Question:
Discuss about the Assistive Technology for Biomedical Engineers.
Ethical dilemmas faced by the biomedical engineers in the field of assistive technologies
Biomedical engineering is field which utilizes various branches of medication, engineering, and biology for the development of products for human ease and to make human independent in carrying out their daily activities and used for the physically disabled persons and older age groups. The ethical dilemma is a situation in which forces a person to choose between the two alternatives; however, the outcome of both is negative based on personal guidelines and community. An ethical dilemma arises when there is a violation of ethical codes and principles of biomedical engineering, which states “ to emphasize on the larger result of the product developed keeping key parameters in mind such as cost, best health care service, and its availability.”
Patient Privacy: Biomedical engineer’s major ethical dilemma is the maintenance of patient confidentiality. They experiment on clinical equipment, help in the design and advancement of artificial organs, therapeutic ways, biological sensors, development of imaging techniques and medical products testing for effectiveness and safety. It is not easy to appropriately analyze medical devices or products without access to adequate patient details. Biomedical engineers require the evaluation of past medical histories, treatments, and personal data to properly check the efficiency of developed healthcare products. The patients might feel the violation of their rights if the physician or nurses, share patient information to help biomedical professionals. Here the biomedical engineers are in the dilemma to maintain patient information or develop best products based on correct patient data.
Ethical dilemma in the field of research to design assistive technologies: Biomedical professionals face ethical dilemmas in aspects of artificial life, stem cell research, and synthetic biology to modify and improve human life span. They try to innovate and progress the biomedical research by encouraging experimentation while opponents consider that the biomedical engineers should not play with God creation. These unavoidable and difficult ethical problems have resulted in the public protests and defiance from the religious community and organization. Hence, biomedical engineers stuck in the dilemma whether to avoid opposition by discontinuing their current research or continue it with opposition. Biomedical engineers also face the ethical dilemma in germline engineering research as it is a controversial practice, which involves testing and modification of genes of early embryos, eggs, and sperm as it results in inheritable genome alteration as it is against God. The embryonic tissue extracted from human embryos were destroyed after the process, which is a violation of ethics of killing or destroying human embryos.
Targeted sites and funding issues for the development of assistive technologies: The biomedical engineering faces various challenges as it designs the product by combining the medicine and products, but they don’t always match each other’s need. In this case, if engineers will develop invasive and highly targeted products then that can cause side effects or if less intrusive methods will be used then there will be low risk, but not completely help treat disease. Doctors, engineers, and patients try to find the way to balance between the medical care and innovative technology. The cost of research to develop biomedical products is expensive and biomedical engineer’s got trapped in ethical dilemma due to limited resources and funds and face difficulty in designing the product which affordable but low in quality or expensive but high in quality.
Socially Assistive Robot and it’s benefits to the aging population
Socially assistive robots are robots which assist and help in social interaction and physical disabilities without any physical contact. The aim of SAR is to develop an effective and close interaction with the user for the provision of assistance, achievement of recovery progress, learning, and rehabilitation.
PARO is a socially assistive domestic robot, which helps in enhancing the mood, assistance in communication, and social interaction for the patient with dementia. It is preferred for the patient as it is a non-pharmacological method for treatment of dementia. [9]Dementia does not occur due to aging, but its risk factor is aging.
It is a combination of assistive robot and interactive robot. PARO, a robotic seal similar to the appearance of the baby harp seal with a surface of the antibacterial coat, and it is made up of various types of sensors, light, temperature, tactile, audition, and posture. PARO has two layers: behavior generation and behavior planning coatings. It was developed by Shibata et al., and it has been in application since 2003 with promising and positive results. It was certified in 2009 by FDA (Food and Drug Administration) and used as a neurological therapeutic agent. It helps in improving the cognitive function of older adults in the dementia patient. It has been developed as companion robots for the patient and to provide the patient with cost-effective treatment methods for improving social interaction, communication, and mood, which consequently help in achievement of the well-being of the patient and to limit the workload of the healthcare assistants.[8] PARO gives positive result than the conventional methods, and it increases motivation, helps in stress reduction, the cortical activity of the neuron. The robot responds to various stimulations (holding and striking) produced by its users and also senses the voice direction. It also produces positive results in other brain defects or disorders. There are a large number of patients with dementia every year, which requires the greater number of healthcare assistants to assist the patient for the period of six weeks for their treatment. PARO provides humans with cost-effective technology and support in the achievement of mental peace. PARO therapy includes standardized bodywork of activities: the introduction of PARO, baby-sitting, grooming, feeding, making over, and wardrobe.[7] Pet therapy by PARO was based on the physical contact followed by intimate experience with the pet. It plays an important role in elderly care, behavioral and cognitive rehabilitation and it also eliminates the risks of allergies, scratches, feeding, walking, or bites.[6] It provides the patients with mechanical love compared to previous treatment which made patient aggressive and agitated. It engages the person and act according to the expectation of the patients. It acts as a social mediator and assists the physician to negotiate on an emotional ground. SAR is very helpful in today’s scenario to help the aging population as it increases the social contact, maintenance of peace, alleviation of cognitive impairment, less dependence on the human for emotional experience, and cost-effective method. It is able to support the complex therapeutic methods in a flexible mode.
Analysis of video on “Physical impairment” and application of assistive technology for its user
In the video “Move son from bed to wheelchair” the mother is helping the physically disabled child move into the wheelchair to provide him assistance in mobility. The wheelchair is used as mobility devices as it is a very common assistive technology used by patients of different ages having the physical impairment and inability to move independently. It helps the user by fitting in their lifestyle and requirements. [11]Wheelchair is available in different accommodation and sizes according to the user and equipped with various instruments to assist the user in caring out their daily activities and movement. The video shows the application of assistive technology “wheelchair” which was comprised of headrests and operative components. In the above video, the child is assisted to continue his daily activities, and the assistive technology helps the child to less dependent on the mother. The child can go to school and continue his education, able to live his childhood with the support of a wheelchair, which provides him assistance to sit without any human support.[10] Wheelchair assists the child to balance in sitting position with the support rectangular piece, which is present in front of it, and protect the child from falling. The stirrups present in the wheelchair aid in keeping his legs right posture and outside support bars serve to relax his arms and muscles. Wheelchair straps were used as a seat belt for the stable sitting posture and then on the back of the wheelchair, there is 5 point and 4 point harness which was fixed underneath the headrests and combined with bilateral side piece plastic and one more bottom piece which was fitted underneath the head and back taking care of child’s neck choking.[24] This technology helps the child to move from home to another place and long distance walking. It helps the child to take part in different types of regular daily activities. It helps the child to avoid bed sores and maintain proper blood circulation in the body. It is light weight, convenient, and portable for school, doctor visits, recreation with friends and family, and day programs. It is user-friendly and provides comfort to the family members of the child. The wheelchair is a cost effective technology for provision of assistance and improvement of the quality of children’s life and to do the task that the child is unable to carry out. Assistive technology helped the child to enjoy life to the possible extent. In the video, the wheechair played an important role in the advancement of life of the child and making things easy for the child to promote self-independence, courage, and motivation to fight his current situation. The benefits of assistive methods for the child are it helps him to maintain his self-confidence and eliminated the feeling of social isolation or difference. The child in the video was kept in a safe environment and the wheelchair helps him feel equal with other children of his age and also prevents psychological harm to the child.
Brain-machine interface
BMIs are also called as Brain-computer interfaces (BCIs) which are defined as the real-time process of connection between machine and brain. It is fast growing research field which helps in prevention of illness and serious injuries. It is applied to the patient with lost motor function and lost limbs.[15] It is a wireless device, which is attached to the human skull and transmits through thought signals of radio collected from the implant in the brain and the collected signals help to steer the robotic arm, or wheelchair, etc. It also comprises of processor assists in amplification of signals produced by neuron and the radio for purpose of transferring the signal to few meters to the receiver. It transmits the information out of the skull at the speed of 48 Mbps similar to an internet connection.
Despite the immense efforts and research in this field, it is unable to take off due to its complicating factors and issues related to it. The reasons for failure to implement this technology are: it is not reliable and simplified.
The very first complicating factor that does not enable it to operate is obtaining consent from the subject patient as it is a new technology and people know less about it, it is not easy to gain their trust. And it is right to treat the patient without their informed consent. BMIs also face the problem of not meeting the expectation of the patient sometimes, which may cause psychological impact and distress on the patient. The use of electrodes to detect the cortical signals comprises various kinds of invasiveness and variable range of benefit to risk ratio. Then the second is the durability of the BMIs as the researchers are unsure about its durability which relates to the problems of patient safety as replacement of the BCIs needs surgical intervention. It has restricted warranty could not solve the complication related to safety and durability. As the BCI is the latest technology, the question arises about its distribution to the public throughout the world.
BCIs major need is to train the surgeons for brain implantations, which would require skilled professionals to train and more resources. [17] It also requires training phase for the users about its positive effects and associated limitations with the support of medical practitioners.
The issue arises when there will be limited quantity of BCIs then which type of patient should be given preference?[13] Other problematic factors are how they can be implemented in the medical plans; insurance coverage will be provided to BCIs, or it will be affordable to only rich ones.
The occasional problem of low BCIs information transfer rate (ITR) and its impact on the reduction of the commands. The issue of availability of BCIs to some patient only, not to the entire general public and its application in children of enhancement of mental and physical capacity makes the introduction of BCIs difficult in the public to promote fairness among the public. [14] The above factors are responsible to prevent the BMIs technology to come in real-time practice, and there is a need to solve questions and problems to fair utilize this technology. Bionics.
Introduction
Assistive technology (adaptive devices) helps elderly and disabled for their daily activities walker, magnifying glass, hearing aids, adaptive switches, and communication equipment, computer access, learning and education( education audio books and brail writing), sensory enhancements, therapy, transportation devices, home modifications, tools for independent living, job-related items, mobility aids, orthotic or prosthetic instrument, recreational assistance, and seating aid. [23] The body of the human is the greatest creation of Mother Nature, which comprises of various combinations of skeletons, sensory, organs, and neural network, etc. However, with time and unknown circumstances these natural system stops to function or sometimes destroy completely. As we do not have the ability like lizard or starfish to regain the lost body parts and the researchers were not sure about the stem cell research at that time, which all give rise to bionics. It has the potential to copy the properties of nature made systems and to recover disabilities or lost limbs issues.
Progression of bionics from the past to present
Bionics is a type of assistive technology which involves machines and hardware parts to be implanted in the body and act as the mediator between the connected machine or computer and CNS (central nervous system). It is divided into interface and prosthetics. Bionics started from the ancient times of the Egyptians, who created prostheses for the appearance of humans and were utilized as a psychological and spiritual sense of the entirety. Jack. E. Steel started bionics in 1958. Bionics was made famous in 1972 with T.V. show “The Six Million Dollar Man.” The examples of bionics are Cat’s eyes, Resilin, Velcro, Coating paints, etc. Bionics with the assistance of medicine field gave birth to artificial limbs, which is a boon to the people with amputations. The initial true prosthetics were utilized in Rome and Greece for wars and battle. Limb loss was frequent in the soldiers.[22] During that time, a man named Ambroise Pare served the role of the military surgeon in helping the French started to make prostheses create artificial lower and upper limbs. Pare and another scholar Alessandro Volta began the advancements in the field of bionic medicine, and in 1797 Volta realized that the hearing can be recovered with the help of electrical stimulation. The touch bionics was started to develop prosthetics for children suffered from Thalidomide. The research began to construct electronic arms, wrists, hands, and shoulders in 1986. [21] Then in 1993, the development of electric shoulder took place. Scottish company created “i-limb-hand” during the year 2007, which was the first prosthetic hand with articulating fingers. In 2008, silicone prostheses developed similar to human skin by mimicking the properties of three skin layers, and it helps in daily activities. Bionics also developed i-limb digits for the same prosthetic hand made earlier in 2009 and it provide finger solution to the patient with lost fingers. In 2010, i-limb pulse was launched made up of aluminum with increased durability and in 2011, i-limb Ultra was made to enhance the pulsing grip power and durability. These inventions led to the revolution of i-limb, demonstrating the power of rotating thumb. Apart from the touch bionics, there were inventions of (external) the cardiac pacemaker in 1950 followed by an implantable pacemaker in 1958. In 1964, the first myoelectric arm was launched. Cochlear implants were made for recovery of lost sensory function in 1978. In 1998, bionics gave birth to myoelectric shoulder for amputations. Neurobionics is the latest field of research to help recover and treat neurological disorders such as epilepsy, depression, and Parkinson’s disease. The reason for the creation of assistive technologies: Peoples were scared of amputation more than the death in some cultures and the earliest prosthetic instrument was made during the time of 1500 B.C. and at that time mummy’s toe was amputated and substituted with a prosthetic made of leather and wood. It reduces dependence, avoid paid helpers, avoid nursing homes, and reduce the cost of care for elder and disabled. To control gesture i-limb quantum and i-digit quantum was launched in 2015 and to gain independence and complete daily activities of the patient. Till today, touch bionics are continuing to deliver effective care and patient outcome and assists to overcome limb deficiency.[19] Bionics in the present era made several artificial implants available to the humans which are controlled by electrical motors. The problem faced in the field of bionics is biocompatibility problem. Bionics are changing human lives at a fast pace by inventing different products of human use by incorporating the wizards of science, engineering, and medicine. The future prosthetics of bionics are bionic senses, bionic lungs, bionic heart, bionic filters for air, and bionic tissues. Bionics helped the people with cochlear implants, artificial limbs, and other organs. Bionics create the possibility for augmented soldiers, education assistance, entertainment, and advanced video conferencing, and future generation will be able to make choices between the two alternatives of a bionic membrane or human. Its application in defense department will be a boon to the shoulders and to partially recover their lost ability. By the year 2090 bionic will emerge as fastest growing and applied field for treatment and replacement of human organ defect with the organ transplant.
Conclusion
Even after large amounts of research and product inventions in the field of bionics it has not able to reach the required persons or groups due to less accessibility of the people in the tech industry. Bionics in future will help to develop human cyborg, which involves entire communication via thoughts only, with biochips, and an infinite memory. But it also raises the question that everyone will be able to read other’s thoughts? And maniacs would try to take control over all humans by firing bombs and missiles. It could have negative impacts like making one race more powerful than the other. But positive impacts of bionics outweigh its negative impacts which can be controlled by laws, regulation, ethics, and restricted use to only those who need the technology to overcome the disability. This assistive technology can change the level of independence and dignity in physically disabled persons.
References
[1]S. Gnanavel, “Self-plagiarism: The latest ethical dilemma in biomedical research”, Indian J Psychol Med, vol. 36, no. 4, p. 448, 2014.
[2]C. Dahlof, “Ethical considerations in biomedical research: A personal view”, Cephalalgia, vol. 33, no. 8, pp. 507-511, 2013.
[3]J. McKendrick and P. Bennett, “Health research across cultures — an ethical dilemma?”, Monash Bioethics Review, vol. 25, no. 1, pp. S64-S71, 2006.
[4]B. Franklin, “Biomedical Ethics for Engineers: Ethics and Decision Making in Biomedical and Biosystem Engineering”, Biomedical Instrumentation & Technology, vol. 43, no. 3, pp. 196-196, 2009.
[5]”Trends of Robot Therapy with Neurological Therapeutic Seal Robot, PARO”, Journal of Robotics and Mechatronics, vol. 26, no. 4, pp. 418-425, 2014.
[6]S. Šabanović and W. Chang, “Socializing robots: constructing robotic sociality in the design and use of the assistive robot PARO”, AI & Soc, 2015.
[7]K. Takayanagi, T. Kirita and T. Shibata, “Comparison of Verbal and Emotional Responses of Elderly People with Mild/Moderate Dementia and Those with Severe Dementia in Responses to Seal Robot, PARO”, Frontiers in Aging Neuroscience, vol. 6, 2014.
[8]R. Yu, E. Hui, J. Lee, D. Poon, A. Ng, K. Sit, K. Ip, F. Yeung, M. Wong, T. Shibata and J. Woo, “Use of a Therapeutic, Socially Assistive Pet Robot (PARO) in Improving Mood and Stimulating Social Interaction and Communication for People With Dementia: Study Protocol for a Randomized Controlled Trial”, JMIR Research Protocols, vol. 4, no. 2, p. e45, 2015.
[9]S. McGlynn, S. Kemple, T. Mitzner, C. King and W. Rogers, “Understanding Older Adults’ Perceptions of Usefulness for the Paro Robot”, Proceedings of the Human Factors and Ergonomics Society Annual Meeting, vol. 58, no. 1, pp. 1914-1918, 2014.
[10]W. Mortenson, W. Miller and J. Miller-Pogar, “Measuring wheelchair intervention outcomes: Development of the Wheelchair Outcome Measure”, Disability and Rehabilitation: Assistive Technology, vol. 2, no. 5, pp. 275-285, 2007.
[11]S. Sprigle and W. Delaune, “Factors That Influence Changes in Wheelchair Cushion Performance Over Time”, Assistive Technology, vol. 26, no. 2, pp. 61-68, 2014.
[12]S. Murchland and H. Parkyn, “Promoting Participation in Schoolwork: Assistive Technology Use by Children With Physical Disabilities”, Assistive Technology, vol. 23, no. 2, pp. 93-105, 2011.
[13]A. Machado, “New Frontier: The Brain Machine Interface“, Neuromodulation: Technology at the Neural Interface, vol. 16, no. 1, pp. 6-7, 2013.
[14]K. Jebari, “Brain Machine Interface and Human Enhancement – An Ethical Review”, Neuroethics, vol. 6, no. 3, pp. 617-625, 2013.
[15]V. Asari, “Brain signal analysis for emotion recognition and brain machine interface”, J Inform Tech Soft Engg, vol. 05, no. 02, 2015.
[16]B. Allison, E. Wolpaw and J. Wolpaw, “Brain–computer interface systems: progress and prospects”,Expert Review of Medical Devices, vol. 4, no. 4, pp. 463-474, 2007.
[17]M. Slutzky, “Brain machine interfaces: state of the art and challenges to translation”, Neurobiology of Disease, vol. 83, pp. 152-153, 2015.
[18]F. Werner, J. Oberzaucher and K. Werner, “Real-life evaluation of a socially assitive robot”,Gerontechnology, vol. 11, no. 2, 2012.
[19]R. Neurohr and C. Dragomirescu, “Bionics in Engineering Education Considerations, Experiences and Conclusions”, Applied Bionics and Biomechanics, vol. 5, no. 3, pp. 91-97, 2008.
[20]”Stepping into the Future of Bionics [Industrial Activities]”, IEEE Robotics & Automation Magazine, vol. 20, no. 3, pp. 20-102, 2013.
[21]J. Bryan, “Bionics and prosthetics – into the future”, The Bulletin of the Royal College of Surgeons of England, vol. 97, no. 2, pp. 58-60, 2015.
[22]G. Clark and G. Wallace, “Bionic Ears: Their Development and Future Advances Using Neurotrophins and Inherently Conducting Polymers”, Applied Bionics and Biomechanics, vol. 1, no. 2, pp. 67-89, 2004.
[23]R. Sinha, W. van den Heuvel and P. Arokiasamy, “Adjustments to amputation and an artificial limb in lower limb amputees”, Prosthetics and Orthotics International, vol. 38, no. 2, pp. 115-121, 2013.
[24]”Move Son From Bed To Wheelchair”, YouTube, 2012. [Online]. Available: https://www.youtube.com/watch?v=O-PEeErV05Q. [Accessed: 22- May- 2016].
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