Albert Manero, PhD, president of Limbitless Solutions, and Shea McLinden, University of Central Florida undergraduate student studying health sciences with a minor in medical sociology, talk about a new technology that could be life changing for children with limb loss.
Interview conducted by Ivanhoe Broadcast News in June 2022.
Can you describe what Limbitless is?
MANERO: Limbitless is a bionic arm innovation non-profit based here at the University of Central Florida. We’re creating new creative and expressive prosthetics and we are able to incorporate this high-tech component with this beautiful art and expression for children at absolutely no cost to those families.
What are you and your colleagues studying?
MANERO: Our team is focused on being able to translate the research from here in the laboratory into the real world. That means that children will come, and through a clinical trial process, be able to receive one of our bionic arms. And then, we start to learn how they’re using it on the playground and in real life. And we’re able to use that to inform how we make the next generation of bionic arms even better.
What are some things that can cause children to be born without limbs?
MANERO: Children are born with limb differences about five out of every 10,000 live births. It’s oftentimes related to a condition called amniotic band syndrome, which isn’t genetic. It’s not anyone’s fault. There’s not much that can really be done about it. It’s just that a womb tendril will wrap around a growing limb bud, and it can reduce the growth of that limb. For children with limb differences, getting access to prosthetics, especially expressive prosthetics, can still be quite difficult due to a number of challenges. All those challenges are things that Limbitless is hoping to provide new options for.
How long have prosthetics been around?
MANERO: Prosthetics have been around since the ancient Egyptians. We saw in the United States after the Civil War is when a lot of prosthetics started to take their more modern shape. With Limbitless, we’ve been working on this project for a new generation of bionic arms using 3D printing and different types of creative expression. We’ve been around for the last eight years.
How did this project come about?
MANERO: In 2014, there was a local family that reached out to me and found my email on a website for people that were interested in prosthetics and 3D printing. I will never forget the email. It said, “Could you build our son a bionic arm?” We didn’t know how to do that. I called all my friends and colleagues and said, “Would anyone help me on this project?” We started putting together the team that has now snowballed into what you see here today at Limbitless Solutions, with a full team of students and researchers who come together. I think we’re at about 50 total people working on this project.
What part of the brain will be responsible for controlling the limbs?
MANERO: In our upcoming clinical trial with Wolfson Children’s and Nemours Hospital in Jacksonville, we will be investigating how the child’s motor cortex that controls their different limbs, how it changes and evolves from using a prosthetic. The prevailing research is looking at how that motor cortex will change and grow or reorganize. Cortical reorganization can tell us more about how the brain is starting to learn how to control both the prosthetic, as well as the rest of that organic limb.
How many people have been in this clinical trial so far?
MANERO: That new clinical trial is just getting ready to start. We’re in the recruitment phase and excited as there will be five children to get selected to participate in that. And hopefully, we’ll be able to use that as a pilot study to then launch a much larger study where we can explore how your brain learns how to use prosthetics at a much larger scale.
How could this research impact someone who’s been born without a limb or lost a limb?
MANERO: For our work, being able to understand how the brain controls your limbs and how it can develop new skills for children who have grown up without part of their limb, I think that’s going to be an interesting takeaway from this pilot study. That same portion of the brain and how it controls or how it activates for your limb is also related to that phantom limb sensation for people with traditionally acquired amputations or traumatic events. We hope that that information will push the whole field forward about amputations, limb differences and prosthetics.
Do you guys only make arms and hands, or do you also make legs and feet?
MANERO: Limbitless has been very focused on being able to create for children these prosthetic arms and hands. Our second project that has been developing is using very similar controls to the prosthetic on your arm. But instead, we put the electrodes on your face and then you were able to control a wheelchair or vehicle by flexing your jaw muscles and temporalis muscles. We just finished the pilot study with Mayo Clinic in Jacksonville. We’re really excited as that is getting ready to be published quite soon.
Do the kids continue to come back to get new limbs as they grow, or do they stick with just one?
MANERO: When we start working with a family, I think through that clinical trial process, we commit to being able to support them. And that means as children rapidly grow, being able to create new modular parts that can adjust the size, just like you might get a new pair of shoes over the course of a couple of years. We hope to be able to do that for them.. We are able to check in with them, double check things, or we’ll just ship them new parts that they can integrate to be able to change the sizing.
Is there anything else that you want people to know about Limbitless?
MANERO: The team at Limbitless has grown, it feels exponentially, over the past year as we moved into our new facility. This study uniquely leverages video game- based training that converts muscle flexing into the video game character’s actions, led by UCF faculty members Matt Dombrowski with UCF’s School of Visual Arts and Design and Peter Smith with UCF’s Nicholson School of Communication and Media. We’re really proud of our 48 undergraduate students that are working on this research. They come from all different disciplines, including game design, the fine arts, engineering, biomedical sciences, to push this technology forward. I think that’s a critical part of being able to get things to start in the laboratory and then make its way to the bionic kids.
Can you describe the difference that you’re seeing in these children as the months and years go on?
MANERO: For many of the children we get to work with, the difference in their confidence of being able to wear one of these bionic arms, it seems to help them control the conversation around their limb. When the conversation shifts to, “That’s such a cool bionic arm, how did you get it? How does it work? How do I get one?”, I think that enables the bionic kids to have that sense of empowerment and the expression that comes with all the cosmetic components, too. That’s what we hope to do with the prosthetic, to give them that as a tool for them to realize that it was in them all along.
Can you describe the bionic arm? How is it functioning when it’s attached to a child’s limb?
MANERO: Our new version of the bionic arm uses electromyography, which is when your muscles flex or contract, they produce a voltage like a battery. With the same stickers that you would use for having an EKG on your chest, we can put them on the bicep muscle or whichever muscle is closest to the amputated limb. Then, when that muscle is contracted, we read that signal and send it to the computer chip that’s in the hand. That will tell the hand to do different gestures and routines. With a very simple surface mounted sticker, we’re able to have the children open and close, do a pinch, and even a point. With some parental controls, of course, on what gestures are available, it empowers them to do two-handed tasks and to interact in the world around them. The cosmetic components magnetize right to the exterior part of the arm, and that allows children to have different expressions, just like we have different fashion style depending on the day of the week or where we’re going. We think that opens up a whole different way to look at prosthetics as equal parts, form, and function.
In what ways have the prosthetics changed? What have you learned or what have you changed since you first started?
MANERO: Our research team here has pushed the technology forward on what we’re able to pack into that bionic arm without adding a lot of weight to the prosthetic because that’s a critical driver. The new version is Bluetooth to their parents’ smartphone. So, there’s a mobile app for them to take control and troubleshoot or even communicate with us if they need anything with the prosthetic. That puts the control back into their hands. Being able to have the multi-gesture component where they can process through these different gestures, I think that those have been critical components. The frontier now is how do you train a child to be able to use a prosthetic? Our solution for that has been to partner with UCF’s video game design school and create video games that use the same controls as their prosthetics. So, they’re flexing their arms and their muscles to make the character do different superpowers.
How many kids have had your bionic arm at this point? How many have you created? How many families are still coming back?
MANERO: There are 18 families who participated in the original clinical trial that has been ongoing for the last three years.
Since the bionic arm is made at no cost to families, are there sponsorships or grants that cover the cost?
MANERO: We’ve worked with our community and foundation partners to raise philanthropy and corporate sponsorship to cover all the costs, including providing a travel stipend to reduce the costs of participating as our goal with these clinical trials was not to leave anyone out from being able to participate. Hopefully with the pilot program continuing to advance, we’ll be able to incorporate more people and rally our community to advance this technology and provide access for children.
What’s the goal of the upcoming clinical trial that you and your colleagues are recruiting for? What do you guys hope to determine?
MCLINDEN: The goal is to use functional MRI, which is a type of brain imaging, to look at the brains of children when they are using a prosthetic. We’re going to be analyzing what parts of the brain they are utilizing while they perform different motions that they would be using in the prosthetic while they’re in the machine, and we’re going to track changes in their brain prior to using prosthetic and then throughout the trial.
What’s the hypothesis? What do you think you might see while this is happening?
MCLINDEN: We’re looking at seeing if there are any changes in the brain and the associated functionality and what areas are designated towards focusing on that limb and then controlling the prosthetic device.
How do the video games play a part in this?
MCLINDEN: The video games are essential to Limbitless and learning how to use the bionic arms because it gives children a chance to practice muscle discretization. It allows them to flex at different levels or percentages. They learn that through using the video games so that they have better control over the multi-gesture function of the prosthetic.
What’s the time period for the clinical trial? Is this not a very long period of time that you’re studying?
MCLINDEN: The length of the trial is four months with three check-ins.
At the end of that time, what will you do? Will you be comparing the MRIs, or can you tell me a little bit about how you’ll be processing the data?
MCLINDEN: There is a database of MRI’s that we can compare to. We will also be looking at each child specifically, how theirs changed over time.
Have you been working with some of the families?
MCLINDEN: Yes, I have had the opportunity to work with some of the families.
Your face lights up when you say that. Can you talk to me a little bit about the difference that these limbs are making?
MCLINDEN: It’s exciting to see the kids with their prosthetics and to have their experience and watch how they’re learning and growing with the prosthetic, and just all the different things they can do. It makes everything we do here at Limbitless worth it. I enjoy that aspect a lot.
Is there anything else that you would want to make sure that people know about your work, your team’s work, or about the project?
MCLINDEN: I would want everyone to know about Limbitless Solutions and how it’s an interdisciplinary team. We get to work with a ton of students and faculty at the University of Central Florida. But then, the community outreach and the impact that we’re able to have is exciting – to have that at an undergraduate level, to see what I’m working on in lab and having that make a difference in a child or family’s life. Seeing that change over time is one of the biggest reasons why I’m with Limbitless Solutions. I’ve been here for almost two years now.
What is the goal of the clinical trial?
MCLINDEN: The goal of the clinical trial is to use FMRI, which is functional MRI, and to look at the brain of children as they use their prosthetic limb and as they’re practicing with the video game and the different gestures they’re doing. So, we’re going to ask them to be in the MRI machine and then flex their muscles. And we can see how the brain reorganizes over time.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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