“We’re going to be able to give people limbs that are not made of flesh and bone, but carbon, fiber, and metal. There’s going to be a time, at some point in the future, when it’s not going to make a difference what you’re made out of.”

Hugh Herr, Professor of Media Arts and Sciences at the MIT Media Lab, and co-leader of the Yang Center for Bionics at MIT.

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Last week, PBS aired a documentary film directed by Matthew Orr, formerly of STAT News (Boston Globe Media) and now on the faculty at Medill School of Journalism, Northwestern University. “Augmented” shows how a climber, Hugh Herr, became an MIT biophysicist whose work developing brain-controlled prosthetic limbs has benefited people all over the world—including Jim Ewing, a climber friend from his early days. This in­cludes the de­vel­op­ment of the kind of ver­sa­tile pros­thet­ics that en­abled Mr. Herr not just to re­turn to rock climb­ing but ex­cel fur­ther at it—mod­u­lar feet and ad­justable leg shafts that al­lowed him to climb in places, and across sur­faces, that might have been im­pos­si­ble be­fore he was in­jured. Here’s a link to the trailer for the film:

The more fu­tur­is­tic ob­jec­tive of “Aug­mented,” how­ever, is reached dur­ing the story of Jim Ew­ing, a rock-climb­ing ac­quain­tance of Mr. Herr who has be­come the name­sake of a sur­gi­cal tech­nique de­vel­oped by Mr. Herr and Matthew Carty, a sur­geon at Brigham and Women’s Faulkner Hos­pi­tal in Bos­ton.

“Hugh Herr, Matthew Carty and their teams at MIT Media Lab and Brigham and Women’s Hospital have developed a new approach to amputation that has the potential to vastly improve the lives of countless patients.”

Matthew Orr, Director, “Augmented”

Dr. Carty points out in the film that am­pu­ta­tion had been a pro­ce­dure that hadn’t ad­vanced since the Civil War. As “Aug­mented” illustrates in sev­eral straightforward and co­gent ways, the stan­dard re­moval of a limb and the use of skin and mus­cle to cre­ate a stump thwarts the natural mes­sag­ing from the brain. By redi­rect­ing the trau­ma­tized nerves and mus­cles into a pros­thetic that chan­nels the mes­sages properly (this is, ad­mit­tedly, a sim­pli­fied ex­pla­na­tion), the brain can con­trol the pros­thetic. Mr. Ew­ing, who suf­fered a fall from a cliff face in the Cay­man Is­lands and even­tu­ally was go­ing to lose a foot, be­came the first am­putee to un­dergo the process that Mr. Herr and Dr. Carty developed.

The long-term hope for the procedure is that people with Ewing amputations will be able to further adapt to the bionic limbs shown in the film, which Herr’s team is developing at MIT. When the film shows Ewing wearing a bionic foot, Carty explains how it mimics an attached limb through electrodes that send signals back and forth between the man and the machine. The foot is, for all intents and purposes, controlled by his brain. More testing is needed on the bionic leg, but a version of the device could be publicly available in a few years.

“It’s a tremendously exciting time to be caring for patients with severe limb injuries. Up until very recently, we aimed to restore patients to their pre-injury state. In the not-so-distant future, patients with amputations may be able to regain full function, and maybe even become better than they were originally.”

Matthew J Carty, Surgeon, Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital

The end of the documentary shows Ewing returning to the site of his injury. Outfitted with a bionic foot specifically designed for the sport, Ewing confidently scales a cliff. Later, in a TED Talk, Herr introduces Ewing as “the first cyborg rock climber.”

Despite Ewing’s improved quality of life, the documentary points out that the ethics of this emerging technology are murky. In the film, a bioethicist, Keisha Ray, raises questions of equity — who will get access to the advanced limbs? This issue is brought into sharper focus when it becomes clear that people could use these bionics “to run faster, to jump higher, to do all kinds of things that you can’t even imagine today,” as Herr opines in the film.

“You’d be able to maybe even go beyond innate human abilities. That’s exciting, and also a little scary.”

Matthew Orr, Director, “Augmented”

The team recently held a virtual event where key players in the film talked about their research and experiences and looked forward to what’s next. You can watch a recording of that event from STAT here.

It’s sci­ence-fic­tion, ex­cept it’s not fic­tion, and the sci­ence is made ac­ces­si­ble in Mr. Orr’s fas­ci­nat­ing documentary. As of November 2019, the below-knee operation has been performed on 20 patients. The research team has received funding to develop the procedure for arm amputation as well. The researchers predict that adapting the Ewing procedure for the upper limbs could be a game-changer for patients who need arm amputations. Like the original Ewing procedure, the upper-limb amputation procedure aims to similarly link muscle pairs to better enable prosthetic control, preserve limb volume and eliminate neuropathic pain. Together with MIT and Walter Reed Army National Military Medical Center, Dr. Carty and his clinical team are recruiting patients for a three-year elective upper-extremity amputation clinical trial. With funding from the Department of Defense, the team has performed three surgical simulations at Walter Reed and New England Donor Services.

If you haven’t seen the documentary yet, you can watch it on the PBS Video app. Or, if you are a PBS subscriber you can watch it using PBS Passport. Either way, it’s the best hour I’ve spent watching TV in a long time.