IEEE Technology and Society Magazine - September 2023 - 38

Commentary
new artificial limbs or devices every five years [9].
The Veterans Bureau, a predecessor of the VA, was
responsible for providing prostheses to World War
I Veterans beginning in 1921 [9]. In May 2014, the
FDA approved the DEKA prosthetic arm [10]. The
significantly more advanced system developed by
DEKA Integrated Solutions Corp. expands prosthesis
choices for amputees, who have generally used
body-powered prostheses-in particular, the splithook
device which was invented in 1912.
As for the legislative role of the VA, on 16 October
2017, the VA published a proposed rule in the Federal
Register to revise the VA's regulations governing
the provision of prostheses, among other rehabilitative
items and services to eligible veterans, known
as Federal Regulation 84245 [11]. Coming into effect
on 27 January 2021, the rule established that the VA
is authorized to provide various categories of prosthetic
and orthotic services, sensory aids, and medical
devices to veterans nationwide as part of their
active treatment and ongoing rehabilitation [11].
Previously, the provision of these services and
devices varied across VA medical centers. According
to VA Secretary Robert Wilkie [12], " It (the rule)
ensures Veterans receive the same standard of service
for the rehabilitative devices they need to live
independently, no matter which medical center they
walk into. " The rule reflects VA's more recent veteran-centered
approach to health care, by empowering
veterans and clinicians to decide together which
prosthetic equipment will best meet the veteran's
needs. While the equipment provided to veterans
may not change much, the rule enables VA to identify
current best practices to serve as the standard for
all veterans who receive their care through the VA.
Defense Advanced Research Projects Agency
(DARPA), a research and development agency
of the DOD, is responsible for developing emerging
technologies for military use. Benefitting from
President Obama's BRAIN Initiative, which started
in 2013, DARPA launched the revolutionizing prosthetics
program in 2014 [13]. The program aimed to
gain FDA approval for an advanced electromechanical
prosthetic upper limb with near-natural control,
enhancing independence, and improving the quality
of life for amputees [13].
Revolutionizing prosthetics is not DARPA's only
program pursuing the restoration of amputees.
For example, the Agency's hand proprioception
and touch interfaces (HAPTIX) program seeks an
38
alternative approach by using the peripheral nervous
system to communicate motor commands and
sensory feedback between the brain and a prosthetic
limb [14] to restore the sense of touch. Originally
created by Dr. Doug Weber, HAPTIX program is
being operated under the auspices of DARPA's Biological
Technologies Office (BTO) [14]. It features
a modular architecture and an extensible platform
that provides a framework for future developments
by themselves or others. The program was planned
to initiate take-home trials of a complete, FDAapproved
HAPTIX prosthesis system by 2019 [14].
While DARPA has done exciting work on arms
and hands, the most remarkable breakthrough in
foot, ankle, and leg prostheses has come out of medical
academia. For instance, Hugh Herr, an American
biophysicist at MIT, and his colleagues devised
a new surgery: Agonist-antagonist myoneural interface
(AMI) [15]. In the old amputation method,
the connections between many agonist-antagonist
groups are often severed, but AMI reconnects these
pairs and builds new ones [15]. Artificial muscle
electrodes are placed on each AMI pair and communicate
with computers within the bionic limb. The
contraction stretches the antagonist's muscle, and
these dynamics are communicated to the central
nervous system, giving the person a sense of muscle
length, speed, and force [16]. This sense is known as
proprioception.
Proprioception is the body's ability to sense
movement, action, and location [17]. For example,
when walking, this capability allows one to place
their foot in front of the other without thinking about
it. According to ClinicalTrials.gov, the AMI technique
is still recruiting for its clinical trial phase and
is not expected to be finished until February 2024
[18]. Therefore, it will be a while before the results
are compiled and sent to the FDA for approval.
Dr. Herr was a champion mountain climber
before losing both of his lower legs in a climbing
accident. Nathan Copeland (Figure 1) regained
some functions in his arms after 16 years of living
with quadriplegia, as illustrated in Box 1 [19]. However,
some people with certain disabilities may not
directly benefit from these discoveries, such as those
with cerebral palsy, and some may be more hesitant
to consider cures like functional replacement of eyes
and other organs. But what about the people who do
want to improve or restore their quality of life?
IEEE Technology and Society Magazine
http://www.ClinicalTrials.gov
IEEE Technology and Society Magazine - September 2023

Table of Contents for the Digital Edition of IEEE Technology and Society Magazine - September 2023
