Baking by Ear

Baking By Ear Hour 23.01.07

SM Sarah McConnel
LP Laura Puaca
CE Christine Eubanks
SS Siddhartha Sikdar
DM Daniel Miner

AUDIO SAMPLE
Adventures of Ozzie and Harriet starring the entire Nelson family. Here is Ozzie, who plays the part of Ozzie Nelson. And of course his lovely wife, Harriet, as Harriet Nelson. The older of the Nelson boys, David, appears as David Nelson. And his younger brother, the irrepressible Ricky, played by Ricky Nelson.

SM
In the 1950s, the idea of the perfect housewife was supercharged with help from pop culture icons like 'Ozzie and Harriet.'

AUDIO SAMPLE
"Have you seen the boys?" "Oh, they're outside playing football." "Boy, you should see the mess they left in the upstairs hall." "They were looking for their football helmet. Oh, say by the way, have you seen my little yellow apron? The one with a little flowers in it?" No, why'd, you lose it?" "Well, evidently, I can't seem to find it anywhere." "Well, why don't you retrace your steps. Just figure out what you've been doing?" "Well, I was upstairs doing the vacuuming. Then I came downstairs to the kitchen." "Dinner ready yet mom?" "No, not quite, Dear." "Hi, Pop." "Hi, boys."

SM
There's a lot to critique about the happy homemaker. But being housewife was a certain kind of high status then. And something that wasn't an option for all women. Race, class and disabilities were obstacles. After going blind Margaret Neill left her hospital stay and was anxious to return to homemaking.

LP
And she found cooking to be especially challenging. She wasn't able to read the the labels, she wasn't able to read the recipes. She was actually very discouraged by members of her family who, essentially, and this was her phrasing of it, expected her to just sort of sit in the back room and not do anything.

SM
So then, Margeret Neil got General Mills involved to make recordings of recipes and cooking tips by Betty Crocker.

AUDIO SAMPLE
The many convenience foods and mixes on the market today are a boon to all homemakers. But especially to the blind. Made with ingredients of fine quality, pre-measured and packaged with easy-to-follow, mistake-proof directions, mixes take most of the work out of cooking and give you have almost limitless possibilities for delicious and nutritious family meals.

SM
From Virginia Humanities, this is With Good Reason. I'm Sarah McConnell, and today on the show, adaptive technology for people with disabilities. My first guest is Laura Puaca. She's a history professor at Christopher Newport University. And she's working on a new project about Betty Crocker's talking recipes.

SM
Laura, you came across some wonderful old records where Betty Crocker's offering blind homemakers cooking tips. Where did you stumble across these?

LP
I was working on a larger book project about the history of disability and domesticity in the United States. And I was in the archives sifting through boxes, and I found an advertisement for one of them. And I became instantly intrigued. I had never heard about these. I didn't know that they existed. But I was, you know, I was eventually able to just learn a little more information about them. And to my surprise and delight, my husband was actually able to get one of the sets for me on eBay for Christmas a few years ago, which was, which was really, really exciting.

SM
Let's play one of these. I think the voice sounds like that woman who played Beaver's mother in the 60s sitcom 'Leave It to Beaver.'

LP
Yeah, well the actor who played Betty Crocker, her name was actually Adelaide Hawley Cumming. And so I know many people are often very disappointed to learn that Betty Crocker was not a real person. She was fictional.

SM
Okay, here's the first one, just a sec.

AUDIO SAMPLE
This is Betty Crocker with a message for you. Because we want to help all homemakers everywhere, we've been trying to find a way for you to use successfully all of our mixes. As we know that not all of you read braille, that was not the answer. But now we have it, on these records, which you can play on your talking machine. It makes us very happy to have the privilege of giving you the directions for the whole family, of our Betty Crocker mixes on records.

SM
When did these records first come out? And who pushed General Mills into making them?

LP
So the first set of records came out in 1956. And there are a number of developments that I guess led to the production of the records. It's actually a little bit hard to pinpoint the precise moment or the precise date for which the project started. The first evidence that I found, though, of General Mills trying to... sort of looking for ways to make its products accessible to blind people, began sometime in the 1950s or so. And most of those early efforts seem to focus on braille actually. And so in the early part of that decade, for example, a member of General Mills' Home Service Department – which is basically their home economists – a woman by the name of Dorothy Elliot, she had actually begun transcribing some of the Betty Crocker recipes into braille using a braille typewriter at home.

But the project just ended up being too labor intensive for her to do all by herself. And so that, like I said, was in the early 50s. And shortly thereafter, it seemed like company officials, and also some sort of local community members with ties to the Minneapolis Society for the Blind – Minneapolis being where General Mills was located – they sort of expressed interest in providing recipes to blind homemakers on sort of a larger scale, right? More than what Dorothy Elliott could do by herself. And it was around that same time that General Mills was also approached by sort of an association for blind people in New York for permission to reproduce some of its Bisquick directions, and cake mix directions, in a braille cookbook that this association happened to be compiling. And that actually came out in 1955. And it seems that General Mills started thinking about doing recorded recipes at around the same time.

The idea for this might have come, or at least a part of the idea for it sort of came, after it received a letter from a homemaker in Rochester, New York. And she reported having difficulty seeing. And she inquired whether General Mills put out recipes on records or not. And she explained that it was just really important to her to be able to listen to recipes, especially because she was concerned about her eyesight, and her son was actually going to record her favorite recipes for her. And so if the day came, and she can no longer see, then she could still listen to her favorite recipes.

LP
Let's play a few of these recording tips for sightless women that General Mills eventually put out. I think you have to hear them to really appreciate how useful and varied and interesting they are. This is one where Betty Crocker tells people how to tell when a roast is done if you can't see it.

AUDIO SAMPLE
If your oven is accurate, a marked timer is the best way to tell when foods are done. But you may also want to test by touch. Meats, when they're done, feel rough to the touch. Biscuits have a firm crust, and cookies have a firm but not too hard crust.

SM
It's really interesting, isn't it? That those are useful things to say?

LP
Yeah, absolutely. It was not uncommon for braille cookbooks to basically be literally transcribed and contain, and still contain references for sighted users. So to contain these visual references like "cook until golden brown," or "cook until until the center is no longer pink."

SM
And this one's probably my favorite one. This references what you can hear as something is done. She talks about "the cake is done when it stops whispering." Let me play that.

AUDIO SAMPLE
Record one side B. More kitchen tips. Your senses of smell and hearing will also help you to tell when food is done. For example, when cake is done, it stops whispering. A toothpick should always be used to test cakes. If it comes out dry and clean, the cake is done.

SM
That's so interesting. She incorporates sound into cooking tips, right?

LP
Yeah. Those were developed in collaboration with blind students and blind homemakers through the kitchens at the Minneapolis Society for the Blind.

SM
So the first set of these records that came out in 1956 was basically this actress playing Betty Crocker, reading all the recipes in the recipe instructions. It really wasn't tips for blind cooks, right?

LP
Right. In early of 1956, General Mills was contacted by a local Red Cross worker who contacted General Mills at the urging of a woman by the name of Margaret Mumford Neil. So Neil was this 60-year-old blind homemaker who lived in Minneapolis. She had been a home economics teacher. She was a mother of four grown children. She was the wife of a university professor. And she had become blind a few years earlier, in 1953. She had... it was a result of acute glaucoma that followed this cataract operation. And, um, in a later interview, she explained that when she returned from the hospital, the very first thing that she wanted to do was to get her home going.

And she found cooking to be especially challenging. So even though, you know, her kitchen was filled with all the ingredients she needed, she wasn't able to read the the labels, she wasn't able to read the recipes, she didn't know braille, and she found that she couldn't just, she couldn't necessarily rely on family members to read to them either. And she was actually very discouraged by members of her family who, essentially and this was her phrasing of it, expected her to just sort of sit in the back room and not do anything. And she was incredibly frustrated by this, and so she started trying to seek out resources that would help her with her work. And she contacted the Library of Congress, because since the 1930s or so the Library of Congress had been making available talking books and talking book machines that blind adults could borrow for free of charge. And so she contacted them looking for cooking resources. And she was incredibly disappointed that they didn't have any.

And in this interview that she gives later on she sort of reflects on this moment, and gives this really a great quote where she explains that you could get 'War and Peace,' or 'How to Take Care of Sick Turkeys,' but not a single record to help the homemaker.

SM
Right.

LP
And after much, much insistence, like being very incredibly persistent, and over the course of several meetings, General Mills agrees to sort of go forward with this plan. And, and Neil was absolutely instrumental in it. And so she and General Mills, and both students and teachers at the Minneapolis Society for the Blind, would take these... at first they were Betty Crocker recipes, mostly cake mixes, and they would, you know, test them, and revise them, and test them, and revise them until sort of the, they could modify the directions in a satisfactory way. So that sort of this process was accessible to blind users.

SM
When the records came out with these recipes and tips for sightless homemakers, were they popular?

LP
Oh, incredibly so. And General Mills was just flooded with, with, with letters saying how useful they were, and how very much appreciated they were. And they were so popular that users, they wanted even more. And so in some of the letters that General Mills received, users requested additional, right, additional resources. And so in addition to the directions for, for Betty Crocker mixes, a number of users also asked for directions for how to make different foods from scratch. And some even included their own recipes or, or directions for doing so. And so it was sort of in response to the stated demand that General Mills decided to do a second set that were very much made from scratch items. And so that would actually be the second of what would eventually be four sets that General Mills would produce.

SM
Were they sold or were they free?

LP
They were free. And General Mills also distributed them, especially to organizations for blind people, and schools and libraries for blind people.

SM
Was this also part of a sort of broad recognition that we want to provide more services to people who are sightless across the country?

LP
So in the post World War Two period, the vocational rehabilitation system, initially focused on male veterans and wage earners, expanded to include a much wider range of people. And so this would mean women who worked in the paid labor force, but also homemakers. Or in other words, the creation of programs that were designed to aid homemakers with a range of mostly physical disabilities carry out their work.

SM
What about also an effort by the U.S. to get back into pre-war mode in terms of domesticity, right? Do you think that there was some thinking that women could get off their war footing and go back to cooking and cleaning?

LP
Well, certainly there was a rise in domesticity in the post World War Two period. Certainly, you know, the so called happy homemaker model that many of us are likely familiar with. This white middle class woman who after World War Two married, and had kids, and moved to the suburbs. And she surrounded herself with all the newest appliances and consumer products. And certainly historians have challenged this a number of ways. You know, some have questioned just how happy this homemaker was, you know, calling attention to the discontent, or the restlessness or boredom that many experienced. Others have suggested that post-war domesticity was not as confining or all encompassing as is often assume, and, you know, often pointing to the range of political activities or jobs that American women pursued at this time.

So it is important to keep in mind that, you know, even being like a bored homemaker was a luxury that many women couldn't afford. And so my question is, you know, how does the story of post-war domesticity look different when we use the lens of disability? You know, historians, for example, who studied blind women at the turn of the 20th century have shown that relatively few women believed that, you know, blind women could run a household or provide a suitable environment for a husband or a child. And so they were often deemed unmarriageable. And these sort of expectations and stereotypes persisted well into the post World War Two period as well. And so to some degree then, these Betty Crocker talking recipes helped to challenge some of these assumptions.

SM
Laura Puaca, thank you for talking with me on With Good Reason.

LP
Well, thank you. It was great being here.

SM
Laura Puaca is a history professor at Christopher Newport University. Clips from Betty Crocker talking recipes are courtesy of the General Mills archives.

SM
Hearing aids are now available to purchase over the counter and without a prescription. And this could be a game changer for people who can't afford much more expensive hearing aids. Christine Eubanks is a clinical audiologist at Longwood University. And she says the over-the-counter hearing aids are not a great option for everyone.

SM
Christine, you've suggested that we shop for hearing aids the way we shop for a car. What do you mean by that?

CE
I've had people tell me, you know, "I think I need hearing aids, how much are hearing aids?" And I ask them, "how much is a car? You can get four wheels and a steering wheel, and it'll get you where you want to go. Or you can get leather seats, and GPS, and Bluetooth on your dash. And it'll cost more, and it will be for your convenience." And hearing aids are often the same way. Every hearing aid amplifies the sounds that you need amplified, and doesn't amplify the sounds you don't need amplified. But the more sophisticated hearing aids manage background noise. And the more automated they are, the more they cost.

So if you want to be able to go from a quiet room to a noisy room, to the outdoors, where there's wind noise, and have the hearing aid make all those adjustments automatically, you'll end up paying more. But if you know that you're going to go into certain listening situations like church, you can make a program that's just for church, but you'll have to think about it. You'll have to say, "Oh, I'm going to church, let me push this button and put it in church mode, and then take it out of church mode when I leave." And that way you can save a little money and still have things sound the way you need them to.

SM
Okay, let's say I want a hearing aid that does it all. About what would that nice hearing aid cost?

CE
Oh, that's so hard to know. Because it depends on where you, where in the country you live.

SM
But that's what we hate, right? I just want to say that there's a fair price for a decent hearing aid. What is it?

CE
See, that's the tricky part. Because someone who has to keep the lights on. You know, someone who's in private practice has to have a certain amount of markup to cover their expenses. And I'm not in private practice. So I don't speak for them.

SM
Oh, are you saying the difference is how much the audiologist is paid?

CE
See? I think okay, I think the question is, the cost of the hearing aids includes the services that the audiologist provides. And it may be more expensive for the audiologist to provide services depending on where they are

SM
Interesting. I totally get that you pay the audiologist, and you pay the audiologist over time. I didn't realize it was built into how much you're gonna end up paying for hearing aids.

CE
Yes.

SM
What do you think of that? I mean, I know you are both an audiologist and somebody who fully understands that you wouldn't necessarily want to go through it that way.

CE
I worry about the people who are not hearing well and stay at home because they can't afford the fee to come in and get their hearing aids adjusted. Because when they bought the hearing aids they had the funds, and then a year and a half later, the house needed a new roof and for whatever reason, they don't have the funds. And then they feel like they can't come in and get something adjusted. And sometimes it doesn't cost very much. But they don't know that. They think that they're going to have to pay for an office visit. Part of the problem is that hearing aids aren't often covered by insurance. They're, many times, an out-of-pocket expense. And there's actually a bill in Congress now to actually ask Medicare to pay for hearing aids, which it doesn't do currently. Statutorily doesn't pay for hearing aids. So it would literally require an act of Congress to change that.

SM
So, go back to the question of how much for that nice hearing aid that sort of does it all without me paying a walloping amount extra?

CE
It's not a huge difference regionally, I would say $5,000 to $6,000 is reasonable. There are places where you will possibly spend more. And I think that my colleagues in Miami are probably going to shoot me when I say that it shouldn't cost more than $6,000. But you know, I'm not paying their rent. So...

SM
Do you think we could get an, a hearing aid of that caliber over the counter? I mean, even if we pay...

CE
No. I don't think...

SM
.... four to five thousand dollaras, let's say.

CE
No. I don't, I don't... well, $4,000 to $5,000? See, I'm not sure that I would invest that over the counter without someone to help me.

SM
Right. I went online, and I saw them from about 99, all the way up to 2,500. But I wouldn't know the difference.

CE
No, you wouldn't. And the cheap ones are probably going to sound cheap. I mean, just think about radios. I think we probably have to step back a little bit, because the people that these are designed for are people with mild hearing loss. And they, by definition, don't need as much assistance as people with more significant hearing loss. And the thing about hearing loss is that it's not all or nothing. It's not just volume. People assume that if they had a hearing loss, everything would just sound softer. And if you just made things louder, like turning up the TV, you'd be fine.

But I think most people know people who have hearing loss of a certain type that just turning up the volume doesn't help. There are people that have hearing loss for high pitch sounds and normal hearing for low pitch sounds. So when you turn up the volume, it gets loud, but it doesn't get clear. Those folks need different help than what these hearing aids are designed to provide. The other thing about these hearing aids is that they're going to be self-fitting, which means that you need to be able to use an app to test your own hearing, and save the information, and adjust the aid yourself, which many people won't be inclined to do, or won't be able to do if they don't have a smartphone.

SM
Yeah, I think an older population can't do that.

CE
Probably not. But I think the more sophisticated hearing aids are for people who have more significant hearing loss, more complicated hearing losses, where background noise is really the issue. And being able to amplify speech, and reduce background noise, and reduce background noise that is speech because the hearing aid isn't smart enough to know who you're listening to. So it has to pinpoint the person with a directional microphone. You know, the one you're looking at is who you want amplified, and the person off to the side who's talking is noise. And that has to be reduced. So that's fairly sophisticated processing.

There are hearing aids that, if you're sitting in a cafe, and the band starts to play on your right side, the right hearing aid adjusts differently than the left hearing aid, and the microphone's pattern of directionality changes to focus on the person you're looking at. I mean, this is fairly sophisticated technology. So a $200 hearing aid is probably just going to be turning up the volume. And it'll sound like that. And if turning up the TV doesn't help, turning up the volume on hearing aid isn't going to help.

SM
So what is your most generous and honest answer for why the FDA took this step to allow hearing aids to be sold over the counter?

CE
I think they feel that they're helping a large proportion of people who feel that they have mild to moderate hearing loss. I think they don't understand that most people, if you ask them, think they have mild to moderate hearing loss. They don't think they have anything more unusual or severe than that. So I think some of it is, is not really understanding the unintended consequences of someone buying something over the counter, having it not work. , and having that person say "well see, I didn't think hearing aids really worked." And then they don't try again for 10 years.

SM
Are audiologist up in arms over this development? Because they know what you just described?

CE
Yeah, I think we're frustrated that, that, that some people are going to not get what they need. I think most of us would be very happy to see people who really have mild to moderate hearing loss get hearing aids of any sort, because most of them don't. Most of them kind of struggle along because they're feeling like they're managing or faking it well. Whether they are or not is a different thing. So yeah, I would love to see some of those folks wearing hearing aids. I also worry that there are going to be parents out there who are going to get them for their children, because they can't afford hearing aids.

And the other thing that's frustrating is that the General Assembly passed a bill last session to pay... to require insurance companies to pay for hearing aids for children. But it went to the Insurance Commission, and the Insurance Commission said "No, it will cost too much money," and the bill was never enacted. So now they're going to have to go back in and try to renegotiate that, so... So I really worry about parents trying to program a hearing aid for their children with not enough information. Because kids can't give good feedback about how things sound.

SM
So really, what you're saying is that, if we're not working with an audiologist, it's not going to help us that much.

CE
I think there's going to be some trial and error involved. And so my advice to people is to make sure you've got a good return policy. You know, it's, it's much less of a chance to spend, you know, $200, let's say, if you can take it back if it doesn't work. And even if you get the $1,000 hearing aid, because that's what they're gonna cost. Bose and Sony are, you know, going to be $1,000, $1,200, something like that. If you get wax in it, are you going to be able to take it to the Geek Squad and have them help you get the wax out of it? You know, because earwax is a real thing. And it's one of the big issues with hearing aids. And I'm not sure that Best Buy knows what they're getting themselves into.

SM
The Geek Squad is going to be the earwax squad?

CE
Well, you know, I don't know that they know that. But... no, I think what will happen is that someone will say, "Well, you know, you could take that to an audiologist, and they can probably help you." And we will, but then we'll have to charge them for an office visit. And so they're kind of back in the same boat. I think it's gonna to be helpful for people who are comfortable with Bluetooth headphones, other computer iPhone kinds of things. I think those folks will benefit tremendously, you know, so I forsee a lot of adults, children of people with hearing loss, helping mom and dad program their phone to work with their hearing aids. But then the earwax issue is still going to be an issue.

SM
Well, Christine, thank you for sharing your insights on With Good Reason.

CE
Oh, you're very welcome.

SM
Christine Eubanks is a clinical audiologist at Longwood University. This is With Good Reason, we'll be right back.

SM
Welcome back to With Good Reason, from Virginia Humanities. Most trauma-related amputations in the U.S. involve upper limbs. And yet about half of all Americans who get a prosthetic arm or hand eventually stop using it. The technology is hard to use and the limbs aren't always that helpful. Siddhartha Sikdar is a bioengineering professor at George Mason University. He and his colleagues are developing new technology for better prosthetic arms and hands. Siddhartha, what percent of people who are fitted with upper limb prosthetics eventually stop wearing them?

SS
So the estimates vary, but some studies have estimated that almost half of the individuals eventually stop using them.

SM
Do you get that? Do you, do you appreciate why they do?

SS
I do they can be quite frustrating to use, especially when you're doing activities of daily living. The limitations of the technology are quite significant. We get frustrated with technology all the time in our daily lives. Now imagine trying to pick something up, or cut vegetables, or do other activities of daily living, and your prosthetic device just doesn't want to do what you would like it to do. That can become quite frustrating. And many individuals find that they can be more functional without using their prosthetic device.

SM
Right? They can be freer, it's probably cumbersome and heavy.

SS
That's right. Comfort is actually a big reason why people abandon devices. Comfort, and the weight of these more sophisticated devices are quite heavy. Some of these hands that have fingers that can move individually. These hands, they're actually quite heavy. The first time I picked up one of these hands, I was shocked at how heavy it was. And then you know, the socket doesn't always fit properly. The technology is quite sophisticated, but it has a long way to go.

SM
So tell me about the first level of prosthetics that were most commonly used until fairly recently.

SS
Yes, the arm and hand prosthetics are probably the more challenging ones, just because we have so much more dexterity with our arms and hands. And upper limb devices have been around since the Roman times. Individuals who lost their limbs in war made these fairly sophisticated hands that have fingers that could be moved. And until recently, and even now, body powered prosthetics which involve essentially a harness that you wear over your shoulders and upper torso. And you can essentially move your shoulders, or upper body, to control the opening and closing of this, almost like a hook, if you will. And you can open and close the hook by moving your shoulders using a harness and pulley system.

SM
And then after this more basic non-battery, non-electric system, what's been the second most customary class that was developed in recent times?

SS
Yeah, so those would be the powered prosthetic hands or limbs, with essentially batteries that have an electric motor that can open and close the hand. Simpler versions of these are essentially, again, like hooks. Sometimes with a wrist, you could open and close the hook, or you could rotate the wrist. And these operate with a battery, so there is a motor and a battery associated with this. So these are electrically powered devices. And to control these devices, there are sensors that record the activity of the muscles. So the sensors sense when you are contracting your muscles to try to move the hook. It senses the muscle activity and then opens and closes the hook.

SM
How did you become involved in this work? How are your skills brought in to see if we could find a more sophisticated prosthetic upper limb?

SS
Right. So my training has been, as a bio engineer, developing imaging devices and sensors. I was not trained in prosthetics technology. But being in a bioengineering department, I constantly met colleagues who were working in the area of prosthetics. And one such colleague was my previous department chair, Dr. Joe Pancrazio. Joe and I spoke often about our mutual research interests. So he was describing the challenges that they faced in their field of trying to control these prosthetic devices. So I suggested, why don't we try ultrasound? And Joe was very excited about it, because nobody in this field had really thought about trying to use ultrasound for controlling prosthetic devices. And so we put some undergraduate students to work to see if this could ever work.

SM
What was he frustrated by? What was the limit of the technology that they were using wasn't working well enough for them?

SS
In an ideal world, what you would like to be able to do is to move individual fingers of a prosthetic hand independently. That's sort of the holy grail of prosthetic technology. Currently, that is not possible using electrical sensors that are used to detect muscle activity. The problem is that the sensors cannot differentiate the activity of individual muscles that control individual fingers.

SM
Because they're only sensing the muscles on the surface?

SS
That's correct. They are only sensing a portion of the muscle using a sensor that's placed on the skin surface. And sometimes the activity is happening deep inside the muscle, and the sensors from the skin surface are not able to pick it up. Other times, the muscles that control, let's say the index finger and the middle finger, the electrical activity cannot be differentiated from the skin surface. And that has been a long standing challenge in the area of prosthetics.

SM
You know, when I think of ultrasound, I picture the technique that doctors and nurses use to detect a baby in the womb. And it seems, it seems more elaborate and cumbersome than what you would need for a device attached to your elbow or your wrist.

SS
That's right. The promise of ultrasound of course is that you are able to see inside the body and create pictures of, let's say the baby moving inside the womb. So imagine we are using the same technology to look at these muscles moving deep inside the tissue, inside your forearm in there as (INAUDIBLE). Now, the big challenge is how do we take the ultrasound technology that a lot of us are probably familiar with in the doctor's office. How do we take the technology and make it small enough that it can fit inside a prosthetic socket?

SM
Can you do that?

SS
Yes, we can indeed make the technology sufficiently small, that it can actually go inside a prosthetic socket. So that has been an engineering challenge. But we have been able to overcome that challenge. And we now have working systems that are small enough that it can fit inside of the prosthetic socket.

SM
So, given that you can use this tiny ultrasound technology to sense the muscles and create movement in the hand, is the movement better? Is, is it able to detect more nuanced movement this way?

SS
That's what we have shown in our research until now, is that indeed we can detect more nuanced movement. We can differentiate between many types of movement. So, imagine trying to turn a key, or turn a doorknob, or pick up a coin, or pick up a pencil. So all these different activities require different types of grasps. These are very fine, dexterous movements that individuals who have intact hands are able to do quite easily. But it is very challenging for somebody who is a prosthetic user to do the same tasks. We have shown in our research that we are able to differentiate between these different types of grasps using our ultrasound technology. The other interesting aspect of this is that we have shown that individuals are able to learn how to control the prosthetic devices using our ultrasound technology much quicker.

So, with much less training than with the current state of the art that's commercially available. The state-of-the-art technology that's commercially available requires quite a bit of training before individuals are able to control their prosthetic devices. With our technology, we believe that training time can be much smaller. We believe this is potentially a more intuitive way of controlling

SM
Training is how long for the other device typically? And how short might it be with the ultrasound prosthetic device?

SS
Training has many different aspects to it. So even before somebody is fitted with the prosthetic device, they undergo several sessions of training with their prosthetist to learn to use this electrical sensors. The prosthetist would often work with an amputee subject for several sessions, even before they're fitted with the prosthetic. And after they're fitted with the prosthetic, then they often work with an occupational therapist or their prosthetist over several sessions to learn to use that prosthetic device, and perform activities of daily living with that. So this training is often quite extensive, it takes several sessions. We believe that we can significantly reduce this training time with our ultrasound technology. Of course, we do not have a commercially available ultrasound controlled prosthetic device yet. So this has not been deployed clinically. But we believe that our research indicates that this training time can be significantly reduced to one or two sessions.

SM
You've been trying it out on people that need this device. Are they people who are engineers working in your lab, or are they people that you know who've been trying out this device?

SS
We have worked with engineers who themselves are prosthetic users. We work very closely with prosthetists, with clinicians, with research subjects who come to our labs who participate in our studies. Potential users are very excited about it. Almost all of them who have used our technology in our lab have commented on how easy it is to control different degrees of freedom. The engineers who themselves are prosthetic users are also very excited about this technology. So there is a lot of enthusiasm about the potential for using ultrasound as an alternative.

SM
What's the biggest challenge you're facing right now?

SS
There was a lot of engineering challenges that we had to overcome to make this technology miniaturized and fit inside a prosthetic hand. Now the next challenge is trying to actually move this technology towards commercialization. So that's... we are working on that right now. We still have to do much more extensive clinical trials comparing our technology against the current state of the art. The biggest future challenge is to combine this with the ability to provide some kind of feedback to the user, some kind of feedback about touch. So the way our motor system works, is it's constantly using feedback from the environment.

So when we pick up a cup, it is not just a matter of moving the hand to grab the cup. Our brain is constantly monitoring the feedback it receives from the touch sensors on the hand. And that is crucial in enabling fine movements. Obviously, in a prosthetic device, that sense of touch is missing. So what we are very interested in is combining new technologies for sensing contact, and combining that with our ultrasound technology so that we can provide a sense of touch as well.

SM
How long do you imagine before someone who needs this can actually use it? Before it's available?

SS
So we are working very hard to make this available as soon as we can. I anticipate that in the next several years we should have commercially available devices that use this technology.

SM
Siddhartha Sikdar thank you for sharing your insights and your advances on this with me on With Good Reason.

SS
Thank you very much. It was a pleasure talking with you.

SM
Siddhartha Sikdar is a Professor of Bioengineering at George Mason University, and Mason's Director of the Center for Adaptive Systems of Brain Body Interactions.

SM
Many of us have heard of wheelchair basketball. But what about wheelchair kayaking, waterskiing, or wakeboarding? My next guest has been working with Wheel Love, a Virginia community group that helps make recreational activities available to people with disabilities. Daniel Miner is a Professor of Physical Rherapy at Radford University. Danny, there's been so much progress made in water sports making them more accessible to people who are in wheelchairs full time. What are the barriers?

DM
You know, I think, I think one of the biggest barriers is... I mean, it depends on the sport that you're talking about. If you think about trying to get into the lake to try out wakeboarding or water skiing, you know, the barrier from how do you get from the lake shore to the dock. Once you get onto the dock, how do you get into the water to actually give it a shot? You know, we also have done quite a bit of adaptive kayaking and, you know, getting from a wheelchair down into a kayak, and then getting the kayak into the water. You know, there's, there's barriers every step of the way from an accessibility standpoint, I think. Especially the more rural you are, the fewer and further between accessible options are.

SM
You work with a group called Wheel Love, W-H-E-E-L. What a great name.

DM
Yeah, it's, it's a fun group. It started really as a group of us, but it was really Scott Mills, who is just a great advocate in our area for adaptive sports and recreation. He was injured himself several years ago. He had an accident which resulted in a spinal cord injury and he's a full time wheelchair user. But you know, he was extremely active and into action sports before his injury. And he has just been extremely motivated to find ways to stay active and still, you know, there's nothing that Scott can't do. He's actively engaged in adaptive snow skiing, adaptive wakeboarding.

And so Scott was really the impetus behind the group and, and several of us who work at Carillion as physical therapists and occupational therapists have really just kind of seen it as a way to give back to the community and help the people that we work with in rehab, recovering from their injuries, to kind of see that there's life outside of the hospital. That they can get back to enjoying some of the recreational opportunities and sporting activities that they enjoyed before they were injured.

SM
To do so much of that, to do the adaptive kayaking, waterskiing, wakeboarding and all that. Is it more about learning the skill, or is it more about gaining the confidence to even try?

DM
Yeah, you know, I think for us, it's really about showing people what's possible. It's amazing to see the confidence that people develop just after they get over that initial barrier of being afraid to give it a try. We often have people that come to our events for the first time and they kind of observe from the sideline, and, you know, they see the fun that people have, you know, trying these things out. And so once they get over that initial barrier of fear, you know, it's great to see the smiles light up their faces, the confidence that that that helps to develop.

You know, we had one gentleman that came to our most recent adaptive kayaking event. And he was a little bit apprehensive about getting in the, in the kayak for the first time. And he's a full time wheelchair user due to a spinal cord injury, and doesn't have a whole lot of control of his trunk to balance himself and so... But we were able to help him get into the kayak and into the pool. And then we had volunteers spotting him in the pool to help him just kind of gain some confidence and get a feel for how the kayak would respond to him paddling around. And once he was able to get a little more confident in the kayak, you know, he wanted to kind of test his limits a little further. He's like, "Well, what if I fell out of the kayak? Would I be able to get myself upright? You know, would I'd be able to handle that?" And so, it scared his wife to death. But, you know, he said, "Okay..."

SM
I bet!

DM
"He said, I'm gonna go for it," you know, and 1-2-3, dumped himself out of the kayak and was able to successfully right himself in the water, and, you know, just had a victorious grin on his face, which was great to see,

SM
you must have lived through that with him in the sense that you can only go as far along with him as he's willing to go, right? In terms of self confidence, fear?

DM
Oh, yeah, absolutely. That's one of the things that we really try to do at our events is, you know, create a safe environment where people can kind of feel out their own limits and, and test those limits, but do it in a safe way where they, you know, nothing, nothing bad is gonna happen. We have plenty of volunteer support there to make sure that people are kept safe. And, you know, I think that it's such a supportive community that, that we're developing that, you know, people are cheering each other on. And I think that camaraderie helps to really help instill even more confidence when people are, you know, kind of pulling, pulling together and pulling for each other.

SM
Yeah, I can see that. I can see how the community doing this with each other would be more valuable even than the activity itself in some cases.

DM
Yeah. You know, and that was one of the reasons for... I mean, Wheel Love started out as a support group, you know. But under Scott's direction, you know, we didn't really want it to be a support group where people sit around and kind of talk about their feelings. You know, we wanted it to be a support group where we set up these fun sports and recreation events, and people come and give things a try that they might have been afraid to try otherwise. And, you know, the camaraderie and friendships that develop from experiencing something like that together, I mean, I think are much more powerful than any kind of support group where you're just sitting around and talking about life in a wheelchair.

SM
You also have an event coming up in March. Tell me something about that.

DM
Yeah, so in March we have our annual wheelchair basketball tournament. We have historically partnered with Roanoke College, and they have a group at Roanoke College called Toy Like Me. And we partner with the Charlottesville Cardinals, who are a wheelchair basketball team who have been previous national champions in wheelchair basketball. And they're just a great not only wheelchair basketball team, but also advocacy group that help provide educational programming for elementary schools, middle schools, high schools and universities to increase awareness about wheelchair basketball.

They bring down a trailer full of basketball wheelchairs to allow people who are wheelchair users, and those who are not, kind of compete together in the same tournament. So we you know, we have, it's basically a three-on-three wheelchair basketball tournament. It typically is a competition event as well as a educational event. So that's our first event in the spring. And then every June is when we do our Wake the World adaptive wakeboarding event at Smith Mountain Lake. And we work with a great nonprofit organization called Wake the World out of North Carolina. And we host a two day adaptive wakeboarding event at Crazy Horse Marina at Smith Mountain Lake. And that's typically towards the end of June each year, so...

SM
Do you think that so much more is possible than you once realized for people that are confined to wheelchairs?

DM
You know, absolutely. You know, and I think, to some degree, people have kind of a preconceived notion of what life in a wheelchair is like. But I think once you become part of a community, like Wheel Love, and you meet people like Scott, there's nothing that Scott can't do. I mean, yeah, Scott uses a wheelchair as his primary mode of mobility. But Scott gets up on top of his roof and works on his house. He's a welder, and there's nothing that he can't build. Seeing people that have found a way to adapt and overcome from whatever challenge, you know, they face is pretty powerful and an eye opening experience. And, you know, you want to just help people realize what is possible.

SM
Well, Daniel Miner, thank you for sharing your insights on this with me on With Good Reason.

DM
Yeah, thank you. It's a pleasure to talk to you.

SM
Daniel Miner is a Professor of Physical Therapy at Radford University.

SM
With Good Reason is produced by Virginia Humanities, which acknowledges the Monacan nation, the original people of the land and waters of her home in Charlottesville, Virginia. Our production team is Alison Quantz, Matt Darroch, Lauren Francis and Jamal Milner. Cassandra Deering and Aviva Casto are our interns. Special thanks to Jennie Taylor for booking assistance. For the podcast, go to with good reason radio dot org. I'm Sarah McConnell. Thanks for listening.