The University of Southampton

Engineering Replacement body parts 2023-2024

An interdisciplinary module

What’s new in diabetes management and where have we come from?

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I was contemplating David Simpson’s lectures on sensors within prosthetics and was drawn to an article he attached outlining the artificial pancreas device for type 1 diabetics. The device, also called the closed loop system (CLS), wirelessly connects a continuous glucose monitor (CGM) to an insulin pump to stabilise blood sugar levels automatically. This is revolutionary for diabetics who struggle to manage their blood sugars manually, and reduces the likelihood of long-term complications such as diabetic neuropathy (nerve damage). My mother is a type 1 diabetic, so I decided to look further into this.

A brief history of diabetes testing

Back in 600BC, scientists noticed that ants were attracted to the urine of those with diabetes and one brave (or questionable) lad personally confirmed its distinctive sweet taste. Fast forward to 1841 and we have the first clinical test for diabetes, before the 1940s produced urine test strips to quantify these results.

Today the glucometer, first developed in 1970, is still widely used. It relies on a fingertip pin prick to draw blood for the test strip, which is then inserted into the meter. The physics behind this is actually very interesting – the glucose in the blood sample reacts with glucose oxidase on the strip, generating an electrical signal. This translates into a digital readout of the glucose concentration.

Example CGM graph

CGM – tech for the internet age

The truly ground-breaking CGM attaches on the arm and records glucose levels every 15 minutes, creating a graph that shows the fluctuations throughout the day, transmitted to a mobile app. Extra functionality shows rising or falling sugar levels, adding an important new level of precision to injection decisions. There’s still a fair bit of maths to go wrong here though, as I saw following one horrifying mistake that left my mother guzzling 375g of dissolved sugar to counter an overdose on her fast-acting insulin.

The CLS – a lottery win?

Significantly more automated, the CLS aims to stabilise sugars with minimal input by combining the CGM with an insulin pump. Whilst users still need to compute carbohydrate intake, the main job of the CLS is to prevent hypos overnight by delivering tiny doses of insulin to keep blood sugars level. Hypos occur when sugars drop below normal range and can be extremely dangerous if not resolved quickly.

A game-changer for lots of diabetics, one user claims it has “cut out about 90% of [their] low level dips into hypoglycaemia”. The principal drawback appears to be in roll-out due to relative cost. One CLS user told me it’s also a bit cumbersome as they have to move their injection sites around to avoid build-up of scar tissue which could stop the insulin from being administered properly.

Diagram of the CLS
An interview with my mother provides insight into the consumer’s experience.

Diabetes – no longer a chronic disease?

The prospect of a cure has been touted for years with no solutions yet. However, scientists have recently created tiny implants containing stem cell-derived pancreatic progenitor cells that can emulate a healthy pancreas and produce insulin. The hope is that the encapsulated cells are protected from the diabetic’s immune system which is intent on destroying them.

Researchers are highly optimistic, with some even claiming this may “turn into a cure a soon as 2024”. However, I noticed a potential ethical issue, as implementation of the implant is reportedly limited by shortage of donor stem cells. If this leads to a shortage of potentially curative therapy, how do they decide who gets it and who doesn’t?

Could tissue-engineered blood vessels transform the treatment of vascular disease?

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Following our lecture on sensors I was intrigued to find out more about the uses of Doppler Ultrasound in medicine. The body’s vasculature is complex and intricate, and serves a crucial role in keeping our organs and body alive. Ironically, this fundamental element for survival has potential to present a significant threat to life.

The Doppler effect is used to measure the velocity of red blood cells

What is Doppler Ultrasound?

Doppler Ultrasound is a non-invasive method of measuring blood flow through a vessel using sound waves and is important in diagnosing conditions such as heart valve defects, aneurysms, and blocked or narrowing arteries. Additionally, Doppler Ultrasound is essential in monitoring blood flow in vessels before and after specific surgeries, including organ transplants, heart-valve replacements, and stent implantations.

I was fortunate enough to talk to a Clinical Vascular Scientist about the importance of Doppler Ultrasound in her day-to-day work:

A significant health concern?

After speaking with Marie, I became increasingly aware of how prevalent vascular disease is in the UK, with heart and circulatory diseases causing 26% of all deaths in England. That’s one death every four minutes! Vascular disease is severe and can result in poor wound healing, organ damage, stroke, heart attack, and even amputation of limbs. I had a discussion with Bethany, a student nurse who recently completed a placement on a Cardiac Intensive Care Unit. Bethany gave me valuable insight into the negative impacts that vascular disease has on both a patient’s quality of life and the NHS. I was shocked to find out that CVD-related healthcare costs amount to about £7.4 billion per year in England! This prompted me to question, “Could tissue-engineering replacement blood vessels serve as a viable option in the treatment of some vascular diseases?”.

The three main layers that make up blood vessels

Are they needed?

I looked into some current surgical treatment options and found that stents are commonly used to restore blood flow in a narrowed or blocked artery. However, when multiple arteries become blocked, an artery bypass graft may be performed using segments of healthy blood vessels from other parts of the body. “Would tissue-engineering new blood vessels be necessary if bypass grafts are usually successful?” I thought, especially when they would face a minimal risk of rejection coming from the patient themselves. After reflecting on this question, I concluded that tissue-engineered blood vessels would add value if successful. Some patients don’t have suitable blood vessels in other parts of the body to use in a bypass graft, and this shortage is a factor that could be overcome. Additionally, the vessel could be perfectly engineered to fit the patient and “grow” as they age.

How far away are we from successful tissue engineering of blood vessels?

Weinberg and Bell tissue-engineered the first blood vessel in 1986 using collagen, smooth muscle cells, endothelial cells, and fibroblasts. Adult stem cells are usually preferred as a cell source in tissue-engineered blood vessels over embryonic stem cells due to lower ethical concerns. I created a timeline with some key dates leading up to the development of the first tissue-engineered blood vessel to help organise my thoughts.

Timeline of key dates

I was pleasantly surprised by the developments made through the years as blood vessels are such complex structures and this creates many challenges. Although progress has been made since 1986, there is still a long way to go before these blood vessels reach the clinic, but I believe we are not too far off witnessing significant advancements in vascular medicine.

Is brain implant possible

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Neuralink

Human testing experiments have been a controversial topic in the science field. A recent news article came across me. Neuralink, a ‘medical research’ company founded by Elon Musk in July 2016, reported that the first chip brain, ‘Telepathy’, was being implanted into the human brain.

https://www.nytimes.com/2024/01/29/business/elon-musk-neuralink.html: Is brain implant possible

‘Telepathy’ was designed for the disabled who have lost the use of their limbs. The human clinical trial was first opened for patients with restricted or zero available use of upper arms caused by cervical spinal cord injury or by amyotrophic lateral sclerosis, a fatal motor neuron disease about degeneration of nerve cells in the spinal cord and brain. By placing a tiny, wireless brain chip on the surface of the brain attached to the cortex, movements could be revived by the intention to move.

Neurological mechanism of neurons

The brain consists of nerve cells called neurons, which transmit signals and messages over the body afferently and efferently.

Afferent neurons refer to receiving stimulations and sending signals from the environment through the spinal cord to the brain. Efferent neurons do the reversing way, sending motor signals from the brain to the peripheral nervous system in order to initiate movements.

The electrodes in the Neuralink chip are responsible for reading these afferent signals, translating them into efferent signals and turning them into motor movements.

Human experimentation

The largest controversy of human experimentation is said to be unethical. Pseudoscientific frameworks like race science are argued to be not ethical. This also raises problems with informed consent, in which research subjects freely volunteer to participate after being made aware of the potential dangers and benefits. However, past incidents where participants were misinformed about the real purpose of the experiment, such as the Tuskegee Syphilis Study in the United States, have brought attention to the significance of informed consent. It also includes torturing people which causes them to be mentally or physically injured. During the experiment, the research subject may be exposed to risks from physical injuries to psychological distress. To balance the benefits of the study and the potential risk to the subjects is the biggest concern a scientist should be aware of.

In May 2023, the US Food and Drug Administration gave the approval for Neuralink’s human clinical trials. However, the specific approach of how Neuralink balances between experimenting and the risk of reseach subjects might face is still unknown.

Conclusion

Similar to other implants in the human body, Neuralink brain implants may result in unfavourable consequences like inflammation and scarring. Additional problems might be bleeding or hardware-related concerns with the implant. Of course, it is still a very new technology and still requires a lot of research and experiment, but it’s a hope for patients with spinal cord injury to move again. Overall, with suitable and appropriate observation under medical and neurological professionals, the brain implant could be a direction for patients to live more conveniently than before.

Bridging Realities: Prosthetics in Fiction, Is Any Of It Real?

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In the realm of fiction, prosthetics often take center stage, portraying characters who transcend physical limitations with cutting-edge technology. From Luke Skywalker’s robotic hand to Iron Man’s sleek armor, prosthetics in popular culture captivate audiences with their seemingly limitless capabilities. But how accurate are these portrayals when compared to the advancements in real-world prosthetics?

While the prosthetics depicted in fiction may appear futuristic and awe-inspiring, the truth is that they often stretch the boundaries of scientific feasibility. However, that’s not to say that there aren’t elements of truth behind these imaginative creations. Many fictional prosthetics are inspired by real-world advancements in prosthetic technology.

One area where fiction tends to diverge from reality is in the speed and ease with which characters adapt to their prosthetics. In many stories, characters seamlessly transition from being disabled to mastering their new limbs or devices in a matter of moments. In reality, the process of adjusting to a prosthetic limb can be long and challenging, requiring extensive physical therapy and training to regain functionality. The Portsmouth Regional Prosthetic Service outline a 5 Stage Rehabilitation Process and they state it usually takes 3-6 months to adjust using the prosthetic limb, such as a leg, through intensive physiotherapy.

Moreover, while fictional prosthetics often boast superhuman abilities, such as enhanced strength or agility, real-world prosthetics are still limited by the constraints of current technology. While significant advancements have been made in creating prosthetic limbs that mimic natural movement, they are still a far cry from the fantastical capabilities seen in movies and television shows.

However, that’s not to say that real-world prosthetics aren’t impressive in their own right. In recent years, advancements in materials science, robotics, and neuroscience have led to significant improvements in prosthetic technology. For example, prosthetic limbs equipped with myoelectric sensors can detect electrical signals from remaining muscles, allowing users to control their prosthetics with astonishing precision. Studies have shown promising clinical outcomes for patients after transhumeral amputation, who received a neuromusculoskeletal prosthesis that allowed intuitive and unsupervised daily use over several years.

Additionally, ongoing research in the field of brain-computer interfaces (BCIs) holds promise for the future of prosthetics. BCIs allow users to control prosthetic limbs directly with their thoughts, bypassing the need for muscle signals altogether. While this technology is still in its infancy, early experiments have shown promising results and could eventually lead to prosthetics that are even more intuitive and responsive.

In conclusion, while the prosthetics depicted in fiction may push the boundaries of scientific reality, they are often inspired by the advancements and possibilities within the field of prosthetic technology. While we may not yet have prosthetics with the capabilities of those seen in movies and TV shows, real-world prosthetics continue to evolve and improve, offering hope and opportunities for individuals with limb differences to lead fulfilling and active lives. As technology continues to advance, the line between fiction and reality may blur even further, bringing us closer to the futuristic visions of prosthetics seen on screen.

Sources:

https://www.porthosp.nhs.uk/departments-and-services/Portsmouth%20Enablement%20Centre/The%20five%20stage%20rehabilitation%20process%20leaflet.PDF

Ortiz-Catalan, M., Mastinu, E., Sassu, P., Aszmann, O., & Brånemark, R. (2020). Self-Contained Neuromusculoskeletal Arm Prostheses. New England Journal of Medicine, 382(18), 1732–1738. https://doi.org/10.1056/NEJMoa1917537

Tissue Engineering- Is it ethical?

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In the realm of medical science, tissue engineering stands as a beacon of hope, offering revolutionary solutions to some of the most challenging health problems. It’s a field where biology meets engineering, aiming to regenerate, repair, or replace damaged tissues and organs using a combination of cells, scaffolds, and bioactive molecules. While the potential benefits of tissue engineering are vast, it also raises significant ethical questions that demand careful consideration.

At its core, tissue engineering holds the promise of transforming healthcare by providing alternatives to traditional organ transplants, which is often limited by donor shortages, immune rejection, and the need for lifelong immunosuppression. With tissue engineering, scientists can create tissues and organs tailored to individual patients (using their own tissue), which reduces the risk of rejection and eliminates the need for donor matching.

One of the most common applications of tissue engineering is in the field of regenerative medicine. Imagine a world where patients with severe burns can have their skin regenerated using bioengineered skin substitutes, or where individuals with a damaged cartilage can receive custom-made cartilage implants! These advancements have the potential to improve countless lives, offering hope to where previously there was none.

Ethical concerns loom over the field of tissue engineering, prompting researchers and policy makers to navigate a complex ethical area. One of the primary concerns is the source of cells used in tissue engineering. While some cells can be harvested from a patient’s own body, others may come from embryonic stem cells or induced pluripotent stem cells (iPSCs), raising ethical questions about the destruction of human embryos and the manipulation of genetic material. Moreover, the commercialisation of tissue engineering raises concerns about accessibility and fairness in healthcare. Will these cutting-edge treatments be available only to the wealthy and elite, widening the gap between those who can have access and those who don’t? Ensuring equal access to tissue-engineered therapies is not just a matter of scientific advancement but also a moral imperative.

Another ethical dilemma arises from the potential for unintended consequences. As we delve deeper into the complexities of tissue engineering, we must be mindful of the long-term effects of manipulating biological systems. Could bioengineered tissues lead to unforeseen health complications down the line? These are questions that require ongoing research.

Despite these ethical challenges, the field of tissue engineering holds tremendous promise for the future of medicine. By cultivating interdisciplinary collaboration and engaging in transparent dialogue with stakeholders, we can navigate the ethical complexities while harnessing the full potential of tissue engineering to alleviate human suffering and improve quality of life.

In conclusion, tissue engineering represents a remarkable collaboration of science, engineering, and medicine, offering unprecedented opportunities to address some of the most pressing health challenges of our time. However, as we journey into this brave new world of regenerative medicine, we must tread carefully, ensuring that our scientific advancements are guided by ethical principles and a commitment to the greater good. Only then can we fully realize the transformative potential of tissue engineering while upholding the rights of all individuals.

A life for a life

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Over recent years, I have become more aware of the crisis that the NHS has found itself in, regarding organ transplants. The lack of viable donors who agreed prior to death was limited and did not cover anywhere near the number of people waiting for transplants. I know that they tried to get around this by introducing the opt out system for organ donation in 2020 which was a massive step forward, however it still has its limitations. The main thing I think affects organ donations is the disparity of the genetics between the donor and the patient, leading to the need for immunosuppressant drugs to be taken for life.

Organs commonly used in transplants.

One thing that I have seen that could aid this is the use of chimeras with human derived stem cells being used to grow human organs. This would tackle so many of the current problems, as they could be genetically identical to the patient, and not require another person to die at just the right time in a specific way to allow transplant to be safe and effective.

The ethical side of this is a bit less clear cut. Currently, there are thoughts that animal chimeras would be used, for example pigs that grow human hearts or kidneys. These would be genetically engineered to lack certain organs which would be replaced with human grown ones. I can’t help but feel that the use of animals that have higher brain functioning is unethical, as they may experience unknown side-effects and experience pain and suffering that we could not prepare them for. I have always loved animals and the thought that we just decided that we were better than them and they don’t deserve the same rights has always been something that I’ve felt uncomfortable with. They are unable to consent to the research that we would be carrying out on them which makes me thing we are abusing the power we have over them.

This is the same with smaller animals such as rodents, which are deemed ok to test on. I completely understand however that this ethical dilemma is opposed by the number of people that would greatly benefit from the organs that would save their quality and quantity of life. Almost 7000 people in the UK are awaiting transplants, and 439 people died last year whilst waiting. Is it wrong to deny them the chance of life if we could save them?

A comparison of the brain makeup of rat, pig and human brains, showing the similarities between human and pig brains.

When people push for chimeric organs, they often compare it to way we slaughter pigs every day for food, and that there is little difference between this and genetically modifying them. I do not feel this to be accurate, as we are not letting them live their lives as they would do in nature, and we could not be sure that no harmful effects would be experienced by the animals. They would likely have to spend all of their life being monitored and tested to ensure the organs were growing properly, and that they were healthy.

Overall, I think that the use of chimeric animals in organ farming is not clear cut. Laws and ethical regulations would have to be heavily regulated to ensure that the animals were not adversely affected and the organs were of a high enough standard to make the animal lives lost worth it. If implemented, it would likely save countless lives awaiting transplant and reduce the illegal trafficking of organs, leading to better outcomes for all.

Empowering Lives: How Technology Enhances Prosthetics

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Modern advancements in technology have given humans the capability to utilise the body in ways that were never even considered as being possible 100 years ago. As a Biomedical Electronics Engineer, I’m passionate about the application of myoelectric prosthetics to help people achieve a better quality of life – something made possible through modern engineering marvels.

My passion for this stemmed from a BBC show named “The Big Life Fix”, in particular, an episode about a girl who wanted to become a dancer but was unable to do so due to a partial leg amputation. The engineers on this show designed her a custom prosthetic which allowed her to fulfil her dream – this inspired me and made me want to follow in their footsteps.

News article showing how a bionic arm is aiding with improving the quality of life of amputees https://www.bbc.co.uk/news/technology-68368439

The lecture about biological sensing particularly appealed to me, especially the article written about the “bionic arm powered by AI”. This article demonstrated how a man, born with no lower arms or legs, was shocked at the research and development made by a company in California. This prosthetic combined EMG with machine learning to power a prosthetic arm capable of performing many complex movements, whilst also having haptic feedback which allowed the user to feel when they’re gripping something. The combination of these technologies made me question: What other technologies are used in prosthetics?

What other technological innovations are evident in the prosthetics industry?

Machine learning applied to a prosthetic hand

Further exploration into this showed that many modern prosthetics use machine learning to improve their efficiency. Machine learning is a form of AI which relies on complex algorithms to analyse data and “learn” which data is more favourable, leading to more human-like decisions. Combining this with electromyography (EMG) and electronic systems paves the way for the potential for the creation of life-like artificial limbs.

Whilst 3D printing does not contribute significantly to how a prosthetic is powered, modern advancements in these technologies have allowed for rapid prototyping. The different methodologies, varying from FDM (Fusion Deposition Modelling) to SLA (Stereolithography), alongside material innovations have lead to a conclusion that 3D printing is an entirely suitable manufacturing process for prosthetic production, especially as the lead times can be very short.

Additive manufacturing techniques from https://nwirc.org/debunking-myths-of-3d-printing/

Ethical Issues with Prosthetics

Whilst the idea of prosthetics is generally a positive topic, there are issues regarding their sustainable use. A study by researchers at the University of Bristol suggests that humans could become overdependent on embodied devices which results from the seamless inclusion of machine learning. An argument that they made was that a prosthetic user would be unable to act effectively in an emergency situation due to the slow and sometimes inaccurate feedback of the device.

Another factor to consider is that some prosthetics can be invasive, requiring sub-surface EMG electrodes, with others requiring friction-fit sleeves which, over time, could cause injury to patients adding further financial stress to the healthcare sector.

Assuming that ethical issues are taken into consideration and legislation is followed, prosthetics could become the forefront of future limb rehabilitation.

The combination of these technologies with new innovations and improvements is improving the quality of life of countless individuals, which I find truly inspiring. Technology has improved drastically within the last 100 years, so the true capabilities are really unknown. Potential issues today could be solved in the near future – I find this very exciting, especially with the knowledge that people in the future requiring a prosthetic will have more promise and improved lives.

The Future of Prosthetics

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Modern Prosthetic Leg
Cairo Toe

Since the development of the Egyptian ‘Cairo toe’, prosthetic limbs have developed greatly. The Cairo toe was made from pieces of wood sculpted into the appearance of a toe and held together by leather thread. This simple model contrasts drastically to the modern-day prosthetics often constructed using metals and synthetic materials such as plastic and silicone which can provide individuals with high levels of functionality and are available with a range of different aesthetics.

Sensors of APL bionic hand

Scientists are constantly trying to improve prosthetics for their recipients. Recent developments have focused on the ability to control prosthetics in the same way we would control the natural limb – with our minds. Johns Hopkins University have developed the APL bionic arm which can be controlled by the human brain. In 2016, Melissa Loomis, who lost her arm after being bitten by a wild racoon, became the first recipient of this prosthetic and one of the only amputees at the time to be able to control her prosthetic with her mind. The arm receives inputs from her nerves in her nervous system which are interpreted by the arm and result in the desired output of movement. The prosthetic also has a range of sensors across it which send signals back to her nervous system allowing her to be able to detect temperature and provide some of the senses, such as touch, to the limb. This could be life changing to amputees like Melissa who said touch was ‘the thing she missed the most’ in an interview with Motherboard.

Whilst this was a huge leap forward in prosthetic science it is not without its disadvantages. The APL bionic arm is extremely expensive, and patients need to undergo a long invasive surgery known as targeted sensory innervation to allow the prosthetic to be connected to the patients nervous system. Whilst currently these factors make the prosthetic less accessible, it still provides an exciting glimpse into the future of prosthetics for amputees.

MiniTouch lets existing prosthetic hands relay a sense of temperature

However, for those who are unable to consider this advanced APL bionic arm, prosthetics such as the MiniTouch, recently described in nature,  may be desirable. The MiniTouch technology allows the detection of temperature through prosthetic limbs without the need for surgery. The technology works similarly with temperature sensors on the prosthetic that deliver thermal information to the patients’ neurones through points on their skin. It can be attached to many different prosthetic limbs already on the market making it much more accessible to amputees.  

Developments like these were unimaginable during the time of the Cairo toe indicating that the possibilities with prosthetics could be endless. One limb amputation happens every 30 seconds and there are over 2.1 million people living with a limb amputation in the US alone. Therefore, these advancements provide a promising glimpse into the future of prosthetic limbs with increased functionality and accessibility.

How the NHS falls behind: the tech gap

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You turn up at hospital and what is the first, most basic test that they carry out? Vital observations. From the most minor injuries to surgery and intensive care, throughout the hospital at every level, vital observations are integral to medical understanding and monitoring of the individual. They can be relatively rudimentary signal acquisition systems, relaying physical signals from the patient through a signal amplifier and analog to digital converter where electrical signals can be analysed and monitored on a computer. So how has this relatively straightforward technology become so outdated in anywhere other than the operating room, when recently in Los Angeles, California, I was presented with cutting edge, holistic, remote medical sensing technology at Massimo biotechnology?

Working throughout the RD&E Exeter and SGH Southampton Hospitals, and most recently work in Coronary Care and Emergency Majors department has raised my awareness of the failures of vital monitoring systems so highly relied upon. For instance, ECG monitoring on Cardiac units currently rely upon either static or cumbersome remote ECG monitors that can be very restricting to the patient (especially those generally mobile or that become agitated without activity), require manual operation, and generally provide minimal amount of information solely related to one requirement, in comparison to the holistic, versatile, and minimally invasive remote monitoring systems currently being innovated and sold on the market.

Currently, Massimo offer the Radius VSM which provides the ‘versatility of a bedside monitor in a wearable device’. This includes pulse oximetry monitoring, respiration monitoring and rates, noninvasive blood-pressure which have customisable intervals of observation, temperature, patient mobility and orientation monitoring providing ability to detect falls and prevent pressure sores, and ECG with 6 different waveforms. The ability to monitor these variables from the nursing desk, regardless of where the patient is, can be much more time efficient and less restricting than current methods. This must also be able to factor in for artefacts that can present themselves in readings, for instance mains interference or EMG (electricity radiated from muscle) as a result of movement.

While perhaps the NHS has equipment that will “do the job”, does it work to what could be its current full potential and reflect the incredible recent advances made in bioengineering (which could lead to improved patient outcomes)? No.

The NHS has a multifaceted problem with innovation and development. This comes down to difficulty in implementing changes to a highly decentralised and overly bureaucratic system which would require a lot of coordination and investment. Investment with a tight budget from the British taxpayer and high competition between arguably just as, if not more important medical devices and materials, proves another problem. In terms of innovation, inevitably there is a reluctance within healthcare professionals to step out of the comfort zone into a new era when the old is tried, tested, and already payed for.

Despite the NHS working at a sufficient level, how far does its ethical obligation to innovate, stretch into the modern age of technology. Patient wellbeing would improve with more accurate, less restrictive systems. Equality and access to healthcare across the country with better outcomes, improved efficiency and reduced waiting times for any individual regardless of background, would also be possible. Furthermore, innovation would be an obligation of beneficence and non-maleficence with patients best interests in mind. However, to what extent this is significant in terms of resource allocation must be up for contemplation.

Evidently now the NHS has realised their need to develop in this niche with necessary trials being launched. However, the delay in this being a priority is evidence of the NHS need to improve.

Cochlear Implants: An Advancement or Ableist?

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Hearing loss, whether congenital or developed later in life, affects many people. 1 in 5 adults in the UK experience hearing loss, are deaf or have tinnitus. More widely, 5% of the world’s population experience disabling hearing loss. Hearing, in conjunction with the other 4 senses, aids us in our understanding and interpretation of the world around us. So you would think that anything that helps to restore hearing is a net positive, right?

Not exactly.

There is a divide in the deaf community. Some see their deafness as a medical condition, whereas others see it as a cultural identity. The former group tend to see cochlear implants as a beneficial advancement and a great option as it can potentially improve their condition. Those who fall into the latter category tend to believe that cochlear implants are inherently negative, as the promotion of them implies that deafness is something that needs to be fixed. The deaf community have their own way of communicating that has been developed over many years, and the mass adoption of cochlear implants may cause them to lose the language and culture they have developed.

Cochlear implants are beneficial, with a 2020 study in adults showing that word recognition improved from 8.3% to 53.3% after implantation. However, it requires a lot of work for the person wearing the implant to reach this point. They will have to undergo speech and language therapy, and it can take many years to adjust to. The implant also does not restore hearing in the same way that non-deaf people can hear, as some may believe.

Below is a thread from an X/Twitter user, discussing how people without hearing loss may be insensitive to the emotions and agency of deaf people surrounding their choice of whether or not to use cochlear implants. The comments are taken from a video of a child who did not want to wear her implant after her parent asks her to put it on, and requests for her parent to sign with her instead.

In the thread, the user shares screenshots of people making comments such as, “If she didn’t want it she should pay her folks back for it”, and “Everyone cannot sign. She needs to be flexible and adaptable to make it in this world”, with many comments using ableist language.

With comments and language such as this, it’s understandable why there are deaf people who advocate for children to not be allowed to have cochlear implants until they can consent to the procedure.

The comments also display misconceptions about cochlear implants. There is a rampant attitude of “If you have an implant, why should I use sign language?” The consensus is that the child is choosing to not wear her implant out of insubordination. It is common for deaf people with hearing aids or implants to want “hearing breaks”. Some people with an implant still use lipreading and sign language as they may find it easier for many reasons.

This situation highlights the main issue that some deaf people have with cochlear implants; they can be seen as an excuse for the lack of accommodations that society has for deaf people.

Overall, cochlear implants are not a miracle cure. They have the potential to help deaf people, but it is an emotionally taxing process and it is not fair to expect all deaf people to want one (or two). If someone has a cochlear implant, but doesn’t want to use it all the time, we should be empathetic to that.