Puschel Sorensen undergoing physical therapy using Cyberdyne's hybrid assistive limb, left, and with her grandson while still in a wheelchair.
Puschel Sorensen first noticed something was wrong when her fingertips began to tingle. Later that day, she grew weak and fell.
It picked up small electrical impulses on her skin's surface and turned them into full movement in her legs.
Her family rushed her to the doctor, where she received the devastating diagnosis of Guillain-Barré Syndrome -- a rare and rapidly progressing autoimmune disorder that attacks the myelin sheath covering nerves.
Sorensen, a once-spry grandmother in her late fifties, spent 54 days in intensive care in 2018. When she was finally transferred to a rehab facility near her home in Florida, she was still on a feeding tube and ventilator, and was paralyzed from the neck down. Progress with traditional physical therapy was slow.
Sorensen in the hospital after her diagnosis of Guillain-Barré syndrome.
And then everything changed. Sorensen began using a cutting-edge technology called an exoskeleton to relearn how to walk. In the vein of Iron Man's fictional power suit, it confers strength and mobility to the wearer that isn't possible otherwise. In Sorensen's case, her device, called HAL – for hybrid assistive limb -- picked up small electrical impulses on her skin's surface and turned them into full movement in her legs while she attempted to walk on a treadmill.
"It was very difficult, but super awesome," recalls Sorensen, of first using the device. "The robot was having to do all the work for me."
Amazingly, within a year, she was running. She's one of 38 patients who have used HAL to recover from accidents or medical catastrophes.
"How do you thank someone for giving them back the ability to walk, the ability to live your life again?" Sorensen asks effusively.
It's still early days for such exoskeleton devices, which number perhaps a few thousand worldwide, according to data from the handful of manufacturers who create them with any scale. But the devices' ability to dramatically rehabilitate patients like Sorensen highlights their potential to extract untold numbers of people from wheelchairs, and even to usher in a new paradigm for caregiving – one of the fastest growing segments of the U.S. economy.
"I've been a physical therapist for 16 years, and (these devices) help teach patients the right way to move in rehabilitation," says Robert McIver, director of clinical technology at the Brooks Cybernic Treatment Center, part of the Brooks Rehabilitation Hospital in Jacksonville, Fla, where Sorensen recovered.
Another patient there, a 17-year-old named George with a snowboarding injury that paralyzed his legs, was getting around with a walker within 20 sessions.
As patients progress in their recoveries, so does exoskeleton technology. Jack Peurach, CEO of Ekso, one of the leaders in the space, believes within a decade they could resemble an article of clothing (a "magic pair of pants" is his phrase). They also may become inexpensive and reliable enough to transition from a medical to a consumer device. McIver sees them eventually being used in the home on an ongoing basis as a personal assistive device, much like a walker or cane, to prevent falls in elderly people.
Such a transition "certainly could eventually lessen the need for caregivers," says Sharona Hoffman, a professor of law at Case Western University in Cleveland who has written extensively on aging and bioethics. "We have a real shortage of caregivers, so that would be a good thing."
Of course, having an aging and disabled population using exoskeletons in much the same way as an Apple Watch raises issues of its own.
Dr. Elizabeth Landsverk, a California-based geriatrician and founder of a company that performs house calls for elderly patients, believes the tech holds some promise in easing the burden on caregivers, who sometimes have to lift or move patients without assistance. But she also believes exoskeletons could become overhyped.
"I don't see robotics as completely replacing the caregiver," she says. And even if exoskeletons became akin to articles of clothing, she is skeptical of how convenient they could become.
"It's hard enough to get into support hose. Would an older person be able to get in and out of it on their own?" she asks, noting that a patient's cognitive levels could pose a huge barrier to donning such a device without assistance.
If personal exoskeletons did wildly succeed, Hoffman wonders whether they would leave the elderly more physically mobile yet also more socially isolated, since caregivers or even residing in an assisted living facility may no longer be required. Or, if they were priced in the hundreds or thousands of dollars, he worries that the cost would exacerbate social inequalities among the elderly and disabled.
"It's almost like a bad dream that [my illness] happened."
With any technology that confers superhuman ability, there's also the question of appropriate usage. Even the fictional Power Loader in the movie Alien required an operator's license. In the real world, such an approach would likely pay dividends.
"We would have to make sure physicians are well-trained in these devices, and patients have a way of getting training to operate them that is thorough and responsible," Hoffman says.
But despite some unresolved questions, it is a remarkable achievement to be able to give people back their lives thanks to new technology.
"It's almost like a bad dream that [my illness] happened," says Sorensen, who managed to walk in her daughter's wedding after her recovery. "Because now everything is pretty much back to normal and it's awesome."
A recent study in The Lancet Oncology showed that AI found 20 percent more cancers on mammogram screens than radiologists alone.
Published in The Lancet Oncology, the study analyzed the scans of 80,000 Swedish women with a moderate hereditary risk of breast cancer who had undergone a mammogram between April 2021 and July 2022. Half of these scans were read by AI and then a radiologist to double-check the findings. The second group of scans was read by two researchers without the help of AI. (Currently, the standard of care across Europe is to have two radiologists analyze a scan before diagnosing a patient with breast cancer.)
The study showed that the AI group detected cancer in 6 out of every 1,000 scans, while the radiologists detected cancer in 5 per 1,000 scans. In other words, AI found 20 percent more cancers than the highly-trained radiologists.
Scientists have been using MRI images (like the ones pictured here) to train artificial intelligence to detect cancers earlier and with more accuracy. Here, MIT's AI system, MIRAI, looks for patterns in a patient's mammograms to detect breast cancer earlier than ever before. news.mit.edu
But even though the AI was better able to pinpoint cancer on an image, it doesn’t mean radiologists will soon be out of a job. Dr. Laura Heacock, a breast radiologist at NYU, said in an interview with CNN that radiologists do much more than simply screening mammograms, and that even well-trained technology can make errors. “These tools work best when paired with highly-trained radiologists who make the final call on your mammogram. Think of it as a tool like a stethoscope for a cardiologist.”
AI is still an emerging technology, but more and more doctors are using them to detect different cancers. For example, researchers at MIT have developed a program called MIRAI, which looks at patterns in patient mammograms across a series of scans and uses an algorithm to model a patient's risk of developing breast cancer over time. The program was "trained" with more than 200,000 breast imaging scans from Massachusetts General Hospital and has been tested on over 100,000 women in different hospitals across the world. According to MIT, MIRAI "has been shown to be more accurate in predicting the risk for developing breast cancer in the short term (over a 3-year period) compared to traditional tools." It has also been able to detect breast cancer up to five years before a patient receives a diagnosis.
The challenges for cancer-detecting AI tools now is not just accuracy. AI tools are also being challenged to perform consistently well across different ages, races, and breast density profiles, particularly given the increased risks that different women face. For example, Black women are 42 percent more likely than white women to die from breast cancer, despite having nearly the same rates of breast cancer as white women. Recently, an FDA-approved AI device for screening breast cancer has come under fire for wrongly detecting cancer in Black patients significantly more often than white patients.
As AI technology improves, radiologists will be able to accurately scan a more diverse set of patients at a larger volume than ever before, potentially saving more lives than ever.