0011/0711 Section, L07
THE IMPORTANCE OF THE DEVELOPMENT OF NEURAL PROSTHETICS
AND ITS APPLICATION IN COGNITIVE REHABILITATION
Erica Reiser (ELR56@pitt.edu)
“physically independent, but have such significant disorders
of cognition that they are unable to perform the most basic
tasks.” Even patients who seem to have good cognitive skills
on the surface can be presented with subtle changes in
behavior and personality that make them strangers to their
friends and families [2].
Although the biotechnologies applying to the physical
aspect of rehabilitation and recovery are obviously essential,
it is critical to give attention to the mental component as
well. This component is also extremely important because
“the recovery of physical abilities and functional skills such
as mobility occurs rapidly, often within 3 months after
injury; however, recovery of cognitive abilities (particularly
higher level cognitive and communicative skills) tends to
take much longer.” There doesn’t seem to be a final endpoint
to the recovery process; rather, the pace of recovery slows
with time and its span narrows [3]. This being said, with the
continual development of neural prosthetic devices, the
recovery of these cognitive skills will be faster and more
efficient. The goal is to keep the mind on track with the body
while the patient is going through their recovery process.
The number of people with cognitive disorders is
increasing along with the demand for neural prosthetic
technologies which is why I think this topic is so important
today. “Globally, the number of people older than 65 years
is anticipated to double between 1997 and 2025” and
“perceptive, cognitive, and musculoskeletal diseases that
impair motor skills dramatically increase with age” [4].
So, although neural prosthetic technology has helped
more people to live longer, this increase in the elderly
population also means that more technology is needed to
help them. “The population of people with reduced
functional capabilities due to aging or disability is already a
large and growing segment of our world and the number and
percentage of people in need of advanced assistive
technology are increasing every year. About 60 million
Americans already have a disability that affects one or more
of their major life activities” [4].
INTRODUCTION
The continual focus on the development of neural
prosthetic technology is imperative in the bioengineering
field because of its application in cognitive rehabilitation.
This technology includes artificial extensions to the body,
especially the brain, that can restore or supplement functions
of the nervous system lost during injury or disease. Helping
disabled individuals acquire the ability to regain control of
their bodies is important because it will help lead them to
fuller and more productive lives [1]. Some examples of
neural prosthetic application include the procedure of deep
brain stimulation for patients with Parkinson’s disease and
the cognitive rehabilitation of injured soldiers. These
examples illustrate the application and importance of neural
prosthetics as a way to improve people’s lives.
It is important that the development and use of neural
prosthetic technology follows the codes of ethics for
engineers and bioengineers specifically. As a proponent of
neural prosthetics, I feel that although the technology is
extremely useful, it should only be developed and used in a
fair and ethical way. Being a prospective engineer, the main
reason I want to go into the field of bioengineering is to have
an opportunity to develop medical technologies that will
positively impact people’s lives.
I chose to research neural prosthetics because it is a
relevant and life-changing component of the bioengineering
field. This demonstrates the value of such a project of
research and writing within a freshman engineering
education. During this assignment I learned about something
I was interested in while also gaining knowledge of the realworld application and business side of engineering as well as
developed my writing skills. I highly recommend that this
project be included in any freshman engineering education
curriculum.
THE IMPORTANCE OF NEURAL
PROSTHETIC TECHNOLOGY
TYPES OF NEURAL PROSTHETIC
TECHNOLOGIES AND HOW THEY WORK
I believe that the development of neural prosthetic
technology is well worth the time and energy of
bioengineers because it aids in the process of cognitive
rehabilitation which is extremely important although
sometimes overshadowed by physical rehabilitation and
recovery. Advancements in external prosthetics such as
prosthetic arms and legs are often discussed; however, they
are not necessarily the most crucial type of prosthetic. Often
the most tragically disabled patients are those who are
There are several different types of neural prosthetic
technologies used in cognitive rehabilitation, but one most
commonly used is the neural interface. “Neural interfaces
are systems operating at the intersection of the nervous
system and an internal or external device.” Research in
neural interfaces and development of neural prosthetics has
University of Pittsburgh, Swanson School of Engineering
October 30, 2012
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Erica Reiser
benefited patients by providing substantive aid to individuals
in need [1].
“One example is the development of cochlear implants,
which bypasses damaged hair cells in the auditory system by
direct electrical stimulation of the auditory nerve. In
addition, neural interfaces that allow deep brain stimulation
have been useful for some patients in reducing the motor
symptoms associated with Parkinson's disease” [1]. Deep
brain stimulation is used on patients whose medications do
not help them overcome debilitating symptoms such as
tremor, rigidity, and slowed movement. “Deep Brain
Stimulation uses a surgically implanted, battery-operated
medical device called a neurostimulator—similar to a heart
pacemaker and approximately the size of a stopwatch—to
deliver electrical stimulation to targeted areas in the brain
that control movement, blocking the abnormal nerve signals
that cause tremor and Parkinson’s Disease symptoms” [5].
Before the procedure, the exact location in the brain where
the symptoms are being produced is targeted so that the deep
brain stimulation system can be inserted. A thin insulated
wire which is connected to the neurostimulator is connected
to the brain through a small opening in the skull. After this
system is inserted, it works by electrical impulses being sent
from the neurostimulator into the brain. These impulses
interfere with and block the electrical signals that cause the
Parkinson’s disease symptoms.
Several other diseases have been targeted for neural
prosthetic applications as well. Individuals suffering from
stroke, spinal cord injuries, and amyotrophic lateral sclerosis
have benefitted from neural prosthetic devices that have
assisted them in improving their quality of life by helping
them to regain their cognitive functions such as their
communicative and motor skills.
One group in particular that has been dramatically
impacted by this new technology is injured soldiers. Today,
the rehabilitation of wounded armed service members is
higher than anyone could have imagined a few years ago.
Some soldiers who have gone through rehabilitation and
would like to return to active duty are sometimes even given
the opportunity to do so. “Robert Gailey, PT, PhD, associate
professor at the University of Miami’s Department of
Physical Therapy and director of the Functional Outcomes
Rehabilitation and Evaluation Laboratory at the Miami VA
Medical Center, has seen changes in military rehabilitation
protocols over the past few years, largely due to new
prosthetic technologies. He says, “The military recognized it
has a large investment in the soldiers, both in their education
and ability to serve, and that, if possible, it’s best to bring
them back into active service”” [6]. Amputee soldiers often
receive external prosthetics, but there are also a significant
number of soldiers who return home with traumatic brain
injury or post-traumatic stress disorder that are in need of an
internal prosthetic device. With the continual development
of neural prosthetics, I hope that we can help these soldiers
regain themselves and live happy, healthy lives.
ETHICS
The NSPE Code of Ethics has several key points that I
find most relate to the field of bioengineering and in
particular the development and use of neural prosthetic
technology. Under the first fundamental canon which is
“Hold paramount the safety, health, and welfare of the
public”, there is a point that states “If engineers' judgment is
overruled under circumstances that endanger life or
property, they shall notify their employer or client and such
other authority as may be appropriate” [7]. This pertains to
all types of engineering but I find it especially important in
the bioengineering field because it deals most closely with
the health of patients. Bioengineers sometimes perform
procedures that can be very dangerous and sometimes even
life-threatening, so it essential that there be a part of the code
that addresses this. Some of the procedures involved in
inserting neural prosthetic technologies are invasive and
therefore potentially dangerous, especially because they
involve the brain. It is important that clients know, before
endangering their lives, if the procedure is the best for their
circumstance.
Another area of the NSPE Code of Ethics is under the
canon which says “Perform services only in areas of their
competence” [7]. This seems obvious, but in the
bioengineering field, lines can be blurred between medical
doctors and engineers. Concerning the medical health of a
patient, an engineer should not overstep their boundaries to
make important decisions about a patient’s well-being. In
regard to neural prosthetics, engineers have the capability to
develop the technology and put it to use on a patient, but not
necessarily diagnose the patient. For example, if someone
has a disease that affects their cognitive abilities, the
engineer will develop the technology to help them out, but
not diagnose them with the disease or decide what treatment
is done.
Other than the general code of ethics for engineers, there
is also the BMES Code of Ethics for bioengineers. The two
parts of this code that I found to be most significant are the
“Biomedical Engineering Professional Obligations” and the
“Biomedical Engineering Health Care Obligations”. The
professional obligations section includes that engineers shall
“Use their knowledge, skills, and abilities to enhance the
safety, health, and welfare of the public” and “Strive by
action, example, and influence to increase the competence,
prestige, and honor of the biomedical engineering
profession” [8]. To me, enhancing the safety, health, and
welfare of people should be the main goal of bioengineers
which is why I favored this section. The goal of bioengineers
should not be to make money or to create ineffectual
technologies; it should be to help better people’s lives. If a
certain technology had only been created for profit, and it
wasn’t really needed then all the time and energy it took
developing that technology would have been wasted and
could have been used to create something beneficial.
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0011/0711 Section, L07
The second section I mentioned states that engineers
involved in health care activities shall “Regard responsibility
toward and rights of patients, including those of
confidentiality and privacy, as their primary concern” and
“Consider the larger consequences of their work in regard to
cost, availability, and delivery of health care” [8]. This
section has to do a lot with the medical side of
bioengineering and particularly relates to neural prosthetics
since it is in a professional, health care related field. Unlike
some other types of professional engineers, bioengineers
often have patients; therefore, the code of ethics regarding
these patients must be similar to any other profession that
deals with patients such as medical doctors and
psychologists. One particular point that is relevant to the
development and use of neural prosthetic devices is the
second point that talks about the consequences of work in
regard to cost, availability, and delivery of health care. Even
though bioengineers may have the knowledge and skills
needed to create a certain device doesn’t mean they have to
disregard the factors of cost, availability, and delivery of the
technology. These aspects are all very important when
figuring the best and most efficient way to incorporate a new
biomedical technology, such as neural prosthetic devices,
into a system.
In my opinion, these codes of ethics can be easily
followed and are generally followed by all professional
engineers. After researching these codes of ethics, I have
come to a conclusion that the continual development and use
of neural prosthetic technology is conducted under these
codes and there is no ethical reason to object to this
development. Neural prosthetics are designed to ameliorate
the health, safety, and welfare of the people and done so in a
fair and trustworthy way.
broader perspective of the issues that concern their
profession such as social, environmental, and economic
issues, but they haven’t” [9]. Although I haven’t has much
experience in the engineering world yet, I agree that having
the broad perspective is crucial for future engineers. In my
opinion, this writing assignment was a good way to
introduce students to these areas of social, environmental,
and economic issues because it forced us to learn about
engineering applications in the business world and what it
entails. Writing about the development and use of neural
prosthetic devices and how they are used in cognitive
rehabilitation made me realize that there are many social
aspects to bioengineering such as dealing with patients and
working with other engineers and professionals.
Incorporating the codes of ethics into the assignment was
also very informative because it taught me how
professionals engineers are expected to behave in.
One problem that the article discusses is that
“Engineering curricula are too focused on engineering
science and technical courses without providing sufficient
integration of these topics or relating them to industrial
practice. Programs are content driven” [9]. Although this
may be true for many engineering schools around the world,
at the University of Pittsburgh there seems to be a heavy
concentration on educating students on all aspects of
engineering, not just the technical ones, and this writing
assignment is an example of that. In reality, professional
engineers need writing skills as well as technical skills and
social skills to succeed. I highly recommend that engineering
schools incorporate assignments and projects like this one
into their curriculum if they haven’t already to better prepare
their students for future success.
CONCLUSION
EDUCATION
The use of neural prosthetic technology is and will be
continued to be used as an option in the process of cognitive
rehabilitation. One of the worst impairments that a person
can have is not being able to control their own mind or body,
but with the continual research and development of neural
prosthetics, recovery is becoming increasingly likely.
Helping those unfortunate enough to be stricken with
Parkinson’s disease or those who have been injured risking
their lives for their country should be the number one
priority to those who can help.
This is especially the case for bioengineers, whose job it
is to develop aids that help people in need and to use their
knowledge to solve real-world, biological problems like
these. Besides the examples provided in this paper, think
about how many other diseases and disorders there are that
could potentially be fixed using similar processes. Nothing is
more valuable than life itself, and not being able to fully live
is a travesty. Bioengineers have already made so many huge
strides with the success of several neural prosthetics
operations and they shouldn’t stop now especially since they
Writing this paper and researching neural prosthetics as
well as engineering ethical codes was a very eye-opening
and interesting experience for me. I learned so much about
neural prosthetics and their role in cognitive rehabilitation
which was fascinating, but more importantly I was exposed
to an example of an application of bioengineering to help me
understand more about what bioengineers actually do.
This pertains to researching the ethical codes also. I think
it is important to be familiar with the engineering code of
ethics and although I don’t feel that it necessarily needs to be
incorporated into the engineering education curriculum, I
think this assignment was very beneficial in providing an
understanding and overview of the codes. This assignment
familiarized me with the code of ethics and how it is relevant
in engineering practice and I recommend that it be continued
and shared with other engineering programs.
A recent article on engineering education discusses
several problems within the engineering education system.
The article argues that engineering students “need to have a
University of Pittsburgh, Swanson School of Engineering
October 30, 2012
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Erica Reiser
are doing it in an ethical manner. It is important that
engineering students like me learn about these codes of
ethics and how they are followed in the professional
engineering world. This is why I recommend that this
project be included in all freshman engineering education
curriculums. I have benefitted greatly from researching and
writing about the codes of ethics and applications of
biotechnology. The bioengineering field is one of the most
relevant and essential, which is why I chose to write about it
and why I aspire to become a bioengineer.
[8.] "BMES | Code of Ethics." BMES | Code of Ethics. N.p.,
n.d. Web. 30 Oct. 2012.
<http://www.bmes.org/aws/BMES/pt/sp/ethics>.
REFERENCES
AKNOWLEDGEMENTS
[9.] Mills, Julie E., and David F. Treagust. "Engineering
education—Is problem-based or project-based learning the
answer?." Australasian Journal of Engineering Education 3
(2003): 2-16.
<http://champs.cecs.ucf.edu/Library/Journal_Articles/pdfs/E
ngineering%20Education.pdf>.
[1.] "Neural Interfaces Program." : National Institute of
Neurological Disorders and Stroke (NINDS). N.p., n.d.
Web. 08 Oct.2012.
<http://www.ninds.nih.gov/research/npp/index.htm>.
I wish to express my gratitude towards Professor
Bateman Newborg and Dr. Bursic for giving me all of the
essential tools and information that made this assignment
possible. Thank you to the library staff of the University of
Pitsburgh for helping inform me about the university’s
online library system. Lastly, I would like to thank Jennifer
Greene for answering, to the best of her ability, all of my
questions regarding this paper.
[2.] Burns, Lauren. "Cognitive rehabilitation following
traumatic brain injury." CME: Your SA Journal of CPD 26.3
(2008): 160+. Academic OneFile. Web. 8 Oct. 2012.
<http://go.galegroup.com/ps/i.do?id=GALE%7CA20448222
8&v=2.1&u=upitt_main&it=r&p=AONE&sw=w>.
[3.] Whyte J, Hart T, Laborde A, Rosenthal M.
Rehabilitation of the patient with traumatic brain injury. In:
Delisa JA, Gans BM, eds. Rehabilitation Medicine
Principles and Practice, 3rd ed. Philadelphia: LippincottRaven, 1998: 1195-1196.
[4.] Center for Health Workforce Studies. The Impact of the
aging population on the health workforce in the United
States. School of Public Health, University at Albany; 2006.
<http://www.sciencedirect.com/science/article/pii/S1350453
308001641#>.
[5.] National Institute of Neurological Disorders and Stroke
(NINDS). N.p., n.d. Web. 08 Oct. 2012.
<http://www.ninds.nih.gov/disorders/deep_brain_stimulation
/deep_brain_stimulation.htm>.
[6.] Waldrop S, Wojciechowski M. The "Bionic" Warrior:
Advances in Prosthetics, Technology, and Rehabilitation.
PT: Magazine Of Physical Therapy [serial online]. April
2007;15(4):60-66. Available from: Academic Search
Premier, Ipswich, MA. Accessed October 8, 2012.
<http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=
52807fcc-908b-4d17-8577e6cf9bbbe8d1%40sessionmgr115&vid=2&hid=110>.
[7.] "NSPE Code of Ethics for Engineers." NSPE Code of
Ethics for Engineers. N.p., n.d. Web. 30 Oct. 2012.
<http://www.nspe.org/Ethics/CodeofEthics/index.html>.
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0011/0711 Section, L07
University of Pittsburgh, Swanson School of Engineering
October 30, 2012
1