Medical robotic devices today are used to
perform complex surgery, replace missing limbs, assist in
rehabilitation, and deliver nutrients to precise locations
inside the human body. Exciting innovations in robotics are
allowing people to overcome health problems in ways that were
never before thought possible. Surgeries on the battlefield
can be performed with a remote control from half way around
the world, patients are responding to robotic therapists, and
paraplegics are walking with the assistance of a robotic
backpack. Research and Development (R&D) is spearheading
the efforts. Federal and State research and development tax
credits are available to shoulder the costs.
The Research &
Development Tax Credit
Enacted in 1981, the federal Research and
Development (R&D) Tax Credit allows a credit of up to 13
percent of eligible spending for new and improved products and
processes. Qualified research must meet the following four
criteria:
New or improved products,
processes, or software
Technological in nature
Elimination of uncertainty
Process of experimentation
Eligible costs include employee wages, cost of supplies, cost
of testing, contract research expenses, and costs associated
with developing a patent. On January 2, 2013,
President Obama signed the bill extending the R&D Tax
Credit for 2012 and 2013 tax years. A similar extension is
expected for 2014.
Surgical Robotics
Intuitive Da
Vinci
To remove a
gallbladder or get to another organ, surgeons typically used
conventional hand tools. Today, many sit at a computer
console, guiding tiny robotic arms which are downscaled to
enter the patient's body through small incisions in a way that
traditional methods could not accomplish. Minimally invasive
surgery robots such as the Da Vinci Surgical Systems, made by
Intuitive Surgical Inc. of Sunnyvale, California, translate a
surgeon's hand movements on the operating console to reduced
scale micro-movements of tiny instruments inside the patient's
body while the surgeon tracks his/her movements on an
amplified video screen of the surgery area. The effect of the
machine is to give the surgeon more control and visibility in
a minimally invasive environment. An NYU surgeon noted, "It's
as if I've miniaturized my body and gone inside the patient."
Proponents say the surgery involves less scaring, less pain,
less blood loss, fewer complications and shorter hospital
stays than conventional surgery, which often involves larger
incisions. Intuitive is consistently updating their machine as
well. The latest version, The Da Vinci Xi system is the fourth
version of the surgical robot since the year 2000. The
recently FDA approved machine costs about the same as older
models, but includes overhead surgical arms which make it
possible to reach all parts of a person's anatomy without
repositioning the machine during surgery. Still, the machine
is costly starting at $1.85 million But, Intuitive says that
even if the robot costs more money it brings in extra revenue
because many patients will only go to a hospital that uses the
robot. Intuitive is constantly innovating its product as well.
In 2013, it had R&D expenses of $167,700,000.
The chart below shows the R&D expenses for Intuitive
Surgical Inc. and Stryker Corp,. another leading publicly
traded surgical robotics company, both discussed above:
*Reflects combined Mako & Stryker R & D
Surgical robots such as the Da Vinci made by US company;
Intuitive Surgical and the ZEUS, made by US Computer motion
are already widely in use. Since 2000, 1,370 U.S. hospitals
have purchased at least one of the Da Vinci robots.
The military wants
to use robotic operating machines similar to the Da Vinci to
perform surgery on wounded Veterans from a safe distance.
Blake Hannaford and colleagues at the University of
Washington, in Seattle have come up with a system small enough
to fit in the back of an armored vehicle. Implementing this
machine could solve a large problem, namely the lack of
skilled surgeons on the battlefield available to perform
complex surgeries.
Telepresence
In 2013, iRobot introduced the RP-VITA,
(Remote Presence Virtual + Independent Telemedicine Assistant)
-- the medical version of the Ava which is commonly used in
business settings (Discussed more thoroughly in R & D Tax
Aspects of Service Robotics) The 5-foot, iPad-controlled robot
is a rolling webcam that can navigate hospital floors fully
autonomously while projecting a doctor's face and voice on a
monitor for interaction with patients from half way around the
world. It has a map that is integrated with hospital records
allowing it to find patients on its own, so that a doctor can
simply command it to visit a certain hospital room for a
visit. This telepresence technology makes doctors more widely
available, thus increasing doctor/patient interaction. Not
only does technology like this enable live video conferences,
but it also allows surgeons to operate on patients perhaps
from anywhere in the world, with more precision and less
scaring than traditional methods.
Prosthetics
The i-Limb Hand was originally launched by
Touch Bionics Inc. (Mansfield, Massachusetts) in 2007 as
perhaps the world's most advanced and versatile prosthesis
available. With over 20 years of research and development
behind it, the i-Limb is designed to move and look like a
natural hand. The company says its product -- "offers more
dexterity and moves more like a natural hand than any other
powered prosthetic hand." It allows users to program a number
of different grip types that can be triggered by different
muscle movements. For people that use certain objects
repeatedly, the company has introduced "grip chips" which can
be stuck to objects in order to activate a certain grip type
when the hand comes into contact with the object. For
instance, a user could stick a "grip chip" to a keyboard so
that the prosthetic hand always uses the appropriate grip
strength when typing. It is this type of innovation which
continues to drive the industry worldwide.
Ekso Bionics
Ekso is a San Diego based company that
makes robotics designed to help disabled people or make the
human body superhuman. Its name originates from the word
"exoskeleton". The company was originally financed by the
military in a collaborative effort with the University of
California, Berkeley and Lockheed Martin to develop the "Hulk",
an exoskeleton which allows soldiers to carry heavy equipment
over mixed terrain.
More recently Esko
has been designing bionic suits for physical therapists which
help their patients get out of wheelchairs and make use of
their lower bodies so their muscles do not deteriorate. The
titanium/aluminum suit costs about $140,000 and includes
several levels of difficulty so patients can reduce the
assistance provided by the suit as they make progress. The
product looks like science fiction, but offers new hope to
many veterans paralyzed by spinal cord injuries. Soldier
Socks, a Stamford, Connecticut based nonprofit company plans
to purchase and donate 10 suits to Veterans they expect will
use them full time, rather than like an exercise bike which
might sit out and gather dust in the garage.
The machine is battery operated and the settings can be
set so that either: 1) the therapist controls using a button
for each step, 2) the patient controls using a button on the
crutches or 3) the patient controls simply by shifting his/her
weight. With recent advances in carbon fiber durability,
battery technology and robotic control systems the
functionality of the device is becoming increasingly
practical. Still, the major obstacle is its price. At $140,000
the machines are specialized and scarce. Nonetheless, wider
use by the military coupled with research and development
aimed at efficiency might help bring costs down. Russ Angold a
founder and chief technology officer at the company envisions
a day where one is -- "able to walk into a sporting goods
store, like an REI, and pick up an exoskeleton . . . [t]hey're
like the jeans of the future."
Rehabilitation robots
Perhaps the most extensive use of robotic
technology for medical applications has been in rehabilitation
robotics. The MEDi robot (short for Medicine and Engineering
Designing Intelligence) by the French company Aldebaran
Robotics is a robot designed to help ease anxiety in children
during routine medical procedures. The robot greets children
with a high-five, collects toys and asks questions to help
divert attention. During a flu shot the humanoid asks a child
to blow on a toy which it describes as dusty. While the child
exhales the nurse timely injects the needle. Researchers at
Alberta Children's hospital in Calgary, Alberta conducted a
study in which they performed medical procedures on 57 boys
and girls divided into segments with and without the
assistance of robots. What they found was that the children in
the robot group were significantly more cooperative and
experienced less pain and distress than the children in the
other group. This is because the robot acts as a decoy during
the process. The U.S. Department of Veteran Affairs uses
robot-assisted training to help people with moderate to severe
weakness in their extremities. Their research and development
includes using robotics to develop and test new rehabilitation
therapies in order to empower Veterans and other disabled
Americans throughout their lives to fight back against
disability and improve cardiovascular health.
University Research
Carnegie Mellon
At the Medical
Robotics Technology Center at Carnegie Mellon (The Robotics
Institute) researchers are innovating in areas such as
computer-assisted surgery, smart medical and diagnostic tools,
rehabilitative and prosthetic devices, assisted living,
preventive healthcare equipment and continuous healthcare
process improvement. Their most recent innovation involves the
HeartLander which is a miniature mobile robot designed to
facilitate minimally invasive therapy to the surface of the
beating heart. Under physician control, the robot enters the
chest through a tiny incision below the sternum, adheres to
the epicardial surface of the heart, autonomously navigates to
the specified location, and administers the therapy.
MIT
At MIT, researchers
are working with Boston Marathon bombing survivor, Adrianne
Haslet-Davis, a professional ballroom dancer who lost part of
her leg in the attack. The group has spent the past 200 days
developing a new prosthetic limb for Adrianne that will allow
her to dance again. This is consistent with much of the
Universities' biometric robotics research which focuses on
designing robots that function like humans do. But before
figuring out how to make a robot arm or leg maneuver a certain
way scientists must figure exactly how and why the human body
operates the way it does in order to translate the process to
the robots. Thus, much of the research focuses on the
musculoskeletal and neuromuscular systems.
Nanorobots
Here the concept is to develop billions of
microscopic robots and set them to work within the body. They
could be sent out to fix broken bones, deliver medication to a
certain place or exterminate cancer cells. They are largely in
the research-and-development phase but scientists from Harvard
have already discovered a way to make the nanorobots bind to
leukemia and lymphoma cells and then self-destruct, killing
the cancer cells in the process. . These innovative efforts
involve the use of bio-engineering to construct synthetic DNA
molecules using predictable chemical rules. Instructions to
self-destruct are then sent out by altering the environment
around the bots which causes them to have a natural chemical
reaction. But, as innovative as this may seem some developing
ideas are far more ambitious. Google's director of engineering
Ray Kurzweil has this to say: "We'll have millions - billions
of blood cell-sized computers in our bloodstream in the 2030's
keeping us healthy, augmenting our immune system, also going
into our brain, putting our neo-cortex on the Cloud," This is
consistent with Google and the rest of the industries
aggressive stance on robotics innovation.
Robotic Pills
Google Inc.'s venture capital unit has
recently backed an ingestible robotic-like injection-pill that
punctures the small intestine with tiny hollow needles made of
sugar. The sugar-needles then safely deliver drugs so the
patient does not have to poke him/herself with a syringe every
day. Such an idea is still largely in the developmental phase
because stomach acids break down proteins in the pills before
they reach the small intestine. Recent advancements in
scientific development have stirred up ideas that would have
been unimaginable just a few years ago. Mir Imran, the
brainchild of the drug says clinical studies have shown that
his robotic pill can boost drug absorption at least as high as
syringes can. The next step is intensive trial and error
testing with pharmaceutical companies. Proteus Digital Health
Inc. of Redwood California has recently received FDA clearance
to put sensors in pills in order to help doctors determine how
much of the drug patients have taken.
Conclusion
The medical industry is experiencing
exciting innovations in robotics. Research & Development
is driving the efforts. Taxpayers should be aware of Federal
and State tax incentives which are available to help shoulder
the costs of innovation.
