can be a tactical challenge. The ovarian artery is less than a third of a millimetre in diameter, in fact so small [that] many gynaecologists have never seen it,” he said.

The transplant from an identical twin made it unlikely that the organ would be rejected. Transplants can be extended to close relatives but immuno-suppressive drugs are needed to prevent rejection of the organ.

Gynaecologists have already carried out transplants of strips of ovarian tissue, which have resulted in at least three births. This is the first known pregnancy from a whole ovary transplant, although a series of the transplants has been carried out by Silber. Transplants of these pieces of ovarian tissue last for about three years. Silber believes that a whole ovary could last for up to a decade.

Times Online

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Claudia Mitchell lost her left arm at the shoulder in a motorbike accident.

Her new arm works by detecting movements of a chest muscle that has been connected to the remains of nerves that once went to her real arm.

The first prototype was fitted to double amputee Jesse Sullivan four years ago.

However, the latest version has been significantly improved.

Using it Ms Mitchell, 26, can now fold clothes, eat a banana and do the washing up.

At a press conference in Chicago to reveal her new arm to the world, Ms Mitchell said: “I can move my elbow up and down and I can open and close my hand simply by thinking that that’s what I want to do.”

Big advance

With her older prosthetic arm, she could only do one thing at a time – either bend her elbow or open her hand.

The technology, developed by the Rehabilitation Institute of Chicago (RIC), took about five hours to install.
The ends of the nerves that once controlled the arm were removed from her shoulder and connected to nerves in the chest muscle, some of which conveyed sensation from the skin above.

Over several months the transplanted nerves grew into the muscle tissue.

Once this happened electrodes fixed to a harness worn on the shoulder were able to detect impulses emitted from the nerves into the muscle and forward them to the arm.

These impulses are processed by a computer, which is able to direct the arm to make very precise movements.

Ms Mitchell said: “Before the surgery, I doubted that I would ever be able to get my life back.

“But this arm and the RIC have allowed me to return to a life that is more rewarding and active than I ever could have imagined.

“I am happy, confident and independent.”

She said the arm was heavy, but that was due to extra motors which gave it a greater range of function.

Many could benefit

At present, if Ms Mitchell is touched on the patch of skin on her chest where the nerves to the hand have been re-routed, she feels that her hand is being touched.

The next step will be to develop a way to have the signals come back from the fingers on the prosthetic to the nerves in the chest and then the brain, so that Ms Mitchell can feel pressure, heat or cold, and even a sharp edge.

The Chicago team estimates that the technology could potentially help more than 400 US military personnel who have had amputations after serving in the Afghanistan and Iraq wars.

Todd Kuiken, the director of RIC’s Neural Engineering Centre for Bionic Medicine, said: “It is so rewarding for me as a physician and a scientist to lead research with the potential to positively impact the lives of amputees.”

Ms Mitchell said she was concerned that her new arm looked as attractive as possible.

“When we got the glove that goes over it I asked them if I could put nails on it and they said yes, so I headed straight for the nail salon.

“She (the manicurist) was pretty terrified, she was afraid she was going to mess something up, but I assured her it was OK.”

BBC NEWS | Health | Woman is fitted with ‘bionic’ arm

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