Machines That Work Miracles

By Ann Blackman/Washington

David Bristol knows all about hardship -- and overcoming it. The 42-year-old government attorney, whose cubbyhole of an office is just across the street ! from the White House, was born with cerebral palsy. When he started his job with the U.S. Office of Thrift Supervision, his hands shook so much that it was impossible for him to type reports by himself.

But that was before technology lent him a hand. Watch him now. Taking a seat at his word processor, Bristol dons a headset with a microphone and starts to dictate. "This is a test of my new computer program," he says. As he talks, his words pop up on the screen. "This program allows me to dictate my weworts." Bristol spots the spelling mistake and grimaces. "Oops," he says into the microphone. The machine understands the word oops, backs up one word and automatically goes into spell-check mode. Five words sounding like weworts appear on the screen, including No. 3, "reports." Bristol snaps the command "Choose 3," and the word reports replaces weworts.

The $9,000 system, called DragonDictate, is not just a curiosity. It is on the cutting edge of technology for the 43 million Americans with some form of physical disability. Equipment that uses computers, lasers and lightweight composite materials is enabling the disabled to overcome once insurmountable barriers and participate more directly in everyday life. This exciting -- but still expensive -- technology promises to open whole new vistas to those who have trouble seeing, hearing, walking, talking and even breathing.

People without the use of their arms or legs can now rely on computerized "sip and puff" machines. With light puffs into a plastic straw, users can switch on the TV and change its channels, telephone a friend and play computer games. Electronic nerve stimulars are helping men with severe spinal-cord injuries to father children; penile implants are enabling men who cannot sustain an erection to make love. Wheelchairs that stand up make it possible for the disabled to greet someone face-to-face and to take a book from a shelf. Laptop word processors that "talk" give individuals with no voice a way to communicate. Materials designed by the National Aeronautics and Space Administration reduce the average weight of a crippled person's leg braces from 6.4 kg (14 lbs.) to .45 kg (1 lb.).

"When I entered this field 17 years ago, we had only low technology: drab, durable medical equipment mostly made of stainless steel," says Jan Galvin, director of assistive technology at the National Rehabilitation Hospital in Washington. "In the past five years, there has been a real explosion of devices, and the next 10 years will be really amazing. This technology is changing everything, and not just for people with disabilities. By the year 2000, we will all be talking into our word processors instead of typing."

Galvin is one of thousands of specialists -- doctors, scientists and engineers -- working on designs to meet the needs of today's disabled population. "We used to look at people who were disabled as shut-ins," she says. "Not anymore. Computers, new materials and new attitudes have revolutionized our industry. If you can move one muscle in your body, wiggle a pinkie or twitch an eyebrow, we can design a switch to allow you to operate in your environment."

Consider the case of Eileen Carlton, 65, of Danvers, Mass., who had a stroke five years ago and lost almost all ability to speak. Today, working with a visual-communications computer program designed by linguists at the Tufts University School of Medicine, Carlton uses symbols to construct sentences, so that she can communicate with her family and friends. "This has opened a whole new world to her," says her son Bill, 39. "Writing is too complicated for her, but she knows what she wants to say. So instead of spending the rest of her life playing charades, she uses symbols on the computer to tell us that she is visiting a neighbor or wants to go shopping. She's regained some control over her life."

Robert Cushmac, 16, of Alexandria, Va., was paralyzed from the neck down in a car accident six years ago. Now Bob gets around in a power wheelchair activated by a chin-controlled joystick. He is mobile enough to attend T.C. Williams public high school, where he is an honor student and a member of the French and Latin clubs. Unable to breathe without assistance, Bob has been fitted with an Avery Diaphragm Pacer, which uses a battery-powered transmitter to send electric impulses to his phrenic nerve. This causes his diaphragm to contract, simulating normal breathing. "Without this technology, Bobby wouldn't be alive," says Dr. Alan Fields, associate director of critical care at Children's Hospital in Washington.

Some of the new work is being done on old technology. "The old prosthesis was made of willow wood and was very heavy," says Kyle Scott, director of orthotics and prosthetics at the National Rehabilitation Hospital. "Now we're using polyesters and acrylic resins." Scott designed an artificial foot for Jeff Wycliffe, who had his left leg amputated just below the knee after a motorcycle accident three years ago. With the $7,000 Flex Foot, Wycliffe, 24, not only walks without a limp, but also jogs, bats and plays volleyball and tackle football. In some ways, his replacement foot seems better than the original. "When I come down on it from a jump, I have a lot of spring," says Wycliffe.

The Du Pont Co. produces an acetal resin used to make the Seattle Foot, a flexible, lifelike prosthesis. Among well-satisfied customers is Bill Demby, a former high school basketball player who had both legs amputated below the knee after being caught in a rocket attack in Vietnam. In a widely broadcast Du Pont TV commercial, Demby is shown taking a jump shot in a school-yard game.

Perhaps the most remarkable devices are the computerized vans specially designed for disabled drivers. One owner is Pulitzer-prizewinning columnist Charles Krauthammer, who was paralyzed from the chest down in a diving accident 19 years ago. After logging 85,000 miles in one of these vans, Krauthammer just bought a customized $53,000 Dodge Caravan designed by Les Schofield of San Antonio's International Mobility Products. Krauthammer calls Schofield the "Chuck Yeager of rehab technology."

To open the new van, Krauthammer holds a magnet up to a tail light, activating a door lock. The door slides open, the whole van lowers to a few centimeters off the ground, and a ramp slides into place. Krauthammer rolls his wheelchair onto the ramp and maneuvers it into the van. Once inside, his wheelchair locks into place and becomes the driver's seat. His right hand operates a horizontal steering wheel that takes almost no effort to turn; his left hand rests on a lever that activates a vacuum pump that in turn operates both the gas and brake controls. When the lever is pushed toward the window, the van accelerates; when it is pushed toward the center of the vehicle, the van brakes.

The main drawback to such a vehicle -- and to most of the other new technology -- is its cost. Because 68% of disabled people are unemployed, many cannot afford the equipment, and insurance companies often do not cover the devices. "If there's no money available, there's no technology," says Dr. Fields. "It's a question of who pays."

The complex equipment can also be fragile and costly to maintain. Bob Cushmac's Diaphragm Pacer once shut down when he was caught in the rain. Another time it stopped when someone spilled coffee on it. He might have suffocated, but a nurse is with him at all times to provide help. Says George Cushmac, Bob's father: "It's lovely stuff, but it comes with the price of having to repair it when it breaks down. This isn't like owning a Maytag washer with a serviceman waiting to be called."

One reason for the high prices is that the severely disabled population is relatively small and divided into groups with specific needs. Since the market for many of the products is limited, companies cannot produce enough of them to reduce the price to a moderate level. And some promising technologies may not interest any manufacturers. The Massachusetts Institute of Technology, for example, has been experimenting with a computerized brace that controls muscle tremors in people with multiple sclerosis and other diseases. So far, no company has agreed to market the device.

Despite such problems, the technological advances are undeniably dramatic, and an irreversible revolution is under way. It is up to scientists, researchers, doctors, insurance companies and governments to work together to provide America's disabled with more independence, more freedom and more hope -- at a price they can afford.