A recent competition in Switzerland saw people with paraplegia and other motor disabilities battle it out using hi-tech wheelchairs, exoskeletons, robotic arms and mind control. Amazing stuff — but what will it take for such technologies to be useful in everyday lives?

Greg McClure lost the use of his legs in a motorbike accident in 1993. But in October this year, he represented Team Sydney in an international cycling race — thanks to electrodes that stimulated his leg muscles to push the pedals.

Specialised bikes like his were just one of the technologies for people with disabilities that were put to the test at the world's first Cybathlon in Zurich.

Loading...

Greg's pedal power came from electrodes firing in a set sequence, informed by sensors that detected the angle of the pedals.

But it took Greg a long time to get to this point, because his muscles had to be in good condition to be stimulated by the electrodes.

"I've been training now for over 20 years," says Greg, who has been building up his muscles on stationary versions of bikes using this technology, called Functional Electrical Stimulation (FES).

Despite a disappointing setback due to battery problems, Greg managed to come 7th in the FES Bike Race at the Cybathlon.

He took eight minutes to complete the 750-metre circuit while some younger, fitter competitors did it in half the time.

The US winner, who was actually older than Greg, took just three minutes — but this was with the aid of electrodes that were actually implanted.

"You get more power and less fatigue with implant technology," says Cybathlon initiator Professor Robert Riener of ETH-Zurich.

But for Greg, who "grew up on bikes", getting the chance to ride again has been worth it all.

As he says in a promotional video for the Cybathlon:

"I feel like I'm free and I don't have to rely on my arms and hands to move around and it's good to use the legs again … It's a great feeling within."

Robotic limbs, mind control and exoskeletons

A reality check suggests we're a long way off Terminator-type technology ( Supplied: Alessandro Della Bella )

In another Cybathlon competition, amputees used prosthetic arms to carry out tasks like changing a light bulb, opening a can and putting pegs on a line.

Meanwhile, competitors with quadraplegia ran virtual races using technology that decoded their brain signals. Using their thoughts alone, they got avatars to accelerate, and to jump over — or roll under — obstacles, in a specially-designed computer game.

Professor Riener says the hope is once such brain-computer interfaces become more reliable and robust, they will allow people to control wheelchairs, kitchen devices and even cars.

In one race, people with prosthetic legs had to repeatedly get up off a couch and sit back down again ( Alessandro Della Bella )

Other Cybathlon races involved competitors with above-knee amputations or paraplegia tackling an obstacle course using prosthetic legs or other technologies .

These included wheelchairs that looked more like tanks or four-wheel drives, navigating bumpy surfaces and going up and down ramps — and even stairs.

But according to Professor Riener, the competition showed there is still a long way to go with robotics and technology such as exoskeletons.

He says exoskeletons in particular — motorised frames that allow people with paraplegia to walk upright with the aid of walking sticks — proved exhausting to manipulate.

Exoskeletons help people with paraplegia to walk upright but they are tiring to use ( Alessandro Della Bella )

Technology for everyday?

Disability researcher Professor Simon Darcy from University of Technology Sydney (UTS) is impressed by the technologies that were on show in Zurich, but warns that these devices face many more hurdles before they will prove useful in an everyday setting.

"The news-grabbing visionary gee-whizzery that is embedded in engineering, computers and biomed tech is awesome," says Professor Darcy, who has himself been living with a disability for the past 32 years and relies on a powered wheelchair.

"But I'm interested in what difference it will make in the life of the person?"

An exoskeleton may help someone with paraplegia walk around, and see eye to eye with people. And it may even help them realise their dreams of, say, walking their beloved down the aisle, says Professor Darcy: "You've got no idea how overwhelming the able-bodied norm is."

But, he says, an individual may have other priorities before walking.

"Everybody thinks that making paraplegics walk again is the best thing since sliced bread but if you ask the average paraplegic or quadriplegic what would they would prefer, it would be bladder, bowel, sexual function before walking."

Could people one day be able to control wheelchairs, kitchen devices and even cars with their brain signals alone? ( Nicola Pitaro )

Professor Darcy says brain-computer interfaces could improve the independence of anyone who cannot use their limbs, and an all-terrain wheelchair would be a boon for a less disabled person who fancies heading out to a national park.

But such a machine would also need to be transportable.

And, according to Team Sydney's biomedical engineer and exercise scientist, Dr Che Fornusek, some teams at the Cybathlon struggled to fit their powered wheelchairs into the back of vehicles.

"Even the ones that didn't look like tanks were quite large," says Dr Fornusek of the University of Sydney. "That speaks to the question of how practical these devices are."

"The wheelchair I've got I can pull it all apart in a matter of seconds and get it into the car," adds Greg.

Making a difference



And while the FES bike he raced in may be good for sport or recreation, Greg doesn't see it as a substitute for his wheelchair.

"It doesn't give you the same freedom.

"Wheelchairs are more manoeuvrable into shops and around the home. It's easier to live in a wheelchair."

He says the same applies to the exoskeletons demonstrated at Cybathlon: a person might now be able to walk, but their arms would be tied up with walking sticks when using the technology.

The winning prosthetic arm had a hand that looked more like a claw ( Getty Images: Michael Buholzer / Stringer )

For now, at least, it seems the most useful tech is not necessarily the most advanced.

When it comes to prosthetic arms, the Cybathlon showed a comparatively simple claw-like arm was better than sophisticated-looking robotic hands.

"It just goes to show that robotics is not well developed yet," says Professor Riener.

He says it will probably take "many decades" to make robotic technology really useful and convenient.

"There is no 'terminator'. Hollywood is wrong. We need further development … That's why we need the Cybathlon."

Team Sydney's Dr Fornusek said he saw evidence at Cybathlon that robotic hands with lots of moving parts were vulnerable to mechanical failure.

"One of the guys was hammering his finger back in."

Loading...

And while the Cybathlon was intended to test the everyday usefulness of technologies, in reality races were designed to cope with a specific course in each case. Real life is a bit more unpredictable, says Dr Fornusek.

He says the event was also often a test of the general fitness of the competitors, and their ability to endure what was required of them.

"For example, using exoskeletons required a lot of upper body strength, and the average disabled person may not have that."

On the topic of fitness, Dr Fornusek adds it is important that new technologies don't help disabled people to the point that their remaining functional muscles become too passive.

"People with paralysis generally get a higher rate of metabolic disease and diabetes than the non-disabled populations," he says. "Robotics can do a lot for people, but it could mean they become too inactive, and this would be bad for their overall health."

Weighing cost and benefit

Every technology will have a cost and a benefit, says Professor Darcy. And each individual will have to weigh this up given their particular circumstances.

Apart from the obvious question of affordability, there's the time involved in, say, training to ride an FES bike, or the risks and commitment involved in implanting technologies.

"What you need to do to engage in new technologies can be quite intrusive on your life," he says.

For example, despite having a lot of surgery, Professor Darcy chose to forgo having wires and a control box implanted in his body to improve his grip.

"I knew there would be follow-up surgeries and replacements."

Instead, he relies on design to get by — such as a modified water bottle holder that he can hook his finger through to take a drink.

And he has written numerous books and papers using speech recognition software.

Environmental design

How wheelchair friendly is your railway station. This one has a ramp to get over the railway station but steps to and from the platform ( Supplied: Anna Salleh )

Professor Darcy says regardless of how amazing "assistive technology" is, it should always be seen as "icing on the cake".

"It's much better if the environment is more welcoming of people."

For example, ramps and lifts and other wheelchair-friendly design features should be considered the norm.

"If you've got a universally designed environment, you don't need chairs that climb stairs."

On this front, he says, there is some work to be done.

"Only 18 per cent of train stations in NSW are wheelchair accessible."

Greg agrees.

While he's seen a big improvement in wheelchair accessibility over the years, his work on the local council's access committee draws his attention to ongoing problems.

"In one place up here you couldn't cross the road because there was no access to kerbs, no ramp to a traffic island and no wheelchair recess," he says. "So it was quite dangerous."

"There's still a little bit more to do."

Hear more about this story on RN Life Matters