Last month, I wrote about the cost of caring—the challenges of justifying and receiving payment for health care provider occupations. Reimbursement funds are constantly being trimmed from any applicable resource, and the health care situation looks mighty grim to those seeking to make a living in providing care. While the doom and gloom of reimbursement challenges are a constant in this industry, it's important to keep in mind that there are many positive trends in health care, including scientific research in advanced technology. I recently came across a series of articles in IEEE Spectrum Online that piqued my interest and confirmed my feeling that despite the bleak conditions of reimbursement, fascinating research projects and technological advancements are taking place to help people function better.

The articles focus on the Defense Advanced Research Projects Agency (DARPA) prosthetics program, an ambitious effort to provide the most advanced medical and rehabilitative technologies for military personnel injured in the line of duty. The DARPA program consists of two inter-related programs: Revolutionizing Prosthetics 2007, which aimed to deliver a working advanced prosthetic arm and hand with a neural interface by the end of 2007, and Revolutionizing Prosthetics 2009, which will have a neurally controlled arm and hand prosthesis ready for FDA approval and clinical trials in 4 years. More than $48 million has been awarded to fund product research and development. By 2009, DARPA aims to produce a mechanical arm that closely mimics the properties and sensory perceptions of a biological limb.

Some of the progress that has been made is fascinating. Take, for example, the progressive developments in robotic prosthetics. Currently, robotic prosthetics on the market have only two joints: an elbow that bends and a hand joint that is essentially a pincher.¹ A researcher at Vanderbilt University in Nashville, Tenn, has created a device that has 21 joints that allow 9º of freedom. A laboratory prototype with an exoskeleton that a user straps onto his or her arm is used to test the robot arm, which proved to grip a light bulb without breaking it and pull a single sheet from a box of tissues.

Another extremely remarkable lifelike prosthetic is called the "Luke arm," which enables 18º of freedom—the human arm has 22º of freedom.² The Luke arm enables test subjects to unlock a door, shake a hand, and even pluck coffee beans one by one. A sensor on the Luke hand, which connects to a microprocessor, sends a signal to a small vibrating motor, and that signal changes with grip strength, allowing the user to drink out of a flimsy paper cup without crushing it or firmly hold a heavy cordless drill without dropping it.² According to the lead researcher, technology for prosthetic legs is indicative of the 21st century; however, current technology for prosthetic arms is in The Flintstones.² The Luke arm project, which awaits funding for clinical trials, is aimed at bridging that gap. (See a video of the Luke arm through this link: www.spectrum.ieee.org/video?id=221.)

These are just two examples of the many scientific advancements taking place within the DARPA program. While the research and development was generously funded, large sums of money are still needed for clinical trials. Once clinical trials are done, money will again be needed to expense the allocation of these products to patients. Will reimbursement levels be able to match and/or keep up with these technological advancements to allow users to actually use these lifelike prosthetics? I'd love to hear your thoughts on this.

Arati Murti

References

1. Jones WD. Fueling a robotic arms race. IEEE Spectrum Online. spectrum.ieee.org/dec07/5794. Accessed April 17, 2008.
2. Adee S. Dean Kamen's "Luke arm" prosthesis readies for clinical trials. spectrum.ieee.org/dec07/5957. Accessed April 17, 2008.