Patrick Kane at Pace rehabilitation centre in Stockport.

Being bionic: how technology transformed my life

Prosthetics have made amazing advances in recent years – and are slowly changing people’s attitudes to disability. By Patrick Kane

I was born with the usual set of limbs. When I was nine months old, I contracted meningococcal septicaemia, a dangerous infection of the blood, which very nearly killed me. I survived, but because I had sustained major tissue damage, it became necessary to amputate my right leg below the knee, all of the fingers on my left hand and the second and third digits on my right hand. I learned to walk on a prosthetic leg at the age of 14 months, and have gone through my life wearing a succession of artificial limbs.

As time has passed and technology has advanced, so too have my limbs. Like our mobile phones, prostheses have become lighter, faster and more efficient. When I was nine, I was fitted with a lifeless silicone hand, a useless thing that was purely cosmetic, and so clumsy that I refused to wear it after the first day. Now, at 21, and a student in my third year at Edinburgh University, I wear a bionic arm with nimble fingers that move independently, which I operate using controlled muscle movements in my forearm, as well as an app on my phone. As a child I wore a stiff artificial leg attached with straps that frequently fell off; earlier this summer, I took delivery of a new dynamic right leg with shock absorption and carbon fibre blades.

Prosthetics have been around for more than 3,000 years: wooden toes, which strapped on and were specifically designed to work with sandals, were found on the feet of Ancient Egyptian mummies . For most of history, prosthetics have been designed to make life more comfortable for adults, to afford the wearer some limited movement, and to avoid drawing attention to their disability (by filling an empty jacket sleeve, or concealing a stump). It is only recently, as advances in robotics and computing power have been incorporated into artificial limbs, that function has become paramount, and the needs of active disabled people, especially children, have begun to influence design.

Until May this year, the leg I wore was fairly simple: a carbon fibre socket fastened with a pin, and a titanium pole attached to a waterproof foot. It certainly got me around, but it had its limitations, especially on uneven surfaces such as cobbled streets, pebbled beaches and any significant slopes – which, incidentally, describes most of Edinburgh.

In April 2016, I started working with Össur, a prosthetics developer that makes hi-tech joints and limbs for amputees, and has pioneered a new kind of attachment that helps balance and weight-bearing. Two years later, on a bright and chilly May morning, I drove to the Pace Rehabilitation centre in Stockport, where a physiotherapist would fit me with a new leg. I was a little nervous, since I had been going to the same prosthetics centre in Hampshire since I was two, but now that I spend a lot of my time in Scotland, the drive had become too long. Paul, my new prosthetist, met me at the door. I had spoken to him at an Össur training day some months before, and there was no danger of forgetting him. He has tattooed sleeves down both arms, long hair tied back in a ponytail and a strong Geordie accent, but what I remembered most was how many questions he asked.

Paul and a physiotherapist asked a ton of questions and filmed me walking the length of the room several times. They noticed that my old right leg was about an inch too short, a fact that had never occurred to me. When they were satisfied that they had all the information they needed, they made a full plaster cast of my leg. Just three hours later, a simple test socket had been mounted on to the new technology. As Paul described each component and how it is designed to help me move, it was hard to not start planning a marathon in my head.

The top of the new leg has a carbon fibre socket and is attached by vacuum. This evenly distributes the pressure, and won’t tug on any part of my stump, meaning I will no longer have the permanent, painful love-bite where the pin used to pull too hard on my skin. Below a titanium connecting component, there is a large hollow rubber sphere, which provides torsion – the ability to rotate. Dual carbon fibre blades curl into the hollow plastic foot. The blade in the foot is split in half, along where your big toe is. This is so the foot can deal with uneven ground (it also means I can wear flip flops). A small carbon fibre lever rests on top of the blade within the foot. Each time I take a step, my body weight bends the foot slightly, pushing the lever and drawing air out of the socket. It is designed to mimic a human foot as closely as possible, and it all looks very cool.

My first steps in the new leg were unsteady. As I put my weight through the prosthesis, I felt the heel compress and naturally rolled my weight on to the front of my foot, which then pushed me off with the toes. It turned out that I had been putting a lot of effort into walking on my right leg. All of a sudden, my new leg was putting effort back into me. It was extremely comfortable, and I left the clinic after five hours with a spring in my step. I even fancied going for a stroll. Previously, walking was a considerable effort and I wouldn’t do it unless it was necessary, but that evening, I found myself walking around my friend’s garden for the sheer pleasure of it, for the first time I can remember.

I had been a healthy baby, and the first sign that anything was wrong with me came after an unsettled night’s sleep. This was nothing too alarming for a baby of nine months, and my parents went to work that morning as normal, leaving me with my nanny, Sandra. By the afternoon, I was vomiting, floppy and drowsy. Within a few hours I would be fighting for my life.

My mother was at work, and booked a taxi to take Sandra and me to the GP, which was near our house in west London. The GP did not think it was anything too serious, and recommended Calpol: the liquid paracetamol that is a staple in every family’s medicine cabinet. Not quite content with this, my mother, still on the end of the phone, got the taxi to take me to the clinic at St Mary’s hospital in Paddington, less than a mile away. This geographical accident, and my mother’s persistence, saved my life.

At the hospital, I was received by Dr Parviz Habibi, one of the founders of the paediatric intensive care unit at St Mary’s. I spoke with Habibi recently, and he talked me through my arrival with such clarity that you would have thought it happened a couple of weeks ago. Within an hour, I had developed a meningococcal rash, which spread over my entire body. Habibi and his team recognised the signs and hooked me up to a catheter inserted in a large vein in my chest, to give my body the fluids it needed. But the intesive care unit’s medical devices were just not designed for a child that young, and my skin began to stretch and split as fluid leaked from my capillaries. I ballooned to four times my weight in a matter of hours.

Six hours after my arrival, multi-organ failure set in, affecting my kidneys first, then my blood, heart and lungs. Habibi recalled that it was in these first hours that most of the damage was done to my body, and the rest of my nine-week stay in hospital was spent solving the problems caused on the first day. My baptism was originally set for St Patrick’s Day, but because my parents were afraid I would die, it was dragged forwards to the evening of my second day in hospital, with close family and friends awkwardly huddled between the tubes and blinking machinery keeping me alive.

Kane having a new prosthetic leg fitted at Pace Rehabilitation in Stockport.

It was among these beeping boxes and flashing lights that my mother slept, vowing not to leave hospital until I did. People handle these traumatic situations differently, and my mother’s way of coping with it was to master the machinery of my care. She made it her mission to understand every tube’s purpose, know which light meant what, and alert a nurse as soon as there was a change on the monitors. I have no recollection of ever being ill, and had no sense of “fighting” the disease; however, I do often think of the strength shown by my mother in those months as an inspiration. When my five-year-old sister, Rosie, decided this had all gone on long enough, she stormed into my room and shouted, “Wakey wakey, Patrick!” For the first time in almost a month, my eyes flickered open.

Over the following days and weeks, different problems arose. I had become addicted to morphine, which I had been given for pain relief. My father vividly remembers seeing my body going into spasms of withdrawal. Once I was weaned off the drug, which took a few days, I was stable enough to be transferred from intensive care to a high-dependency ward. This, strangely, was the most testing time for my family. My mother had taken comfort in understanding the medical machinery and on the new unit, there was none. Without the monitors for reassurance, she felt lost and helpless.

Moving out of intensive care also meant I was well enough to undergo surgery again. Over the weeks, a few of my fingertips had become blackened and gangrenous, because not enough oxygenated blood was getting to them, and my family had expected me to lose some of them. But the blackening spread, including to both of my legs. Somehow, my left leg returned to normal after a few hours, but the right leg stayed black. When this happened, it meant the tissue was dead, so there was no choice but amputation. Each time I went into theatre, my parents would see me return with yet another bandaged stump hanging from me.

My entire life, people have been asking what happened to me, and when I tell them the story they always respond “poor you, how awful”. I have never seen it this way. The fact that I had come so close to death at such a young age had a profound effect on my parents’ attitude to my disability: because they were aware that things could have gone much worse, they did not have, and did not pass on, a “poor me” attitude. I have no memory of those months: I was not the one experiencing the stress and trauma of my illness. It was not until I was much older that I realised what the impact must have been on my family.

P rosthetic legs don’t have barcodes. My mother and I discovered this on a trip to the supermarket when I was about two years old. I used to sit in the child seat of the trolley, with my cumbersome prosthetic leg held on with several straps. Between the frozen produce and the fresh fish my mother heard a clunk, following by loud gasps from everyone else in the aisle who had just witnessed my leg falling off. This was common enough; my mother picked it up and put it in the trolley with the groceries. It would be too much hassle to put it back on there and then, so it could wait until we were in the car. At the till, one item after another went through the scanner, until the cashier’s hand reached for the leg, its little shoe still on. The poor woman was stunned.

I had a normal childhood. It was only in moments like this that we realised it was not quite so normal for everybody else. Three months after I left hospital, when I was 15 months old, we all went on a family holiday to Marbella. My arms and legs were healed up by then, and I was getting the hang of using my stumps to crawl around and hoist myself up on to tables and chairs. One day my sister came running to my mother, crying. One of the other children had told her that her little brother was “disgusting”.

It was not long after that holiday that I was fitted with my first prosthetic leg, and by the time I was 18 months old, I could walk. But it’s hard to design legs for babies. The first ones I used were awkward, and often fell off. My parents found Dorset Orthopaedic, a private clinic near Salisbury that was able to tinker with the standard procedure, initially adapting an arm socket for my leg, to get a better fit. These new prosthetics were up to the task of keeping up with my daily habits, and were designed to look as much like my leg as possible. The flesh-coloured “skin” had the consistency and texture of a fabric bandage, which punctured or tore easily with a fall. I would grow out of one every six months between the ages of three and 18. They weren’t waterproof, but I would always use my most recently discarded leg to go in the water to swim. By the time I was done with a leg, it often looked like I had been attacked.

Patrick Kane having a new prosthetic leg fitted at Pace Rehabilitation in Stockport

The legs allowed me to play however I chose. But the prosthetics, and the private clinic, were very expensive. They were only available to me due to another incredible stroke of good fortune. At the time, my father was working for Sunday Business, a weekly financial newspaper, which was owned by the Barclay brothers – the British billionaire twins who also own the Daily Telegraph. Sir David Barclay read about my illness and wanted to help, so he set up a fund to pay for my prosthetics. I am acutely aware that most amputees do not have this possibility. The NHS simply can’t afford to support the cost of this technology.

My parents’ attitude was that I should do everything my siblings did, and when I went to pre-school, I was expected to do everything the other kids could. This meant that I could discover my own limits, rather than have them defined for me by others. It turns out, apart from wearing only shoes with Velcro straps and being slightly less gifted on the recorder, I didn’t have too many issues.

In my first “show and tell” at school, I brought in a sack of prosthetic legs, and it was received as a cool, exciting thing, rather than something to hide. I was fearless, and my choice of legs soon began to reflect this – going from fleshy imposters to bright blue and covered in postage stamps, and even a waterproof leg decorated in leopard print.

I discovered early on that I didn’t want to fit in, if it was at the cost of my own ability to function. While I used a series of prosthetic legs, I carried on using the stump of my left hand effectively, learning to touch type and single-handedly beating my friends at Fifa . When I was about nine, I tried a false arm. My left arm is short, due to damaged growth plates, and all of the fingers are amputated at the knuckle. It looks like half an arm, but it has always been useful, allowing me to hold objects against my body, or to push with. The false arm had a silicone cosmetic glove that fitted over my stump, complete with wrinkles and realistic nails. It was a beautiful looking thing, but I hated it. It was entirely passive, and just sat there. I found that it removed the function I had with my stump, such as typing or catching a ball, and was only there to appease other people’s idea of “wholeness”. I wore it for one day and then never again. I think it was some time before my family understood my decision.

This all changed in 2010, when I was 13, and my stepfather saw an advert in the newspaper for the i-limb pulse, which claimed to be the most advanced prosthetic hand in the world. He phoned the Scottish company that made it, Touch Bionics, and we arranged to meet them. I was doubtful about the benefits of a fake arm: I was functioning very well with Velcro shoe straps, and I could always get family members to cut up my food.

The team from Touch Bionics demonstrated how the hand worked, and checked the muscles in my forearm that control the hand.

They showed me the different looks the hand could have, including skin-toned silicone. I wasn’t interested in imitation flesh, and asked if they had anything that showed off the technology better. They pulled out a semi-transparent thin glove with pointed fingers, through which the robotic components can be seen. It looked perfect.

The hand has slender, elegant black fingers powered by individual motors, which allows each finger to move separately from its neighbours, and to wrap around unusually shaped objects, just as a real hand does. The hand attaches to the socket with a twist motion, and can be removed by rotating it a full 360 degrees. The socket, containing the batteries, wires and electrodes, extends just past my elbow.

The whirring noise of the motors was pure science-fiction. The team from Touch kept telling me I shouldn’t get my hopes up, as there was a chance I wouldn’t be able to use the technology, but it was proving impossible not to get excited about becoming the Terminator. I was fitted with the arm a few months later, and aged 13, became the youngest person in the world with a bionic arm.

M y life was transformed by my new arm. Everything got easier. I used to open bottles of water by clamping them between my thighs and twisting with both hands, but now I simply hold the bottle in my firm bionic grip and twist with the other. I noticed that it also changed how others perceive me. No longer did I get looks of pity when walking in public. Instead, the looks I got changed to genuine curiosity at this robotic device. People would approach me to say, “I just have to know what this is and how it works.” I have discovered that people would much rather talk about these things – they just don’t know if it’s allowed. The non-realistic look of the hand is a message to others that I am happy to talk about it.

Patrick Kane

The hand operates very simply. There are two electrodes that touch my skin when I place my arm into the socket. One of them is responsible for opening the hand, the other for closing it. All I have to do is send a muscle signal. I had a week’s training when I was first fitted with the hand, to teach me how to separate the signals, by twisting and bending my wrist, so I could send each one separately and clearly.

I would upgrade to newer generations of the hand as they emerged, every few years, each better than the last. But I would also need to get a new socket every year or so, as the shape of my arm changed as I grew. My current hand, the i-limb quantum , has titanium digits for increased weight bearing. An app on my iPhone sets the fingers into one of 36 different grip patterns, allowing me to get the right configuration for a specific task, from using a spray cleaner to operating a computer mouse. After more than eight years of practice, I can control the arm to the extent that I can hold a grape between my thumb and forefinger, and squish it on command.

By the time I was 13, my stepfather took over paying for my prosthetics. These devices cost around £20,000 and I was extremely fortunate that my family could afford it. The biggest cause of amputation in the UK is vascular disease, although in younger people, trauma is more often caused by accidents, especially in cars. Sophisticated knee joints have recently become available through the NHS, and the hope is that, in the future, multi-articulating prosthetic hands could become routinely available. But for the moment, they remain out of reach for most people.

I’m acutely aware that my position is extremely privileged, so I see it as an obligation to speak about what happened to me. In 2013 I became an ambassador for the UK Sepsis Trust, and help them to raise awareness by giving talks and doing interviews. In 2015, I became an ambassador for Touch Bionics. I receive free upgrades to the hand in return for helping with research and development of the device. I give them feedback about specific things – such as which grip patterns I use, or how long the charge lasts (two days). I have told them I won’t be fully happy until I can juggle – and I’m only half joking. The hand currently goes from fully open to fully closed in 0.8s, so we still have a way to go.

Beyond bionics: how the future of prosthetics is redefining humanity – video

As an ambassador, I regularly meet other amputees, usually at conferences, where they are looking at the different products. In 2016, Touch Bionics was bought by the Icelandic prosthetics company Össur, founded in 1971 by Össur Kristinsson, the inventor of a revolutionary silicone interface for prosthetic sockets. When I was working with Össur representatives in China, one of them said something I had never considered before: “We have a duty to our customers that other businesses do not, because nobody chooses to need our products.”

The vast majority of amputees do not have access to either the technology or the expertise needed to fit these sophisticated devices. In China, on a visit representing Össur, I spoke to many people who couldn’t afford the latest technology, and had ill-fitting sockets, or limbs they had grown out of, sometimes causing discomfort and injury. “Recycling” old limbs is always difficult, because every person’s residual limb is unique. With more than 1 million new amputees each year globally, the need to make these resources more widely available is increasing. Fortunately, the continued advance of technology such as 3D printing has the potential to bring prostheses to parts of the world where there are no specialist prosthetic teams.

A lthough I lost part of my right leg and left arm as a baby, it’s only recently that I’ve learned that I am disabled. For most of my childhood, I avoided the word, scared of having it pinned on me. Disabled things are broken and they don’t work. When you enter the password incorrectly too many times on your iPhone, it becomes disabled. I always preferred to be called an amputee, as this says what happened to me without making assumptions about my ability.

The greatest ambition of amputees used to be to fit in, and be normal. I have noticed that it’s partly a generational thing: older people generally aim to make their prostheses as lifelike as possible, and there can be an amazing level of detail involved in making them look lifelike, complete with hairs, moles and tattoos. But for a lot of young people, the priority is function. The new generation of prostheses don’t look like human limbs, and they’re not supposed to blend in. Some of the legs I have seen over the years have had flames, football logos and even speakers. The running blades developed for use in sport are made of woven carbon fibre in a large C-shape, which looks nothing like a leg, but functions very well indeed .

Technology is key to changing perceptions, and does far more than previous generations of well-meaning awareness-raising campaigns have done. The portrayal of bionic characters as superhuman and powerful is helping to shape society’s attitudes towards disability. The change may be slow, but as technology continues to improve, perceptions are evolving. I am sure there will come a time when there won’t have to be a trade-off between function and looks, but even then, will we want these devices to look normal? The more closely something imitates real life, the more jarring it looks. I still enjoy standing out from the crowd.

Patrick Kane at Pace in Stockport.

Although I have made a great effort not to let myself be sidelined by disability, I have also learned that it’s important not to distance myself from a marginalised group just because privilege has taken me somewhat out of it. The sobering truth is that I am – as many disabled people are – just one incident away from seriously struggling. In January I dislocated my knee, and since I can’t use crutches, I couldn’t leave my flat for three days. I had flatmates to bring me food from the shops, but I could not help but think about how helpless I would have been if I was living alone.

While doing research for this piece, I came across one written by my father in 1999. “This time last year my nine-month-old son, Patrick, was as close to death as it is possible to be,” it began. Reading that piece today, it’s hard not to be struck by how far we have come in the 19 years since it was written. The overriding tone was one of worry about what the future might hold for me, and how my life would be difficult. One line in particular stood out: “Barring major advances in medicine, he will never be able to use his left as a normal hand.” When I asked my father about that article recently, he said: “I was wrong, on two counts. Prosthetic technology has been more innovative than I could have imagined. And you have been far more resilient and determined then even I could have known back then.”

Technology is playing an important role in redefining disability, but attitudes are going to have to adapt, too. There are more than 13 million disabled people in the UK, yet a recent survey by Scope reports that 67% of the British public feel uncomfortable talking to disabled people: 21% of 18- to 34-year-olds admit they have avoided talking to disabled people because they were unsure how to communicate with them.

Occasionally I am reminded of the gap between the way I see my disability, and how the rest of the world sees me. When I was 18, I was contacted by an assistant TV producer who had seen my TEDxTeen talk about disability and wanted to know if I would appear on the dating show she was working on. She sent over an email promising it would be shot tastefully and “sensitively portray my search for love”. Wary of the voyeurism of this kind of show, I declined. I later learned that I had been invited to appear on the astoundingly named Too Ugly for Love? The show ran for three seasons, which says a lot about how much work is still needed to change attitudes towards disability.

Advanced prosthetic technology will force a change in public attitudes, as they blur the gap between disability and ability. We have Olympians arguing that legless amputees should not be allowed to compete against them , in case they have an unfair advantage, which would have been tough to imagine at the time of the first Paralympic Games in 1960. Blind people are having their vision restored by cameras, paraplegic people are learning to walk again with powered exoskeletons and I can control my bionic hand with an app on my phone. But sometimes really significant change is more straightforward. It can be as simple as me being able to tie my own shoelaces, and walk away.

  • The long read

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The Rise of the Bionic Human

New technology is allowing the paralyzed to walk and the blind to see. And it’s becoming a smaller leap from repairing bodies to enhancing them

Randy Rieland

Randy Rieland

Body suits are allowing paralyzed people to stand and move.

Chances are you saw the video of a woman named Claire Lomas finishing a marathon in London last week. If not, I should tell you that it did not end with the classic pose—head back in exhaustion, arms raised in joy.

No, Lomas’ head was down as she watched herself literally place one foot in front of the other. Her arms were down, too, holding on to metal braces. Directly behind, husband Dan moved in stride, steadying her with his hands. And Lomas wore something never seen before in a marathon–a body suit of sensors and motors, which, along with a small computer on her back, moved her legs forward.

It took her 16 days to finish the race, covering just under two miles a day. On the last day, there was a crowd gathered at Big Ben, her starting point. She thought they were tourists. But they were there to cheer on Moser, who’s been paralyzed from the chest down since a horse-riding accident five years ago. Afterwards, she was hailed as a “bionic woman”—an allusion to the ReWalk suit she wore that took steps forward in response to shifts in her balance.

For many of us, our first exposure to the notion of bionic humans was the 1970’s TV series “The Six Million Dollar Man.” It was ostensibly about science, but really was a fantasy about man-made superpowers. (You knew when they were kicking in because lead character Steve Austin would go all slo-mo on you and you’d hear this oscillating synthesizer note suggesting strange and powerful things were happening inside his body.) Turns out, though, that so far bionics has come to be about repairing bodies, not enhancing them, and making people normal, not superhuman.

But the effect is no less remarkable.

I see the light

The ReWalk suit, invented in Israel, allows people with paralyzed lower bodies to sit, stand, walk and climb stairs. And now similar “lower body systems” are being sold to hospitals and rehab centers. Another model, created by a California company called Ekso Bionics, works much like the ReWalk suit, not only giving paralyzed patients an opportunity to stand and move, but also helping people rebuild muscles after an injury or relearn to walk after a stroke. It’s powered by a battery that could run your laptop.

Equally amazing advances are being made in developing a bionic eye. Earlier this month came reports about two British men who had been totally blind for years , but now, after electronic retinas were implanted in their heads, they’re able to see light and even make out shapes.

The device is a wafer-thin microelectronic chip that’s placed behind the retina and connects through a very fine cable to a small control unit and battery placed under the skin behind the ear. Pixels in the chip serve as the eye’s rods and cones. When light enters the eye, it stimulates the pixels, which then send a message to the optic nerve and ultimately, the brain. So the light is “seen.”

And just last Sunday Stanford scientists published research that refines the bionic eye even further. Their artificial retina would largely function the same way, except it would be powered by light. So, no wires, no battery.

Instead, a pair of glasses fitted with a video camera records what’s happening before a patient’s eyes and fires beams of infrared light on to implanted chip. It messages the optic nerve and the brain processes the image.

This device has been tried only with rats so far, but scientists in Australia say yet another version of the retina implant could be tested in humans as early as next year.

Which leads to the obvious question: Isn’t it just a matter of time before eye implants will come with apps that zoom, record, maybe throw in a little augmented reality? Some would say–such as those in the transhumanist movement –that we have an obligation to be the engineers of our own evolution.

Maybe some day we will be able to run like the Six Million Dollar Man. Hopefully, minus the sound effects.

Going bionic

Here’s more from the cutting edge of bionics innovation:

  • Straight to the brain: Two Rhode Island scientists have invented a robot arm that people can control directly with their brain, allowing them to bypass a nervous system damaged by a stroke or accident.
  • Sugar control: Later this year trials will begin for a handheld artificial pancreas. It will automatically regulate the insulin and blood sugar levels of Type 1 diabetics. A person just enters what he or she ate and the device adjusts insulin levels appropriately. No more pricking your finger five times a day to check your blood sugar.
  • Joint action: An engineer at Vanderbilt University has developed the first prosthetic leg with powered knee and ankle joints that operate in unison, and with sensors that monitor motion. If the leg senses the person is about to stumble, it plants the foot securely on the floor.
  • Stick it in his ear: A new invention could mean an end to cochlear implants for people with serious hearing problems. With this device, all of the components would actually be inside the ear, including a very tiny microphone.
  • Take that, Mr. Tooth Decay: Researchers at the University of Maryland have developed a nanocomposite that can not only fill cavities, but can kill any remaining bacteria. But wait, there’s more. It apparently can also regenerate the part of the tooth that’s been lost to decay.

Video bonus: Watch Cathy Hutchinson, who hasn’t been able to use her arms and legs for 15 years, pick up a coffee cup, using only her brain to control a robotic arm.

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Randy Rieland

Randy Rieland | | READ MORE

Randy Rieland is a digital media strategist and contributing writer in innovations for

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Becoming Bionic: Engineering Beyond Biology

By Eliza Strickland, Ariel Bleicher, Mia Lobel, and Laurie Howell

“Becoming Bionic” explores how engineers and scientists transmute nature to engineering. Adapting what they observe in the living world, they create useful products or processes, going beyond the simple imitation of biological structures. Part of the "Engineers of the New Millennium" series, this program is a co-production of the Directorate for Engineering of the National Science Foundation, and IEEE Spectrum Magazine.


Building human organs on a chip, bionic eye implants promise vision for the blind, turning tobacco plants into vaccine factories, tobacco plants: efficient protein makers, skinlike walls could slash a building’s energy use.

Susan Hassler: We’re going to start with the basic biological units of all known living organisms. Cells.

Phil Ross: When we talk about bionics, we typically talk about hardware that’s added to the human body to make it stronger or more capable. But Eliza Strickland is here to talk about an idea that goes in the other direction.

Eliza Strickland: Right. Here’s the idea: By taking living human cells from the body and adding them to external devices, scientists think they can make big improvements in medical research.

Susan Hassler: We’re still talking about the merging of humans and hardware, but that merging is taking place on gadgets in the lab?

Eliza Strickland: That’s right. And one particularly exciting example of this is called organ-on-a-chip technology. An organ on a chip is an attempt to mimic the essential functions of a human organ, like the heart or the lungs, on a chip of silicone rubber that’s smaller than your thumb.

Susan Hassler: And why do researchers want to make these miniature imitation organs?

Eliza Strickland: Well, they’re hoping that these chips can be used to develop new drugs. They say that testing new drugs on these organs on chips would be cheaper, faster, and less controversial than testing on animals. To learn more, I went to talk to the world’s foremost expert on this technology.

Don Ingber: I’m Don Ingber; I’m the founding director of the Wyss Institute for Biologically Inspired Engineering at Harvard University.

Eliza Strickland: I meet Ingber at the Wyss Institute’s headquarters in Boston, inside a glassy high-rise building. The institute is only three years old, and everything looks shiny and new. Ingber walks me through the labs and stops at a lab bench where some samples are displayed.

Don Ingber: Here what you see is a lung, a heart, a kidney, a bone marrow, a gut.

Eliza Strickland: But we aren’t looking at messy, fleshy organs oozing blood into jars. Instead, we’re staring at five small pieces of clear and flexible plastic with a few tiny lines etched into them. Several tubes are plugged into the chips to push air or a bloodlike fluid through them. These are very clean and simplified versions of our human organs.

Don Ingber: Yes, so this is the lung on a chip. It’s this crystal clear microdevice the size of a computer memory stick, so we can actually hold it although this mimics literally the mechanical breathing motions and flows and absorptions of the human lung.

Eliza Strickland: Tens of thousands of human cells are thriving on this chip. And they’re not growing in unorganized clumps, like they would in a petri dish. Instead, the chip replicates the basic structure of one of the lung’s 700 million air sacs, where blood flows through tiny capillaries and exchanges carbon dioxide for fresh oxygen.

Eliza Strickland: In this chip, a spongy and porous membrane is coated with the lung cells on one side, and air flows over these cells through a microscopic channel. The other side of the membrane is coated with the capillary cells found in our smallest blood vessels, and a fluid that mimics blood flows past those cells in another tiny channel.

Eliza Strickland: This allows researchers to watch biological processes happen in a simplified form, right there on the chip. So researchers can put a drug in the chip’s airway, for example, and watch to see how it’s absorbed into the blood.

Don Ingber: It is bringing it down to the essence.

Eliza Strickland: But there’s one more element necessary to mimic the human system. In our lungs, our air sacs expand and contract with each breath. So the lung on a chip has to expand and contract, too.

Don Ingber: This controls the breathing motions.

Eliza Strickland: In Ingber’s system, a precisely controlled pump applies suction to both sides of the rubbery chip.

Don Ingber: And the whole device is crystal clear, flexible silicone rubber, so when the suction is pulled, the device with the cells, the two layers of cells stretches, and then when it releases, they relax.

Eliza Strickland: These chips are fabricated using techniques learned from computer microchip manufacturing. That industry perfected ways of etching microscopic channels into silicon wafers to make patterns.

Don Ingber: It’s not like we’re forcing cells into microchips, but we’re using computer microchip fabrication to fabricate systems that meet our needs.

Eliza Strickland: Now that the researchers have built this functional model of a human lung, the next step is putting it to use. And that’s where the drug industry gets involved.

Don Ingber: The catchphrase that I’ve been told by pharmaceutical executives is we have to learn how to fail quickly and cheaply. But remember, a single drug, it can cost [US] $2 billion to take a single chemical all the way from discovery all the way through human clinical trials. This is a major, major decision.

Eliza Strickland: Ingber says that the current system of testing a drug in petri dishes and animals doesn't predict very well whether it will actually work in human beings.

Don Ingber: They’ll do some work with cells in dishes, in fact, even human cells in dishes. But the problem is, when a cell is on a dish it loses most of the specialized properties it has in the body—it’s usually just proliferating, it’s not functional. And what they end up doing is really relying on animal studies to validate which drug to choose ...

Eliza Strickland: And Ingber says that animal studies aren’t just controversial—they’re also ineffective.

Don Ingber: The problem is more often than not, what they predicted from the animal studies fails to predict what happens in humans, and they have these huge failures, and they’ve already spent hundreds of millions if not billions of dollars. And so that’s where there comes the phrase “We want to learn how to fail quickly and cheaply,” because they’d much rather say “This is a mistake” early in the process and then choose another drug.

Eliza Strickland: If drug companies can test a new drug on a chip that mimics the functions of a human lung, they can find out right away if the drug is toxic to human cells, and they can study how it’s absorbed into the bloodstream. The researchers can even introduce white blood cells into their chip systems to study how the immune system responds to the drug. And the lung on a chip is just the beginning.

Don Ingber: We’re working to many organs. We’ve made some breakthroughs in bone marrow on a chip, and kidney on a chip. We’ve targeted 10 different organs and the idea of linking all of them together in different orders and different ways.

Eliza Strickland: Ingber wants to link a whole series of chips together and to connect them with flowing fluids to mimic the way they’re connected in the human body. He’s essentially working towards making a human on a chip.

Don Ingber: It’s like taking a biology textbook diagram and bringing it to life.

Eliza Strickland: Creating life on a chip. The stuff of monster literature is alive and well and living on tiny chips in this Boston laboratory. I’m Eliza Strickland.

Photo: Wyss Institute

Susan Hassler: Phil, do you ever wonder what it might feel like to actually be bionic?

Phil Ross: Sure, it’d be great! I mean, who wouldn’t want to have an arm as strong as a bulldozer or an eye that can zoom in and out?

Susan Hassler: I don’t know…maybe it wouldn’t be quite as fun as you think. I think I might feel a bit freakish. Like Edward Scissorhands or Frankenstein’s monster. But of course, that’s all science fiction. Our reporter Ariel Bleicher has a real-life tale about what it really means to become bionic.

Ariel Bleicher: Right. So let me just start by introducing you to someone.

Miikka Terho: Yeah, my name is Miikka Terho. I’m a native of Finland.

Ariel Bleicher: When you meet Miikka, he seems like just a regular guy. He’s in his late 40s, slender, athletic, blond hair, and he’s got these brilliant sea-blue eyes. But when he was a teenager, he found out he had a degenerative disease.

Miikka Terho: Yeah, it’s a disease called retinitis pigmentosa—RP, as they call it.

Ariel Bleicher: About a million and a half people have RP. They’re born with a genetic defect that causes cells in the retina—the tissue lining the back of the eye—to deteriorate over time. These cells—the photoreceptor cells—they detect patterns of light entering the eye. And they convert those patterns into electrical signals, which they pass on to their neighbor cells. Then those cells pass the signals on to their neighbors, and this relay chain goes all the way to the brain.

Susan Hassler: So if the photoreceptor cells stop working, the chain is broken.

Ariel Bleicher: Right. By the time Miikka was in his mid-30s…

Miikka Terho: Then I lost the central eyesight altogether.

Ariel Bleicher: He was blind for 15 years. Then one day he heard about a small experimental study led by an ophthalmologist and researcher at the University of Tübingen, in southern Germany.

Eberhart Zrenner: My name is Eberhart Zrenner. I run a clinic for hereditary retinal degeneration. I see patients with these diseases.

Ariel Bleicher: In the 1990s, Dr. Zrenner had this crazy idea.

Eberhart Zrenner: I thought about this concept: Why not replace natural photoreceptors with technical ones? They are everywhere, these chips – in the mobile phones and why not put it into an eye?

Ariel Bleicher: He put together a team of researchers, got investors, did experiments with rats and rabbits and pigs, eventually started a company. And the product that came out of all this effort was this…

Eberhart Zrenner: …very tiny, tenth-of-a-millimeter-thick little chip.

Ariel Bleicher: It’s about the size of a freckle.

Phil Ross: And this chip is surgically implanted into the eye—right where the dead photoreceptors are?

Ariel Bleicher: Yeah, that was the idea. It’s actually a really elegant design. The chip is made up of 1500 teeny-tiny electronic devices called photodiodes, each of which is paired with another tiny device called an electrode. And all these pairs of photodiodes and electrodes, they’re all laid out on the chip in a grid pattern. Basically, they act like little electronic pixels in a camera. So when light passes through the eye and falls on the chip, each of the 1500 photodiodes…

Eberhart Zrenner: … takes each point of the picture, translates it into a tiny little current.

Ariel Bleicher: Then the photodiode passes the current on to the electrode it’s paired up with. Then the electrode…

Eberhart Zrenner: … depending on the brightness of this particular spot, puts a current into the neighboring cell.

Ariel Bleicher: And the relay chain that was broken—it’s now fixed. Anyway, that was how things were supposed to happen.

Susan Hassler: Supposed to happen?

Phil Ross: Let me guess. It didn’t work.

Ariel Bleicher: It didn’t work. At least not the way Dr. Zrenner had hoped. In 2005, he started a small pilot study with 11 patients. And the first 10 patients, they couldn’t see much at all. Some of them could tell whether a line on a computer screen was horizontal or vertical. But that was about it.

Eberhart Zrenner: We didn’t know at the time whether we will have success ever. But there was one patient, the last patient—essentially, Miikka.

Ariel Bleicher: The results from the first 10 patients were so poor that Dr. Zrenner and his research team, they decided to do something a little different with Miikka. They told the surgeon to place the chip right in the center of Miikka’s eye, under a structure called the fovea, which in sighted people is responsible for producing really sharp, detailed images—like the text on a computer screen or the features on someone’s face. The researchers had avoided the fovea before because the tissue is especially delicate, and they knew the chip wouldn’t be able to produce perfectly sharp images anyway. But this was their last patient, maybe their last chance, and they figured it was worth a try.

Ariel Bleicher: When Miikka woke up from the operation, the first thing he remembers was, he was groggy and he had a headache. He looked like he’d been punched in the face. The skin around his left eye, where the chip had been implanted…

Miikka Terho: was like in all rainbow colors: yellow, green, purple.

Ariel Bleicher: The only evidence of his new bionic self was a slender wire power cable, with a plug at the end, poking out from the skin behind his ear. One of the researchers attached a control box with a battery to that cable, flipped a switch…

Miikka Terho: …and then I was asked like do I get any kind of visual sensations and I said yes. There was a flash of lights, many flashes of lights.

Ariel Bleicher: At first, he had no idea what he was looking at. He just knew he was seeing .

Miikka Terho: But then minute by minute, hour by hour, then everything started making more sense.

Ariel Bleicher: He learned to read simple letters again: L s, T s, C s, O s. And recognize objects…

Miikka Terho: Fork, spoon, knife blade, mugs, cups...

Ariel Bleicher: He even took a vision test and scored just above the cutoff for being legally blind.

Phil Ross: Wow! So after 15 years of being blind, he can see again!

Ariel Bleicher: Not exactly. Three months after Miikka got the chip, a surgeon went back in and took it out.

Susan Hassler: They removed the chip that had given him sight?

Phil Ross: Why?!

Ariel Bleicher: Protocol. Remember, this was a pilot study—to show it’s worth doing a big clinical trial. It was the first time the chip was going to be implanted in humans, and the researchers wanted to take as few risks as possible—avoid infections and things like that. So they left the chip in just long enough to test it, and then took it back out.

Susan Hassler: So now that Miikka’s gotten a taste of this new bionic vision, does he miss it?

Miikka Terho: Oh yeah. Like I said of course, naturally. It would be nice to get the chip back or even get the eyesight back. But also I understand that whatever, if I ever get any kind of a central eyesight back permanently, it’s not normal seeing. I cannot just go to the beach and look at the babes. It’s not that good. I may go there and I see the shapes of those babes [laughing], but I cannot really identify them. So it’s not that normal seeing ’cause it’s an artificial form of seeing anyway. But then it will be a hell of a lot better than nothing.

Ariel Bleicher: It’s still evolving—and improving. I visited the company in Tübingen, Germany, that’s making the chips—it’s called Retina Implant. They’re currently in the middle of a clinical trial, and they expect to get approval to sell the device in Europe by the end of the year. So far, they’ve tested the newest version in 22 more patients, and some of those patients can see just as well as—or in a few cases, better —than Miikka.

Phil Ross: And surely someone someday will make a bionic retina as good as a natural one.

Susan Hassler: Or better !

Ariel Bleicher: Well, it turns out that’s still a pretty big dream. A natural human retina has about 115 million photoreceptors, whereas the chip has just 15 hundred electronic ones. So the technology definitely has a ways to go. But I did ask the CEO of Retina Implant—his name’s Walter Wrobel—I asked him what he thinks might be possible in the future.

Walter Wrobel: [sigh] I don’t know. I really don’t know.

Ariel Bleicher: He says probablyyou could improve the chip’s picture quality by finding a way to squeeze in more electrodes and photodiodes. You could also maybe widen the window through which a patient sees—his visual field—by implanting several chips in a row. But then Wrobel, very casually, he said something that totally surprised me.

Walter Wrobel: You can also think about being able to recognize infrared light…

Phil Ross: Wait, did he just say an electronic retina could recognize infrared light?

Walter Wrobel: …infrared radiation, which is very close to red but not visible anymore.

Ariel Bleicher: It’s just outside the wavelengths of light that you and I can see.

Susan Hassler: So he’s saying that it’s possible for people with this chip to see things that even sighted people can’t see?

Walter Wrobel: Yeah.

Ariel Bleicher: Crazy, right? Wrobel told me that one day, out of the blue, one of the study patients suddenly blurted out to two doctors in the testing room…

Walter Wrobel: “Oh, you have different coats. One coat is bright and the other one is dark.” And they were astonished because both of them had dark coats.

Ariel Bleicher: But the patient insisted…

Walter Wrobel: He said, “No, no—one is bright and the other one is dark.” Hmph.

Ariel Bleicher: So the researchers looked at the coats through a night vision scope, which can detect infrared light. And sure enough…

Walter Wrobel: …and it really turned out that in infrared, one of the coats looked bright—made from plastic, looking bright. And the other one was cotton or wool and was dark. So he really could see this infrared light.

Phil Ross: Wow. So what’s stopping the company from making a chip that lets people see, say, ultraviolet light, like butterflies do?

Ariel Bleicher: Well…nothing! But Wrobel says that’s not the point.

Walter Wrobel: There are some science fiction authors and so on who are dreaming about that. We are not dreaming; we are realizing our devices.

Ariel Bleicher: Miikka has a similar grounded attitude toward the whole experience. He says the chip didn’t make him feel like a superhero, and it didn’t make him feel like a freak either. He was just happy to take part in the pursuit of something important and good—something that could help a lot of people. Which, if you think about it, is all we can ever really ask from technology—that it help make us better versions of the selves we already are. I’m Ariel Bleicher.

Photo: Retina Implant

Susan Hassler: We’re going to move on to a different kind of bionics now: from bionic body parts to another kind of biotechnology based on natural processes.

Phil Ross: It’s happening at the University of California, Davis.

Susan Hassler: We’ve been promising to tell you about researchers hijacking tobacco plants. Well, this is it.

Phil Ross: They’re using tobacco plants to produce compounds that are otherwise really expensive and hard to make. Vaccines.

Susan Hassler: Bottom line: They want to be able to develop vaccines more quickly and cheaply.

Phil Ross: Here we go, to the UC Davis laboratory where chemical engineer Karen McDonald works.

Karen McDonald: And what I’ll do is I’ll first take the top off of the vacuum chamber. It’s a chamber that’s about, oh, about a foot in diameter and maybe 18 inches high.

Susan Hassler: She takes a small tobacco plant, cut at the base, and places it upside down into a clear solution. She replaces the top of the vacuum chamber and then flips a switch.

Karen McDonald: And as the vacuum increases, what we’ll see is that the air that’s inside the leaves that are submerged in the liquid will actually start coming out of the leaf. And at the surface of the leaf, these bubbles will be generated, and then those bubbles will rise up to the air interface. It takes a few minutes to reach the vacuum level.

Phil Ross: This is a process called vacuum agroinfiltration, and it’s used to inject new DNA instructions into the cells of the plant. These instructions tell the plant to produce a protein that it wouldn’t produce naturally—for example, a vaccine for the common flu.

Karen McDonald: The main thing that inspired me to pursue this project was the realization, probably primarily in 2009 when the H1N1 pandemic arose, that the current manufacturing technologies to make vaccines aren’t fast enough to respond to a new pandemic. So what we found over the last few years is that plants, and particularly tobacco, make very efficient biofactories to make vaccines very quickly. And the technology that we use is one in which we can basically go from the genetic instructions for the vaccine to making the vaccine in several weeks.

Susan Hassler: Traditional egg-based vaccine production generally takes a few months and is quite costly, about ten to fifteen dollars a dose. McDonald’s process could dramatically speed this up and lower this cost to less than a dollar per dose, potentially revolutionizing the industry.

Karen McDonald: And so basically we’re using the biosynthetic machinery of the cells within the leaf, the plant cells, to make our product for us. And the—the advantages are that those cells have been grown using photosynthesis, one of the most efficient—energy-efficient—processes around.

Phil Ross: Right now, McDonald’s vacuum infiltration process can yield 1 to 10 doses per plant. But with a bit of tweaking, she expects to be able to get up to 100 doses. All using a plant that’s naturally suited to this kind of work.

Karen McDonald: Tobacco plants are a good host to make vaccines for a couple of reasons. One is that tobacco’s a nonfood, nonfeed crop, so you’re not competing with other uses of the plant. It’s a big, leafy, high-biomass plant, and for our applications we need leaves, a lot of green leafy tissue, so in that aspect, tobacco’s a good host. And also tobacco farmers are looking for alternative uses of tobacco other than smoking, and this is a efficient use of it to make a high-value product.

Susan Hassler: That’s products plural, actually. Her method isn’t limited to flu vaccines.

Karen McDonald: Yeah, this type of production could be used to produce basically any type of recombinant protein. And that would include things like monoclonal antibodies, industrial enzymes, biodefense agents, human blood proteins, biopolymers.

Phil Ross: A whole host of compounds that have traditionally been hard to produce in a scalable way. McDonald’s process essentially turns these tobacco plants into mini biofactories, pumping out proteins faster, cheaper, and more efficiently than current manufacturing processes.

Karen McDonald: So now we’re about 15 inches of mercury, and I’ll go ahead and release the vacuum. And at that point you’ll see the leaves turning from a light green to a very dark green. [loud noise] And then we’ll take the top off, take the top off the vacuum chamber. And you can take the leaves out and you can see visually the dark areas of the leaf where the solution has infiltrated the tissue.

Susan Hassler: She lets the plant dry for a few minutes and then places the leaves into a humidified box.

Karen McDonald: And we just store it in the dark for, like I say, five to seven days and let, let the plant cells do their thing.

Phil Ross: All you need are the right genetic instructions.

Karen McDonald: We’re hoping that our work helps to basically catalyze this new industry in which plants are used to make high-value, very important protein products. And so that’s—we’re hoping to bring more attention to this strategy as a biomanufacturing strategy and hopefully lower the cost of therapeutics and increase the speed with which new molecules can be produced.

Susan Hassler: They’re pretty close. But McDonald and her team still need to figure out one key step.

Karen McDonald: So my perspective as an engineer is always one in which everything we do in the lab we look at from the perspective of, “Is this process step scalable? Or are there constraints that would limit the scalability of the process?” Because we recognize that even though you could make a vaccine in a very small scale in the lab, can you do this in a large scale where you need to make millions of doses of the vaccine? And so sort of an attention to each of the steps and how scalable those steps are is an important aspect that I think engineers bring to the team.

Phil Ross: Scalability of McDonald’s process—the fact that it’s easily expanded or upgraded as needed—means larger and more efficient vacuum infiltration pumps and a huge and readily available crop of tobacco plants.

Susan Hassler: Once the vaccine has been produced, you have to get it out of the leaf. Which in McDonald’s case means grinding it and separating it from all the other proteins and plant parts that you don’t need.

Phil Ross: That can be a messy and inefficient process; you essentially destroy your manufacturing plant every time you harvest.

Susan Hassler: But we’ll tell you in a moment how scientists get around that. Stay with us.

Photo: Gregory Urquiaga/UC Davis

Susan Hassler: We promised to tell you how researchers are turning tobacco plants into biofactories without destroying the plants.

Phil Ross: The workaround involves doing something tobacco plants do all on their own.

Susan Hassler: Here’s Mia Lobel with the story.

Mia Lobel: So where are we headed?

Bob Morrow: Going down into the basement where most of our laboratories are located.

Mia Lobel: Bob Morrow leads me down a cement staircase at Orbital Technologies in Madison, Wisconsin. There’s a series of heavy doors in the dim hallway. He opens one, and I’m hit with a blast of hot air.

Bob Morrow: This is the room that Ryan’s using right now for his plants.

Mia Lobel: It’s a space about the size of a small dormitory, packed with 15 or 20 tobacco plants of various sizes, broad leaves swaying in the forced air. It’s about 75 degrees in here—and humid.

Ryan Shepherd: The room itself, we love it, because—I mean, it’s a secured environment, and the plants grow better here than, than any greenhouse I’ve ever seen.

Mia Lobel: That’s Ryan Shepherd, cofounder of the biotech start-up PhylloTech. His lab is just a few miles up the road at the university research park. But he keeps his plants here, where Bob Morrow can control the temperature and humidity, carbon dioxide levels, and light to create an optimal growing environment.

Ryan Shepherd: So if you, I mean, if you look at some of these tobacco plants—I mean, the leaves are huge. I mean they have, you know, a couple of feet in length. And you know, you can imagine the entire surface area is covered with trichome glands. That’s a large amount of productive space that we can now harness for protein production.

Mia Lobel: Trichomes are the little hairs you see on the surface of tomato and potato plants, sunflowers, and tobacco leaves. They secrete compounds that protect the plant from predators, parasites, and fungus. And they’re the key to the process Shepherd has been able to harness to turn these tobacco plants into biofactories for valuable and hard-to-produce compounds.

Ryan Shepherd: Most current efforts at using plants to make heterologous proteins—the proteins are typically made in leaf interiors, and so then they have to be collected in some manner. And that typically requires grinding up leaves and then trying to purify the protein.

Mia Lobel: Tobacco plant proteins can be collected by simply washing them from the leaf’s surface. This opens the door for countless potential opportunities in biomanufacturing.

Ryan Shepherd: All of this stemmed from a basic fundamental observation in plant pathology: the secretion of these native proteins. And you know, once we determined how these native proteins arrived at the leaf surface and what they did, we can now ask the questions to where exactly can we go with this. You know, what, what other applications can we approach?

Mia Lobel: If Shepherd could genetically alter the plants’ DNA to produce other proteins, he could potentially use tobacco plants as biofactories to secrete whatever protein he wanted. His first target is the silk of the black widow spider.

Cheryl Hayashi: Latrodectus hesperus; it’s a native species to Southern California here. I find them very charming, actually. [Laughs]

Mia Lobel: Cheryl Hayashi is a biologist at UC Riverside. She’s been working with spiders for more than 20 years.

Cheryl Hayashi: Spider silk has captured the attention of a lot of, you know, engineers, biologists, industrialists because of its wonderful combination of mechanical properties. So it’s strong. A lot of other materials are strong, but it’s also stretchy. And it’s this combination of being strong and stretchy that really, really, really make them different from most other materials that people use, you know, for building things.

Mia Lobel: The applications for this light and flexible yet superstrong material are endless: high-performance textiles; biomedical applications like high-tech bandages; artificial joints, tendons, and ligaments; electronic devices…not to mention high-fashion clothing items.

Cheryl Hayashi: Another really appealing aspect to spider silk is that it’s protein-based. So it’s not a petroleum-based material such as nylon, for instance. And being protein-based, it means it can be a green technology.

Mia Lobel: But collecting spider silk for broad use is impractical, to say the least. A few years ago, an international group of artists displayed a 13-foot spider silk cape. It took seven years and more than a million spiders to complete.

Cheryl Hayashi: So, you know, I get calls pretty frequently from people that say they have a good idea for how to use spider silk and, you know, could I send them a hundred pounds of it. And that’s, you know, pretty darned prohibitive. You know, I can’t have undergraduates, you know, having that many silking sessions with spiders in my lab. It’s just—we just can’t do it. And that’s just not feasible.

Mia Lobel: But if Shepherd could successfully produce spider silk proteins in his tobacco plants, he could potentially scale that process to create enough material for all kinds of applications. In 2010, Hayashi sent Shepherd his first sample of spider silk DNA. Shepherd inserted this DNA into the tobacco genome and let the plants grow with the new genetic instructions. And it worked. The tobacco plants secreted the spider silk protein right to the surface of the leaves, where it could be collected, studied, and, they hope, one day soon, spun back into a fully functional strand of silk.

Cheryl Hayashi: You know, I want to see a big bucket of each of those kinds of silk proteins, and I want to—my next thing I want to see is, you know, fibers made from those big buckets of plant-produced silk proteins. And I think, you know, once we have that kind of material, really, I think the sky’s going to be the limit in terms of, you know, what we and other people would be able to do with that material.

Mia Lobel: Even more exciting is the possibility this raises for other proteins—any large protein, really: antibiotics, enzymes, antibodies—all produced faster, cheaper, and more efficiently than they are now.

Ryan Shepherd: Now, our innovation, I believe, is that by targeting the production to trichome glands we are able to not only utilize the plant to produce the protein but also purify it so that we don’t have to grind up the leaf and destroy the plant to recover the protein. And we don’t have to spend, you know, a lot of time, money, and resources trying to extract the target protein from everything else that exists within the plant. So really the hardest part of this is the initial generation of the plant. But once you achieve that and collect seeds, then, yeah, you basically have a system with unlimited growth.

Mia Lobel: Ryan Shepherd says this could transform the way people look at plants.

Ryan Shepherd: I’m hoping that, that our work with trichome bioproduction will enhance people’s opinions of plants as bioproduction platforms. And that by targeting proteins to the glands—essentially using the plant to both produce and purify the protein—that we will be able to make a cost-effective system for protein production.

Mia Lobel: The success of this process could have far-reaching effects.

Ryan Shepherd: So I am a plant scientist, a plant pathologist. I, I very much like the idea that we’re taking a basic fundamental discovery in plant pathology—the idea that plants secrete proteins to their leaf surfaces to provide resistance against pathogens. It’s very exciting to me and invigorating that we can take that discovery now and utilize it for a truly applied purpose: the production of other proteins. And so I think the broader implications are that plants using our technology will hopefully become a viable production platform for many other targets in addition to spider silk and the things that we’re working with currently. And I think once that is attained, plants could be the go-to source for protein production.

Mia Lobel: Shepherd says he hopes to have his tobacco plant biofactory fully operational in the next three to five years. I’m Mia Lobel.

Photo: Mia Lobel

SUSAN: We began this hour with some of the smallest-scaled bionic technologies. And we’ll end by reporting on a technology that will surround you—the Living Wall.

PHIL: It copies the way your skin works to regulate your body temperature.

SUSAN: Laurie Howell went out to explore the Living Wall.

Laurie Howell: We begin in the Engineering Center at the University of Colorado. It's a picturesque campus at the base of the Rocky Mountain foothills. This is where John Zhai, an architectural engineering professor, leads a multidisciplinary team of engineers and architects on a creative venture of a lifetime. They’re designing what they call a “living wall.”

John Zhai: Traditional building designs just want to block the heat. “Hey, we don't want to heat—don’t let the heat in.” We say, “Okay. Let the heat in, but we’re going to deliver this heat to where we need it.”

John Zhai: Okay. So, this is our building system lab. [unintelligible] So, come on in…

Laurie Howell: John Zhai calls the living wall the “skin of the building” because it would autoregulate the temperature of a building, just as skin helps regulate body temperature.

John Zhai: The veins underneath the skin can take the heat from the surface to the body and also can have a fat that’s kind of insulation. So this automatic system is natural in our body. So if we think of the whole building as a body, so the envelope of that is skin.

Laurie Howell: It’s like a human vascular system of capillaries, veins, and arteries: Water is collected at each floor through small tubes and pipes within the living wall, controlled through a computerized brain or building automation system. The hot water is redistributed throughout the building for heating, domestic hot water, or adding heat into the shaded living walls to augment the chimney effect for cooling. The entire system works on a basic law of thermodynamics. The living walls move energy from hot to cold very rapidly and efficiently, whether collecting or distributing heat through water or air.

John Zhai: So the envelope of that is skin. So, can we do something similar or mimic to this natural body systems, which has the fat insulation layers, have all these veins, those blood flow, the air flow, all the stuff, and then very likely we can have a building envelope that can adapt to the environment. So whatever environment is changing, the core body, body inside temperature is always constant. So if we can achieve that same thing, that would be perfect.

Laurie Howell: Zhai says the living wall system could slash energy use by—get this—75 percent. And energy use decreases 75 percent not by improving heating and cooling systems but by eliminating them altogether. No more boilers or chillers to create that comfortable room temperature. The living wall system would use passive heating and cooling: working with the outside temperature instead of against it.

Zhai’s fellow CU professor Fred Andreas is the lead architect on the team putting this million-dollar prototype together.

Fred Andreas: There’s no reason, other than business as usual, that we heat and cool and light our buildings the way we have: as hermetically sealed units that are disconnected from the environment. So the idea of the living wall is to turn the skin of the building into a living skin, copying essentially biologic processes and so trying to autoregulate heat and cooling and ventilation and light through the skin of the building and supplant the huge HVAC systems, heating, ventilation, air-conditioning systems inside of any building and then using natural daylight as much as possible.

Laurie Howell: The outside layer will use current smart glass technology which can block or tune the sun’s rays and control how heat and light enter the wall. The next layer of the living wall is just open space for collecting and distributing passive heating and cooling. And the bottom of the wall, there will be cool water coming in from a source, such as a river, or a lake, or the ocean, or an underground aquifer. And the top of the wall will be hot from baking in the sun. Now think about how a chimney works, and that’s what happens here: The cool-hot temperature difference produces an updraft, and that updraft passively forces hot air up, up inside the multilayered walls, drawing cool air through the building and producing natural ventilation. The hotter the air, the faster it rises. So as crazy as it is to imagine, for this passive cooling design, the hotter the wall, the better!

John Zhai: That’s a testing room we have here which can test all the building systems, the walls, systems. So this is one of the chambers. Watch the steps.

Laurie Howell: We’re walking along an HVAC system which stretches for roughly 40 feet. There are two rooms which can be made any temperature. This will be where the team installs and tests its first prototype.

John Zhai: So, you see all these air systems. We have water panels here. We can, this can provide radiation. We can simulate solar radiation so we can, you know, mimic the outside environment, so we don’t have to go outside to do the real test, cause there's challenging where the real environmental test is.

Laurie Howell: The team envisions one day creating living wall kits for retrofitting buildings, possibly even homes. But right now, they’re focused on overcoming some puzzling design issues. Their biggest challenge is a layer in the living wall that will be made with something called hydrogels. Hydrogels are chemical compounds, or polymers, that absorb or release liquids depending on temperature. They’re used in products, such as diapers, and for a variety of purposes, such as tissue engineering. And they are key to making the living wall work because when the temperature changes, hydrogels embedded in the wall begin pumping water. Depending on the temperatures outside and inside the living wall, the hydrogels pump hot or cold water from one side of the wall to the other, cooling or heating the building. The big challenge for these researchers right now is how to contain the hydrogels within the living wall.

Fred Andreas: So that’s the challenge is, how do we get a plastic collection panel that maximizes heat collection at its best and move that heat through these flexible gels into the depth of the panel, and how do we get those flexible gels into the panel in manufacturing? That’s our challenge right now.

John Zhai: Right. That’s why we cannot use traditional concrete or wood. Right? We’ll have to use a polymer material that’s [a] porous medium so that these kinds of materials can be embedded or attached somewhere in the polymer, those bubbles, so that makes a whole piece of a wall.

Fred Andreas: And here’s the other challenge is, it can’t be glass because glass, when it’s formed, is so hot that it would destroy these hydrogels. So we have to figure a way to get these hydrogels infused into this panel at a relatively low temperature.

Laurie Howell: This is not just another greener building design, this is a change in the way we’ll design the buildings of the future.

Fred Andreas: Typical systems and typical approaches with the same kind of HVAC systems, although they’re very high efficiency and they’re very high technology, they’re still using the same assumptions that we’ve used throughout the 20th century. And this fundamentally changes it, basically moves away from the idea of interior-conditioned buildings to passively controlled buildings.

Laurie Howell: Yeah, truly a game changer.

Fred Andreas: Game changer.

Laurie Howell: And that’s why it's captured the imagination of the next generation of building designers. Grad students Tamzida Khan and Scott Rank are excited about what’s on the horizon for smart building design.

Scott Rank: You know, pretty soon there shouldn’t be green architecture. It should just be architecture and that should be in all of it, integrated into it. So, I think, yeah, we’ve come a long way, but I think it definitely has a lot further to go as well.

Tamzida Khan: If we don’t take risk, then we will not move forward, and I think it’s really important for us to take risks.

Fred Andreas: I keep saying to my students I fundamentally believe that they’ll be looking at this period of time right now, this change to the 21st century, that they’ll be looking back at this in 1000 years as the Renaissance, equivalent to the artistic and cultural renaissance that happened previously. I think that this is an architectural and engineering renaissance that we’re experiencing right now at the early part of the third millennium.

Fred Andreas: I think the sky is the limit.

Laurie Howell: In the early part of the third millennium, reporting on what’s possibly an architectural and engineering renaissance, I’m Laurie Howell.

Susan Hassler: Living walls, like our body’s own layers of skin.

Phil Ross: Intriguing concept! I like it.

Susan Hassler: And what a payoff! By eliminating heating and cooling systems, the energy costs drop 75 percent.

Phil Ross: Working with the outside temperature instead of against. it. More to watch for in our bionic future.

Susan Hassler: You’ve been listening to “Becoming Bionic,” a coproduction of IEEE Spectrum magazine and the Directorate for Engineering of the National Science Foundation.

Phil Ross: The directorate supports people whose discoveries and inventions make our lives more productive, sustainable, and enjoyable.

Susan Hassler: For transcripts of this program, and expanded stories, check out the IEEE Spectrum website:

Phil Ross: You’ll find many other engineering features at the website for the National Science Foundation:

Susan Hassler: Our thanks to Cliff Braverman, Cecile Gonzalez, Valerie Thompson, John Wassel, Prachi Patel, Nancy Hantman, Ramona Gordon, and Paul Ruest at the Argot Studios.

Susan Hassler: Our technical producer is Dennis Foley. Our executive producer is Sharon Basco.

Phil Ross: I’m Phil Ross.

Photo: iStockphoto

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  • Perspective
  • Published: 31 May 2021

Toward higher-performance bionic limbs for wider clinical use

  • Dario Farina   ORCID: 1 ,
  • Ivan Vujaklija   ORCID: 2 ,
  • Rickard Brånemark   ORCID: 3 , 4 ,
  • Anthony M. J. Bull   ORCID: 1 ,
  • Hans Dietl 5 ,
  • Bernhard Graimann 6 ,
  • Levi J. Hargrove 7 , 8 , 9 ,
  • Klaus-Peter Hoffmann 10 ,
  • He (Helen) Huang 11 , 12 ,
  • Thorvaldur Ingvarsson 13 , 14 ,
  • Hilmar Bragi Janusson 15 ,
  • Kristleifur Kristjánsson 13 ,
  • Todd Kuiken 7 , 8 , 9 ,
  • Silvestro Micera   ORCID: 16 , 17 , 18 ,
  • Thomas Stieglitz 19 ,
  • Agnes Sturma   ORCID: 1 , 20 ,
  • Dustin Tyler   ORCID: 21 , 22 ,
  • Richard F. ff. Weir 23 &
  • Oskar C. Aszmann 20  

Nature Biomedical Engineering volume  7 ,  pages 473–485 ( 2023 ) Cite this article

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  • Biomedical engineering
  • Electromyography – EMG
  • Motor control
  • Sensorimotor processing
  • Translational research

Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs.

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We were supported by the Academy of Finland (I.V.), Austrian Federal Ministry of Science (A.S. and O.C.A.), Bertarelli Foundation (S.M.), the European Union (A.S., D.F., K.-P.H., O.C.A., R.B. and S.M.), the European Research Council (A.S., D.F. and O.C.A.), German Federal Ministry of Education and Research BMBF (K.-P.H. and T.S.), the German National Research Foundation (T.S.), the Royal British Legion (A.M.J.B.), the Swedish Innovation Agency (VINNOVA) (R.B.), the Swedish Research Council (R.B.), the Swiss National Competence Center in Research (NCCR) in Robotics (S.M.), US Department of Defense (R.B. and H.H.), US Department of Veterans Affairs (D.T.), US Department of Veterans Affairs Rehabilitation Research and Development Service (R.F.ff.W.), US National Institute on Disability, Independent Living and Rehabilitation Research (H.H. and T.K.), US National Institutes of Health (D.T., H.H., L.J.H. and R.F.ff.W.), US National Institute on Neurological Disorders and Stroke (R.F.ff.W.), US National Institute on Bioimaging and Bioengineering (R.F.ff.W.) and US National Science Foundation (H.H.).

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Department of Bioengineering, Imperial College London, London, UK

Dario Farina, Anthony M. J. Bull & Agnes Sturma

Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland

Ivan Vujaklija

Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA

Rickard Brånemark

Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden

Ottobock Products SE & Co. KGaA, Vienna, Austria

Ottobock SE & Co. KGaA, Duderstadt, Germany

Bernhard Graimann

Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA

Levi J. Hargrove & Todd Kuiken

Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA

Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA

Department of Medical Engineering & Neuroprosthetics, Fraunhofer-Institut für Biomedizinische Technik, Sulzbach, Germany

Klaus-Peter Hoffmann

NCSU/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA

He (Helen) Huang

University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Department of Research and Development, Össur Iceland, Reykjavík, Iceland

Thorvaldur Ingvarsson & Kristleifur Kristjánsson

Faculty of Medicine, University of Iceland, Reykjavík, Iceland

Thorvaldur Ingvarsson

School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland

Hilmar Bragi Janusson

The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pontedera, Italy

Silvestro Micera

Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pontedera, Italy

Bertarelli Foundation Chair in Translational NeuroEngineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland

Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, BrainLinks-BrainTools Center and Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany

Thomas Stieglitz

Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria

Agnes Sturma & Oskar C. Aszmann

Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA

Dustin Tyler

Louis Stokes Veterans Affairs Medical Centre, Cleveland, OH, USA

Biomechatronics Development Laboratory, Bioengineering Department, University of Colorado Denver and VA Eastern Colorado Healthcare System, Aurora, CO, USA

Richard F. ff. Weir

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D.F. and O.C.A. conceived the project, and D.F., I.V., A.S. and O.C.A. edited the manuscript. All authors contributed to writing and revising the manuscript, and approved the final version.

Corresponding author

Correspondence to Dario Farina .

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Competing interests.

L.J.H. and T.K. have a financial interest in Coapt LLC ( ). S.M. is a co-founder of Sensars Neuroprosthetics ( ). T.S. is a co-founder and scientific advisor of CorTec GmbH ( ) and neuroloop GmbH ( ). R.F.ff.W. is a co-founder and president of Point Designs Llc ( ). H.D. and B.G. are scientific managers at Ottobock SE & Co. KGaA. T.I. and K.K. are scientific officers at Össur Iceland. R.B. is the founder and chairman of Integrum AB. A.M.J.B. is co-founder and director of Biomex Ltd.

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Farina, D., Vujaklija, I., Brånemark, R. et al. Toward higher-performance bionic limbs for wider clinical use. Nat. Biomed. Eng 7 , 473–485 (2023).

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How bionic technology will change what it means to be human

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Lockheed's powered HULC exoskeleton could let fighters carry 200 pounds of combat gear without getting tired.

Scientists have been making amazing advances in  bionic technology in recent years: robotic exoskeletons that help people walk, artificial eyes that help blind people see. Some of these technologies are meant as medical aids to help people regain function. But some of this research — by, say, the military — is meant to help give people superhuman capabilities.

And that raises all sorts of thorny ethical questions. Is there any point at which human augmentation is just wrong? Or are these just tools like any other — and part of our inevitable future?

To explore these questions further, I called up Jonathan Moreno, an ethicist at UPenn who's written extensively on these issues, including in his book  Mind Wars: Brain Science and the Military in the 21st Century . Some highlights from our interview are below.

Artificial limbs may become so advanced, we'll prefer them to normal limbs

ilimb Touch Bionics

( Touch Bionics )

"People may end up liking them better," says Moreno. "But my guess is that they'll like them better for certain things, and under some circumstances they won't want to use them. A prosthetic arm might be a great idea if you're trying to play a sport. But if you're trying to make a sexual conquest, it may not be so good, unless we've evolved to the point where it's socially acceptable to put on your bionic arm."

But humans are unlikely to become full cyborgs

Cell culture

This is one way to grow a ton of cells. (Shutterstock)

When many of us think of human augmentation, we think of cyborgs — people who are half human, half machine. Moreno is skeptical that this is what the future will look like. "That's the way we've sort of been conditioned to think of it," he says. "And then we know, of course, about the exoskeletons that DARPA is developing and so forth. We tend to think of it that way, but I'm not sure that's right."

"Could there be a world in which we're all bionic, the old science fiction stuff, all bionic bodies? I kind of doubt it."

Instead, the future will probably be a bit more biological — using human cells to create new organs or encourage the body to regenerate limbs, for example. "I think it's going to take a long time for this to work out, but what's going on right now in the tissue engineering labs, in the stem cell labs, ultimately I think that's where we're going and that these other sort of static-material technologies, these non-biological technologies, are a bridge — but they're not the final answer."

"There are certainly people who think that there's no reason that we can't somehow remember what our bodies have lost in evolutionary time, which is how to regrow a limb. Because there are obviously animals that do that, reptiles do that."

Steroids are nothing compared to what's coming

Man with muscles


The military could possibly use the tissue-engineering approach to someday develop strong supersoldiers. "It would be figuring out a way to get our normal ability to grow muscle cells and tissues to be even better. So you would introduce stem cells that would help the muscles grow."

This may, however, be a ways off. "I won't be around to see it," Moreno says. "But I think in 30, 40, 50 years there will be some of that. And the junk that our athletes take now to grow muscle mass and so forth, that's going to be prehistoric. I really think that tissues will be the way to go."

"That's going to start mostly with tissues for therapeutic purposes, not for enhancement. Y ou've got the tissue engineers and the people working with these new induced pluripotent stem cells and things like that, are trying to find alternatives to organ transplants. And eventually I have no doubt that people will find that there are some ways of using programs like that to build muscle."

There might be limits to how far we can augment humans

Dead end

Moreno thinks there are likely natural boundaries of how far we can push the human body. Many advances might help restore human function — helping blind people see, helping people walk again. But superhuman soldiers could be more difficult. "If the cognitive-enhancement area has taught us anything, it's that it's hard to get the body, including the brain, to function at a continuously, reliably higher level than some physiological norm. It's much easier, it seems, to get somebody up to some physiological norm than it is to make them a lot better than that."

What's really at stake: our humanity

Cyborg robot bionic woman

I asked Moreno what the creepiest thing about human augmentation was. "The creepiest thing is that we become more than human. Much of the history of ideas in the last 150 years, I think, is a response to Nietzsche, who said human beings, basically, that this is as far as we're going to get. And to solve all these problems we have we're going to have to develop an Overman or Superman, something that's more than human. And this whole business about transhumanism, the platform is really Nietzsche."

"For people like you and me, will we be able to redesign ourselves so that we really are transhuman and we live a lot longer and we live a lot healthier and we're a lot stronger and smarter and faster?"

"What that adds up to is a debate among social conservatives: Is there something we're giving up when we're no longer essentially what destiny decided we would be or what we were fated to be? At some point are we really giving up what it means to be human?"

"So part of that is the genetic lottery. And the other part of that is to be human you're supposed to strive. You're supposed to work really hard."

"The whole embryonic stem cell debate — that was all about this. That was all about feeling that the life sciences, biology, was taking us in a scary direction where we really were going to lose what it is to be truly human."

We might not ever be comfortable with some body modifications

Neil Harbisson

Neil Harbisson has a sensor implanted in his skull that detects the colors of nearby objects and translates them into different musical notes produced by a chip in his head. That helps him "see" the colors of the world around him, as well as infrared and UV ranges that no human can naturally see.  (Luis Ortiz/LatinContent/Getty Images)

In one sense, humans are already cyborgs — we're connected, via our smartphones, to an enormous body of information. We outsource much of our knowledge and memory to the internet. But people tend to freak out if you start talking about implanting an RFID chip into people, or a wire or electrodes. Interfering with the human body seems to be something we're uncomfortable with.

"It does seem to be," Moreno says. "But if it's cultural, then we can get habituated and become inured to it. It's an open question. And maybe people will not be freaked out by the wiring after a number of people have had it for a while. I don't know. These things that we do to our bodies, we do tend to become habituated. And artificial stuff, I think, is less tendentious as we go on with it."

"It's true there may be psychological limitations. No one really knows. I think if it's aesthetically acceptable, if it doesn't interrupt the contours of the human body, then I think it's more likely to be accepted — if it's invisible to us or if it fits a certain matrix we have in our head about what the human body's supposed to look like. So I think internal implants will be much more acceptable. But if it's grossly external it could be a problem."

"I think it's because we do have these deep — I would say even evolutionarily conserved — ideas about the human body that are really hard to change."

This interview has been edited for length and clarity.

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Book cover

Biomimetic Research for Architecture and Building Construction pp 11–55 Cite as

Bionics and Biodiversity – Bio-inspired Technical Innovation for a Sustainable Future

  • Wilhelm Barthlott 5 ,
  • M. Daud Rafiqpoor 5 &
  • Walter R. Erdelen 5  
  • First Online: 20 December 2016

3264 Accesses

13 Citations

8 Altmetric

Part of the book series: Biologically-Inspired Systems ((BISY,volume 8))

Rethinking the relationship between Homo sapiens and Planet Earth in the Anthropocene is fundamental for a sustainable future for humankind. The complex Earth system and planetary boundaries demand new approaches to addressing our current challenges. Bionics, namely learning from the diversity of life for nature-based technical solutions, is an increasingly important component.

In this paper, we address the interrelated aspects of the uneven geographic distribution of biodiversity, the issue of the continued erosion of biodiversity translating into a loss of the “living prototypes” for bionics, the relationship between bionics and biodiversity and the North-south gradient in institutional capacity related to biodiversity and bionics-related areas. World maps illustrating these points are included. In particular, we discuss historical aspects and complex terminological issues within bionics or rather bionics-related disciplines, the role of evolution and biodiversity as contributors to the fabric of bionics and the contribution of bionics to the attainment of sustainable development.

The history of bionic ideas and the confusing terminologies associated with them (the term bionic was coined in 1901) are discussed with regard to research, design and marketing. Bionics or Biomimetics, as we understand it today, dates back to the period between 1800 and 1925 and its proponents Alessandro Volta (electric battery), Otto Lilienthal (flying machine), and Raoul Francé (concepts). It was virtually reinvented under the strong influence of cybernetics in the 1960s by H. v. Foerster and W. McCulloch. The term biomimetics arose simultaneously with a slightly different connotation. “Bioinspiration” is a convenient modern overarching term that embraces everything from bionics and biotechnology to bioinspired fashion design. Today, marketing strategies play a crucial role in product placement within an increasingly competitive economy. The majority of so-called “biomimetic” products, however, only pretend to have a bionic origin or function; we have introduced the term “parabionic” for such products.

Life arose almost four billion years ago. Today’s relevant living prototypes for bionics have a history of more than one billion years of evolution, in essence a process of “technical optimization” governed by mutation and selection. In one specific example, we provide evidence that superhydrophobicity, an important biomimetic feature, has been in existence since at least the Paleozoic period, the time when life conquered land.

Bionics might be a major contributor to future nature-based technological solutions and innovations, thus addressing some of humankind’s most pressing issues. Bionics and related fields may become a major component of the current “great transformation” that humanity is experiencing on its trajectory towards sustainable development.

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We acknowledge the help and support of many colleagues and friends in preparing the complex text. The first author (WB) had the chance to meet some of the pioneer workers mentioned in the text (e.g. Ingo Rechenberg, Johann Helmcke and Frei Otto). He met the inspiring Heinz von Foerster 1993 on the occasion of the NeuroWorld symposium in Düsseldorf but missed the singular chance to ask him about the origin of the term “bionic” because, at that time, he was unaware of von Foerster’s crucial role in the Dayton Bionic Symposium of 1960. WB acknowledges information from multiple discussions with his colleagues, friends and students such as Christoph Neinhuis, Thomas and Olga Speck, Armin B. Cremers, Stanislav Gorb, Claus Mattheck, Fredmund Malik, Rainer Erb, Bharat Bhushan and the late Günther Osche.

Many of the ideas presented in this paper benefitted from Walter Erdelen’s extensive international experience, in particular his work as Assistant Director-General for Natural Sciences (2001–2010) and subsequently as strategic adviser at UNESCO. He expresses his sincere thanks to UNESCO Member States and their representatives, up to highest political levels, former staff of the Natural Sciences Sector and colleagues in the Organization with whom he specifically collaborated as Head of Delegation to the World Summit on Sustainable Development (2002).

We are grateful to the Hon. Margaret Austin and Patrick Lim, Callaghan Institute New Zealand, for information on the situation of bionics in New Zealand and to Jacques G. Richardson for constructive comments on earlier drafts of the manuscript.

We acknowledge the reviewers for most valuable comments and the help of Danica Christensen in rereading the English version. Last but not least, the text is shaped by our own experience and work in Bionics and Biodiversity, which was supported by the Deutsche Bundesstiftung Umwelt DBU, the German Research Council DFG, the Federal Ministry for Science and Education BMBF, and the Academy of Science and Literature in Mainz.

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Barthlott, W., Rafiqpoor, M.D., Erdelen, W.R. (2016). Bionics and Biodiversity – Bio-inspired Technical Innovation for a Sustainable Future. In: Knippers, J., Nickel, K., Speck, T. (eds) Biomimetic Research for Architecture and Building Construction. Biologically-Inspired Systems, vol 8. Springer, Cham.

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Bionics: The Future of Prosthetics

via Create the Future: An Engineering Podcast

June 1, 2021

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Hugh Herr is an engineer, biophysicist, and pioneer in the field of biomechatronics - technology that marries human physiology and electromechanics to provide greater mobility for those with physical disabilities. A double amputee himself, Hugh has made breakthrough advances in bionic limbs and prostheses that interface with neurology, allowing both control by thought and sensory feedback.

In this episode of Create the Future, we discuss the technologies employed in biomechatronics and explore the implications of Hugh’s work in everything from regenerative medicine and surgery to elderly mobility. We discuss the rise of robotic exoskeletons, explore the challenges of product commercialisation, and Hugh shares some personal highlights from his journey to end disability. New episodes of ‘Create the Future: An Engineering Podcast’ every other Tuesday. 

Optimization of human-powered elastic mechanisms for endurance amplification

H. Herr and N. Langman. Optimization of human-powered elastic mechanisms for endurance amplification, Structural Optimization, vol. 13, no. 1, pp. 65–67, Feb. 1997.

A trotting horse model

H. M. Herr and T. A. McMahon. A trotting horse model, The International Journal of Robotics Research, vol. 19, no. 6, pp. 566–581, Jun. 2000.

A galloping horse model

H. M. Herr, T. A. McMahon

From swimming to walking: Examples of how biology is helping us design better machines

H. Herr, G. Pratt, R. Dennis, N. Rosenthal, and R. Marsh. From swimming to walking: Examples of how biology is helping us design better machines, Second International Congress on Motion Systems, Jena, Germany, Jul. 2001.

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  • People & medicine

Bionic limbs

Advances in human bionics may require us to rethink our concepts of what it is to be human.

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Associate Professor Munjed Al Muderis

Associate Professor Munjed Al Muderis

Macquarie University

Osseointegration Group of Australia

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Dr Emily Ridgewell

Dr Emily Ridgewell

Australian Orthotic Prosthetic Association

  • Bionics can be highly advanced pieces of technology, able to be integrated with various parts of the human body.
  • Bionic limbs are constantly evolving and becoming more lifelike in their form and function.
  • There are many different types of bionic limb technology available, each with its own benefits and drawbacks.
  • Bionic limbs still have a long way to go before they achieve the full range of motion, control and sensitivity of ‘biological’ limbs. 

Faster? Stronger? More powerful? Bionic bodies—and what they may be capable of—have captivated the human mind for centuries. From the bumbling Inspector Gadget to the near‐indestructible Terminator, the idea of using technology to build a ‘better human’ has resulted in continuous technological advances. 

The term ‘bionics’ was first used in the 1960s. It combines the prefix ‘bio’—meaning life—with the ‘nics’ of electronics. Bionics is the study of mechanical systems that function like living organisms or parts of living organisms.  

Artificial limbs, or prostheses, are used to replace a missing body part which may have been lost due to trauma, disease or congenital defect. The type of prosthesis a person can use is dependent on the individual, including the cause of amputation or limb loss, and the location of the missing extremity. 

Basic artificial limbs have been used since 600 BC . Wooden legs, metal arms, hooks for hands—while these primitive replacements gave the wearer back some semblance of movement or function, they were often uncomfortable, difficult to use, had poor functionality and were cosmetically unattractive. 

A prosthetic leg from WWI.

Today, researchers are striving to develop lighter, smaller, better‐controlled, more lifelike and affordable options. What’s different about the new generation of prosthetic limbs is their union with bionic technology, and the way they combine fields of study as diverse as electronics, biotechnology, hydraulics, computing, medicine, nanotechnology and prosthetics. Technically, the field is known as biomechatronics, an applied interdisciplinary science that works to integrate mechanical elements and devices with biological organisms such as human muscles, bones, and the nervous systems. 

External prosthetic limbs

Recent progress in both materials science and technology has resulted in significant advancements in prosthetic limbs. While it’s tempting to imagine these limbs as giving the wearer some kind of superhuman edge, in reality, researchers at present are simply trying to recreate the functionality and range of motion experienced by a healthy human limb. This is more difficult than it sounds.

Think about it—if your nose is itchy, you scratch it. But take a moment to consider how you actually do this. First, you need to bend your elbow while raising your forearm so that it’s in the correct position close to your nose. Then you need to rotate your forearm to the required angle so that your finger can reach your nose, then extend a finger and move it up and down repeatedly on the itch. And you have to do all this while applying the right amount of pressure to stop the itch, but without scratching off any skin. As you can imagine, creating a robotic limb to do all these things seamlessly, easily and quickly is quite a challenge.

A woman scratching her nose

So while giving a high five or walking up a flight of stairs might not seem like very complex activities, behind the scenes (or inside your head) your brain is constantly working to help you perform even the simplest gestures. Nerves, muscles, synapses, brain cortices—they all need to be working seamlessly to allow you to perform these tasks.

It is this interaction between thought, action and response that researchers across the world have been trying to replicate in their bionic technologies.

A number of bionic prosthetic limbs are now available which are beginning to mimic some of the functionality of the original lost limbs. Others are still at the research and development stage, but are showing great promise.  Let’s take a look at some of them.

Myoelectric limbs

Traditionally, upper‐limb prostheses were body powered, using cables and harnesses attached to the individual and relying on body movements to manipulate cables that control the prosthetic limb. This can be physically tiring, cumbersome and unnatural. 

Myoelectric limbs are externally powered, using a battery and electronic system to control movement. Each prosthesis is custom made, attaching to the residual limb using suction technology. 

Once the device has been securely attached, it uses electronic sensors to detect even the smallest traces of muscle, nerve and electrical activity in the remaining limb. This muscle activity is transmitted to the surface of the skin where it is amplified and sent to microprocessors, which use the information to control the movements of the artificial limb. 

Based on the mental and physical stimulus provided by the user, the limb moves and acts much like a natural appendage. By varying the intensity of the movement of their existing functional muscles the user can control aspects such as strength, speed and grip in the bionic limb. If muscle signals cannot be used to control the prosthesis, switches with a rocker, pull-push or touch pad can be used. Improved dexterity is achieved via the addition of sensors and motorised controls, thus enabling users to perform tasks such as using a key to open a door or getting cards out of a wallet.

One of the features of this technology is the ‘autograsp’ function, which automatically adjusts tension when it detects a change in circumstance (such as holding a glass that is then filled with water). An added bonus of the myoelectric limb is that, like traditional body-powered devices, it can be made to replicate the appearance of a natural limb.  

The disadvantages of this technology are that the battery and motor inside it makes it heavy, it’s expensive, and there’s a slight time delay between the user sending a command and the computer processing that command and turning it into action. 


Another bionic limb breakthrough is known as ‘osseointegration’ (OI). Derived from the Greek ‘osteon’, meaning bone, and the Latin ‘integrare’, which means to make whole, the process involves creating direct contact between living bone and the surface of a synthetic—often titanium‐based — implant.

The procedure was first performed in 1994, and uses a skeletally integrated titanium implant, connected through an opening (stoma) in the residual limb to an external prosthetic limb. The direct connection between the prosthesis and bone has several advantages: 

  • It provides greater stability and control, and can reduce the amount of energy expended.
  • It does not require suction for suspension, which makes it easier and more comfortable for the user.
  • The weight‐bearing is brought back to the femur, hip joint, tibia or other bone, reducing the possibility of degeneration and atrophy that can accompany traditional prostheses.

Traditionally, the procedure requires two operations. The first involves the insertion of titanium implants into the bone and, often, extensive soft-tissue revision. The second stage, around six to eight weeks later, includes the refinement of the stoma and the attachment of the hardware that connects the implant to the external prosthetic leg. Gradually, bone and muscle begin to grow around the implanted titanium on the bone end, creating a functional bionic leg. The external prosthesis can be easily attached and removed from the abutment GLOSSARY abutment the portion of an implant that protrudes through the tissues and is designed to support a prosthesis. within a few seconds. Recently, Australia‐based surgeon Associate Professor Munjed Al Muderis has been able to perform the surgery in a single operation. 

Because the prosthesis is attached directly to the bone, it has a greater range of movement, control and, in some cases, has allowed wearers to distinguish tactile difference between surfaces (such as carpet versus tiles) via osseoperception. 

Scanning electron micrograph image of bone-forming cells crawling over monetite crystals.

Gait-training, strengthening and rehabilitation are all important parts of the pre and post‐surgery procedure. Many of the recipients of the new technology have been up and walking independently within weeks of the operation, and have been able to regain much of their quality of life. 

A continuing development in the field of OI is the introduction of products that use a porous metal construction, such as titanium foam. T raditional OI designs intended for the femur were not successful when applied to the tibia as the proximal tibial bone structure is highly spongy.However, with the development of titanium foam technology the application of OI has now been expanded to transtibial amputees. Associate Professor Al Muderis has pioneered a 3D-printed foam surface implant which is successfully used in transtibial amputees. These 3D-printed metal foams may promote and contribute to bone infiltration and the formation and growth of vascular systems within the defined area. In this way, the porous, bone‐like metal foam allows osteoblast GLOSSARY osteoblast a cell which secretes the substance of bone. activity to begin. 

Recipients of the OI procedure say that it almost feels like the real thing. Drawbacks of this type of prosthesis are that it is costly (generally over A$80,000), and unsuitable for many types of amputee.

Mind‐controlled bionic limbs

The next advance in bionic limb technology is the emergence of mind‐controlled bionic limbs. These are prostheses which can be integrated with body tissues, including the nervous system. They are highly advanced, able to respond to commands from the central nervous system and therefore to more closely replicate normal movement and functionality, while also instantly triggering the desired movement with less ‘lag time’. There are several different procedures and technologies currently in the research and development phase.  

A brain-controlled prosthetic arm.

Targeted muscle reinnervation

A surgery called targeted muscle reinnervation uses nerves remaining after an amputation, and the same impulses from the brain that once controlled flesh and blood, to control an artificial limb. The surgery reattaches nerves that control the joints from the missing part of the limb into muscle tissue in the residual limb to allow a more natural thought process and control the prosthesis the same way as myo-electric control. Effectively, the brain impulses are linked to a computer in the prosthesis that directs motors to move the limb. 

In 2014, Les Baugh, a bilateral shoulder disarticulation (through the joint) amputee, was able to use this technology to operate two upper limb prosthesis for the first time. Working with researchers at Johns Hopkins University, he was able to lift cups and perform a variety of tasks with each arm, a result of a procedure which could change the way prosthetic limbs are thought about, developed and used.

The procedure involved numerous steps over many months:

  • Les underwent targeted muscle reinnervation surgery, a procedure which reassigns nerves that once controlled the arm and hand. By reassigning the existing nerves, it became possible for Les to control his prosthetic limbs merely by thinking about the action he wanted it to perform.
  • After recovery, Les was given training on the pattern recognition system that makes up a key part of the technology. Pattern recognition algorithms are used to identify individual muscles, how they are contracting, communicating and working with each other, as well as their amplitude and frequency. This information is then used to create the actual movements of the prosthesis.
  • A brace was custom made for Les’s torso and shoulders. This device supports the prosthetic limbs, while also making the neurological connections with the reinnervated muscles.
  • Les undertook further training on the limb system using a virtual integration environment.
  • Finally, the limbs were attached to the brace, and Les was able to begin to put his training into practice, moving various objects.

Researchers were surprised by the speed at which Les was able to control the technology, particularly his ability to control a range of motions across both arms at the same time—a first for simultaneous bimanual control. 

I think we are just getting started ... There is just a tremendous amount of potential ahead of us, and we've just started down this road. And I think the next five to 10 years are going to bring phenomenal advancement. Revolutionizing Prosthetics Principal Investigator, Michael McLoughlin

There was also an unexpected effect in some patients undergoing this procedure: not only can they move their new limb, they can feel some sensation with it. 

Implanted myoelectric sensor technology

Arms aren’t the only part of the body to benefit from improved technologies. Researchers from Iceland have created a mind‐controlled prosthetic leg that uses implanted myoelectric sensor (IMES) technology. This involves sensors implanted directly into the patient’s limb muscles but, unlike nerve reinnervation, there is no need to transplant nerve tissue from one part of the body to another. Implanting the IMES technology is relatively easy and simple—requiring only a 15-minute operation where each sensor is placed into the tissue via incisions just 1 centimetre long. Once inserted, the sensors don’t need to be replaced unless they become damaged.

Thorvaldur Ingvarsson, the surgeon who completed the operation, described the process : “The technology allows the user’s experience with their prosthesis to become more intuitive and integrative ... They no longer need to think about their movements because their unconscious reflexes are automatically converted into myoelectric impulses that control their bionic prosthesis.”

A participant in the study, Gudmundur Olafsson, said, ‘As soon as I put my foot on, it took me about 10 minutes to get control of it. I could stand up and just walk away ... It was like, I was moving it with my muscles, there was nobody else doing it, the foot was not doing it, I was doing it, so it was really strange and overwhelming.’

The exciting thing about IMES technology is that it can be relatively simple to fit (it does not require complex surgery), functions well in ‘real life’ scenarios and can work for an extended period of time.

The world's first thought-controlled bionic leg

Taking this a step further, in 2015 researchers at the US Defense Advanced Research Projects Agency (DARPA) announced that they had given a paralysed man the ability to feel physical sensations via a prosthetic robotic hand that had wires directly connected to his brain. When blindfolded, the man was able to successfully identify when which fingers on his prosthetic hand were being touched,  and when.

We’ve completed the circuit ... Prosthetic limbs that can be controlled by thoughts are showing great promise, but without feedback from signals travelling back to the brain it can be difficult to achieve the level of control needed to perform precise movements. By wiring a sense of touch from a mechanical hand directly into the brain, this work shows the potential for seamless bio‐technological restoration of near‐natural function. DARPA program manager, Justin Sanchez

How does it all work? An array of electrodes were clinically implanted onto the man’s sensory cortex—the region of the brain responsible for identifying tactile sensations such as pressure and texture. The team also placed arrays on the volunteer’s motor cortex, the part of the brain that directs body movements. Wires from these arrays were connected externally to a mechanical hand, which gave the volunteer the ability to control the hand’s movements. Most importantly, however, the hand contained complex torque sensors which were able to detect different levels of pressure, converting those sensations into electrical signals. These signals were then routed back to the arrays on the volunteer’s brain, stimulating the sensory neurons in the brain and allowing the sensation and feeling of each finger to be ‘felt’ by the patient. 

The technology is not yet commercially available, but offers great potential for future developments. 

Such advances have made these artificial limbs more practical and intuitive, but even the most state‐of‐the-art prostheses cannot yet replicate the full functionality of natural limbs.

Cosmetic improvements

The emergence of 3D printing and computer‐aided design is beginning to help create limbs that are a perfect custom‐fit for the wearer, and should, as time progresses, become more affordable.

While many of the new bionics look like something out of a science‐fiction movie, researchers are also succeeding at creating options that look more realistic than ever before. Prostheses can now be created with anatomically correct shapes that mirror the form of the wearer, and can incorporate details such as accurate skin colour, freckles, birthmarks, hair, veins, tattoos, fingerprints and fingernails. These life-like creations can be made from PVC or a range of silicones and cover the prosthetic limb using a variety of methods, such as adhesive, stretchable skins, suction, form fitting, or a skin sleeve. For many amputees, having a limb that does not attract unwanted attention is very important. 

A prosthetic hand that looks almost identical to a real hand.

What makes us human? Is it our bodies? Our brains? Our emotions? Or something more intangible? Advances in human bionics may eventually require us to rethink our concepts of what it is to be human, as the lines between human and machine become increasingly blurred.

Yet despite the desire to imagine a future of cybernetic enhancements, at present bionic limbs remain chiefly medical devices, designed to restore function and provide people who have lost limbs with a better quality of life. The bionics may look impressively futuristic, but they are not yet able to fully replicate the complexity, range of movement and functionality of a normal human limb. 

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The current state of bionic limbs from the surgeon’s viewpoint

Marko bumbaširević.

1 School of Medicine, University of Belgrade, Serbia

2 University Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Serbia

Aleksandar Lesic

Tomislav palibrk, darko milovanovic.

3 King’s College Hospital, London, UK

Tamara Kravić-Stevović

4 University of Belgrade, Department of Histology and Embryology, Serbia

Stanisa Raspopovic

5 ETH Zürich, Department of Health Sciences and Technology, Institute for Robotics and Intelligent System, Zurich, Switzerland

  • Amputations have a devastating impact on patients’ health with consequent psychological distress, economic loss, difficult reintegration into society, and often low embodiment of standard prosthetic replacement.
  • The main characteristic of bionic limbs is that they establish an interface between the biological residuum and an electronic device, providing not only motor control of prosthesis but also sensitive feedback.
  • Bionic limbs can be classified into three main groups, according to the type of the tissue interfaced: nerve-transferred muscle interfacing (targeted muscular reinnervation), direct muscle interfacing and direct nerve interfacing.
  • Targeted muscular reinnervation (TMR) involves the transfer of the remaining nerves of the amputated stump to the available muscles.
  • With direct muscle interfacing, direct intramuscular implants record muscular contractions which are then wirelessly captured through a coil integrated in the socket to actuate prosthesis movement.
  • The third group is the direct interfacing of the residual nerves using implantable electrodes that enable reception of electric signals from the prosthetic sensors. This can improve sensation in the phantom limb.
  • The surgical procedure for electrode implantation consists of targeting the proximal nerve area, competently introducing, placing, and fixing the electrodes and cables, while retaining movement of the arm/leg and nerve, and avoiding excessive neural damage.
  • Advantages of bionic limbs are: the improvement of sensation, improved reintegration/embodiment of the artificial limb, and better controllability.

Cite this article: EFORT Open Rev 2020;5:65-72. DOI: 10.1302/2058-5241.5.180038


Amputations and, consequently, prostheses as their most immediate solution, have a long history, starting with hooks and other prosthetic replacements of the Middle Ages, continuing to Ambroise Paré’s mechanical hand ( Fig. 1 ), 1 to modern robotic, osteointegrated 2 and bionic limbs, 2 – 9 which are the results of both medical and technological progress. Modern-age prosthesis developmentwas boosted as a consequence of the World Wars – first in Germany 10 and then in the former USSR. 11

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Articulated hand by AmbroiseParé from1579.

There are around 2 million limb amputees in the USA with 185,000 amputations performed annually. 12 Inferred from statistics for Germany, Italy, Ireland and the USA, the EU has approximately 3.18 million limb amputees (4.66 million for all of Europe) and around 295,000 amputations are performed each year (431,000 for all of Europe). 12 – 16 This poses a huge medical and economic problem. Amputations have a devastating impact on a patients’ health and produce psychological distress with consequent economic loss. Patients have difficulties being fully reintroduced to their workplaces in the post-amputation period. 3 , 17 They usually feel the prosthesis as a foreign body (low embodiment), therefore there is a need to provide new prosthetic solutions, which should be more efficient and more easily accepted/embodied by patients. 18 , 19

In the case of a traumatic amputation and if there is an indication for it to be performed, replantation is always the treatment of choice. 20 , 21 From our experience, in cases of severe limb trauma with mangled extremities, microsurgical reconstruction, if indicated and successful, gives much better results than any other possible solution. Alternatively, we have recently witnessed a successful cadaveric limb transplantation, 22 – 24 albeit followed by a requirement for life-long immunosuppressive therapy and the patient’s difficult psychological acceptance of the dead-donor hand.

Yet, prostheses are still an important aspect of orthopaedic practice, since traffic accidents, tumours and especially diabetes are widely present and these patients very often have non-reconstructable limbs. Prostheses try to replicate the appearance and functionality of limbs to the finest detail. We may have reached the pinnacle of prosthetic aesthetics, but the patient’s control and ‘feeling’ of these artificial replacements is still very problematic. 2 – 9 Therefore, the need for modern, intuitively controllable and naturally perceived prosthesis is nowadays even more pronounced. Thus, the aim of many research projects both in the United States 25 , 26 (Revolutionizing Prosthetics and HAPTIX program from Defence Advanced Research Projects Agency) and in Europe 18 , 27 (Cyberhand and NEBIAS from the EU commission) has been to restore the motor control of the device, but also sensation flow from the prosthesis to the body. In the recent past, several research groups have shown the benefits of restoring sensory feedback together with motor control of the prosthesis in upper 2 , 8 , 9 , 28 – 31 and lower limb amputees. 6 , 32 , 33 These approaches have the scope to replicate the near-to-natural motor and sensory limb functionalities of an intact limb, replacing it with an active and sensorized prosthetic device. As a result of these innovations, ‘bionic limbs’ were developed and represent the newest achievement in prosthetics.

This article describes and compares data from literature on bionic limbs, the available technological solutions and limitations, future perspectives and possibilities for further clinical applications. Related surgical procedures are also described and derived from the authors’ personal experience.

Bionic limbs terminology, existing solutions and current pains

The term ‘bionics’ was first used by Jack E. Steele in the US TV show – ‘The Six Million Dollar Man and Bionic Woman’, in which superpowers were imparted to the protagonists by electromechanical implants. Afterwards, this term earned widespread use in literature and television. 34 In current terminology, it mainly addresses devices that make a direct connection with the residual nervous or muscular system of the impaired individuals.

There is a difference in the role and, consequently, construction of bionic limbs for the upper (including hand) and the lower extremities. The functions of the upper limbs (UL) and the lower limbs (LL) differ, and the role of and need for limb replacement in these cases are different; therefore, careful evaluation of the needs and the remaining capacity of patients must be considered during the construction of aprobable bionic limb. The situation in upper limb amputation, hand or forearm, is the most complex, since the hand represents the highest level of evolution with sophisticated and unique functions. Its control of 40 muscles and the involvement of a large surface of the brain cortex, suggests its significant role and importance in human performance. Present commercial prostheses are failing in replicating such control of the actuation or sensing capability. 3 , 4 , 35 , 36 Conversely, the LLs are used for standing, walking, ensuring stability and balance. This is made possible after a transtibial amputation, using the modern below-the-knee prostheses. 6 , 25 Such patients can walk, dance, and play sports at near-normal levels. However, those undergoing high transfemoral (thigh-level) amputations do not regain normal gait and balance, and are at risk of falling and overloading the opposite, healthy leg. Several long-term problems, including osteoporosis, arthritis, back pain, and increased metabolic consumption (with possible disastrous outcomes) frequently occur in these patients. 37 , 38

Bidirectional control

Many efforts have been made to solve a number of technical problems, which were present in prosthetic devices. Batteries are today long-lasting and energy consumption for these limbs is lower. 3 , 39 , 40 Biological residuum and electronic devices interface through the placement of parts of a machine in direct connection with the human body in order to enable bidirectional communication between the electronic signals and ionic currents within the living organism. 34 Actually, a bionic limb is denominated as such, thanks to the inclusion of the hardware that acts as an interface between the residual human nervous system and the device (such as a robotic hand or leg). Novel surgical techniques have improved the efficacy of these technologies interfacing them with several muscular 41 – 44 and nervous structures, 2 , 8 , 9 , 27 , 28 – 31 , 45 , 46 in a more intimate way. These include the muscle direct approach through the injections of small implants, 42 , 47 nerve rerouting for the muscular reinnervation, 18 , 41 , 43 , 44 , 48 – 50 and nerve interfacing around, 2 , 9 or within 8 , 27 , 28 – 31 , 45 the fascicular structures.

A bionic limb is controlled by the electric signals from the muscle and/or nerves above the level of the amputation. Bidirectional control is then completed via sensation restoration through the connection of the remaining nerves or muscles above the level of amputation to the prosthetic device sensors.Therefore these devices enable both intuitive control and natural flow of sensation from the artificial device to the user ( Fig. 2 ). The first successful proof of concept was achieved with bionic hands. 7 – 9 , 41 , 42 , 45 , 48 Modern hand prostheses are actuated by advanced motors, enabling the restoration of sophisticated hand movements, through the connection with direct muscular signals. 31 , 42 , 50

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Surgical targets for bionic limb control andsensing.

In order to restore the sensory information flow, the signals from tactile and position sensors embedded in the prosthesis are converted into electrical impulses by sensory encoding algorithms implemented on a system controller. 8 , 9 , 28 , 30 , 46 Then, the stimulation trains are delivered to the nerve, using a neural stimulator by means of microelectrode implants previously fixed into or around the somatosensory nerves. In this way, users could perceive sensations directly on the phantom limb according to the interactions between prosthesis and external world, being again masters of the space around them.

Implants, nerve and muscles transferring

The neural signal pick-up can be achieved by exploiting the natural nerve motor signal amplification that is obtained on the neuromuscular junction, therefore placing the recording electrode on the surface of the muscle 50 , 51 (surface electromyography (EMG)) or inside the muscle 42 , 52 (intramuscular EMG). Moreover, the motor intentions potentially could be also recorded directly from the peripheral nerves 27 , 31 , 53 (electoroneurography (ENG)) in order to be more selective. Yet the last approach suffers from difficulties with long-term stability and reliability. 4 , 5 , 27 , 31

Bionic limbs can be divided into three main groups, according to the implant used, the type and the tissue interfaced:

Nerve and muscle transferring

Direct muscleinterfacing, direct nerveinterfacing.

Targeted muscular reinnervation (TMR) invented by Kuiken 41 , 43 involves the transfer (rerouting) of the remaining nerves (e.g. median and ulnar nerve) of the amputated stump to the available muscles (e.g. chest muscles), thus amplifying neural control signals via their natural muscular amplifier. Those signals are then registered by the electrodes and transferred to the prosthesis to control its action. 41 , 43 Indeed, when a subject thinks of moving his/her missing hand, the reinnervated chest muscles are stimulated and the signal is then captured by recording electrodes and used to drive the movement of the robotic arm. 41 , 50 The same approach was also applied to lower limb amputees. 44 Additionally, tactile stimulation over the reinnervated areas (e.g. chest) can induce the sense of touch of the missing arm/fingers. 18 , 48 However, when trying to implement real bidirectional control, it is yet impossible to record the signals from the innervated muscle and, at the same time, implement the sensory touch-feedback, since the same area needs to be approached, possibly due to the sensory gating problem. 52 Recently, this issue was tackled, achieving reinnervation of separated motor and sensory fascicles over different muscles. 18 This approach shows promise for the success of such a bidirectional system. The targeted muscle reinnervation approach is an excellent solution, especially for very high amputees (e.g. shoulder disarticulation or transhumeral amputation of the arm).

Recently, an elective amputation, combined with the techniques of selective nerve and muscle transfers and prosthetic rehabilitation to regain hand function, have also been proposed in three patients with brachial plexus injuries. 7 On a similar track, Herr and colleagues 6 , recently proposed the so-called agonist-antagonist myoneural interface (AMI). AMI is a new idea encompassing a surgical construct made up of two muscle tendons – an agonist and an antagonist – surgically connected in a series so that contraction of one muscle stretches the other. The idea of the AMI is to recreate the dynamic muscle relationship that existed within the pre-amputation anatomy, thereby allowing proprioceptive signals from both muscles to be transferred to the central nervous system. Herr and his team surgically constructed two AMIs within the residual limb of a subject with a transtibial amputation, achieving very promising results. 6 Such an elegant surgical approach appears to be very promising in transtibial amputees, while it could be more difficult to apply in transfemoral patients.

In the second type of bionic limbs, the approach to the control signal captured from the residual muscular tissue is made through direct intramuscular implants. 42 , 47 Intramuscular implant-based control consists of small recording devices implanted into the residual muscle to record muscular contractions, which are then wirelessly captured through a coil integrated in the socket. Muscular contractions then actuate the prosthesis movement. In the case of upper limb amputees, 42 control has been achieved over simultaneous grasp and wrist movements; whereas a previously unseen, voluntary control of the ankle motion has been achieved in lower limb amputees. 47 Yet, sensory feedback is not available with this solution. The drawback is that this approach can work better in the case of more distal amputations (low transradial or transtibial), when many of the extrinsic muscles have been preserved, while in more proximal amputations (were muscles are missing) it would be difficult to implement. However, in higher (more proximal) amputations it could possibly be combined with the surgical techniques described above.

The third option involves the direct interfacing of the residual nerves using implantable peripheral neural interfaces. 35 , 36 This may be achieved by means of the neural electrodes going around or through the nerve. It is thus possible to enable control of the device 41 or to impart a sensation from the device. 8 , 9 , 54 , 55 Actually, transformed electric signals from prosthetic sensors stimulate the nerves in the stump, restoring sensation in the phantom limb, and thus allowing the patient to ‘feel’ once more. 27 , 45 The third group of bionic limbs incorporates the sense of the absent extremity via electrodes implanted surgically in the residual nerves, which innervate the UL or LL. To regain and improve bionic limb sensibility 28 – 31 , 56 the electrodes are introduced and placed intraneurally through the fascicles, 5 , 8 , 28 – 31 , 45 or around the nerves by means of an epineural cuff. 2 , 9 , 46 This has its rationale, since the peripheral nerve is positioned transversally from the topographic aspect, thus enabling different structures to be successfully stimulated through the device pinching the nerve transversally. Investigations suggest that intraneural stimulation can revive neural paths and improve control of an artificial limb through very short learning and training processes. 8 , 28 , 30 This is achieved by the process of decoding motor intention from the remaining muscles and encoding the sensation with electric nerve stimulation through the electrodes, 8 , 28 which are placed through the nerve during the intraoperative procedure. 8 , 27 , 28 In specific studies, 8 , 28 – 30 the intraneural implants (two in each median and ulnar nerve) bear external wires that are connected to the artificial touch sensors and a neural stimulator of the bionic limb. This enables them to send impulses to the brain by a process of mapping what patients feel and detect when touch is executed over a certain area of the sensorized prosthesis. These patients exhibit remarkable dexterity 8 , 28 – 30 and even texture recognition. 57 Simultaneously, due to the physiologically plausible afferent drive restoration, phantom pain decreased. 28 , 56 , 58 – 60

Preliminary trials seeking to combine osteointegration and neural interfacing into a fully portable and self-contained bionic device have also been performed. 2

Surgical procedures

Correct interfacing of residual nerves ( Fig. 3 ) is critical. In such case, the surgeon must take extreme care to do the following:

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Position of the electrodes in the nerves (Adapted from: Oddo CM, Raspopovic S, Artoni F, et al. Intraneural stimulation elicits discrimination of textural features by artificial fingertip in intact and amputee humans. eLife 2016;5:e09148 ( )). 57

Note. As (Amplitude), Ts (Pulse duration)

  • Target the proximal nerve area, free of any neuro degeneration (e.g. the valerian nerve).
  • Competently place and fix the interface and cables,while retaining movement of the arm/leg and nerve.
  • Avoid excessive neural damage.

The surgical procedure for electrode implantation is performed in a limited number of cases. 2 , 8 , 9 , 27 , 28 , 31 We have trained in the implantation of TIMEs 61 (transversal intra-fascicular multichannel electrodes) in the median and ulnar nerve of the upper and sciatic nerve of the lower limb of cadavers. The surgical approach to the both UL and LL nerves is direct. The nerves of interest are the median and the ulnar nerve of UL and the sciatic nerve (tibial nerve) for LL. Skin incision and separation of muscles from other soft tissues should be gentle in order to prevent scarring and fibrosis.

Haemostasis must be meticulous to reduce interference with electronic signalling, oedema and infection. Also, special attention must be paid to nerve preparation. As it is crucial to preserve the epineural tissue and fine vascular structure, electrodes must be placed only after mapping the fascicular structure. After a gentle opening of an external neural sheet, it is advised to access fascicular structures ( Fig. 4a ). Electrodes should be perpendicularly inserted into the nerve through as many fascicules as possible to obtain contact with the active sites of the electrodes ( Fig. 4b ). By pulling the straight needle with an 8-0 suture the electrode could be placed into the nerve. Then the electrode is fixed with sutures through the fixation tabs with holes to the surrounding epineural tissue ( Fig. 4c ). The electrode structure is fragile and breakage must be avoided so technique must be meticulous. After electrodes are placed and secured at three levels, a subcutaneous tunnel should be created for the cable and connector towards the neurostimulator. This surgical procedure is a demanding one, and requires an experienced microsurgeon to perform it properly. It enables stable fixation of electrodes and cables, and is suitable therefore for long-term use.

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Intraneural electrode placement (cadaveric preparation): (a) fascicles structures access, (b) electrode placement through different fascicles, (c) electrode fixation.

Discussion and conclusion

Advantages observed in the use of bionic limbs are: the restoration of sensation, improved reintegration/embodiment of the artificial limb and better controllability. For future applications to LLs, we envision the possibility of achieving better balance and a close to normal gait, which will decrease the number of falls and energy consumption.

Despite several promising aspects offered by innovative bionic solutions, there are still several limitations, which must be faced prior to the widespread use of similar devices. The main limitation of the majority of studies presented in this article is that these were mainly time-limited studies; therefore, long-term research regarding the behaviour of electrodes in muscles and nerves must be performed in view of their safety and functionality. In the majority of clinical trials, transcutaneous cables were used. The exit points on the skin for the cables are a matter of concern, both from a mechanical standpoint and in terms of preventing infection. Fully implantable solutions must be developed and tested.

The presence of microelectrodes for recording or/and stimulation inside the body makes the overall approach prone to stress-induced mechanical failures. 28 For future clinical practices, though, the solution should be represented by a fully implantable system, which will avoid any daily connection and disconnection between the electrode cables and the neural stimulator.

Bionic limb replacement promises to be available as a fully implantable, bidirectional device for the upper limb, controlled via implanted electrodes to obtain muscular or nerve signals and with sensory feedback achieved through nerve stimulation. In the future, it would be interesting to implement such bionic solutions to lower limb amputees as well, especially for highly disabling transfemoral amputations, since they hold promise for tremendous health improvements and an overall increase in quality of life. Research efforts are still needed to investigate the long-term presence of electrodes, their fixation, cable fixation, and fully implantable and portable electronics.

ICMJE Conflict of interest statement: The authors declare no conflict of interest relevant to this work.

Funding statement

The paper is supported by Ministry of Science Republic of Serbia no. 175095.

IEEE Pulse

A New Era for Bionic Limbs

  • March 28, 2023

Recent breakthroughs in science and technology have produced prosthetic hands, arms, and legs that increasingly resemble biological ones

Despite remarkable advances in the field of prosthetic limbs, existing products still aren’t meeting the needs of patients. A 2022 survey found that 44% of upper-limb amputees abandoned their prostheses, citing discomfort, heaviness of the device, and problems with functionality [1].

Researchers and product developers are hard at work to change that, developing a new generation of bionic limbs, which are robotic prosthetics that are controlled by signals from users. For people who have lost body parts to trauma, disease, or congenital defects, bionic limbs hold the power to restore a high degree of independence. Pioneering new surgeries, life-like materials, and touch feedback for users are some of the key innovations fueling that progress.

Making the artificial more biological

Several key technological advances have set the stage for prosthetic limbs that are more responsive, resilient, and user-friendly than their predecessors. Improvements in the primary components of robotic limbs, including microcontrollers, motors, transmission systems, batteries, artificial intelligence (AI), and machine learning have occurred in tandem over the past decade, catapulting research in the field to new heights.

Another boon for the field: 3-D printing. PSYONIC, a bionic technology company based in San Diego, has leveraged the relatively inexpensive technique to build its Ability Hand, the fastest hand on the market, but also one of the lightest and most resilient (Figure 1). Rather than using rigid materials common in the field of prosthetics—such as injection-molded plastics and custom machine steel—PSYONIC’s hand is built with soft robotics materials, including silicone and rubber, that more closely resemble human hands [2].

“The number one complaint we heard from patients and clinicians was that their expensive prosthetics would break easily,” said Aadeel Akhtar, Ph.D., PSYONIC’s founder and CEO. “In contrast, our own fingers are flexible and compliant, which is what makes them so impact-resistant and robust.” The Ability Hand 1 has survived a range of durability tests, including punching through flaming wooden boards, breaking ice blocks, falling 30 feet, and tumbling around in a dryer for 10 minutes.

A New Era for Bionic Limbs

Figure 1. PSYONIC’s CEO and Founder, Aadeel Akhtar, Ph.D., with the Ability Hand1. (Photo courtesy of PSYONIC.)

It’s the first hand on the market to give users touch feedback, via six sensors on each finger (one each on the finger pad and tip; four on the shaft). When a sensor makes contact with another object, it transmits a subtle vibration to the user’s residual limb. The firmer the contact, the stronger the vibration (Figure 2).

A New Era for Bionic Limbs

Figure 2. Tina Brockett uses the Ability Hand1, which provides touch feedback to users via six touch sensors on each finger. (Photo courtesy of PSYONIC.)

Mechanical advances have also bolstered lower-limb prosthetics. The Utah Bionic Leg, funded by the German prosthetics firm Ottobock, is about half the weight of any existing robotic leg prosthesis [3]. That can make a big difference for users, because adding weight to a prosthesis makes walking harder, interferes with balance, and can destabilize the interface between the user’s body and the device, said Tommaso Lenzi, Ph.D., an associate professor of mechanical engineering at the University of Utah. “Weight has been one of the biggest issues in translating robotic leg prostheses from the lab to the real world,” he said.

A New Era for Bionic Limbs

Figure 3. Utah Bionic Leg. (Photo courtesy of Christoph Neumann and Sascha Boldt | Ottobock.)

Lenzi and his team have used insights from human biology to refine the Utah Bionic Leg, which has been under development for more than five years. They substituted stiff actuators, common in robotics, for more compliant materials such as springs and dampers, allowing the bionic leg to rely on gravity and inertia the same way a biological leg does. They have effectively created a variable transmission system, allowing users to seamlessly “shift gears” when they need more torque or speed (Figure 3).

The Utah Bionic Leg also relies on the physical properties of biological movement to provide virtually endless battery life for its users. If the battery approaches empty, the device enters a low-power mode, harnessing the energy generated by the user to continue operating. (Because walking on level ground is a net-zero energy task, the energy spent during the acceleration phase of each step is essentially equal to the energy recovered during the deceleration phase.)

Endless battery life is hugely important to the user, affording the freedom to walk without the fear of being stranded. But challenges still remain: namely, handling the unpredictability of the world outside the lab. Lenzi and his colleagues are exploring several approaches to adapting bionics to work in unstructured environments, including an AI and machine learning system that learns about a user’s environment and a neural engineering approach that gives more volitional control to the user.

“Every person walks differently. Every staircase is different. Every chair is different,” Lenzi said. “Dealing with all of the real world’s variability—while giving users a device that’s functional and safe—is a big open challenge.”

Problem of control

The other major question facing prosthetics researchers is how to give users an intuitive way to operate a robotic body part. “A central challenge with bionic limbs is the problem of control,” said Thomas Roberts, Ph.D., a professor of biology and vice chair of the Department of Ecology, Evolution, and Organismal Biology at Brown University. “One of the goals is to come up with a way to measure user intent—essentially a way for a user, without holding some sort of remote, to control various aspects of their prosthetic device.”

The most common existing method for measuring user intent—attaching electrodes to the skin atop remaining muscles near the amputation site—often provides an unreliable signal due to sweat and the movement of electrodes. Many believe that electrodes implanted in the nervous system will be the next big frontier for the field of bionics. At PSYONIC, Akhtar and his colleagues are using Google’s TensorFlow platform to create an algorithm that trains a bionic hand to act like a biological one using implanted electrodes. By recording movements from a user’s remaining hand, they can then leverage the data they collect to train nerve implants on the other side of the body.

PSYONIC is also developing a technique that will enable surgeons to directly anchor a bionic finger to a patient’s residual bone. A titanium implant connects the device to the bone, while an artificial tendon sutured onto a residual tendon allows the user to control the prosthetic finger with their own muscle. Other groups are also working to develop and refine surgical techniques that enhance user control. Hugh Herr, Ph.D., of the Massachusetts Institute of Technology (MIT), and Matthew Carty, M.D., of Brigham Young University, pioneered a technique known as agonist–antagonist myoneural interface, which sutures two opposing muscles to a device to control a prosthetic joint the same way the body operates a healthy one [4].

Roberts and his collaborators, including Herr, Carty, and MIT’s Cameron Taylor, Ph.D., are exploring another innovative way to measure user intent: magnets that detect changes in muscle length. The researchers implanted two spherical magnets along the length of a muscle and used an array of magnetometers to extract data on the distance between the two magnets. When a muscle contracts or a joint changes position, the magnets move in a predictable way. That signal can then be fed through a control algorithm to operate a linked robotic device. Initial tests in animal models show that the magnets accurately measure the changing length of muscles during running, jumping, and other movements [5] and that the implants do not cause inflammation or other problems [6].

Implants can also provide users with sensory feedback, including touch and proprioception, that makes it much easier to operate a robotic limb. At the University of Pittsburgh’s Rehab Neural Engineering Labs, Lee Fisher, Ph.D., and his colleagues stimulated the spinal cord of amputees using implanted electrodes. That stimulation helped restore sensation from a missing foot and improved balance and stability while walking with a prosthetic [7].

As engineers continue to study the most effective methods for controlling robotic limbs, other researchers are exploring how the brain and nervous system adapt to bionic devices [8]. At the University of Cambridge, Tamar Makin, Ph.D. is conducting research to answer questions such as: What conditions enable a person to experience an artificial limb as part of their own body? For example, does a prosthetic limb need to look like a real one? And how does the brain change after using a bionic limb?

A New Era for Bionic Limbs

Figure 4. Tommaso Lenzi, Ph.D., works with a participant to test the Utah Bionic Leg. (Photo courtesy of HGN Lab for Bionic Engineering.)

Democratizing bionic limbs

Engineers tend to focus on improving function—making a prosthetic more powerful, faster, or precise, for example—but users often care more about a device’s intuitiveness, Lenzi said. People want artificial hands, arms, and legs that are under their control and feel like part of their own body. “One thing that’s going to become increasingly important is how much we’re including end-users in our research,” Lenzi adds (Figure 4). In the past, engineers might work on a prosthetic device for years in the lab before testing it with end-users. “Now, I have amputees coming in and out of my lab pretty much every day, and they’re involved very early on with everything we do,” he said. “It’s a fantastic change that is really helping the field progress.”

At the other end of the pipeline, companies like PSYONIC are also prioritizing patient engagement. The PSYONIC Institute, a nonprofit subsidiary of the company, collects donations to subsidize the cost of the Ability Hand 1 for uninsured U.S. patients and people in other countries. Akhtar is also in the midst of an equity crowdfunding campaign that has allowed patients and other members of the public to invest in PSYONIC.

“That’s also part of the future of where the field is heading: democratizing bionics and making them even more accessible, but also making the companies accessible as well,” he said.

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  • C. R. Taylor et al., “Untethered muscle tracking using magnetomicrometry,” Frontiers Bioeng. Biotechnol. , vol. 10, p. 1979, Oct. 2022, doi: 10.3389/fbioe.2022.1010275.
  • C. R. Taylor et al., “Clinical viability of magnetic bead implants in muscle,” Frontiers Bioeng. Biotechnol. , vol. 10, Oct. 2022, Art. no. 1010276, doi: 10.3389/fbioe.2022.1010276.
  • A. C. Nanivadekar et al., “Spinal cord stimulation restores sensation, improves function, and reduces phantom limb pain after transtibial amputation,” medRxiv , Sep. 2022, doi: 10.1101/2022.09.15.22279956.
  • E. Amoruso et al., “Intrinsic somatosensory feedback supports motor control and learning to operate artificial body parts,” J. Neural Eng. , vol. 19, no. 1, Jan. 2022, Art. no. 016006, doi: 10.1088/1741-2552/ac47d9.

Bionic eyes: How tech is replacing lost vision

Bionic eyes could be the solution to one of the most pressing medical issues of our time.

bionic eye

Bionic eye technology

Further development, how a bionic eye works, vision destroying illnesses, a world first, additional resources, bibliography.

The creation of bionic eyes, as a result of recent advances in science and technology, are restoring hope to many who are unable to see or are partially sighted due to injury, illness or genetics . 

With nearly 40 million people suffering from blindness worldwide and another 135 million affected by low vision, according to the World Health Organization (WHO) , the need for new solutions is pressing. Could bionic eye technology lead the way?

A healthy eye takes in light through the pupil and a lens focuses that light onto the back of the eye, where there is a thick layer of light sensitive tissue called the retina. Cells called photoreceptors turn the light into electrical signals which travel down the optic nerve to the brain , which then interprets the images. 

But problems occur when part of that system is interrupted, often by degenerative diseases which can damage parts of the retina. This is where technology steps in to bridge the gap in the part of the process which is missing or damaged.

In 2009 surgeons at Manchester and Moorfields hospital, in the U.K. delivered  the world's first trial of the Argus II bionic eye to patients with Retinitis Pigmentosa, according to the University of Manchester . They implanted the devices into  ten patients with sight loss. The Argus II helped patients recognize shapes and patterns, and in 2013, the U.S. Food and Drug Administration legally approved the device for use.

Argus II

Bionic eye technology has continued to develop and in 2021 researchers at Keck School of Medicine of USC created an advanced computer model to mimic the human retina, according to the Association for Computing Machinery (ACM) . This replicates the shapes and positions of millions of nerve cells and could help bring color vision and improved clarity to the technology.

Scientists at the University of Sydney and UNSW recently carried out successful trials of the Phoenix99 bionic eye in sheep, to determine how the body heals when it is implanted with the device . 

Images: Bionic hand that can feel

Dog vision: How do dogs see the world?

Image gallery: The incredible bionic man

Researchers said there were no unexpected reactions and expect it could safely remain in place for "many years". The work will now pave the way for human trials. One of the problems with the tech though is that it can be relatively bulky, so the race is on to find new ways to power bionic eyes. 

Scientists at the Harbin Institute of Technology in China and Northumbria University recently developed a low-power system to control the synaptic devices in the bionic eyes, with lead professor Professor PingAn Hu describing it as a ‘significant breakthrough’ according to Northumbria University’s press release .

This technology has to translate images into something the human brain can understand. Click the numbers in the interactive image below to find read about how this works. 

There are a whole range of conditions, some which are picked up due to the aging process and others which may be inherited, that can cause sight deterioration. 

Bionic eyes work by ‘filling in the blanks’ between what the retina perceives and how it is processed in the brain’s visual cortex, that breakdown occurs in conditions which impact the retina. It is largely these conditions which bionic eyes could help treat. 

According to Tufts Medical Center , one such disease is Retinitis Pigmentosa, a group of rare genetic disorders that involve a breakdown and loss of cells in that part of the eye.

Another condition is age-related macular degeneration (AMD), an eye disease that can blur someone’s central vision. The condition occurs when aging causes damage to the macula, the part of the eye that controls sharp, straight-ahead vision.

As well as degenerative illnesses, bionic eyes could in theory be used to treat people who have suffered physical injuries which have led to retinal damage too, according to Nature .

Macular degeneration

The first patient to receive a bionic eye was grandfather Keith Hayman in 2009, according to the Association of Optometrists . He was in his 20s when he was diagnosed with retinitis pigmentosa and went blind several years later. 

After being fitted with the bionic eye at Manchester Royal Eye Hospital, he was able to see the difference between light and dark and could detect people moving. 

He said: “It means I can see my grandchildren for the first time. When they come round to see me they wear white t-shirts to help me keep an eye on them. I couldn’t tell you much about what they look like, but at least I can see them coming now!”

You can read more about the future of the bionic eye at the Australian Academy of Science website . To find out about other ways that artificial vision can improve lives, watch this TED Talk by Ziv Aviram .  

“Manchester patients among first to receive bionic eye implants”. The University of Manchester, Faculty of Biology, Medicine and Health.

“Computer Model Fosters Potential Improvements to 'Bionic Eye' Technology”. Association for Computing Machinery (2021).

“Developing the next generation of artificial vision aids”. Northumbria University (2021).

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Mark Smith

Mark Smith is a freelance journalist and writer in Liverpool, England. A graduate in Information Systems, he has written on business, technology and world affairs for organizations ranging from the BBC, The Guardian, The Telegraph  and How It Works Magazine, as well as magazines and websites in the United States, Europe and South East Asia. Subjects of his writing have ranged from quantum computing to the VFX of Tron. He is the author of " The Entrepreneur's Guide to the Art of War ," which Booklist called "Essential reading for the business leaders of tomorrow and a fascinating study of the boardroom as the new battlefield."

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Short History of Bionics

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Jessica Grose

Get tech out of the classroom before it’s too late.

An illustration of a large open laptop computer with many teeth, biting down on a small schoolhouse.

By Jessica Grose

Opinion Writer

Jaime Lewis noticed that her eighth-grade son’s grades were slipping several months ago. She suspected it was because he was watching YouTube during class on his school-issued laptop, and her suspicions were validated. “I heard this from two of his teachers and confirmed with my son: Yes, he watches YouTube during class, and no, he doesn’t think he can stop. In fact, he opted out of retaking a math test he’d failed, just so he could watch YouTube,” she said.

She decided to do something about it. Lewis told me that she got together with other parents who were concerned about the unfettered use of school-sanctioned technology in San Luis Coastal Unified School District, their district in San Luis Obispo, Calif. Because they knew that it wasn’t realistic to ask for the removal of the laptops entirely, they went for what they saw as an achievable win: blocking YouTube from students’ devices. A few weeks ago, they had a meeting with the district superintendent and several other administrators, including the tech director.

To bolster their case, Lewis and her allies put together a video compilation of clips that elementary and middle school children had gotten past the district’s content filters.

Their video opens on images of nooses being fitted around the necks of the terrified women in the TV adaptation of “The Handmaid’s Tale.” It ends with the notoriously violent “Singin’ in the Rain” sequence from “A Clockwork Orange.” (Several versions of this scene are available on YouTube. The one she pointed me to included “rape scene” in the title.) Their video was part of a PowerPoint presentation filled with statements from other parents and school staff members, including one from a middle school assistant principal, who said, “I don’t know how often teachers are using YouTube in their curriculum.”

That acknowledgment gets to the heart of the problem with screens in schools. I heard from many parents who said that even when they asked district leaders how much time kids were spending on their screens, they couldn’t get straight answers; no one seemed to know, and no one seemed to be keeping track.

Eric Prater, the superintendent of the San Luis Coastal Unified School District, told me that he didn’t realize how much was getting through the schools’ content filters until Lewis and her fellow parents raised concerns. “Our tech department, as I found out from the meeting, spends quite a lot of time blocking certain websites,” he said. “It’s a quite time-consuming situation that I personally was not aware of.” He added that he’s grateful this was brought to his attention.

I don’t think educators are the bad guys here. Neither does Lewis. In general, educators want the best for students. The bad guys, as I see it, are tech companies.

One way or another, we’ve allowed Big Tech’s tentacles into absolutely every aspect of our children’s education, with very little oversight and no real proof that their devices or programs improve educational outcomes. Last year Collin Binkley at The Associated Press analyzed public records and found that “many of the largest school systems spent tens of millions of dollars in pandemic money on software and services from tech companies, including licenses for apps, games and tutoring websites.” However, he continued, schools “have little or no evidence the programs helped students.”

It’s not just waste, very likely, of taxpayer money that’s at issue. After reading many of the over 900 responses from parents and educators to my questionnaire about tech in schools and from the many conversations I had over the past few weeks with readers, I’m convinced that the downsides of tech in schools far outweigh the benefits.

Though tech’s incursion into America’s public schools — particularly our overreliance on devices — hyperaccelerated in 2020, it started well before the Covid-19 pandemic. Google, which provides the operating system for lower-cost Chromebooks and is owned by the same parent company as YouTube, is a big player in the school laptop space, though I also heard from many parents and teachers whose schools supply students with other types and brands of devices.

As my newsroom colleague Natasha Singer reported in 2017 (by which point “half the nation’s primary- and secondary-school students” were, according to Google, using its education apps), “Google makes $30 per device by selling management services for the millions of Chromebooks that ship to schools. But by habituating students to its offerings at a young age, Google obtains something much more valuable”: potential lifetime customers.

The issue goes beyond access to age-inappropriate clips or general distraction during school hours. Several parents related stories of even kindergartners reading almost exclusively on iPads because their school districts had phased out hard-copy books and writing materials after shifting to digital-only curriculums. There’s evidence that this is harmful: A 2019 analysis of the literature concluded that “readers may be more efficient and aware of their performance when reading from paper compared to screens.”

“It seems to be a constant battle between fighting for the students’ active attention (because their brains are now hard-wired for the instant gratification of TikTok and YouTube videos) and making sure they aren’t going to sites outside of the dozens they should be,” Nicole Post, who teaches at a public elementary school in Missouri, wrote to me. “It took months for students to listen to me tell a story or engage in a read-aloud. I’m distressed at the level of technology we’ve socialized them to believe is normal. I would give anything for a math or social studies textbook.”

I’ve heard about kids disregarding teachers who tried to limit tech use, fine motor skills atrophying because students rarely used pencils and children whose learning was ultimately stymied by the tech that initially helped them — for example, students learning English as a second language becoming too reliant on translation apps rather than becoming fluent.

Some teachers said they have programs that block certain sites and games, but those programs can be cumbersome. Some said they have software, like GoGuardian, that allows them to see the screens of all the students in their classes at once. But classroom time is zero sum: Teachers are either teaching or acting like prison wardens; they can’t do both at the same time.

Resources are finite. Software costs money . Replacing defunct or outdated laptops costs money . When it comes to I.T., many schools are understaffed . More of the money being spent on tech and the maintenance and training around the use of that tech could be spent on other things, like actual books. And badly monitored and used tech has the most potential for harm.

I’ve considered the counterarguments: Kids who’d be distracted by tech would find something else to distract them; K-12 students need to gain familiarity with tech to instill some vague work force readiness.

But on the first point, I think other forms of distraction — like talking to friends, doodling and daydreaming — are better than playing video games or watching YouTube because they at least involve children engaging with other children or their own minds. And there’s research that suggests laptops are uniquely distracting . One 2013 study found that even being next to a student who is multitasking on a computer can hurt a student’s test scores.

On the second point, you can have designated classes to teach children how to keyboard, code or use software that don’t require them to have laptops in their hands throughout the school day. And considering that various tech companies are developing artificial intelligence that, we’re meant to understand, will upend work as we know it , whatever tech skills we’re currently teaching will probably be obsolete by the time students enter the work force anyway. By then, it’ll be too late to claw back the brain space of our nation’s children that we’ve already ceded. And for what? So today’s grade schoolers can be really, really good at making PowerPoint presentations like the ones they might one day make as white-collar adults?

That’s the part that I can’t shake: We’ve let tech companies and their products set the terms of the argument about what education should be, and too many people, myself included, didn’t initially realize it. Companies never had to prove that devices or software, broadly speaking, helped students learn before those devices had wormed their way into America’s public schools. And now the onus is on parents to marshal arguments about the detriments of tech in schools.

Holly Coleman, a parent of two who lives in Kansas and is a substitute teacher in her district, describes what students are losing:

They can type quickly but struggle to write legibly. They can find info about any topic on the internet but can’t discuss that topic using recall, creativity or critical thinking. They can make a beautiful PowerPoint or Keynote in 20 minutes but can’t write a three-page paper or hand-make a poster board. Their textbooks are all online, which is great for the seams on their backpack, but tangible pages under your fingers literally connect you to the material you’re reading and learning. These kids do not know how to move through their day without a device in their hand and under their fingertips. They never even get the chance to disconnect from their tech and reconnect with one another through eye contact and conversation.

Jonathan Haidt’s new book, “The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness,” prescribes phone-free schools as a way to remedy some of the challenges facing America’s children. I agree that there’s no place for smartphones on a K-12 campus. But if you take away the phones and the kids still have near-constant internet connectivity on devices they have with them in every class, the problem won’t go away.

When Covid hit and screens became the only way for millions of kids to “attend” school, not having a personal device became an equity issue. But we’re getting to a point where the opposite may be true. According to the responses to my questionnaire, during the remote-school era, private schools seemed to rely far less on screens than public schools, and many educators said that they deliberately chose lower-tech school environments for their own children — much the same way that some tech workers intentionally send their kids to screen-free schools.

We need to reframe the entire conversation around tech in schools because it’s far from clear that we’re getting the results we want as a society and because parents are in a defensive crouch, afraid to appear anti-progress or unwilling to prepare the next generation for the future. “I feel like a baby boomer attacking like this,” said Lewis.

But the drawbacks of constant screen time in schools go beyond data privacy, job security and whether a specific app increases math performance by a standard deviation. As Lewis put it, using tech in the classroom makes students “so passive, and it requires so little agency and initiative.” She added, “I’m very concerned about the species’ ability to survive and the ability to think critically and the importance of critical thinking outside of getting a job.”

If we don’t hit pause now and try to roll back some of the excesses, we’ll be doing our children — and society — a profound disservice.

The good news is that sometimes when the stakes become clear, educators respond: In May, Dr. Prater said, “we’re going to remove access to YouTube from our district devices for students.” He added that teachers will still be able to get access to YouTube if they want to show instructional videos. The district is also rethinking its phone policy to cut down on personal device use in the classroom. “For me,” he said, “it’s all about how do you find the common-sense approach, going forward, and match that up with good old-fashioned hands-on learning?” He knows technology can cause “a great deal of harm if we’re not careful.”

Jessica Grose is an Opinion writer for The Times, covering family, religion, education, culture and the way we live now.


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