A big problem for most prosthetics is they don’t send sensory information back to the brain. Until now. Dr. Ranu Jung and her team at Florida International University (FIU) have developed a device that restores the sense of touch and hand grasp when someone is using their prosthetic hands. This technology could eventually be applied to other non-functioning parts of the body. A finalist for the 2020 Cade Prize for Innovation, Dr. Jung is head of the Biomedical Engineering Department at FIU, and the holder of multiple patents. Dr. Jung, who immigrated to the U.S. from India in 1983, credits the “can-do” spirit of her parents for her persistence and sense of discovery. *This episode is a re-release.*
Inventors and their inventions. Welcome to Radio Cade the podcast from The Cade Museum for Creativity and Invention in Gainesville, Florida. The museum is named after James Robert Cade, who invented Gatorade in 1965. My name is Richard Miles. We'll introduce you to inventors and the things that motivate them. We'll learn about their personal stories, how their inventions work and how their ideas get from the laboratory to the marketplace.
Richard Miles (00:40):
A neural enabled prosthesis. That is a hand that actually feels like a hand for people who have lost them. Welcome to Radio Cade, I'm your host Richard Miles. Today I'll be talking to Dr. Ranu Jung professor and chair of the biomedical engineering department at Florida International University. The holder of multiple patents and a finalist for this year's Cade Prize for Innovation. Congratulations and welcome to Radio Cade, Dr. Jung.
Dr. Ranu Jung (01:04):
Thank you, Richard, for giving me this opportunity to be on Radio Cade. I'm excited about talking to you.
Richard Miles (01:10):
So Ranu, if it's okay. If I call you Ranu, you've been at Florida International University for about 10 years now, but you've also spent time at Arizona State University, University of Kentucky and Case Western University in Cleveland. But you started life in New Delhi, India and came to the United States in 1983. So the first thing I'd like to ask, you've had a very illustrious career in academia, but I'm very curious about what was your first impression of the United States? What did you think when you stepped off the plane, were you excited to, do you think you'd made a really big mistake?
Dr. Ranu Jung (01:42):
That's a long time ago, but I was excited because I was going to be able to follow a dream and I had come specifically to follow biomedical engineering. So I came into New York and I actually drove with a family friend from New York to Cleveland. And so what a way to get welcomed to the United States going across the whole of the East coast to the Midwest. It was just absolutely, absolutely fantastic. The whole, the whole beginning, as, as I recollect, it's been a long time ago now. And the other thing in Cleveland was the welcoming nature of us Americans, because another graduate student who was starting in the program had already reached out to me and sent a letter to me saying, would you be interested in being my roommate? So I was really looking forward to meet Ruth tan Bracey who was going to be this new roommate for me. So it was a very, very exciting trip.
Richard Miles (02:35):
That's a great experience. And you probably know this by now, but that is exact route. A lot of early settlers took as we sort of open up the frontier is going from New York through Ohio and further. And that was the frontier at the time. So what a great way to get introduced to the United States?
Dr. Ranu Jung (02:50):
Richard Miles (02:51):
Let's talk about your current work and this is what you are in the finalist for the Cade Prize for Innovation, but it's obviously you've been doing this for awhile and I understand it correctly. You and your team at FIU, Florida International University have developed a prosthetic hand that can actually transmit neural signals to the brain so that a person without a hand can actually feel and control the prosthetic far better than a normal one. That sounds really complicated to me. I don't know if I described it correctly, but tell us how it works and how did you come up with the idea?
Dr. Ranu Jung (03:20):
Yeah. So think about when you touch something, right? You're, you're what you feel, or you've touched somebody's face. How do you feel about it? Or you grasp something you don't really think about it much, right? You just pick up and you automatically know it's hard, it's soft, you don't crush it. And if you touch somebody, you have all the sensations associated with it. Now, if somebody loses their hand for many reasons, often it's because of trauma. Then what are their choices? The choices for them are to get a prosthetic hand. And currently there are prosthetic hands that are available, to, what we call upper limb amputees. Who have lost their hand, that the person can already control. So the way it works is that when we use our own hand, the muscles in our forearms contract and relax, and when they contract and relax, your hand opens or closes, or your fingers will open and close into the whole mechanism that happens. When you have an amputation, the muscles that are above the level of the amputation, that person can still control them. So if you can record the activity of those muscles and that is done with electrodes that are placed on the skin, one of the examples that's the most common is like an EKG system, right? So putting the sensor is on there, those signals are picked up and they can be used to drive motors in the prosthetic hand. This is commercially available and there are different levels of prosthetic hands that are available that are simple to close, or there may be now new better prosthetic hands. So there are many that are available like that, but what is missing is how do you get sensation back. So there has been some attempt of saying, let's take some information back and put a vibratory signal on this pin. So there's approaches like that, that have been done. But what we went about saying is how could we give a better sensorial experience that would interface this information when somebody is touching something or grasping? So basically what our system is, it's not designing the prosthetic hand. It is designing this whole interface with the nervous system to restore, hopefully this whole sensory experience. So in this case, what we have done is we have said, all right, let's look at the prosthetic hand. If the prosthetic hand had sensors in it, can we tap into the sensory information? We process this sensor information to make sense of what is coming out from different parts of the sensors. And then we take that information and pass it on as commands through a wireless link, to a small neurostimulator that is implanted under the skin in the upper arm of the amputee. So what do I mean by a wireless link? You know, when you listen to the radio, there is somewhere a radio station that is sending out radio waves. So there's a transmitting and an antenna and in your radio, and you're now in your phone, there is some kind of receiving antenna. So these radio waves are going back, taking the information and passing it from the transmitting system, long distance into this antenna embedded inside some radio or a device, and it's picking it up and it's being coded. And you do hear the sound now, step into our system. You're not sending radio waves all along very far distance, but we have a transmitting antenna that's connected to the outside of the skin. And that's what is connected to a little box that is inside the prosthetic, where all the processing has happened. And the receiving antenna is right underneath the skin below. There are no wires going back and forth. So it's a wireless connection. Now this receiving antenna is connected to a neurostimulator. What's a neurostimulator is like a pacemaker, but now your similator is connected to very, very fine wires like human hair. And these fine wires are threaded through the nerves in the upper arm. So again, reminding you, it's an amputee who has a forearm that is gone, the hand is gone. They can control their muscles in the leftover arm, open and close the prosthesis as they close, the prosthesis back and forth. Signals are going to come back in. We are going to process them. We you're going to communicate those through this wireless link to the implanted antenna. And that implanted antenna connected to a stimulator connected to fine wires inside nerves. So we give little charges of electrical pulses. When these pulses are delivered, the nerves get activated more precisely the nerve fibers that are inside the nerves get activated. And these nerve fibers would have originally carried sensor information from your hand or some of the nerve fibers are going the other way and are controlling the muscles. So when these nerve fibers get activated, then now this biological neural signal goes into the spinal cord and from the spinal cord to the brain and right there in the brain, there is where a person perceives. So the whole point here is, as we do a task, as you reach out, as you touched something with your prosthetic hand, you hold it, you squeeze something, but you're not looking at it and your eyes are closed. Or maybe you can't even hear it. You get a sense of touch or you understand what you're grasping and how strong you are grasping it. So with this ability, we can do this. It might even embody that prosthetic hand into the person's body. And if that happens, then perhaps this will become really much more a part of the person with the sensory loop factor. They may improve their control and that's one aspect, but the richer sensorial experience may also embody the prosthetic hand better. And that might make people use the prosthetic hands more. And that has many other benefits. For example, they may be compensating with their other hand to do things, but now they may use this prosthetic hand, for example, or a plastic bottle with water in it. If you don't know how much you're squeezing out the water. So usually you would not use that prosthetic hand to do it. You'll use your other hand. You would use compensatory methods. So our system is to restore the sensation through this neural interface.
Richard Miles (09:23):
That's a great explanation. And this happens to me every year when we run the Cade Prize. I read the application. I think I understand the technology, but it's not until talking to the inventor that I finally understand what the real breakthrough is, because it sounds like, as you said, the current state of the art is essentially one way communication only, right? You're sending to the hand, the hand can open, close and so on, but it's that feedback loop that is missing. And because there's no feedback loop, you have somebody who doesn't really feel like this is a part of them and not really delivering what they want it to and they end up not using it.
Dr. Ranu Jung (09:56):
Yeah. So we are really closing the loop. There is some feedback, obviously, if you have models in the system and people are very adapt, we are very, very good at doing things and they learn how much I open and close my hand. So they have learned a lot of that aspect they have learned. So it's not like there is zero feedback and vision is a huge feedback. So if you're looking at things that you can do a lot of stuff just by looking at it and seeing how much repetitive training you can do that, but it's paying attention, not having to second guess yourself. It is having the confidence to reach out to things. All of those things are not there when the loop is not closed.
Richard Miles (10:34):
So a couple of questions come to mind, would this, in theory, at least as you develop the technology and improve, it, would it enable people who've lost a hand for instance, to engage in finer motor skills because they have the feedback or does that not really make a difference?
Dr. Ranu Jung (10:47):
Well, we hope that that is going to make a difference to be able to do finer motor skills. There'll be many things to take into account how dextrous is the prosthetic camp. That will be one of the things, but that's the technology that then, and that's part of the scientific question. What is that information? That one can process when it's coming from this effectively, to some extent an artificial sensor system, right? Do we really need a lot, or do we only need a few things about the cochlear system for hearing, right? They're not people who have lost hearing. It's not like every single sound and every single nerve is being stimulated, but they are interpreting sound. They are reading music. It is become part of the life. When you read, you don't read each letter, you read words, you fill the gap, you put the whole thing together. We don't know how many gaps you could effectively have in the sensor information and the person we are fantastic brains. So what we will do to put all of that together, but yes, it might help us with finer motor control. It might also help with things like picking up lighter weight objects. If it's a heavy thing, something heavy, you are picking up, you know, rest of your arm is going to feel heavy and you will get information back. But what if people are picking up small things, like a towel at home, and you are pulling it, folding that light towel and pulling it. Yeah. The person would contract their muscles really hard and squeeze it really hard and pull it. But if they have the courage, they will know I already touched it. I already have it. I don't have to squeeze. My muscles really had to clamp system. So over time fatigue, short term to make a difference. Long term use will impact the muscles. So all of these will be questions to ask. So you need the system first, you need the technology first. And then you can start to ask these questions and start to ask just pure science questions. How does our brain interpret information? What happens when you have, for a long time use of compensatory strategies, things have changed in the brain, perhaps. How do you pull all of this stuff together? So it opens up Pandora's box.
Richard Miles (12:48):
I imagine, as soon as you solve one question, it just raises probably five more questions. In theory, could this also be applied to feet into legs? Or is there something about this technology that lends itself only to doing hands
Dr. Ranu Jung (13:00):
You are absolutely right. This can be extended to many different levels. So right now our indication is for somebody who has lost their forearm and their hand, but you wouldn't think of it first portions of the upper arm, right? Then you can think about it as people who have lost their lower limbs. Actually what we have, what our technology is, is really think. We can take a signal and based on the signals, we can do targeted, focused stimulation inside the nerves. That's what the technology is. This application is sensor information to go to our nerves that are going to communicate with the brain to give some information for prosthetic hand, but that's not necessarily the only application. So in the very long run, you could think about saying, Oh, I'm going to stimulate another nerve. That's a control system, right? And now are based on a signal that I'm going to get that says, there's a problem with the stomach or the spleen. For example, in the diabetes situation, I will use that signal to stimulate those nerves because we are inside the nerve. We can do very focused stimulation. And so maybe that would be the application that is going to be the killer application. So to speak that you can do a very targeted stimulation of nerves going to organs within the body that would move us into the bioelectronic medicine, right? So pure thinking comes up at the bigger expanse in which the system could work. There are many pathways could be there, but our first application, our focus right now is to restore sensation to people who have lost their hands.
Richard Miles (14:36):
That's really exciting. That would be huge. If that could be developed for other areas of the body. This targeted neurostimulation. Tell us where you are in terms of testing. I know that in the case of the hand, the prosthetic, you want to test this sort of in as much of a real world environment as possible. Tell how that's going. And then what sort of path to market does it look like for you? Are we talking about years away from something that could be widely available for amputees? Or is this something that we're going to see fairly soon?
Dr. Ranu Jung (15:03):
So this is what is called a class, it would fall under, what's called a class three medical device. It's because of the implanted neurostimulator that that is there. So the first step that we had to do was to go to the FDA to get approval for what is called an investigational device exemption in order to be able to run a clinical trial. So we did that. Not many academic labs will take technology such as this all the way through the pathway, to the FDA while companies often do it. And of course, large companies are doing the Medtronic and Boston Scientific is doing this all the time, but it's not usual for an academic lab to have taken it from the scratch, something to the FDA. So we got the investigational device exemption. And so now we are in the process of running a feasibility clinical trial. And what that means is that we will be doing a small sample size of people who have a translatable amputation at first. And putting them through use of the system the way we have it. This is a longterm take home study. So you would do things for about three months in the lab. So after you get the implant, you would come into the lab, it's a person I speak to you. So we would make sure you're fit. And of course we want to collect additional data about how you are doing control of things. You will find some for a large, bigger control. Can you close your eyes and say it's soft or hard or big or small things like that? What do you feel like when you open zip things up or squeeze water bottles? So we do that in the lab and then after three months, the person will take it home and then they will come back for the next three months, a little more often. And then they'll come back for some data collection in the lab for up to two years. So we want to collect the data, but the system is then there's to keep. You know, the implant is hopefully the way we have designed it, it's for life. So the internal part doesn't change. There's no battery inside. So you don't have to undergo another surgery to replace depleted batteries, all the powers with both from outside. And as we're coming up with new algorithms outside, we have smarter prosthetic hands that may come in place. Then the outside can all be upgrade. So that's also a throught through modular design aspect of it. So we are currently in this clinical trial. One person has completed 28 months of use more than 24 at home. And we are currently recruiting people. Once we recruit these people for one site, we also have received funding from the Army to move it to a second site, which would be the Walter Reed National Military Medical Center. We have to go back to their VA and we'll back to the IRB to get approvals for increasing the number of people in the disability file and for the second site. And in case we will also try to see approvals for somebody who has amputations on both sides of bilateral amputee. We believe that this sensory feedback step is going to be really much more important for people who have lost both hands, even more so than somebody who has lost one of them. So once that happens, then we can go to the next step. We have just been accepted, absolutely delighted that we have just been accepted by the NIH in a program, which is called clinic to commercialization CPI program. And that program, our team was just accepted into that part. And that will take us for about 24 months to put a whole business framework in place. So we are expecting that by next year, we will have transcends, we have ideas of how we are thinking about our business framework, but we would start to strengthen that and we'll start putting that in place. And while the feasibility trial is going on, and of course the feasibility trial has to go well for all of that to put it together. And so probably the first place we would have people in the Army, that's where we would probably look to think the first deployment, but the clinical trial is funded by the National Institutes of Health and then new, additional monies from the US Army. So it would be open to all the civilians and it will be opened later to also people through the world to reach. So in a few years, we hope that this is going to be getting ready to be real commercialized.
Richard Miles (19:17):
So Ranu, I have to ask you, how do you spend your average day? Cause what you just listed in terms of your, to do list, I think would require about five or six people. So I'm guessing you're not the one that's doing all of this. You have people around you helping you, giving you advice. What do you focus on? Are you continuing to do a line share of the actual research? Or are you thinking about how do we actually get this into the hands of the people that need it?
Dr. Ranu Jung (19:40):
This is a partnership, as you said, this is not a one person job. This is a partnership. It's an epidemic in this preclinical partnership. A lot of it has been so far in academia. I have the best team I can talk about. It is a long term partnership. It's not two years. One year, three years. It's about 10 years or more. I was talking to James Abbas at Arizona State who has been from the initial concept is research scientists who came same time. I came here, who used to be here. He was my doctoral student, but decided to become an engineer. And then now he's actually going back to do his PhD another one, my old, old grad students have come back as well. I recently graduated grad student who works on the project is spending doing a post doc and is actually taking this commercialization pathway for what it's a team. So what do I do in this team? Because we have cross-training so it's not one person for one thing, but we do the regulatory work in high school. The implant was done right here in Miami, by doctor Aaron Burglar from the Nicholas Children's Hospital. And obviously we have industry partners to make the implants. If we can make them think of like the computer manufacturers who have to buy things from different places, right. We can tell them the design, but it has to be somebody who can make medical products to be able to put an implant in there. And bof course we partnered with prosthetic manufacturers for making the prosthetic hand. So what do I do? I am like the orchestra manager for all of it, but I am officially the sponsor of the trial and the principal investigator of the trial. So I take the responsibility for all of that, all of the negotiations, the legal negotiations and all of that part. I discuss those, all the FDA submissions. I will read them and I will update them and I will review them, but I'm not writing from scratch. And it's over years that has happened. I'm also not writing the program level details. The research scientists are doing, we will discuss, this is what we need to do. This is what we need support, but they are the ones writing the framework and putting all of that code in there. So to speak, what algorithms, what should they capture? So you can think of it as I'm putting the book in place, the chapter organization in place. But the exact words of how you are going to put in that paragraph are written by the engineers and scientists and graduate students that are involved and undergraduate students are involved,
Richard Miles (22:03):
Ranu, one of the questions we asked normally if inventors and entrepreneurs and we're fascinated by it at the Cade Museum is well, what was the inspiration behind their story? And you've said that you were inspired by your parents and their can do spirit. Your father was a metallurgical engineer. Your mother was a school teacher taught English in India. How did they influence your decision to go into engineering?
Dr. Ranu Jung (22:23):
Not in a direct manner to say you should go into engineering because they themselves were doing what they wanted to do. They were pursuing new things. So right from early childhood, it was, you can do whatever you want to do. So it wasn't that, Oh, you should do this or you should do that. So I think them taking that risk, and as I mentioned earlier to you, this was post India independence and a new industrialization happening to be coming in place. So my father who is going to be close to 19 and one of the first engineers and they were all doing this every day and you watch them do it. So you saw him come back and say, we broke this record of the blast furnaces. We melted this much iron ore today. So you saw that kind of atmosphere, you know, this allowed you to think and say, Oh yeah, what could I do? What would I want to do? And so that was the inspiration. And it was an interesting time to be in India. At that time in Indira Gandhi was the prime minister. I still remember going to a rally and listening to this woman, giving a speech. And I think that whole ecosystem was encouraging the children to dream and no boundaries that you need to stay here. You need to stay with the family. So they left their parents and their families to go to this new city and build that up. And for their children, they said, you have the world. You can go wherever you want to go to a very special time in history and a special city be raised in with a group of young entrepreneurial parents we were like a cohort, but then that's what it was. You know,
Richard Miles (23:52):
What I find fascinating too is I know is that you actually consider going into medicine instead of engineering, and then you chose engineering, but now sort of the peak of your career, you're in bioengineering, right? And ultimately you've got to have both things you wanted.
Dr. Ranu Jung (24:04):
And I have to say, undergraduate students going into research lab, they really should explore. And that's how I found out about that. There is a potential possibility. There was a professor who had a lab called problem oriented research lab. And he had actually just spent maybe a semester in the US I don't know exactly how long and come back. And he started this lab where they would bring medical instrumentation for an electronic blood pressure cuff. Oh, I could have a combination of all this electronic stuff. My major was electronics and communications and things. I could have been doing radar. And instead I said, Oh, there's a place I could combine it. But there was nothing in biomedical engineering in India. I even interviewed to sell x-ray machines for a company, so I could get into the medical field, but then getting this opportunity to do grad school at Case Western it really, really a fantastic graduate program. That was the opportunity that helped me solidify my passion and this, I found a place that would be good.
Richard Miles (25:03):
I asked you earlier about what would your advice be to other researchers and entrepreneurs? And you wrote that one piece of advice would be don't cross out ideas too fast because ideas are too early. So why don't we explore that a little bit? How do you keep a good idea alive? Let's say as a researcher, for which there may not be funding right away, or there may not be a commercial application right away, but you know, it's a good idea. How do you keep those going?
Dr. Ranu Jung (25:28):
So let me tell you this idea of interfacing with the nervous system and think of it as out what we call a bio hybrid system, a bionic system, and this together, this idea of pulling this together and interfacing was way back when I was just graduated from my postdoc. And I worked with a professor named Davis Cohain and we were studying lamprey eels. They are like eels. And we looked at the spinal cord and how the spinal cord works and what helps to do the movement and was like, what if we could do a combination of a electronic circuit that mimics part of the spinal cord and interface it with this, I could do the simulations. I could do the experimental prep. I could not make the actual chip hardware, because that was not my background. I went to a summer course. I learned about it. And I came back and said, I gotta find it. Electrical engineering friend who is faculty member who will be willing to put this into hardware, found one practice with her for a few years. She went and did the course came back and we actually then put it into a physical thing. And we interfaced it with this grant. We've got a grant from NIH, which was called the a21. A futuristic grant to say, we can take an electronic chip and you're hearing the word neuro morphic. Now this is now in there talking about in early 1990s, pick up the spinal cord from the lamprey. You can put it into a fluid bag and you can maintain it. And the spinal cord will be activated. We then connected it to this chip and close the loop. And we could show that the electronic chip and the spinal cord activity can go next to each other. I had a very tough time position that who would ever interface these pains, but the living system, what a crazy idea. Okay. So we got into a journal. I was thinking, this should go into science. It never did, but we did get there 10, 15 years later, somebody in the Army saw this paper. This was in the Iraq war. So I founded a small company because who needed a company for this. And we got funding where we basically said, if you're focused injured, you will be stabilized in a false boot underneath it. We will put a small fall spot this spot would we be controlled with a circuit? Hey, what was that stuff like? The spinal cord circuits that we had done way back there. And this spinal cord circuit will be driven by sensors that pick up when the person starts to move. So if your upper leg is okay, as you start to move, there is make movement that will drive that file for circuit, that electronics that moves the food, that is the boot. And so the person can stick their foot into the stabilized park, the false foot, and you can wear this boot and you could walk out of there. And we actually demonstrated that on a person in the lab. So what forward even further, a few years, and this happened around the same time as I got funding for this neural interface thing to me. So I'm thinking all of this and saying, how are we combining electronic interfaces? So it has changed pace, but I idea has moved that you can link artificial systems with living systems and close the loop so that you've got, this merger, this bio hybrid system, where one is impacting the other, where will we go. Will we have adaptive engineered systems because our engineered systems that's feeling not adapted enough. Where will it go? I think they will. Now you'd hear about neuromorphic word. Major companies are doing it, everybody's doing it. So who knows where this is going to go? Where will this organic inorganic link happen? I'm talking about early 1990s. And we were the first people to show that you can interface an electronic circuit in a living spinal cord. It isn't a bat. It's not in the person walking or animal walking per se, but it was a living system. And today we are looking at saying, how can we interface? What are we doing with interfacing in electronic system with a real person and putting them into this room and hoping that this is going to actually improve their whole self, their ability to do different tasks. But most importantly to have is some [inaudible].
Richard Miles (29:35):
I'm pretty sure I never heard the term neuromorphic until probably 2012, 2013, right around there. And I'd never heard of the term before. I thought it was brand new. I had no idea. It had been around since early nineties.
Dr. Ranu Jung (29:47):
Our paper is published with saying your morphic army grant is neuromorphic something. So it was way in the infancy of when that stuff was being talked about. Carver Mead from Caltech had been talking about it. I was very, very fortunate to have is Cohen and worked with her. I met her at the summer course at Woods Hole, Massachusetts on competition neuroscience. You never know where it can get you. So my PhD advisor, Peter Catona who I call him my academic father, who always gave me this type of saying, explore, explore. There was no idea, too crazy to be taken up. There was not this whole, we don't do this, or you can't do this.
Richard Miles (30:25):
Ranu, clearly our judges have done a great job in advancing you to our finals this year. I'm very excited to learn about what you're doing. I hope it succeeds. I hope we can have you back at some point on the show to talk about updates. Again, want to congratulate you on making finals, but also just more broadly on the work that you have done currently at Florida International University, really enjoyed talking to you. So thank you for coming on the show today.
Dr. Ranu Jung (30:46):
Thank you Richard look forward to returning.
Radio Cade is produced by the Cade Museum for Creativity and Invention located in Gainesville, Florida. Richard Miles is the podcast host and Ellie Thom coordinates, inventor interviews, podcasts are recorded at Heartwood Soundstage, and edited and mixed by Bob McPeak. The Radio Cade theme song was produced and performed by Tracy Collins and features violinist Jacob Lawson.