A doctor recognized for developing bionic arms for amputees now wants to help people with quadriplegia — using his University of Arizona mentor as the test patient.
Dr. Albert Chi’s project to give his trusted adviser, UA associate clinical surgery professor Dr. Thomas Wachtel, hand, arm and finger dexterity via technology has resulted in a partnership among the UA, a team of experts from the Johns Hopkins University Applied Physics Laboratory and a Baltimore company called Harmony Robotics.
“The fact I had this tight relationship with Tom and a tight relationship with applied physics — it was the perfect marriage. It was a need and technology we could do together,” said Chi, a former UA medical resident who now practices at Johns Hopkins University.
The exact type of assistive device to be mounted on Wachtel’s powered wheelchair remains uncertain. In an ideal scenario, at least from Wachtel’s perspective, the robotic hands and arms will fit directly over his existing limbs.
More certain is the Kinect Technology the Johns Hopkins team will use to build the arms — the same technology used in XBox video game consoles. If the device works as expected, it could help not just people with quadriplegia, but those who have lost arm movement because of strokes and injuries.
While Wachtel will likely begin by controlling his arms via a computer screen interface, Chi’s team ultimately wants to fit him with computerized glasses. The glasses will get signals from Wachtel’s eye movement to complete tasks like picking up a glass or taking communion at church.
Chi and the team are calling their project “Transcendent Robotics: One Man’s Journey.” They plan to launch a $60,000 Kickstarter campaign to make it happen.
The team has lined up a Washington, D.C.-based producer and cinematographer to create a documentary that will track Wachtel’s robotic arms from creation to development to use.
While Chi’s initial work with advanced robotics involved brain implants to send electrical signals to the robotic limbs, his newer assistive devices do not require surgery. Harmony Robotics — whose president, Tom McCreery, is based in Tucson — has created a computer interface called Harmonie that lets eyes control robotic movement.
“It’s like a POV (point of view) video game where you look at the screen and automatically manipulate objects,” Chi said. “It’s completely intuitive.”
A chief resident
and his mentor
Chi was chief resident in the trauma center at what was then called University Medical Center in Tucson when he met Wachtel in June 2007. Wachtel, a seasoned trauma surgeon and decorated military veteran, guided Chi as he operated on patients coming through the emergency room. An eager and cheerful yet inexperienced resident, Chi was buoyed by Wachtel’s trust.
In addition to trauma surgery, both had the military in common — Wachtel is a former U.S. Navy Reserves captain and Flight Surgeon who served in Vietnam, and retired in 1998 after 37 years of service. Chi is a Lieutenant Commander in the U.S. Navy Reserves.
Wachtel, who had recently retired from Scottsdale Healthcare — Osborn as director of trauma services and disaster medicine, was having the time of his life at the UA.
A resident of Paradise Valley, he was working in Tucson two or three weeks each month. He felt needed at the understaffed trauma department (now part of Banner-University Medical Center Tucson); He loved the hands-on work, enjoyed interacting with residents and looked forward to dinners out after his shifts, when the physicians would talk about new innovations and discoveries.
“Tom Wachtel had kind of instituted almost all the trauma programs in Phoenix, and he was a U.S. Navy guy,” said Dr. Peter Rhee, who became the chief trauma surgeon at University Medical Center in the summer of 2007. “Apparently when he retired, he was moping around. But he got completely revitalized here. The students thought he was a great teacher — very experienced, just a fabulous guy.”
As an attending physician Wachtel encouraged Chi to develop his surgical skills, trusting him to operate on patients rather than doing all the work himself.
“If you are an attending, you can’t let the patient suffer. But if the chief resident is in a place where they can take over, you need to give them the chance to take over and do it by themselves,” Wachtel said.
That trust made a difference.
“His faith in my abilities gave me confidence,” Chi said. “He’s a big reason why I chose trauma surgery.”
Devastating turn of events
On June 1, 2008, as Wachtel steered his silver Toyota Prius toward Tucson along Interstate 10 near Casa Grande, he slammed into a median.
Both the front and back were severely damaged, indicating the car flipped nose to end rather than sideways. There was no evidence that Wachtel had braked before the car flipped, the accident report says.
Wachtel had a broken neck, broken left collarbone, left shoulder blade and three upper ribs. He had a head injury, but remarkably, no significant brain injury showed up on a CT scan.
At the hospital, doctors said he had heart arrhythmia. He doesn’t know if the arrhythmia caused the crash or vice versa.
“I usually drive very carefully,” he said. “I really don’t have a clue how I wrecked.”
Wachtel, now 76, remembers nothing about his six weeks in intensive care at Banner Good Samaritan or the next few weeks at Barrow Neurological Institute, both in Phoenix. His first memory was finding himself at Barrow in mid-August 2008, unable to move his arms or his legs. He learned that his C6 and C7 vertebrae had been crushed.
Initially he could not move any extremity. But after about two and a half months he began to get a little motion in his left arm. By October, he had regained enough left arm motion to drive an electric wheelchair.
Seemingly simple tasks like taking a shower would now necessitate caregivers and costly equipment.
“I couldn’t turn and wipe my nose or anything,” he said. “I went from one side of the system to patient. It was an interesting move and not a good one. I now see the patient side in a different light.”
A rising star in robotics
Chi’s track record of working on high-tech artificial limbs through a U.S. Department of Defense project has landed him on “60 Minutes,” “PBS Newshour” and CNN — and won him the respect of robotics researchers across the country.
Wachtel saw one of those news reports and connected with his former student via Facebook. The two have been in touch ever since.
Wachtel is not surprised Chi has done so well. Chi earned undergraduate and graduate degrees in biomedical engineering from Arizona State University, where his faculty advisor was neuroscientist Dr. Andrew Schwartz, who is known for linking neurons in the brain’s cortex with a robotic arm and hand. Wachtel refers to Chi as “hybrid-trained.”
“Hybrid training is where all the advances come, like the Nobel prize goes to the person who locks it together at the top — people with expertise in biochemistry, internal medicine, engineering, things like that,”he said.
After finishing his surgical residency in Tucson, Chi completed a two-year fellowship at Baltimore’s Shock Trauma Hospital and then became a rising star at Johns Hopkins University in both trauma surgery and robotics.
Given his military background, Chi wanted to help combat veterans who lost arms. Much has been done in advanced prosthetics and technology for people missing lower limbs, but progress with upper limb prosthetics had stagnated. Arm prosthetics were heavy, could be uncomfortable, and technology for complicated hand motions was lacking.
Part of the issue is in the numbers, since most people missing limbs have lost one or both legs, not arms or hands.
Still, people with missing arms needed better options, reasoned Chi, now medical director of the Johns Hopkins Targeted Muscle Reinnervation Program. At the Johns Hopkins Applied Physics lab, he got involved with the U.S. government’s $100 million investment to create a brain-computer interface with direct brain control of a prosthetic.
In 2006, Chi began working with a team from the Defense Advance Research Project Agency called the Revolutionizing Prosthetics Program. Researchers have demonstrated human brain signals controlling a robotic arm, and have recreated sensation in amputees by stimulating nerves that the brain interprets as real.
As amputees tested early forms of the prosthetics using their minds to operate the arms, the team began getting national and international attention.
In early 2014, Chi visited Wachtel and showed him some of his research results. Wachtel was excited to try it, but traveling to Baltimore was impractical. So Chi’s team is bringing the robotics to Wachtel in Scottsdale.
Chi was recently deployed to East Africa, where he’s stationed at Camp Lemonnier in Djibouti with the Naval Reserves. He’ll remain there as chief trauma surgeon through the summer. But Chi, who spoke with the Star via Skype, does not expect his absence to hurt the project since a five-member team from Johns Hopkins is working on it.
“This is the first system of this type created and then demonstrated in someone’s home,” Chi said. “It really will be the most sophisticated upper limb system ever created.”
Without philanthropic support, it may not happen. As fast as advanced robotics is moving, funding for research projects is difficult to find, he said. Team member and Johns Hopkins applied physicist Michael P. McLoughlin says the goal is to raise at least $60,000, but $200,000 would be ideal.
“During my time on this project I have seen firsthand the impact of regaining the ability to move a limb has had on people — I truly believe it can change lives,” McLoughlin said.
Excited by possibility
Bundled in blankets, his legs encased in compression stockings and braces, Wachtel sat in his electric wheelchair at his Scottsdale home one recent day, his excitement about Chi’s project palpable.
A set of robotic arms could help him use his fingers for the first time in seven years. Wachtel, who has had nerve surgery in both arms and has a routine of daily therapy, has regained some movement. He can lift his arms. But he still can’t use his fingers.
“You look at hands that used to be able to sew a liver, fix a hole in the heart. … I can’t use scissors, and I can’t pinch anything,” he said. “Simple things like in Catholic Church, you know, they give the host in the hands. Well, I could pick that up and put it in my own mouth. Now I have to take it on the tongue like the old days.”
He hopes robotic arms will allow him to brush his teeth and comb his hair and perhaps use a regular spoon instead of the adaptive version he uses, attached to a piece of circular plastic that fits around his hand.
“For sure, read a book,” he said, considering the possibilities. “That is a hard thing for me to do right now, turn the pages, hold the book,” he said.
The accident turned life upside down for Wachtel and his wife, Carolyn, who have three children and 10 grandchildren. He works six days per week with caregivers and a personal trainer, which has increased flexibility and strength in his arms.
Every morning he tells himself to do as much as he’s able. His military training made him good at obeying orders, including his own, and he’s determined to go to bed tired every night.
“It has been a little over 6ƒ years of passive and active exercises six days a week to gain back the amount of motion that I have,” he said.
Million Dollar Man
Each morning Wachtel uses a rail in his specially outfitted bedroom to get to the shower. One of his caregivers puts a sling under him in bed and attaches it to a hoist that runs on the rail from the bed to the shower.
“Then they roll me out, do bowel care, put me in essentially a diaper, then short pants over. I only have a couple of pair of long pants,” Wachtel said.
Simple tasks require extraordinary effort.
“You could become a couch potato very quickly,” he said
Before the accident, Wachtel stood 5 feet 10 inches and was in perpetual motion. When he attended Case Western Reserve as an undergraduate, he lettered in football and track. He did military helicopter operations and went on action-filled vacations like trekking in Nepal.
Since his accident, he has self-published fiction under the pen name Tom Lee, based on his experiences. “Vietnam, I Love You” and “Melt My Wings” came out in 2011. “I’m Your Patient” is due out this fall.
As a physician, he has written nine medical books, 22 book chapters and more than 150 scientific papers on burns, trauma, wound healing, nutrition, death and dying, and medical education.
He’s eager to make a new kind of contribution. The way he sees it, he’s a test case for technology that could one day be commonplace for helping others with paralysis.
His ultimate objective is to be like Steve Austin, the bionic man from the 1970s television show, the Six Million Dollar Man. With the right technology, his legs could run, his hands and fingers could function.
But starting with bionic hands and fingers is a fine beginning, he said.
“What’s exciting me? Writing another book. Working with Albert on the arms,” Wachtel said, his face brightening. “I could help other people, like people who have had a stroke.
“There are so many options.”