Transcript

7.3.25 · Smithsonian Magazine

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Speaker 1: Welcome. This is Rebecca Shore for Radio Eye and today
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I will be reading the Smithsonian magazine dated July August
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twenty twenty five. As a reminder, RADIOI is a reading
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service intended for people who are blind or have other
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disabilities that make it difficult to read printed material. Please
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join me now for the first article titled can a
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Medical device Restore Your Balance? Nearly two million people worldwide
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have lost the simple ability to feel steady. Now, researchers
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have developed an experimental medical implant that promises to restore
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the sensory machinery responsible for balance. By Sushma Sabramanian. People
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with thestibular disorders have trouble maintaining balance or other problems
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with vision, touch, and body positioning. Twenty percent of people
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experience vertigo at some point in their lives. A new
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medical device works like a cochlear implant and has shown
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impressive results treating vestibular disorders For almost four years, Richard
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Stephens's brain felt as if it were jiggling around inside
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his skull. If he turned his head, his vision wobbled
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for a few seconds before it became steady again. To cope,
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he had to constantly pause to stabilize himself and make
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every movement deliberately to avoid getting a headache. Though he
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initially had to be in a wheel chair, he trained
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himself to walk around with a cane, and even to
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keep working his job as an employee benefits counselor, though
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he had to be driven there. Stephens already knew what
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ailed him bilateral vestibular loss. He no longer had function
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in the sensory machinery responsible for balance. The involuntary movement
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of his vision was a common symptom. The trouble had
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begun after a motor scooter accident. The hospital treated him
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with antibiotics, and, as happens in rare cases, the medication
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and damaged the hair cells in his inner ear that
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detected his body's motion. Simple tasks like eating popcorn during
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a movie were out of reach, and he was prone
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to falling. He lost tens of pounds of muscle, no
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longer able to do his fitness training. His condition was irreversible,
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so he was prepared to deal with it for the
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rest of his life. It was just mind over matter
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that you knew the sidewalk was not moving, and it
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was just your vision making it look like it was moving,
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he said, I just progressed to the point that I
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could do things, but it was with severe restrictions. Most
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people can't imagine losing their sense of balance completely, but
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simply walking around depends on the vestibular system. It sends
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messages to the brain that combine with other information such
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as vision, touch, and an internal understanding of body position
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called proprioception. The invisible nature of this system makes it
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hard to recognize. We take it for granted until it
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goes awry. While only about one point eight million people
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worldwide have severe vestibular loss, partial loss is extremely common.
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Some twenty percent of people experience vertico at some point,
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and falling is the number one cause of death from
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injury in the elderly because people lose their sense of
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balance as they age. I'd argue there's no area of
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medicine where there's a bigger discrepancy between the number of
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people who suffer from a problem and the number of
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providers who are trying to take care of those patients,
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says Jeffrey D. Charon, director of the Balance and Falls
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Center at the University of California, San Francisco. In twenty sixteen,
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Stephens took friend's advice to reach out to hospitals that
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were researching potential cures. He emailed Charlie Della Santina, an
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inner ear specialist who is also an electrical engineer, a
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biomedical engineer, and a neurophysiology and director of the Johns
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Hopkins Vestibular neuro Engineering Lab. Dellasentina called him half an
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hour later. There is hope, Stephens remembers Della Santina telling
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him around this time, Della Santina had received FDA approval
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for a trial designed to test a new inner ear
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implant to restore balance. Stephens would be the very first
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person in the world to take one home with him
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to test out. Stephens felt like he had nothing to
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lose when he traveled from his home in South Lake, Texas,
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to Baltimore for his surgery. A vestibular implant is a
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device that measures motion using a censor that's attached to
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the side of a patient's head with a magnet. It
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conveys information using a series of electrical impulses that get
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transmitted directly to the vestibular nerve through a device placed
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in the inner ear. By passing the damaged ear cells,
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the system looks and functions much like a cop Clear implant,
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which restores hearing. When Stephens went back three weeks later
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to have the implant activated, Deles and Tina warned him
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that it would take time to adjust to it, but
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right there in the office, Stephens felt as though there
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was an electrical current firing through parts of his brain
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that controlled his sense of balance. He noticed that his
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eyes weren't darting around as usual, and he was stumbling less,
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though he still needed the security of his walking stick,
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and his wife, Susan next to him as they made
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their way to their car. I turned to her and said,
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it's almost like it's normal, he recalled. The couple spent
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the week end in nearby Annapolis, where they walked along
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the Chesapeake Bay and ate grabs. Stephens folded up his
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walking stick to experiment without it, and when his wife
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reached for his hand, he told her he was okay.
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When they were in the car, he didn't have to
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close his eyes to keep his vision from bouncing around.
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While the shaky sensation didn't go away completely, the scene
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in front of him didn't appear to swing several feet
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as usual, just a few inches, which he could manage.
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On Sunday night, while the couple was sitting in bed,
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the hotel room suddenly looked to him like it had
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turned upside down. Disoriented, Stevens fell over on to his
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wife as she sat next to him trying to type
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on her computer. She told him it wasn't funny, but
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it was no joke. It looked to him as though
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the room was flipping back and forth, and he had
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to hold on to the comforter to keep himself from
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falling off the bed. When the movement stopped, he called Dellisantina,
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who sympathetically reassured him that it would take some time
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for his brain to accept the new inputs and that
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they could talk about it at his appointment the next day.
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Bearwith it, Della Santina told him it's a learning curve
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because almost all creatures need to sense gravity. Our ability
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to balance has ancient origins. Even plant roots know how
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to grow into the earth, while stems know to move
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up toward the light. That might be considered a rudimentary
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vestibular system. As soon as there were animals that could move,
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they needed to keep themselves stable and reflexively adjust their
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heads and eyeballs like a steady cam. A jellyfish has
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mechanisms called hair cells that, when brushed up against beach sand,
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tell it where it's tilted in relation to gravity. A
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fish has a line of hair cells that help it
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turn into the flow of water and control its oxygen absorption.
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The vestibular system of reptiles and mammals relies on the
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movement of hair cells within the watery landscape of the
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inner ear organs. Two inner ear structures called otolith sensors
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detect both head motion and the pull of gravity, while
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three structures called semi circular canals specialize and sensing quick
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head rotations, driving a reflex that keeps our eyes and
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vision steady and clear. Fundamentally, the system works by detecting
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the movement of fluid within your inner ear. Is just
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an internalized version of the ocean that you have learned
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through millennia of evolution to carry around with you. Tellysantina
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says scientists have never seen the cells inside a living
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person's inner ear. The tiny system is embedded in the
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densest bone in the body, deep within the base of
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the skull. Accessing it would risk damaging it. You know
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how Lincoln is on a penny, says Konstantina M. Stankovic,
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an ear and skull based surgeon at Stanford University whose
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lab is developing methods to excess these cells. The size
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of the human cochlia, the organ of hearing, in cross section,
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is the size of Lincoln's upper face on a penny,
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and the total fluid volume in the s The entire
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human inner ear is the equivalent to three rain drops,
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like the three legs of a stool. The vestibular system works,
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along with our senses of touch and vision to keep
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us stable. There are fail safes when any part of
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the system doesn't work. If we lose function in one ear,
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the other can mostly handle the job. Even if we
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lose most function in both ears, the brain can amplify
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whatever weak signals still come from the ears, combining them
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with vision and other senses to tell us which way
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is up and how we're moving through the world. But
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all of those fail safes are slower and less reliable
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than the vestibular reflexes that normally keep the eyes, head
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and body upright and steady. Evolutionarily, balance came before hearing.
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Only later did the same kinds of cells that allowed
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animals to sense gravitational pull adapt for sensing by rations
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through the snail shaped cochleia, our organ of hearing, but
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treatments for hearing loss preceded those for balance issues. The
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first cochlear implant was placed in nineteen sixty one, while
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the first vestibular implant was tested in two thousand seven
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by a teen at the University of Geneva in Switzerland
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and Maystreet University in the Netherlands. For the vestibular field,
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it's been a bit longer because we don't understand the
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functioning that well. It's an invisible sense, an automatic sense,
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says Angelica Perez Fornos, a senior lecturer at Geneva University Neurocenter,
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which pioneered the vestibular implant. We have the success of
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the cochlear implants to inspire us to move forward and say, okay, yes,
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we can maybe do something. The Geneva patients had hearing
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loss as well as vestibular malfunction. Scientists didn't want to
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risk damaging a patient's hearing by trying a vestibular implant
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on its own, but they wanted to test whether cochlear
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and vestibular implants could work in the same way. Initial
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tests showed that the system gave patients more controlled eye
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movements in the lab. Over time, the vestibular implant became
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more complex with additional electrodes, though it still stimulates only
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the semi circular canals of the inner ear to steady
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a patient's gaze. By then, Della Santina was already at
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work on a device that was solely for a vestibular
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loss and secure enough that a patient could wear it
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long term. To an onlooker, some one with a vestibular
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disorder can appear clumsy or awkward or drunk, which adds
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a level of embarrassment to what's already a serious physical impairment.
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In the TV series Arrested Development, a character played by
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Eliza Minnelli made the condition into a running gag. It's
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not easy to explain a balanced disorder to the average person,
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let alone to a doctor. The Geneva Research group did
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one small study that found patients took an average of
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three years to receive a diagnosis after their first symptoms appeared.
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Many described being misunderstood by their doctors, who sometimes hesitate
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to acknowledge a condition they can't treat. In recent years,
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research in the vestibular field has exploded. Along with the
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exciting developments on a vestibular implant, a whole other field
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of gene research could soon help patients with genetic hearing
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and vestibular problems, replacing the mutated gene with a healthy copy.
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Effective treatments, Perez Pornos says, could also make doctors take
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these cases more seriously and diagnose patients faster, because there's
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finally a clear reason to do so. Our understanding of
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the field also helps patience a lot, because they're not
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ignored any more. Perez Bornos says, when I visited Della
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Santina's lab, he was getting ready to meet with the
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patient who would become an implantee the following day. Michel Bernass,
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a woman in her fifties from Waterford, Michigan, lost her
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vestibular function slowly for reasons she still doesn't know. She
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simply became more unsteady over time and fell more often.
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Through testing, she learned that her balance function was nearly gone,
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but because she's been able to compensate using vision, other
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people have a hard time understanding her condition. I tell
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them that I feel dizzy and off balance. That if
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I were to fall, I couldn't catch myself. That I'm
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not able to help myself once it starts, she told me.
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And you know, they really don't get it. People don't
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believe you, and that can be tough. Another trial participant
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named Michael Le Framboise, a maple syrup farmer from Orwell, Vermont,
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lost hearing in one ear in his twenties and the
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other in his fifties. To day, he is in his
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sixties and he doesn't know the reason he lost balance. Initially,
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he suffered from debilitating nausea, and while his body eventually
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got over that discomfort, he could never manage to focus
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his eyes unless he was completely still. He said he
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went from doctor to doctor trying to figure out what
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was wrong with him, before landing on an ear, nose
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and throat specialist who suggested he get involved in medical
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trials for a vestibular system treatment. He received his implant
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four years ago, and he said it improved his visual
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focus by about fifty percent. That's been enough for him
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to resume most of his daily tasks. I watched la
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from Boise perform various timed exercises, standing on a balance beam,
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walking in a straight line on the floor and practicing
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standing on one foot with varying levels of electric stimulation.
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When he took a break, I told him how hard
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it was to understand, as some one who's never had
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a vestibular issue, what the loss of balance would feel like,
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because he seemed to be doing quite well. Let me
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show you, he said, looking at me steadily, look at
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my eyes when I turn off the prosthesis. He removed
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the magnets that connected the prosthesis to his head, and
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his eyes began shaking back and forth uncontrollably. I'm back
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to where I started. Della Santina has said he would
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make time for me to go through balance testing too,
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so I could see what the patient's experience. They were
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also in need of some control subjects who didn't come
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in with balance disorders. He'd mentioned something about a rotary chair.
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I asked Laffram Boys what I should expect, and he
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warned me about it. It's worse when your vestibular system
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is working, he said. You'll know that you're spinning and
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you'll get sick. But without it working, you don't realize
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you're spinning. You just feel the breeze. Della Santina came
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in a few seconds later, telling me the team was
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ready for me, so I stepped out into the hall
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for them. The researchers had me subtract numbers while standing
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in awkward positions and walking on a line of tape
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on the floor. After getting the lamb's first perfect score
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on my balance and gait test, I sat down in
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the chair. It was a large contraption that looked like
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an airline pilot's seat. Once I was strapped into the harness,
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I had to maintain a straightforward gaze so that the
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researchers could measure my eye movements. Soon I felt myself spinning,
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my eyes shifting back and forth, trying to make sense
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of what my body was doing. After a few moments,
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I got used to the sensation and stopped feeling the
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motion so much. When the chair stopped a minute later,
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I felt as though I was being jerked back the
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opposite way. I've seen that happen sometimes, said Evan Vesper,
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a pH d student in biomedical engineering. He compared my
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inner ear to a spinning coffee cup that stops abruptly.
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The fluid continues to spend for a while longer after
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the container is standing still. The feeling only started to
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go away after they spun me around in the other
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direction for a minute. A wave of nausea hit me.
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Once I stood up to walk again, it took a
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few minutes to dissipate. To be in balance is much
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more than avoiding falls or walking in a straight line.
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I realized it is to feel in alignment. It affirms
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us to ourselves. Before Della Santina went to medical school,
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he completed his pH d in bioengineering at the University
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of California, Berkeley, where he helped manufacture silicon electrodes to
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study hearing and balance. Once he became a doctor, he
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started helping patients with hearing and balance laws. The first
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cochlear implants were rudimentary, but feedback helped to improve them.
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To day, they helped not only people with near zero hearing,
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but also those with less severe hearing loss. Yet, these
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patients need some time to adjust to them. The sounds
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they hear might seem electronic or robotic at first, It
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can be months before the brain learns how to take
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in this new input and interpret it in a useful way.
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When Stephens fell over in bed that first weekend, Dele
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Santina suspected the same process was occurring in his balance system.
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Your brain is thinking, what the heck is going on,
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Della Santina reassured his patient. It has to adapt to
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that and learn how to interpret these new inputs. We
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know that people get really good at that with repeated practice.
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Because Stephens had spent years coping by the time he
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got his implant, he knew what to do. He lay
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down to rest for the night, and the next morning
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he sat in the back seat of the car and
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closed his eyes or looked sideways out the window. If
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he looked straight ahead, his entire field of vision would
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bounce every time the car went over a pothole or
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accelerated at a green light. At the clinic, Della Santina
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put Stephens through the usual set of tests. He applied
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different patterns of electrical impulses to the vestibular nerve and
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asked Stephens what he felt. A vestibular implant can't exactly
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replicate the complex patterns and organic vestibular nerve receives, each
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of which a particular direction, speed, and timing of head motion,
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but a technician can usually find a pattern that feels
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natural enough for the patient's brain to accept as a
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useful signal. After Stephens went home with his device, his
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improvement was steady. The main benefit for Stephens and the
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other patients who received the implant after him seems to
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be an improved ability to walk independently. None of the
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patients are using the canes or walker's they came in with.
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Dellasantina said it's been five years since implantation and the
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tremors in Stephens's eyes are becoming much rarer. He says
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he's return to about seventy five percent of his typical functionality.
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He was able to restore his driver's license. He even
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started resuming some of his strength training and running, and
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is in better physical shape than most sixty somethings. His
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old cane is permanently hanging on the coat rack at
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his gym, where it's been for years. I think running
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is about as challenging a task as we could ask
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any one to do. Della Santina says, every time your
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heel hits the ground, everything you see is bouncing. He
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marvels that Stephens is now able to carry out this
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complex activity again thanks to a device that sends signals
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to his inner ear. It's really amazing. Next. When The
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Whiz debuted on Broadway fifty years ago, it sparked a
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brand new day for audiences. How the remarkable musical transformed
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a beloved folk tale into a celebratory vision for the
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future of Black America. By Kayla Randall, Digital Editor, Museums.
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When Dwandaling Reese was a kid in the nineteen seventies,
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her mother took her to see the original Broadway production
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of The Whiz, the ground breaking all black stage adaptation
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of The Wonderful Wizard of Oz. Watching Stephanie Mills play
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the role of Dorothy and telling this story from this
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point of view, it made an impact, recalls Reese, who
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is now the Associate Director for the Humanities at the
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Smithsonian's National Museum of African American History and Culture. The
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musical not only reimagined the story with black characters, but
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it also carved out its own identity with new songs
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written by, among other artists, the composer Charlie Smalls and
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the R and B legend Luther Vandross. From Eeson Down
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the Road, a soulful take on follow the Yellow Brick Road.
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To Everybody Rejoice, a brand new day. The latter song,
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like many Van Dross classics, is jubilant, and its exaltations
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of liberation and hope take on special mess when sung
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by black characters, speaking to the long struggle for freedom.
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The show, directed by the Trinidad born American actor and
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dancer Jeffrey Holder, who also designed the costumes, earned seven
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Tony Awards, including Best Musical, Best Direction, and Best Costume Design.
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Sidney Lumette's nineteen seventy eight film version, starring Diana Ross,
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Richard Pryor, and Michael Jackson, further cemented the story as
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a part of American pop culture. Essential to the Whiz was,
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of course, the Whiz played on Broadway by Andre Deshields.
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This character was modern, He could move to soul music,
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and he had something to say. Rhese says. He wore
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a tight white jumpsuit, boots, and a spectacular emerald lined cape.
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With that cape and collar, Deshields says in an interview
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with Smithsonian, he's a superhero. Deshields now seventy nine, brought
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his electric style and charisma to the character. His famous
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introductory number is so you wanted to meet the Wizard
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and Deshield's Whiz with somebody every one would want to meet.
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Even fifty years later, fresh off reprising a Tony winning
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role in Hadestown in London's West End, Deshields remembers the
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creative joy of bringing the Whiz to life. That's the
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deliciousness of being an actor, he says. You become a chef.
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You get into that kitchen and you see what you've
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got in your cupboard. You take a little of this
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and a little of that, a pinch of this and
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a pinch of that, a morsel of this and a
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morsel of that, and you throw it in altogether and
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you make something new, different, exciting, surprising, and medicinal. Underneath
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the whizzes Bravado, Deshields says he's just as low lost
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as young Dorothy, who only wants to get back home.
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He wears the mask of an all powerful wizard to
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hide the fact that he's an ordinary person. He discovers
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that by helping Dorothy and her friends realize that they
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had the brains, heart and courage they sought all along,
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he is also empowering himself. Turns out he really was
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the Whiz all along too. A big part of the
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show's identity is its distinctive look. Holder, describing his inspiration
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for the stage production in an interview years later, said
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I wanted to make it an American fairy tale, and
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as Rhese points out, the Whiz costumes esthetic fits squarely
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in the realm of afro futurism, an artistic movement that
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blends Black history with science fiction, fantasy, and other speculative elements.
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It also often specifically represents the African diaspora. At the
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heart of afro futurism, says Stephen Lewis, Curator of Music
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and Performing Arts at the museum, is wanting to celebrate
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and affirm not only African American culture, but different Black
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cultures around the world. Reece has previously described Holder's costume
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design as embodying his interest in African heritage, his own
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Caribbean upbringing, and his eventual diasporic perspective, which made the
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Whiz a down to earth folk interpretation of the original material.
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For example, Holder's tin man, which is also in the
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museum's collection, brings various influences together. His oil can was
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fashioned from a Dominican percussion instrument known as a guira.
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His hat was a skillet, and his beer can and
26:50
scrap metal suit looked as though it was collected straight
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from the streets of American cities. Holder's designs feel rooted
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in the past while in new horizons. As Deshields puts it,
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you cannot know where you're going if you do not
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know where you're coming from. And for a man who
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famously escapes Oz in a hot air balloon, the Whiz
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is fittingly dressed. His costume is a flight jumpsuit. It's
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a spacesuit, Rees says, symbolizing an endeavor that literally and
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figuratively exemplifies reaching new heights, that liberation of aspiring towards space.
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That's a very clear message. Reflecting on Afrofuturism's special resonance
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for black audiences, Deshields zooms in on one word imagination.
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His Whiz character, he says, created a persona to make
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it in the land of Oz, just as people do
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in reality. Our strongest tool for survival is the imagination.
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This concludes readings from the Smithsonian Magazine for today. Your
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reader has been Rebecca Shore. Thank you, thank you for listening,
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and have a great day.