New collaboration aims to strengthen orthotic and prosthetic care in Sierra Leone

MIT’s K. Lisa Yang Center for Bionics has entered into a collaboration with the Government of Sierra Leone to strengthen the capabilities and services of that country’s orthotic and prosthetic (O&P) sector. Tens of thousands of people in Sierra Leone are in need of orthotic braces and artificial limbs, but access to such specialized medical care in this African nation is limited.

The agreement, reached between MIT, the Center for Bionics, and Sierra Leone’s Ministry of Health and Sanitation (MoHS), provides a detailed memorandum of understanding and intentions that will begin as a four-year program.  The collaborators aim to strengthen Sierra Leone’s O&P sector through six key objectives: data collection and clinic operations, education, supply chain, infrastructure, new technologies and mobile delivery of services.

Project Objectives

  1. Data Collection and Clinic Operations: collect comprehensive data on epidemiology, need, utilization, and access for O&P services across the country
  2. Education: create an inclusive education and training program for the people of Sierra Leone, to enable sustainable and independent operation of O&P services
  3. Supply Chain: establish supply chains for prosthetic and orthotic components, parts, and materials for fabrication of devices
  4. Infrastructure: prepare infrastructure (e.g., physical space, sufficient water, power and internet) to support increased production and services
  5. New Technologies: develop and translate innovative technologies with potential to improve O&P clinic operations and management, patient mobility, and the design or fabrication of devices
  6. Mobile Delivery: support outreach services and mobile delivery of care for patients in rural and difficult-to-reach areas

Working together, MIT’s bionics center and Sierra Leone’s MoHS aim to sustainably double the production and distribution of O&P services at Sierra Leone’s National Rehabilitation Centre and Bo Clinics over the next four years.

The team of MIT scientists who will be implementing this novel collaboration is led by Hugh Herr, MIT Professor of Media Arts and Sciences. Herr, himself a double amputee, serves as co-director of the K. Lisa Yang Center for Bionics, and heads the renowned Biomechatronics research group at the MIT Media Lab.

“From educational services, to supply chain, to new technology, this important MOU with the government of Sierra Leone will enable the Center to develop a broad, integrative approach to the orthotic and prosthetic sector within Sierra Leone, strengthening services and restoring much needed care to its citizens,” notes Professor Herr.

Sierra Leone’s Honorable Minister of Health Dr. Austin Demby also states: “As the Ministry of Health and Sanitation continues to galvanize efforts towards the attainment of Universal Health Coverage through the life stages approach, this collaboration will foster access, innovation and capacity building in the Orthotic and Prosthetic division. The ministry is pleased to work with and learn from MIT over the next four years in building resilient health systems, especially for vulnerable groups.”

“Our team at MIT brings together expertise across disciplines from global health systems to engineering and design,” added Francesca Riccio-Ackerman, the graduate student lead for the MIT Sierra Leone project. “This allows us to craft an innovative strategy with Sierra Leone’s Ministry of Health and Sanitation. Together we aim to improve available orthotic and prosthetic care for people with disabilities.”

The K. Lisa Yang Center for Bionics at the Massachusetts Institute of Technology pioneers transformational bionic interventions across a broad range of conditions affecting the body and mind. Based on fundamental scientific principles, the Center seeks to develop neural and mechanical interfaces for human-machine communications; integrate these interfaces into novel bionic platforms; perform clinical trials to accelerate the deployment of bionic products by the private sector; and leverage novel and durable, but affordable, materials and manufacturing processes to ensure equitable access to the latest bionic technology by all impacted individuals, especially those in developing countries. 

Sierra Leone’s Ministry of Health and Sanitation is responsible for health service delivery across the country, as well as regulation of the health sector to meet the health needs of its citizenry. 

For more information about this project, please visit: https://mitmedialab.info/prosforallproj2

 

The ways we move

This story originally appeared in the Winter 2023 issue of BrainScan.
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Many people barely consider how their bodies move — at least not until movement becomes more difficult due to injury or disease. But the McGovern scientists who are working to understand human movement and restore it after it has been lost know that the way we move is an engineering marvel.
Muscles, bones, brain, and nerves work together to navigate and interact with an ever-changing environment, making constant but often imperceptible adjustments to carry out our goals. It’s an efficient and highly adaptable system, and the way it’s put together is not at all intuitive, says Hugh Herr, a new associate investigator at the Institute.

That’s why Herr, who also co-directs MIT’s new K. Lisa Yang Center for Bionics, looks to biology to guide the development of artificial limbs that aim to give people the same agency, control, and comfort of natural limbs. McGovern Associate Investigator Nidhi Seethapathi, who like Herr joined the Institute in September, is also interested in understanding human movement in all its complexity. She is coming at the problem from a different direction, using computational modeling to predict how and why we move the way we do.

Moving through change

The computational models that Seethapathi builds in her lab aim to predict how humans will move under different conditions. If a person is placed in an unfamiliar environment and asked to navigate a course under time pressure, what path will they take? How will they move their limbs, and what forces will they exert? How will their movements change as they become more comfortable on the terrain?

McGovern Associate Investigator Nidhi Seethapathi with lab members (from left to right) Inseung Kang, Nikasha Patel, Antoine De Comite, Eric Wang, and Crista Falk. Photo: Steph Stevens

Seethapathi uses the principles of robotics to build models that answer these questions, then tests them by placing real people in the same scenarios and monitoring their movements. So far, that has mostly meant inviting study subjects to her lab, but as she expands her models to predict more complex movements, she will begin monitoring people’s activity in the real world, over longer time periods than laboratory experiments typically allow.

Seethapathi’s hope is that her findings will inform the way doctors, therapists, and engineers help patients regain control over their movements after an injury or stroke, or learn to live with movement disorders like Parkinson’s disease. To make a real difference, she stresses, it’s important to bring studies of human movement out of the lab, where subjects are often limited to simple tasks like walking on a treadmill, into more natural settings. “When we’re talking about doing physical therapy, neuromotor rehabilitation, robotic exoskeletons — any way of helping people move better — we want to do it in the real world, for everyday, complex tasks,” she says.

When we’re talking about helping people move better — we want to do it in the real world, for everyday, complex tasks,” says Seethapathi.

Seethapathi’s work is already revealing how the brain directs movement in the face of competing priorities. For example, she has found that when people are given a time constraint for traveling a particular distance, they walk faster than their usual, comfortable pace — so much so that they often expend more energy than necessary and arrive at their destination a bit early. Her models suggest that people pick up their pace more than they need to because humans’ internal estimations of time are imprecise.

Her team is also learning how movements change as a person becomes familiar with an environment or task. She says people find an efficient way to move through a lot of practice. “If you’re walking in a straight line for a very long time, then you seem to pick the movement that is optimal for that long-distance walk,” she explains. But in the real world, things are always changing — both in the body and in the environment. So Seethapathi models how people behave when they must move in a new way or navigate a new environment. “In these kinds of conditions, people eventually wind up on an energy-optimal solution,” she says. “But initially, they pick something that prevents them from falling down.”

To capture the complexity of human movement, Seethapathi and her team are devising new tools that will let them monitor people’s movements outside the lab. They are also drawing on data from other fields, from architecture to physical therapy, and even from studies of other animals. “If I have general principles, they should be able to tell me how modifications in the body or in how the brain is connected to the body would lead to different movements,” she says. “I’m really excited about generalizing these principles across timescales and species.”

Building new bodies

In Herr’s lab, a deepening understanding of human movement is helping drive the development of increasingly sophisticated artificial limbs and other wearable robots. The team designs devices that interface directly with a user’s nervous system, so they are not only guided by the brain’s motor control systems, but also send information back to the brain.

Herr, a double amputee with two artificial legs of his own, says prosthetic devices are getting better at replicating natural movements, guided by signals from the brain. Mimicking the design and neural signals found in biology can even give those devices much of the extraordinary adaptability of natural human movement. As an example, Herr notes that his legs effortlessly navigate varied terrain. “There’s adaptive, stabilizing features, and the machine doesn’t have to detect every pothole and pebble and banana peel on the ground, because the morphology and the nervous system control is so inherently adaptive,” he says.

McGovern Associate Investigator Hugh Herr at work in the K. Lisa Yang Center for Bionics at MIT. Photo: Jimmy Day/Media Lab

But, he notes, the field of bionics is in its infancy, and there’s lots of room for improvement. “It’s only a matter of time before a robotic knee, for example, can be as good as the biological knee or better,” he says. “But the problem is the human attached to that knee won’t feel it’s their knee until they can feel it, and until their central nervous system has complete agency over that knee,” he says. “So if you want to actually build new bodies and not just more and more powerful tools for humans, you have to link to the brain bidirectionally.”

Herr’s team has found that surgically restoring natural connections between pairs of muscles that normally work in opposition to move a limb, such as the arm’s biceps and triceps, gives the central nervous system signals about how that limb is moving, even when a natural limb is gone. The idea takes a cue from the work of McGovern Emeritus Investigator Emilio Bizzi, who found that the coordinated activation of groups of muscles by the nervous system, called muscle synergies, is important for motor control.

“It’s only a matter of time before a robotic knee can be as good as the biological knee or better,” says Herr.

“When a person thinks and moves their phantom limb, those muscle pairings move dynamically, so they feel, in a natural way, the limb moving — even though the limb is not there,” Herr explains. He adds that when those proprioceptive signals communicate instead how an artificial limb is moving, a person experiences “great agency and ownership” of that limb. Now, his group is working to develop sensors that detect and relay information usually processed by sensory neurons in the skin, so prosthetic devices can also perceive pressure and touch.

At the same time, they’re working to improve the mechanical interface between wearable robots and the body to optimize comfort and fit — whether that’s by using detailed anatomical imaging to guide the design of an individual’s device or by engineering devices that integrate directly with a person’s skeleton. There’s no “average” human, Herr says, and effective technologies must meet individual needs, not just for fit, but also for function. At that same time, he says it’s important to plan for cost-effective, mass production, because the need for these technologies is so great.

“The amount of human suffering caused by the lack of technology to address disability is really beyond comprehension,” he says. He expects tremendous progress in the growing field of bionics in the coming decades, but he’s impatient. “I think in 50 years, when scientists look back to this era, it’ll be laughable,” he says. “I’m always anxiously wanting to be in the future.”

Magnetic sensors track muscle length

Using a simple set of magnets, MIT researchers have come up with a sophisticated way to monitor muscle movements, which they hope will make it easier for people with amputations to control their prosthetic limbs.

In a new pair of papers, the researchers demonstrated the accuracy and safety of their magnet-based system, which can track the length of muscles during movement. The studies, performed in animals, offer hope that this strategy could be used to help people with prosthetic devices control them in a way that more closely mimics natural limb movement.

“These recent results demonstrate that this tool can be used outside the lab to track muscle movement during natural activity, and they also suggest that the magnetic implants are stable and biocompatible and that they don’t cause discomfort,” says Cameron Taylor, an MIT research scientist and co-lead author of both papers.

McGovern Institute Associate Investigator Hugh Herr. Photo: Jimmy Day / MIT Media Lab

In one of the studies, the researchers showed that they could accurately measure the lengths of turkeys’ calf muscles as the birds ran, jumped, and performed other natural movements. In the other study, they showed that the small magnetic beads used for the measurements do not cause inflammation or other adverse effects when implanted in muscle.

“I am very excited for the clinical potential of this new technology to improve the control and efficacy of bionic limbs for persons with limb-loss,” says Hugh Herr, a professor of media arts and sciences, co-director of the K. Lisa Yang Center for Bionics at MIT, and an associate member of MIT’s McGovern Institute for Brain Research.

Herr is a senior author of both papers, which appear today in the journal Frontiers in Bioengineering and Biotechnology. Thomas Roberts, a professor of ecology, evolution, and organismal biology at Brown University, is a senior author of the measurement study.

Tracking movement

Currently, powered prosthetic limbs are usually controlled using an approach known as surface electromyography (EMG). Electrodes attached to the surface of the skin or surgically implanted in the residual muscle of the amputated limb measure electrical signals from a person’s muscles, which are fed into the prosthesis to help it move the way the person wearing the limb intends.

However, that approach does not take into account any information about the muscle length or velocity, which could help to make the prosthetic movements more accurate.

Several years ago, the MIT team began working on a novel way to perform those kinds of muscle measurements, using an approach that they call magnetomicrometry. This strategy takes advantage of the permanent magnetic fields surrounding small beads implanted in a muscle. Using a credit-card-sized, compass-like sensor attached to the outside of the body, their system can track the distances between the two magnets. When a muscle contracts, the magnets move closer together, and when it flexes, they move further apart.

The new muscle measuring approach takes advantage of the magnetic attraction between two small beads implanted in a muscle. Using a small sensor attached to the outside of the body, the system can track the distances between the two magnets as the muscle contracts and flexes. Image: Hugh Herr

In a study published last year, the researchers showed that this system could be used to accurately measure small ankle movements when the beads were implanted in the calf muscles of turkeys. In one of the new studies, the researchers set out to see if the system could make accurate measurements during more natural movements in a nonlaboratory setting.

To do that, they created an obstacle course of ramps for the turkeys to climb and boxes for them to jump on and off of. The researchers used their magnetic sensor to track muscle movements during these activities, and found that the system could calculate muscle lengths in less than a millisecond.

They also compared their data to measurements taken using a more traditional approach known as fluoromicrometry, a type of X-ray technology that requires much larger equipment than magnetomicrometry. The magnetomicrometry measurements varied from those generated by fluoromicrometry by less than a millimeter, on average.

“We’re able to provide the muscle-length tracking functionality of the room-sized X-ray equipment using a much smaller, portable package, and we’re able to collect the data continuously instead of being limited to the 10-second bursts that fluoromicrometry is limited to,” Taylor says.

Seong Ho Yeon, an MIT graduate student, is also a co-lead author of the measurement study. Other authors include MIT Research Support Associate Ellen Clarrissimeaux and former Brown University postdoc Mary Kate O’Donnell.

Biocompatibility

In the second paper, the researchers focused on the biocompatibility of the implants. They found that the magnets did not generate tissue scarring, inflammation, or other harmful effects. They also showed that the implanted magnets did not alter the turkeys’ gaits, suggesting they did not produce discomfort. William Clark, a postdoc at Brown, is the co-lead author of the biocompatibility study.

The researchers also showed that the implants remained stable for eight months, the length of the study, and did not migrate toward each other, as long as they were implanted at least 3 centimeters apart. The researchers envision that the beads, which consist of a magnetic core coated with gold and a polymer called Parylene, could remain in tissue indefinitely once implanted.

“Magnets don’t require an external power source, and after implanting them into the muscle, they can maintain the full strength of their magnetic field throughout the lifetime of the patient,” Taylor says.

The researchers are now planning to seek FDA approval to test the system in people with prosthetic limbs. They hope to use the sensor to control prostheses similar to the way surface EMG is used now: Measurements regarding the length of muscles will be fed into the control system of a prosthesis to help guide it to the position that the wearer intends.

“The place where this technology fills a need is in communicating those muscle lengths and velocities to a wearable robot, so that the robot can perform in a way that works in tandem with the human,” Taylor says. “We hope that magnetomicrometry will enable a person to control a wearable robot with the same comfort level and the same ease as someone would control their own limb.”

In addition to prosthetic limbs, those wearable robots could include robotic exoskeletons, which are worn outside the body to help people move their legs or arms more easily.

The research was funded by the Salah Foundation, the K. Lisa Yang Center for Bionics at MIT, the MIT Media Lab Consortia, the National Institutes of Health, and the National Science Foundation.

Hugh Herr

Revolutionizing Bionics

Hugh Herr creates bionic limbs that emulate the function of natural limbs. In 2011, TIME magazine named him the “Leader of the Bionic Age” for his revolutionary work in the emerging field of biomechatronics, an emerging field that marries human physiology with electromechanics.

Herr, who lost both of his legs below the knee to a climbing accident in 1982, has dedicated his career to the creation of technologies that push the possibilities of prosthetics. As co-director of the K. Lisa Yang Center for Bionics, Herr seeks to develop neural and mechanical interfaces for human-machine communications; integrate these interfaces into novel bionic platforms; perform clinical trials to accelerate the deployment of bionic products by the private sector; and leverage novel and durable, but affordable, materials and manufacturing processes to ensure equitable access of the latest bionic technology to all impacted individuals, especially to those in developing countries.

Herr’s story has been told in the National Geographic film, Ascent: The Story of Hugh Herr as well as the PBS documentary, Augmented.

Augmented: The journey of Hugh Herr

Augmented is a Nova PBS documentary that premiered in February 2022, featuring Hugh Herr, the co-director of the K. Lisa Yang Center for Bionics at MIT.

Follow the dramatic personal journey of Hugh Herr, a biophysicist working to create brain-controlled robotic limbs. At age 17, Herr’s legs were amputated after a climbing accident. Frustrated by the crude prosthetic limbs he was given, Herr set out to remedy their design, leading him to a career as an inventor of innovative prosthetic devices. Now, Herr is teaming up with an injured climber and a surgeon at a leading Boston hospital to test a new approach to surgical amputation that allows prosthetic limbs to move and feel like the real thing. Herr’s journey is a powerful tale of innovation and the inspiring story of a personal tragedy transformed into a life-long quest to help others.

Read more at PBS.org.

New bionics center established at MIT with $24 million gift

A deepening understanding of the brain has created unprecedented opportunities to alleviate the challenges posed by disability. Scientists and engineers are taking design cues from biology itself to create revolutionary technologies that restore the function of bodies affected by injury, aging, or disease – from prosthetic limbs that effortlessly navigate tricky terrain to digital nervous systems that move the body after a spinal cord injury.

With the establishment of the new K. Lisa Yang Center for Bionics, MIT is pushing forward the development and deployment of enabling technologies that communicate directly with the nervous system to mitigate a broad range of disabilities. The center’s scientists, clinicians, and engineers will work together to create, test, and disseminate bionic technologies that integrate with both the body and mind.

The center is funded by a $24 million gift to MIT’s McGovern Institute for Brain Research from philanthropist Lisa Yang, a former investment banker committed to advocacy for individuals with visible and invisible disabilities.

Portait of philanthropist Lisa Yang.
Philanthropist Lisa Yang is committed to advocacy for individuals with visible and invisible disabilities. Photo: Caitlin Cunningham

Her previous gifts to MIT have also enabled the establishment of the K. Lisa Yang and Hock E. Tan Center for Molecular Therapeutics in Neuroscience, Hock E. Tan and K. Lisa Yang Center for Autism Research, Y. Eva Tan Professorship in Neurotechnology, and the endowed K. Lisa Yang Post-Baccalaureate Program.

“The K. Lisa Yang Center for Bionics will provide a dynamic hub for scientists, engineers and designers across MIT to work together on revolutionary answers to the challenges of disability,” says MIT President L. Rafael Reif. “With this visionary gift, Lisa Yang is unleashing a powerful collaborative strategy that will have broad impact across a large spectrum of human conditions – and she is sending a bright signal to the world that the lives of individuals who experience disability matter deeply.”

An interdisciplinary approach

To develop prosthetic limbs that move as the brain commands or optical devices that bypass an injured spinal cord to stimulate muscles, bionic developers must integrate knowledge from a diverse array of fields—from robotics and artificial intelligence to surgery, biomechanics, and design. The K. Lisa Yang Center for Bionics will be deeply interdisciplinary, uniting experts from three MIT schools: Science, Engineering, and Architecture and Planning. With clinical and surgical collaborators at Harvard Medical School, the center will ensure that research advances are tested rapidly and reach people in need, including those in traditionally underserved communities.

To support ongoing efforts to move toward a future without disability, the center will also provide four endowed fellowships for MIT graduate students working in bionics or other research areas focused on improving the lives of individuals who experience disability.

“I am thrilled to support MIT on this major research effort to enable powerful new solutions that improve the quality of life for individuals who experience disability,” says Yang. “This new commitment extends my philanthropic investment into the realm of physical disabilities, and I look forward to the center’s positive impact on countless lives, here in the US and abroad.”

The center will be led by Hugh Herr, a professor of media arts and sciences at MIT’s Media Lab, and Ed Boyden, the Y. Eva Tan Professor of Neurotechnology at MIT, a professor of biological engineering, brain and cognitive sciences, and media arts and sciences, and an investigator at MIT’s McGovern Institute and the Howard Hughes Medical Institute.

A double amputee himself, Herr is a pioneer in the development of bionic limbs to improve mobility for those with physical disabilities. “The world profoundly needs relief from the disabilities imposed by today’s nonexistent or broken technologies. We must continually strive towards a technological future in which disability is no longer a common life experience,” says Herr. “I am thrilled that the Yang Center for Bionics will help to measurably improve the human experience for so many.”

Boyden, who is a renowned creator of tools to analyze and control the brain, will play a key role in merging bionics technologies with the nervous system. “The Yang Center for Bionics will be a research center unlike any other in the world,” he says. “A deep understanding of complex biological systems, coupled with rapid advances in human-machine bionic interfaces, mean we will soon have the capability to offer entirely new strategies for individuals who experience disability. It is an honor to be part of the center’s founding team.”

Center priorities

In its first four years, the K. Lisa Yang Center for Bionics will focus on developing and testing three bionic technologies:

  • Digital nervous system: to eliminate movement disorders caused by spinal cord injuries, using computer-controlled muscle activations to control limb movements while simultaneously stimulating spinal cord repair
  • Brain-controlled limb exoskeletons: to assist weak muscles and enable natural movement for people affected by stroke or musculoskeletal disorders
  • Bionic limb reconstruction: to restore natural, brain-controlled movements as well as the sensation of touch and proprioception (awareness of position and movement) from bionic limbs

A fourth priority will be developing a mobile delivery system to ensure patients in medically underserved communities have access to prosthetic limb services. Investigators will field test a system that uses a mobile clinic to conduct the medical imaging needed to design personalized, comfortable prosthetic limbs and to fit the prostheses to patients where they live. Investigators plan to initially bring this mobile delivery system to Sierra Leone, where thousands of people suffered amputations during the country’s 11-year civil war. While the population of persons with amputation continues to increase each year in Sierra Leone, today less than 10% of persons in need benefit from functional prostheses. Through the mobile delivery system, a key center objective is to scale up production and access of functional limb prostheses for Sierra Leoneans in dire need.

Portrait of Lisa Yang, Hugh Herr, Julius Maada Bio, and David Moinina Sengeh (from left to right).
Philanthropist Lisa Yang (far left) and MIT bionics researcher Hugh Herr (second from left) met with Sierra Leone’s President Julius Maada Bio (second from right) and Chief Innovation Officer for the Directorate of Science, Technology and Innovation, David Moinina Sengeh, to discuss the mobile clinic component of the new K. Lisa Yang Center for Bionics at MIT. Photo: David Moinina Sengeh

“The mobile prosthetics service fueled by the K. Lisa Yang Center for Bionics at MIT is an innovative solution to a global problem,” said Julius Maada Bio, President of Sierra Leone. “I am proud that Sierra Leone will be the first site for deploying this state-of-the-art digital design and fabrication process. As leader of a government that promotes innovative technologies and prioritizes human capital development, I am overjoyed that this pilot project will give Sierra Leoneans (especially in rural areas) access to quality limb prostheses and thus improve their quality of life.”

Together, Herr and Boyden will launch research at the bionics center with three other MIT faculty: Assistant Professor of Media Arts and Sciences Canan Dagdeviren, Walter A. Rosenblith Professor of Cognitive Neuroscience Nancy Kanwisher, and David H. Koch (1962) Institute Professor Robert Langer. They will work closely with three clinical collaborators at Harvard Medical School: orthopedic surgeon Marco Ferrone, plastic surgeon Matthew Carty, and Nancy Oriol, Faculty Associate Dean for Community Engagement in Medical Education.

“Lisa Yang and I share a vision for a future in which each and every person in the world has the right to live without a debilitating disability if they so choose,” adds Herr. “The Yang Center will be a potent catalyst for true innovation and impact in the bionics space, and I am overjoyed to work with my colleagues at MIT, and our accomplished clinical partners at Harvard, to make important steps forward to help realize this vision.”