about bionics,

今天我想和你們談談

which is the popular term

生物工學

for the science of replacing part of a living organism

這個流行的專有名詞

with a mechatronic device, or a robot.

意指藉機電裝置或機器人

It is essentially

來取代生物體部份機能的學問

the stuff of life meets machine.

本質上就是

And specifically, I'd like to talk with you

生命和機器結合的東西

about how bionics is evolving

我要特別跟你們談談

for people with arm amputations.

生物工學對使用義肢的人

This is our motivation.

如何地進展

Arm amputation causes a huge disability.

這是我們的動力來源

I mean, the functional impairment is clear.

手臂截肢會造成極度不便

Our hands are amazing instruments.

在功能上的損傷是很明顯的

And when you lose one, far less both,

我們的雙手是驚人的工具

it's a lot harder to do the things

我們不要說失去雙臂，光是失去一隻手臂

we physically need to do.

在生理上執行事情

There's also a huge emotional impact.

就困難許多了

And actually, I spend as much of my time in clinic

在心理方面的影響也非常巨大

dealing with the emotional adjustment of patients

事實上，我在診所處理

as with the physical disability.

病人情緒調節的時間

And finally, there's a profound social impact.

和他們身體功能障礙的時間一樣多

We talk with our hands.

最後，還有廣大的社會衝擊

We greet with our hands.

我們說話時以手為輔

And we interact with the physical world with our hands.

我們用手打招呼

And when they're missing,

我們用手摸索物質世界

it's a barrier.

沒有手

Arm amputation is usually caused by trauma,

就會產生障礙

with things like industrial accidents,

手臂截肢通常由創傷所導致

motor vehicle collisions

例如工業意外

or, very poignantly, war.

機車衝撞

There are also some children who are born without arms,

或殘酷的戰爭

called congenital limb deficiency.

也有些小孩是生來殘缺的

Unfortunately, we don't do great

稱做先天性肢體缺失

with upper-limb prosthetics.

可惜我們在

There are two general types.

上肢義肢方面沒有做得很好

They're called body-powered prostheses,

有兩種主要類型

which were invented just after the Civil War,

一種是身體動力型義肢

refined in World War I and World War II.

發明於南北戰爭過後不久

Here you see a patent

又在第一次和二次世界大戰時經改良

for an arm in 1912.

你現在看到的是

It's not a lot different

1912年的一項義肢專利

than the one you see on my patient.

和我病人身上的義肢

They work by harnessing shoulder power.

沒有太大差別

So when you squish your shoulders, they pull on a bicycle cable.

它們運用肩膀力量來帶動義肢

And that bicycle cable can open or close a hand or a hook

所以當你擠壓肩膀時，就會帶動腳踏車鋼索

or bend an elbow.

而鋼索就會將手鉤打開、關上

And we still use them commonly,

或使手肘彎曲

because they're very robust

這種義肢仍然相當普遍

and relatively simple devices.

因為它們算是非常穩健

The state of the art

相對來說也較為簡便的裝置

is what we call myoelectric prostheses.

第二種較為先進的技術

These are motorized devices

則是我們所謂的肌電義肢

that are controlled

這些機動裝置

by little electrical signals from your muscle.

會偵測

Every time you contract a muscle,

你肌肉所產生的微小電子訊號

it emits a little electricity

每當你收縮一條肌肉

that you can record with antennae or electrodes

它會釋放一些電信號

and use that to operate the motorized prosthesis.

供接收天線或電極記錄

They work pretty well

再用來操作機動義肢

for people who have just lost their hand,

對只失去手部的人來說

because your hand muscles are still there.

使用起來很方便

You squeeze your hand, these muscles contract.

因為你的手部肌肉還在

You open it, these muscles contract.

你握緊手，這些肌肉就會收縮

So it's intuitive, and it works pretty well.

你把手打開，這些肌肉也會收縮

Well how about with higher levels of amputation?

所以它是直覺性的，效果很棒

Now you've lost your arm above the elbow.

那假如截肢範圍更大呢？

You're missing not only these muscles,

假設手肘以上的部份都被截掉了

but your hand and your elbow too.

你不但失去了這些肌肉

What do you do?

連你的手和手肘都沒了

Well our patients have to use

該怎麼辦？

very code-y systems

我們的患者必須使用

of using just their arm muscles

非常編碼的系統

to operate robotic limbs.

單純使用他們的手臂肌肉

We have robotic limbs.

來操作機械手臂

There are several available on the market, and here you see a few.

我們有機械手臂

They contain just a hand that will open and close,

市面上都買得到，這裡也看得到一些

a wrist rotator and an elbow.

包含一隻會開合的手

There's no other functions.

一個旋腕關節及手肘

If they did, how would we tell them what to do?

沒有其他功能

We built our own arm at the Rehab Institute of Chicago

要是有的話，我們要如何操作呢？

where we've added some wrist flexion and shoulder joints

我們在芝加哥復健機構裡建造自己的假肢

to get up to six motors, or six degrees of freedom.

並增加一些橈側屈腕肌和肩膀關節

And we've had the opportunity to work with some very advanced arms

以達到六個馬達, 或是說六個自由度

that were funded by the U.S. military, using these prototypes,

我們也研究一些很先進的假肢

that had up to 10 different degrees of freedom

美國軍方贊助的這些原型

including movable hands.

有高達10種不同的自由度

But at the end of the day,

包括可移動式手臂

how do we tell these robotic arms what to do?

但最終難題還是

How do we control them?

要如何操作這些機械手臂呢？

Well we need a neural interface,

要如何控制它們呢？

a way to connect to our nervous system

我們需要一個神經介面

or our thought processes

來連接我們的神經系統

so that it's intuitive, it's natural,

或思考過程

like for you and I.

讓它很直覺、很自然

Well the body works by starting a motor command in your brain,

像你、我一樣

going down your spinal cord,

我們身體先由腦部下行動作指令

out the nerves and to your periphery.

經由你的脊隨傳遞訊息

And your sensation's the exact opposite.

到神經末梢

You touch yourself, there's a stimulus

你的感官觸動則完全相反

that comes up those very same nerves back up to your brain.

當你觸碰自己，會產生刺激

When you lose your arm, that nervous system still works.

透過相同的神經傳送訊息回腦部

Those nerves can put out command signals.

就算你失去手臂，那個神經系統仍運作

And if I tap the nerve ending

那些神經可以發出指令信號

on a World War II vet,

假如我在一位二戰老兵殘肢上

he'll still feel his missing hand.

輕輕拍打神經末梢

So you might say,

他還是可以感覺到失去的那隻手

let's go to the brain

這時候你可能會說

and put something in the brain to record signals,

我們何不在大腦裡

or in the end of the peripheral nerve and record them there.

放個東西來紀錄信號

And these are very exciting research areas,

或放到末梢神經去紀錄

but it's really, really hard.

這些研究領域是非常令人興奮的

You have to put in

但也相當相當艱鉅

hundreds of microscopic wires

你必須置入

to record from little tiny individual neurons -- ordinary fibers

成百上千個微纜線

that put out tiny signals

來記錄微小單一神經元 - 普通纖維

that are microvolts.

所發出的微弱信號

And it's just too hard

也就是微伏特

to use now and for my patients today.

這對我的患者和使用上

So we developed a different approach.

實在是太困難了

We're using a biological amplifier

因此我們研發出不同的方法

to amplify these nerve signals -- muscles.

我們使用生物放大器 - 肌肉

Muscles will amplify the nerve signals

來放大這些神經信號

about a thousand-fold,

肌肉會放大神經信號

so that we can record them from on top of the skin,

大概一千倍

like you saw earlier.

我們在皮膚表面上能讀取得到

So our approach is something we call targeted reinnervation.

就像你剛才看到的

Imagine, with somebody who's lost their whole arm,

我們的方法就是所謂的標靶神經移植術

we still have four major nerves

想像一個人失去整個手臂

that go down your arm.

但還有四條主要神經

And we take the nerve away from your chest muscle

連接手臂

and let these nerves grow into it.

我們將那些胸肌神經拉出

Now you think, "Close hand," and a little section of your chest contracts.

然後把手臂神經轉移到病患的胸肌

You think, "Bend elbow,"

所以你在腦袋裡想“握拳”，胸肌就會收縮

a different section contracts.

你想“彎手肘”

And we can use electrodes or antennae

胸肌的另一區塊也會收縮

to pick that up and tell the arm to move.

我們可以利用電極或天線

That's the idea.

接收信號讓手臂動起來

So this is the first man that we tried it on.

大概就是這樣

His name is Jesse Sullivan.

這是我們首先測試的對象

He's just a saint of a man --

他叫傑西 沙利文

54-year-old lineman who touched the wrong wire

是個非常好的人

and had both of his arms burnt so badly

這位54歲的架線工因誤觸電線

they had to be amputated at the shoulder.

導致雙臂嚴重灼傷

Jesse came to us at the RIC

在雙肩部位截肢

to be fit with these state-of-the-art devices, and here you see them.

傑西來到芝加哥復健醫院

I'm still using that old technology

裝上這些圖上看到的先進裝置

with a bicycle cable on his right side.

我仍用舊技術

And he picks which joint he wants to move with those chin switches.

在他右肩裝腳踏車纜線

On the left side he's got a modern motorized prosthesis

讓他決定下巴開關要動哪個關節

with those three joints,

左邊裝的是先進的肌電義肢

and he operates little pads in his shoulder

連接三個關節

that he touches to make the arm go.

他操作肩膀上的小墊子

And Jesse's a good crane operator,

藉由碰觸讓手臂動起來

and he did okay by our standards.

傑西是個不錯的起重機操作員

He also required a revision surgery on his chest.

依我們標準來說他表現還不錯

And that gave us the opportunity

他在胸肌還需進行再次手術

to do targeted reinnervation.

這給了我們機會

So my colleague, Dr. Greg Dumanian, did the surgery.

進行標靶神經移植術

First, we cut away the nerve to his own muscle,

於是我的同事葛瑞格杜曼年執行了這項手術

then we took the arm nerves

首先，我們將連接肌肉的神經切掉

and just kind of had them shift down onto his chest

接著我們將他的手臂神經

and closed him up.

轉移到胸肌部位

And after about three months,

最後再縫合好

the nerves grew in a little bit and we could get a twitch.

大約三個月後

And after six months, the nerves grew in well,

那些神經長出來了一點開始抽動

and you could see strong contractions.

再六個月後，神經再生狀況良好

And this is what it looks like.

你可以看出很明顯的肌肉收縮反應

This is what happens when Jesse thinks

看起來大概像這樣

open and close his hand,

當傑西想著

or bend or straighten your elbow.

把手打開和關閉

You can see the movements on his chest,

或手肘彎曲或伸直

and those little hash marks

你可以看到胸肌上的收縮動作

are where we put our antennae, or electrodes.

而且這些小記號

And I challenge anybody in the room

就是我們放天線或電極的地方

to make their chest go like this.

我相信這裡沒有人的胸肌

His brain is thinking about his arm.

可以像他一樣這樣動吧！

He has not learned how to do this with the chest.

他的腦袋想著他的手臂

There is not a learning process.

他並沒有刻意去學要怎麼動胸肌

That's why it's intuitive.

中間沒有任何學習過程

So here's Jesse in our first little test with him.

這樣才算是所謂的直覺性

On the left-hand side, you see his original prosthesis,

這個是我們和傑西作的第一個小實驗

and he's using those switches

在左手邊，你可以看到他原本的義肢

to move little blocks from one box to the other.

他需要那些開關

He's had that arm for about 20 months, so he's pretty good with it.

將小積木從一個盒子裡搬到另一個盒子

On the right side,

他在操作那義肢已有20年的經驗，相當熟練

two months after we fit him with his targeted reinnervation prosthesis --

在右邊呢

which, by the way, is the same physical arm,

是幫他裝上標靶神經移植術義肢的兩個月後

just programmed a little different --

對了，而且是裝在同一隻手臂上

you can see that he's much faster

但設計上稍微不同

and much smoother as he moves these little blocks.

大家可以看到他的速度快了許多

And we're only able to use three of the signals at this time.

移動這些小積木手感也更順

Then we had one of those little surprises in science.

而且我們同時只能用到三個信號

So we're all motivated to get motor commands

接著出乎意料之外

to drive robotic arms.

當我們都在等待運動指令的出現

And after a few months,

來操作義肢時

you touch Jesse on his chest,

幾個月後

and he felt his missing hand.

當你觸摸傑西的胸肌

His hand sensation grew into his chest again

他竟然感覺到他失去的手

probably because we had also taken away a lot of fat,

他手的知覺竟長回到他的胸肌裡去

so the skin was right down to the muscle

可能因為我們也抽掉很多脂肪

and deinnervated, if you would, his skin.

所以皮膚下面就是肌肉

So you touch Jesse here, he feels his thumb;

皮膚神經也被抽掉了

you touch it here, he feels his pinky.

所以當你摸傑西這裡，他會感覺到他的拇指

He feels light touch

摸這裡，他會感覺到他的小指

down to one gram of force.

輕微的碰觸

He feels hot, cold, sharp, dull,

微小到一克的力道都有感覺

all in his missing hand,

甚至是冷、熱、尖、鈍

or both his hand and his chest,

通通在他失去的手上感受到了

but he can attend to either.

或在手和胸肌上同時感受到

So this is really exciting for us,

他兩者都能兼顧

because now we have a portal,

這實在是令我們精神為之一振

a portal, or a way to potentially give back sensation,

因為我們開創了先機

so that he might feel what he touches

或者說，開發了恢復知覺的潛力

with his prosthetic hand.

他才能用義肢

Imagine sensors in the hand

重拾觸覺

coming up and pressing on this new hand skin.

想像手中的傳感器

So it was very exciting.

傳遞到這新的手皮膚部位

We've also gone on

所以這相當振奮人心

with what was initially our primary population

我們也繼續

of people with above-the-elbow amputations.

向我們的原始實驗對象

And here we deinnervate, or cut the nerve away,

也就是手肘以上截肢的族群

just from little segments of muscle

我們從肌肉的一小塊裡

and leave others alone

將神經移除，或切除

that give us our up-down signals

然後把其他的保留

and two others that will give us a hand open and close signal.

這讓我們有上下信號

This was one of our first patients, Chris.

和其他兩個讓手開關的信號

You see him with his original device

這是我們第一個病患，克里斯

on the left there after eight months of use,

你看到他在左邊的是

and on the right, it is two months.

使用了八個月的原本裝置

He's about four or five times as fast

右邊的新裝置，則使用了兩個月

with this simple little performance metric.

這個小效能指標

All right.

讓他速度快了約四、五倍

So one of the best parts of my job

很好

is working with really great patients

我工作最精彩的部份

who are also our research collaborators.

就是能和很棒的病患合作

And we're fortunate today

他們也是我們的研究夥伴

to have Amanda Kitts come and join us.

我們今天很幸運

Please welcome Amanda Kitts.

能邀請艾曼達基茨來加入我們

(Applause)

請歡迎艾曼達基茨

So Amanda, would you please tell us how you lost your arm?

（掌聲）

Amanda Kitts: Sure. In 2006, I had a car accident.

艾曼達，能否請您分享您如何失去手臂的？

And I was driving home from work,

艾曼達：好的。我在2006年出了車禍

and a truck was coming the opposite direction,

當時下班開車回家路上

came over into my lane,

迎面而來一台卡車

ran over the top of my car and his axle tore my arm off.

衝到我的車道上