Prosthesis and robotics have the capability of allowing sign language users to connect to those who do not understand.

Sign language is the fourth most used language in the UK however it is still taboo in the general population. At a selection of schools sign language is an optional extra however it is not part of the national curriculum.

There is an outcoming number of benefits from teaching BSL (British Sign Language) at schools. From an academic foresight there are many qualifications and careers you can pursue through BSL alone. More importantly, it allows effective communication and overcome discriminative barriers. I have experienced these barriers myself working in customer service. I feel helpless when a regular comes in who can only sign or write. It feels dehumanising asking him to write the Lego piece that he wants as it is complex to sign for, the ASLAN would eradicate this for my workplace and improve the quality of life for people; to the extent of scenarios others may take for granted.

There is more than 11 million people in the UK with some form of hearing loss, or one in six of the population.

This number is only expected to increase.

British Academy of Audiology- (Hearing Link Services, 2022)

Engineering students at the University of Antwerp have developed a device called ASLAN. It is a significantly cheap prosthetic that uses artificial intelligence to translate sign language, made at around £400. It allows to overcome the barrier between Sign language users and those who do not understand it, which will be highly beneficial to the quality of life of those with hearing impairments.

ASLAN works by users sending messages which then are finger spelt in sign language. I believe that ASLAN has created a wider topic of research using prosthesis and robotics in conjunction to allow barriers involved with sign language to be completely overcome.

Further development of the ASLAN

There are countless possibilities I have thought further about from coming across the ASLAN such as creating an orthotic glove which the user will wear on their hands and whilst they sign, signals transduce to a system which will convert this to speech using graphite resistance technology or accelerometers. Or in scenarios where a deaf person may not have hands, inspired by ASLAN a prosthetic could be made which signs for the user.

Concepts of the ASLAN

A huge economic benefit of the ASLAN is that it is cheap and easy to make from a 3D printer. The ASLAN can also be mobile, these benefits combined would create less discrimination in industries such as schools and workplaces. Sign users would gain more independence in their day to day lives without the use of an interpreter, positively impacting societal and ethical fields of interest.

Controversies of the ASLAN

In dispute, this could be seen as attempting to replace interpreters, however the creators have assured this is not their intentions and they are developing ASLAN more for situations such as a student who cannot hear in class could use this to communicate convienently.

Another controversy of this topic is if it can be classed as a prosthetic? The ALSAN does replace a body part however it replaces the persons hand who is lacking sign language communication, not the direct user. It however does not attach to that person’s body in anyway therefore it could be classed as an indirect prosthetic. Therefore it could be argued as an orthotic as it aids function.

Further Information

To conclude the ASLAN opens a world of further research to improve the quality of life for BSL users and help overcome communication barriers. I believe this technology paired with increased awareness and education in schools would lead to connecting our two worlds.

References

Fisher- Wilson, G. (2017) There’s not enough sign language translators, so these students 3D printed a humanoid robot | Hubs. Available at: https://www.hubs.com/blog/theres-not-enough-sign-language-translators-so-these-students-3d-printed-a-humanoid-robot/ (Accessed: 9 March 2023).

Hearing Link Services (2022) Deafness & hearing loss facts – Hearing Link Services. Available at: https://www.hearinglink.org/your-hearing/about-hearing/facts-about-deafness-hearing-loss/ (Accessed: 9 March 2023).

Think back to your childhood and the incomparable difference of the technology then and now. Now think of the possibilities that future technology could consist of.

“Back when I was child we didn’t have all this technology”

The loss of limbs has significant impacts on individuals and can occur due to car accidents, wars or even a defect at birth. In America alone there are 185,000 amputees per year and this number is growing Medical and technological advances have currently provided us with some forms of myoelectric bionic arms so what could the future hold for us?

Listen here: Cochlear implants are redefining hearing

When understanding medical and technological advances it must be recognised that for innovative advances in prosthetics, both the scientific and technological aspects have to be advancing at a suitable rate. For example, in order for cochlear implants to of been created, a deep understanding of the physiological antinomy of the ear and nervous system had to be understood. We needed to recognise that individuals with auditory disabilities often stem from the concept of damaged hair cells in the inner ear. By recognising this we used developing technology to replace the need of these hairs. The implant serves to process sound waves through the use of a microphone and are able to convert these sound waves into electrical signals. These can bypass the cochlear hairs and stimulate the auditory nerve fibres. This begs the question, well what other lost functions can we restore?

This singular device has such a huge impact on millions of peoples life’s. Could a prosthetic like this be adapted to have hearing beyond the capability of current humans?

How prosthetic limbs are giving amputees a helping hand !

Currently, we have myoelectric prosthetics which are important in replacing the function of a lost limb such as an arm. These work by using the muscles in the residual limb to send signals to the bionic arm. These signals will inform the electric arm to contract or relax etc. This is done through the stretching and contractions of the muscles from the residual limb. As impressive as this is… it’s not ideal. The user has limited options in what the hand can do, such as very limited finger individual finger movement. Moreover, if there’s a lack of suitable muscle by the residual limb or no residual limb then it becomes almost impossible for the hand and arm to work. A battery is also required meaning the device needs charging or batteries frequently. This is important as in terms of living in society, the individual is still at a disadvantage and due to a limited mobility, the product may not satisfy the consumer enough.

Current research is focusing on fully integrated prosthetics. This would have a huge impact on our society. Fully integrated prosthetics involves solely involves the nervous system to bring about a response. To the user this would almost feel the same as if they had an arm or leg. They would “think” about moving a finger and it would move. In addition, as the interface is controlled by the individual’s own biology, no battery would be required in the same way the average individual doesn’t require a battery. However ethically and legally this could cause concern. Although this would be very effective for the amputee, you would effectively be building a chimera between man and machine. This could be militarised as rather than just restoring the function of an arm or leg, you could enhance it for military purposes. Even having such specific control over a carbon fibre arm; in public this could be conceived as dangerous. New military laws and national laws would have to be introduced.

When designing a product like this, the potential danger that could be introduced to society needs to be examined yet the number of people’s lives that could be improved is incredible. So, the question is… Is it possible to advance/improve our civilisation technologically without causing a new problem? …No, I don’t think so. Do you?

Survival of the fittest is a well known theory presented by Charles Darwin. It suggests that organisms who are more adjusted to the environment surrounding them will become more successful in survival and reproduction. Considering this, if you had the opportunity to ensure your child was the cream of the crop, would you take it?

Why was I fascinated by this topic?

During a recent workshop relating to the law and ethics of replacement body parts, I was fascinated by the debate amongst the group. Specifically relating to ‘Engineering the ‘perfect’ child’, this is a debate brought upon by the altering of genes of an embryo (pre-implementation) using genetic engineering technology: CRISPR. After being split into small groups, with my group consisting of only scientists, it became clear that a lot of our thoughts and feelings towards the subject were very objective, looking purely at the scientific benefit. At the time this view seemed very rational however, after discussing it with some students from the social sciences, our eyes were opened to other perspectives i.e ethical concerns.

At the start of our discussion, I believed this advance in science, namely being able to alter genetics with a desired outcome, could provide life changing techniques to prevent illness in those who are susceptible. It therefore baffled me as to why someone wouldn’t want to beat genetic diseases. For example, being able to remove variations in BRCA1 and BRCA2 genes, which increases a woman’s chance of developing breast or ovarian cancer, where an offspring of parents carrying the gene has a 50% chance of obtaining the harmful mutation from either parent. Upon this case, my initial thought was that there would be elevated stress for the pair that would like to conceive, as they will carry the fear of passing this onto their child. So using this technology was surely a good thing. 

After these thoughts, I watched two videos, the first by the economist on the applications of this technology. A banana farmer, James, had his plantation hit with a disease called necrosis that wiped out entire populations of crops. As such, James spent lots of time genetically engineering bananas that withstand this disease, and prevent the fruit becoming extinct. The limiting factor here is societal views of genetic modifications, meaning people weren’t going to buy them. But why? 

The problems with CRISPR based genetic engineering

Discovering that this technology could be exploited in multiple ways changed my emotion towards it, I felt uncomfortable. Using this technology for cosmetic purposes, e.g. designing a child as if in a life simulation game seemed unnerving. Firstly, this provides further separation in economic classes. Enabling those who are wealthier to create more ‘ideal’ children to fit in current societal standards. Naturally, this will mean that those who have been conceived with idealistic appearances, will be born into wealthy families, and those who cannot afford to do this, will have natural babies that will inevitably, in time, be seen as inferior.

Taking into account both of these possibilities, I decided to further look into this stream of research and watched another video that delves deeper into the CRISPR process and its applications. A statement that stuck out to me in this video was that “.. a door is opened that can’t be closed’. CRISPR is an easy tool, further evidenced by Jennifer Doudna, a biologist who co-discovered how to use CRISPR to edit genes: “Any scientist with molecular biology skills and knowledge of how to work with [embryos] is going to be able to do this,”. Although easy, it doesn’t make it exceptionally accurate. There are possibilities that genes will be edited without intention to. This further poses the question that if an individual had their heart set on a certain child, how would they react to finding out it wasn’t exactly how they planned?

Final thoughts

This debate is far from over, and as time goes on, science will only advance more. It isn’t a case of who is right or wrong but more how we can ensure these technologies are used appropriately. Overall, this debate helped me reflect on my approach to scientific procedures, not only do I have to think about how it might be a great discovery for its intended use, but how it can cause further ethical questions. 

Resources mentioned:

Economist video: https://youtu.be/F7DpdOHRDR4 

CRISPR video: https://youtu.be/jAhjPd4uNFY 

Article on engineering humans: https://www.technologyreview.com/2015/03/05/249167/engineering-the-perfect-baby/ 

Inspired by the lectures on prosthetics, the impact that hip placements have on a patient’s quality and satisfaction of life really struck me. According to the arthritis society, 7% still suffer from moderate limitations and 20% report severe limitations 5 years post-surgery. Despite undergoing a second surgery, only 70% of patients reported that they were doing well.

So why are the 30% still suffering?

There are many minor reasons that hip replacements may fail:

• Wear and Tear: Constant wearing of prosthetics can cause the joint to become loose, requiring further surgery if the problem is severe
• Joint stiffening: soft tissues around the hip replacement become stiff and lead to reduced mobility
• Sensitivity to metal: inserting a ‘foreign’ substance into the body  

However, unfortunately, there are more serious factors which may be at play too:

• Aspect loosening: breakdown of the joint between implants, components and body. It can often cause the release of small particles and debris when the joint starts to wear out. The patient’s body may recognise the hip placement as a ‘foreign’ object. The patient’s immune system will identify these particles and attack them causing inflammation  
• Formation of blood clot: increases risk of thrombosis (including deep vein thrombosis and pulmonary embolism)

A Personal View Point

Wanting to learn more, I contacted a family friend who has recently had her first hip replacement just over 5 months ago to understand what impact the replacement had on life post-surgery.. Prior to her surgery, she lived in discomfort for a long time, but recognised that her hip replacement had an extreme benefit on her quality of life (e.g. her low back pain  has reduced and she is able to sleep better. Recently, she had a second hip operation and is currently recovering. After having the second surgery, she remarks on the great benefit of the first hip replacement on her flexibility and mobility.  

However, despite the positives, she commented that the rehabilitation process is long, frustrating and slow. Your daily routine is disrupted from having to always sleep on your back, being unable to drive or exercise and work being impacted if you are unable to work from home.  Moreover, whilst she was happy with her access to pain relief, she suffered adverse events on opioids of constipation, which she argued was more painful than the hip operation itself.

The most interesting point we discussed was access to physiotherapy. She was fortunate enough to receive her hip replacement on the NHS, however, when comparing herself to a friend who had their hip replacement privately, she commented they had better access to in-person physio and rehabilitation help. I can’t help but think this raises all sorts of ethical issues due to socio-economics factors. But does the NHS have the capacity to do more?

My Final Thoughts ….

Further to having a discussion, there were two points that stuck out to me. I’d love to research more into the rehabilitation process from start to finish (e.g a strict exercise regime to strengthen muscles, and improve balance and blood circulation). A good link for more about this topic is: Hip replacement recovery: timeline, tips and information | Spire Healthcare  . But finally, the most provoking revelation that I encountered was the equal access to healthcare during the rehabilitation process . The final parting question I have is – why doesn’t everyone receive the same level of treatment?

While nowadays we accept the exitance and necessity of bioethics we often overlook their origins. Despite being a physics student, I take a lot of interest in history and ethics so when we covered both these topics, I immediately decided I wanted to look further into it. This led me to the question of how the Nuremburg trials – specifically those for the Nazis doctors of concentration camps – led to the development of medical and bioethics.

Throughout WWII many number of atrocities were committed by the Nazis, but some may argue that the greatest were those crimes against humanity that were committed by doctors of the Nazi state. With ideas of eugenics becoming ever more popular and the Nazi want to eliminate those who they deemed didn’t contribute to the state, millions of innocent people were murdered, and thousands were subjected to medical experimentation. Now while this all sounds like a brief historical overview into the Nazi doctors we can use this information to see how out of this the first ideals of medical and bio ethics were created. Following then end of the war, Nazi leaders were tried at the Nuremburg trials, with there being a specific trial for the doctors who experimented on people in concentration camps throughout the war.

These doctors’ trials led to the creation of the Nuremburg code, a set of ethics rules for conducting medical and biological research. Prior to WWII the only previous outline to medical research ethics were the ‘Guidelines for Human Experimentation of 1931’ which the doctors asked to be tried under for their experimentation , but the prosecutors refused and came to the conclusion of trying 16 out of the 23 for crimes against humanity.

It has been said by some that if they had been in the same situation – a leading country in medical development with unlimited human subjects as resources and the propaganda to believe what they were doing is right – they would have done the same. Looking back now we know how awful this experimentation was and can’t even begin to imagine how someone could have concluded that it was okay. But at the time many Nazi doctors believed what they were doing was right and the growing ideals of eugenics pushed them to further what they thought was acceptable and ‘good’ research. There were many scientific advancements made to understanding different neurological diseases but in no way do the ends justify the means. This merely shows how much of a lack of guidelines behind research ethics there were as no patients were ever informed of what was happening and research was always carried out in the name of science without taking into consideration the person.

Following the Nuremburg trials the code was created as a way to highlight all that was wrong with the Nazi State’s  experimentation and lack of thought for life. They were the first outline for medical ethics, and in which highlighted the need for consent from patients and that the primary concern of doing no harm . While the Nuremburg code was somewhat ambiguous, and statements left open to interpretation, it did lead to the creation of the Declaration of Helsinki. This is an ever-changing document to lay out correct medical practice and ethics in research – bioethics. The Declaration of Helsinki is still to this day a widely respected and followed document for Drs across the globe to hold themselves to in their work and practice. So, we can see that from the atrocities of WWII, eugenics and Nazi experimentation came the creation of medical and bioethics that are followed today. This can all be summed from a quote in the Nuremburg code:

‘All contemporary debate on human experimentation is grounded in Nuremberg’

Nuremburg Code 1947

Imagine a world with no disease, where we can alter our genes to become the best version of ourselves. Maybe you want to be the most fit, have great health , or be the smartest. But at what cost are we willing to get to this?

Recently I watched the documentary Unnatural Selection on Netflix, which delved into the world of genetic editing, and touched on some of the dangers that may arise because of it. One particular issue it focused on what biohacking, which is when people use aspects of biology to change their body in some way. CRISPR, a new genetic editing technology, would allow people to do this easily at home. However, by making changes to the ones genetics, they are altering the the genetics of their offspring, which could possibly have detrimental effects in the future.

So, what is CRISPR?

CRISPR is one of the most versatile gene editing methods, so simple it is often described as cutting and pasting our genes. CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats. Essentially it works by removing a portion of a gene, and letting natural DNA repair systems take over.

Hundreds of studies are currently happening, in terms of how the technology can be used therapeutically, to treat a wide range of diseases, from HIV, blindness, and sickle cell anaemia.

Markus Mapara, MD, from Columbia University, used the CRISPR technology on a patient with sickle cell anaemia, a blood disorder. It is estimated that the disease affects 1 in every 2000 people in the UK, making it one most common genetic disorders in the UK. The genetic mutation causes the body to make an abnormal form of haemoglobin – a protein essential for red blood cells to deliver oxygen around the body. Currently the standard treatment is a bone marrow transplant, however this introduces the risk of infection and rejection. CRISPR is a new promising treatment that may be able to change the outcome for these patients.

So what’s the problem?

In a technology with such promising outcomes, it is hard to imagine why it may be a problem. But for ethicists, it has raised huge concern.

As I mentioned at the start, one of the main concerns brung up in the documentary was biohacking. The documentary goes into the story of Josiah Zayner, a formed NASA scientist. He injected himself with this technology, to grow his muscles. He stated that his motivation was to prove that CRISPR worked, and show the possibilities of gene editing. He believes that people should be able to get involved in science at home, and it shouldn’t just be down to scientists in labs. In addition to trying to grow his muscles, he also performed a full microbiome on himself, including a faecal transplant. The documentary Gut Hack goes into further detail of this, and the outcomes.

To most of us, this seems terrifying – injecting ourselves to permanently change our genes, without knowing the outcome. So why do biohackers do it? They all have different motivations, however the is a general consensus that they are frustrated with the slow progress and tight regulations around these technologies. They believe that they should be more accessible.

This moves onto another problem with the technology – accessibility. A problem that strikes those working on these technologies, is whether the people that need it, will be able to access it. The costs of the technology may be a barrier for those wanting the technology to cure disease. Rather those with money may be using it for enhancement purposes – to make them faster, be able to concentrate longer, be fitter, be smarter etc. However, this will only create a larger divide in society.

This leads of onto the issue of eugenics. Ethicists have concerns that IVF clinics may be able to access this technology, and use it to alter embryos. This was done by a Chinese scientist Jiankui He, who genetically altered the DNA of three embyros, who then developed into babies, including two twins. He was aiming to make the children immune to HIV, however this was deemed irresponsible and he was jailed for 3 years. (https://www.theguardian.com/science/2023/mar/06/forthcoming-genetic-therapies-serious-ethical-questions-experts)

So what’s the outcome?

The topic is very much up for debate within the science, political and ethical world, however I am going to conclude my current thoughts on the technology.

Looking from a utilitarian point of view, I am inclined to believe that the benefits of the technology will one day be more beneficial than the risks. However, I think a lot more regulations need to be put in place before this can happen.

The problem with making it easily accessible is biohackers, however with a lack of accessibility we create a societal divide and lean towards the world of eugenics. My idealist view would be to make it accessible through health care, and not make it a technology that is readily available to the public, however as the documentary Unnatural Selection discusses, this is a very idealist view.

Here is a short video clip of the documentary:

Due to a combination of academic interests including nano-fabrication, quantum physics and computer science; I began researching situations where quantum effects are used to interface with biological systems. It was down this line of inquiry I came across a research paper focused developing a novel form of pacemaker utilising light and microelectronics. Currently a pacemaker is a capacitor that discharges its electrical current to the heart. This leads to altering the pace of the hearts beating. The device also uses electricity to monitor the heart’s beating.  

The widespread adoption of pacemakers has saved an enormous number of lives. This is due to a multitude of heart conditions affecting the rhythmic beating of the heart. 50,000 people are fitted with a pacemaker every year in the UK. The first internal pacemaker was implanted in the UK in the 1960s. The first pacemakers were traumatic to implant and difficult to live with but subsequent advances combining the physics of the devices with the surgical methods used has led to the standard pacemaker being the size of a match box being implanted under local anaesthesia.

The increasing capability of microelectronics especially is allowing more in vivo studies of complete pacemaker devices in rodents. This has the potential to allow more novel technologies to be trialled. 

Researchers at the university of Arizona have developed a pacemaker that has a flower shape and uses light to stimulate the heart. Optogenetic stimulation utilizes light photons to activate excitable tissue. The circuitry integrated into the device also has the capacity to be loaded with machine learning algorithms, these would be especially useful in this kind of device as electrical sensing can be used simultaneously with photo stimulation to continually monitor the hearts beating. The device could then alter the timing of its stimulation to avoid latency that would reduce the performance of the heart. Another reason electrical stimulation may not be the optimum solution is that it causes damage to the stimulation site and is not specific to the cells that need to be stimulated, causing discomfort (although most users stop feeling the pulsing). 

This research is being done in a major part to the miniaturization of the pacemaker devices allowing trials on rodents that could not be achieved before.  

The device used an array of 9 micro-LEDs. And 8 22 micro-Farad Capacitors in parallel to achieve desired capacitance. It was powered by magnetic resonant coupling; this allowed the subjects to move freely within the magnetic field. The device used infra-red report data back wirelessly.  

If a form of this device makes it to human trials, it will not just have to demonstrate the effectiveness and safety of the system. There is also more scope for things to go wrong both within the device and when it interacts with external magnetic fields, as the system will present more potential points of failure. The more complicated the devices are electronically the more maintenance will be required. The electronics would more than likely need to be hard coded as a strong enough magnetic field would totally wipe many forms of non-volatile storage. The use of micro-LEDs also poses physical challenges due to the proximity required to the target cells of complex electronics as opposed to an electrode feeding from a device implanted next to the heart. 

A pacemaker is much more critical to a person’s moment to moment survival than other more periphery devices such as a replacement pancreas. So, there must be some certainty that the device equals or surpasses the abilities of the current pacemakers in use in its most basic objective of long-term patient survival. 

Protistic limbs are life-changing technology for those who have lost limbs through various causes. It became clear that there was a lot of focus on protistic legs and technologies to make them as comfortable and life-like as possible. The engineers have managed to design such a personalized model for making the legs, they can alter the types of legs for the different lifestyles and needs of the patients.

Arm and hand protistic seemed to be a lot more complicated due to the nature of hands having such complex sensory and dexterity properties. This got me thinking about how they can improve the technology, with sensors to help with gaining back complete function. While looking online about the research going on into hand and arm protistic, I came across a man who had recently had a double forearm and hand transplant. I was surprised and interested in this, the fact that they can transplant arms from donors and that this works giving patients back the use of hands that they have lost.

In the UK there is a specialist hand transplant team located at Leeds hospital. In a BBC documentary that has just come out called “Saving lives in Leeds”, in episode one they follow a story of a man who has a double hand transplant. In the documentary, the surgeon talks about the complexity of the surgery and the risk of rejection. Organ donors have always been something that I have known about, so many people would give consent for loved ones to donate a kidney or liver, or heart when they pass away but it had never occurred to me that someone would donate their hands.

The intricate nature of the function of the hands is important to maintain when doing a transplant otherwise it isn’t worth it for the patient. In Saving lives in Leeds the head surgeon talks about how they must connect the blood vessels and replace and sew together bones to allow the donor limb to become part of the recipient’s body. The hands regain sensory over a minimum period of 3 years. The nerve regeneration takes up to 6 weeks before patients start getting feeling in their new limb.

In the documentary, the mother of the patient touches on the impact that this will have on her son’s life. The ability to have full functioning hands again, the doors that will re-open for him, and the quality of life he will now be able to have. The significance of someone’s family allowing the donation of hands is also mentioned. Hands are a very personal feature of our bodies and to allow the donation of these to another person does not go unnoticed.

The UK’s first double hand transplant happened in 2016 at Leeds Hospital with a patient called Chris King. The YouTube video below is him talking about his experience of how a double hand transplant has changed his life.

Listening to these peoples’ stories and reading more about how these procedures are done, got me thinking about how I would feel if someone was to ask my permission for my loved one’s hands or if I would want someone to have my own. It is such a life-changing thing that some can do for another, it is like consenting to a kidney, liver, or heart but in some way, it feels a lot more personal. An interesting and thought-provoking transplant that will hopefully inspire more of these life-changing surgeries. It made me think of all the potential for other body parts that might be able to transplant in the future, such as legs, ones we’ve never thought of before.