"We can rebuild him. We have the technology."¹

This statement in a recent article in The Economist captured my interest. I thought, are we really that far advanced in science that we can rebuild parts of man—even neurological abilities—with technology? Yes.

When I first became editor of this publication, many PTs who I met at trade shows said that PTs were a bit slow to embrace technology. Through the last 2 years on this magazine, I can understand why that might be the case. In addition to limitations in reimbursement for some technologies, such as low-level laser, physical therapy is a very hands-on field. The human touch between the PT and the patient is part of the healing process in any physical therapy regimen.

However, the kind of technology talked about in The Economist article isn't about replacing the need for human contact in rehabilitation. It is about using the marvels of modern technology to enable patients to perform acts of daily living that able-bodied people don't think twice about.

Take, for example, William de Groat, PhD, professor of pharmacology at the University of Pittsburgh. At the 2007 meeting of the American Association of the Advancement of Science, he described some recent advances in what is being called "smart prosthetics."

Researchers involved in creating these smart prosthetics are concentrating on the construction of parallel nervous systems that help the body perform functions that injury or disease has destroyed.

The device that de Groat has developed provides electronic bladder control. A severe spinal cord injury can sever the connection between the brain and the bladder. While the nervous tissue below the break can remodel itself to create a new bladder-emptying reflex, this does not fill or empty the bladder properly.¹ What de Groat created stimulates one particular nerve that is connected to the sphincter. According to the article, research has shown that signals from this nerve can control the bladder reflex—low-frequency electrical stimulation prompts urine storage; high-frequency stimulation prompts emptying. The device does not completely restore voluntary bladder control, but it helps to reduce incontinence and the risk of bladder infection.

Another bionic advancement in prosthetics is being developed by Hunter Peckham of Case Western Reserve University in Cleveland. Peckham has created a parallel nervous system that picks up electrical signals from the twitching of neck and shoulder muscles, which have some involvement in normal arm and leg movement.The signals are transferred through a cable that runs under the skin to an external box that contains a computer processor. A computer program interprets the signals and determines which leg or arm to contract, and by how much, based on what the brain is trying to achieve. This could lead to previously paralyzed patients being able to pick things up, or even stand (with an assistive device). Donoghue is studying the idea of collecting signals straight from the brain's motor cortex and using them to direct mechanical devices such as artificial arms and even wheelchairs.

What's the most innovative medical technology that has caught your eye or made a difference in your patients? Let me know, and I'll share the interesting submissions with our readers.

Arati Murti

Reference:

1. Bionic People. The Economist. February 2007. Available at: www.economist.com/science/displaystory.cfm?story_id=8733655. Accessed June 24, 2007.