Technical Marvels May Revolutionize Health Care
They're everywhere. Turn on the TV, pick up a newspaper or magazine, and the stories leap out: stem cells to heal the body's failing nervous system; transplanted wombs; the smaller-than-small world of nanotechnology; and yes, as in the previous story, the feverish quest for an artificial heart. Medical innovations abound, and remarkable research has led to products that greatly improve people's lives, or promise to in the near future. Some medical innovations at the cutting edge of Canadian research:
Imagine losing a leg and then, miraculously, getting it back again. Something very close to that has happened to Gerry Moyer, who lives near Brantford, Ont. It's been almost five decades since a surgeon amputated Moyer's right leg above the knee to prevent a tumour from spreading. Since then, Moyer, 64, has owned a dozen prosthetic legs - but nothing compares with the one he has now. His first was carved from the wood of a willow tree. The fitting, recalls Moyer, a retired health-care claims adjudicator, was painstaking, painful and far from perfect - whittling away at the spots that hurt until the leg felt comfortable. By contrast, technicians tuned his latest prosthesis, called C-Leg, with a laptop. When Moyer first tried one on two years ago, he was stunned. "It was just so amazing," he says, "to be able to walk down a steep hill without collapsing."
Kelvin James, a research associate at the University of Alberta in Edmonton, developed the computerized technology and mechanical hardware behind C-Leg. James then licensed it to the German parent firm of Otto Bock Orthopedic Industry of Canada Ltd. For five years, Otto Bock flew James to Germany periodically to pick his brain while investing heavily to refine his research. The end product is an unparalleled prosthesis which gives amputees the ability to move about almost normally. But it comes at a price - up to $45,000 per leg, only partially covered by provincial health plans. About 125 Canadians have a C-Leg. "When I first heard the price," says James, "I thought, boy, how can you get anyone to come up with that kind of money, but they're doing it."
The automated leg features a sensor that measures knee angle. Another monitors the flex in the unit's aluminum shank to determine whether the person is standing on the heel, sole or toe. The leg's electronics calculate speed and position 50 times per second. Two tiny motors adjust the leg's hydraulic piston, which controls the swing of the leg. "With other legs it felt like I was dragging a log," says Moyer, "but the C-Leg is as light as a feather." Powered by a rechargeable battery good for 30 hours, the C-Leg gives him a normal gait and the ability to descend stairs without difficulty. Moyer still goes up stairs one at a time - no battery small enough to fit in the leg can provide the power to lift a human.
The Future O.R. Today
Computers revolutionized the prosthetic leg, and they're doing no less in the operating room. The orthopedic O.R. of the future is due to start functioning at Kingston General Hospital in Ontario in December. There, surgeons won't even have to look at their patients as they snip and bore. Instead, they'll do their job, with greater precision, while staring at a computer screen next to the patient.
First, a patient will get a CAT scan - a 3-D X-ray - of the area to be operated on. Doctors will then plan their surgery on a graphics workstation, and download the results onto terminals in the O.R. The operation will start with the surgeon screwing a light-emitting target into the bone. A bank of infrared cameras mounted to the ceiling, floor or wall will then track that target, aligning the CAT scan image on the surgeon's computer screen with the patient's body. Watching the progress on the monitor, the surgeon will then recreate the virtual operation with precise accuracy on the real patient. The payoffs: smaller incisions, shorter hospital stays and quicker recovery times.
It Is Brain Surgery
Another new technology will remove surgeons from the operating table altogether, and let them work on the brain by means of three robotic arms. The University of Calgary has announced a $6-million deal to develop such a device. In December, engineers from MacDonald Dettwiler Space and Advanced Robotics Ltd. in Brampton, Ont., visited Calgary to witness brain surgery at Foothills Hospital. The plan was to learn as much as possible and apply it to building the robot, known as the neuroArm. "The O.R. nurses," says Tim Fielding, head of mechanical systems for the project, "were waiting for us to pass out and hit the floor."
No one did, and the engineers returned to Brampton to begin their designs. MD Robotics, which bought Spar Aerospace Ltd.'s robotics division and its Canadarm technology for space shuttles, expects to have within two years what it calls "the most advanced medical robotic device in the world." The neuroArm will consist of three limbs: two to perform the surgery, and a third to bear two probing cameras providing views of the patient's grey matter. Magnetic resonance images will add additional detail.
The main advantages will be steadier surgical tools and, in some cases, less invasive surgery. Sitting in a control booth, the surgeon will direct the neuroArm to insert needles, grab tissue, dissect, suture, cauterize, clean - pretty much anything a human could do, but with great precision and tiny access holes. Sensors at the tips will give the surgeon at the controls a sense of touch, says Perry Newhook, who oversees the project's technical systems. "We're trying to provide enough feedback to the surgeons so they're not missing anything by not being there."
Life can be about making the best of a bad situation. That's how Laird Ruehlen, 33, of Campbell River, B.C., looks at his grandmother's cognitive decline. Margaret Ruehlen, 85, has Alzheimer's disease, and while she still knows her family and remembers her wedding in 1938, her short-term memory is almost gone. Laird Ruehlen, a junior high school teacher, says his grandmother is fortunate to live at the Yucalta Lodge nursing home in Campbell River, where 28 residents are monitored by an award-winning surveillance system. "It's the best possible situation," says Ruehlen, "in a not-great situation."
Vigil Health Management Inc. of Victoria developed the system to allow patients more dignity and security, give their families greater peace of mind and place fewer demands on nursing staff. It constantly monitors a patient's room with motion detectors in the ceiling and doorways and sensors in the bed. The Vigil system now keeps watch over 6,800 beds in 89 facilities in Australia, Iceland, the United States and Canada. Its software compiles data to form a patient profile that takes into account the amount of time the person generally spends in the bathroom or moving around in the room. Departures from that norm - the movements of an agitated patient or someone leaving the room at odd hours - trigger an alarm. But there are no video cameras. "The value of being able to have visual privacy," says Ruehlen, "outweighs the Big Brother feeling of having sensors in somebody's room."
Of the three existing types of magnetic resonance imaging (MRI) machines, two require scads of electricity and refrigeration with an expensive liquid-helium coolant. But the third, built by start-up Millennium Technology Inc. in Richmond, B.C., consumes only about the same amount of power needed to run two dishwashers and requires no refrigeration, making the firm a leader in the race to develop the next generation of MRIs.
Like its pricier counterparts, Millennium's Virgo MRI, six of which have been sold in Canada and the United States, can detect brain tumours and various muscular and skeletal disorders. It has a permanent magnet which, unlike other MRIs, does not require electricity to generate the powerful magnetic field used to peer inside the body. At US$800,000, the Virgo costs less than half as much as high-end MRIs. Another plus, says company president Illich Cheng, is a novel C-shaped design that improves patient access. Other machines, resembling giant doughnuts, pose difficulties for the obese, people with claustrophobia and nervous, squirming children. "With the Virgo," says Cheng, "parents can even hold their child's hand."
More Than Skin Deep
Scientists have grown skin cells in the lab and grafted the tissue onto burn victims for more than a decade. But that skin consists of only the outer layer, the epidermis. Dr. François Auger, director of the Laboratory of Experimental Tissue Engineering at Laval University in Quebec City, is trying to grow skin made up of not only the outer protective sheath but also an undercoating of cells - the dermis - to add strength and improve appearance. "The epidermis is the Saran Wrap of your body," says Auger, "but the dermis is more like a cushion, a little bit like Styrofoam."
Auger and his team are well-established pioneers. In 1998, they became the first to grow a blood vessel. Less than a year later, they achieved another milestone: skin grown with tiny capillaries. But the process used to coax skin cells into two-layered tissue is lengthy and needs to work faster before trials with burn victims can begin. If things go as planned, Auger says trials could begin next year. An international race to grow a better skin is underway, and Auger plans to win. "We're up there," he says, "with the best of them."
Maclean's March 25, 2002