Episode Transcript
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Dr. Moira Gunn (00:11):
The ability to
walk, climb stairs, get in and
out of chairs is defining inlife. It affects where you can
go and how and what choices youhave on a moment to moment
basis. In fact, TechnationHealth chief correspondent,
doctor Daniel Craft, saysmobility is the new vital sign.
(00:33):
Daniel, welcome back. Great tosee you.
Dr. Daniel Kraft (00:36):
It's great to
be back.
Dr. Moira Gunn (00:37):
Now you said
something, when we were talking
earlier about mobility being thenew vital sign. You mean, people
can actually measure what we'redoing, and it becomes a part of
our health profile. Is that whatyou're talking about?
Dr. Daniel Kraft (00:53):
Yeah. I mean,
mobility is really key to all
elements of your health. Howmuch you get around, your
cardiovascular fitness, yourability to interact socially,
and, you know, it's been alittle underappreciated. I
think, you know, you tell me. Ithink you actually had a a knee
surgery a year ago.
How did mobility affect yourlife?
Dr. Moira Gunn (01:08):
Well, that's,
you're talking to somebody who's
a major fan. First of all, forall those people out there with
knee replacements, I didn't havea full knee replacement. My hat
is off to you. That is a huge,huge thing, but I was able to
have a a partial kneereplacement. And this is sort of
like putting in a knuckle in onesmall part of my knee.
And, boy oh, boy, it's been ayear. It's been a year. And, not
(01:33):
only do I not have any pain, notonly do I you you know, I'm
moving around like I always did.I managed to lose 10 pounds
without trying. And it's like,what that means to me is that
the weight kinda when you can'tmove, the weight kinda creeps up
on you because you're not movingthe way you were, and you avoid
(01:55):
moving because it hurts.
And then when you actually getsome assistance, in my case, it
was it was surgery, and it wasthe right surgery at the right
time. And, I'm a I'm a majorfan, and, what a what a big
difference. You know, if withoutit, I could see why people sort
of we say in the old days,anything that happened to your
(02:17):
ability to move really just cutyour life shorter and shorter
and shorter, it seems to me.
Dr. Daniel Kraft (02:23):
Yeah. It's a
huge, you know, mobility is, or
lack thereof is a bigcomorbidity. About twelve
percent of Americans have justdifficulty walking up and
climbing stairs. And so I thinkwhat's interesting now, we talk
about mobility as a new vitalsign, is that, you know, that
can sort of be quantified.Right?
You can obviously tell with yourFitbit or your Apple Watch or
your Oura ring or, you know, asimple pedometer, how much
(02:46):
you're getting around is a basicmeasure. But now these sort of
low cost consumer wearables canalso tell you if your gait's a
bit off. Maybe that one hip is alittle stronger or weaker than
the other, and maybe maybe it istime to go take a look at a a
new knee or new hip if you'removing in the wrong direction or
maybe to get a new orthotic andhelp your feet. I mean, my
little mobility issue, boy,three or four years ago, I ended
(03:07):
up with some plantar fasciitis,that sort of pain in the heel.
Dr. Moira Gunn (03:10):
Oh, yeah.
Dr. Daniel Kraft (03:11):
And There's
not that much to do with
stretching and the right kind ofshoes, but, yeah, that really
affects you and your ability toexercise and can affect mental
health beyond it. We're now inthis as we talked about on on
prior episodes, we're in thisdigital age. And now what's
interesting, your smartphonewith the camera, you know,
there's a few apps where you canliterally put it up against the
wall, stretch your arms, standon one foot, stand on another,
(03:33):
hop. It'll start to give you abit of a mobility score and sort
of see where you are. It mightbe to recommend some physical
therapy or stretching orrecognize folks who are likely
to have a fall.
We know that folks who areparticularly in their older
years, a fall can be literallydeadly. The folks who get a a
particularly broken hip, have apretty low survivorship over
over years and months. And so Ithink it's an extending age to
(03:54):
number one, be able to measureit just with a silver wearable
or a camera and then to guidefolks to better musculoskeletal
health. And we have somecompeting interest or we've
talked about GLP one inhibitorsand weight loss. A lot of those
end up causing some sarcopenia,some sort of muscle wasting, and
that can affect your mobilityand especially as as you get
(04:14):
older combined with things likeyour your bone strength.
Dr. Moira Gunn (04:17):
Actually,
anything that's measurable about
you could be a vital sign. Soyou start you're starting to,
you're starting to to persuademe here.
Dr. Daniel Kraft (04:27):
Yeah. It's
that we've you know, we're in
the era of quantified self andquantified health, and our sort
of low cost consumer devices andenvironments constructed measure
them. And it's not about justmeasuring something, but what's
actual information? What'ssomething it could, keep you
from ever knee needing thatpartial knee replacement or, hip
replacement? Or what couldmeasure someone's ability to get
(04:48):
around in their early years andwhat can they do proactively
when they're in their twenties,thirties, forties, fifties,
sixties so that then whenthey're 90, they can get out of
a chair by themselves.
So I think it's a reallyinteresting realm to start
connecting those dots. At thesame time, when people do have
mobility issues, of course,we've seen the sort of standard
walking cane, but even those arebecoming sort of digitally
enabled. There's one called theCanGo, which has a smartphone in
(05:10):
it. It can track your steps, andif you've had a fall, I can call
for help. And so it'd be a sortof a digital companion in your
walking stick.
There were in the ear early erasof exoskeletons. So someone who
might have, weak leg from astroke or from extreme age or
other elements is gonna soon beable to strap on a little low
cost, very lightweightexoskeleton that will give them
(05:32):
extra oomph to their steps. Iactually got to try on a pair of
full exoskeletons that were madefor folks who have full, like,
paralysis. But there are somethat are just enabling folks to
run farther, stretch with themilitary world, of course, and
carry more weight or inworkplaces. But it's gonna
really start to help, improvepeople's abilities, who have
lost some of them.
Dr. Moira Gunn (05:53):
I think what's
also important, I know in my
case, this had to do with a caraccident, you know, decades ago,
and, it had to do with how wewere able to treat that
particular injury then. We wouldnever treat it that way now, but
we are the, what we'd say, theinheritors. We're we actually
(06:15):
have to understand that overtime, even though we may have
the best technology taking careof us when there is some kind of
an accident or an incident,that's actually what we have to
live with for the rest of ourlives, and there may have to be
an an intervention later onbefore you get to just the the
vagaries of old age.
Dr. Daniel Kraft (06:37):
Yeah. %. Now
we're in the era of stem cell
based regenerative medicine.There are several groups,
including some ARPA h fundedprojects where instead of
needing that knee replacement,you'll get an injection of stem
or progenitor cells that turnback into chondrocytes and
cartilage. That's sort of a bitof the holy grail here.
But we're also gonna blend thatwith the world of, you know, AI
and robotics. My friend DeanKamen is well known for, as a
(06:58):
medical device inventor, butinvented the Segway. That
Segway, that some of you haveridden around on the two wheels
of balances really was the nextgeneration of what was called
the iBot. It's a wheelchair thatenables folks who are in
wheelchairs to be able to standup, essentially, in the
wheelchair and go over steps andgo across grass. And so that's
another mobility enabled tool.
(07:19):
And then, other folks like, HughHerr, who's a professor at MIT
who lost both his lower legs,from a climbing accident, has
pioneered the world of sort ofbionic limbs and this idea of,
you know, neural interfaces sothat these bionic limbs or
prosthetics are now sort ofconnected to your brain. So you
can sort of feel your movementand upskill that component. So
(07:41):
it's a pretty exciting time tosort of see the entire spectrum.
First, to sort of hopefullyoptimize your vitality and your
mobility to find problems earlybefore you might have a fall or
need a a joint replacement orintervention. And then for folks
with severe disabilities tostart to enable them and some
cases even super enable it.
Dr. Moira Gunn (07:58):
Well, so many of
us are used to we go to the
doctor, say, every year. I'vebeen bad. But I know you,
Daniel. You say, god. You betterget yourself down there.
I will. It's like you go in, andthe first thing they do, they it
seems like they take, you know,couple of pints of blood out of
you, and they're like, okay. Wewanna see everything we could
(08:18):
read. At those times, no oneever checks out my balance.
Nobody ever checks out really mymy mobility and and, you know,
how everything may be moving.
It seems to me they should.
Dr. Daniel Kraft (08:32):
They should,
and they can start to prescribe
you mobility interventions. Itcould be, you know, an app for
stretching or for doing sorts ofexercises. Now it can blend with
the world of augmented andvirtual reality. These headsets
are now $200, like the the onesfrom Meta or or from others
where you put the headset on.And I I I play off in a game
called supernatural where you'removing and you're hitting bats
(08:55):
with the ball, balls with thebat, or doing boxing.
You can now do that with otherfolks in social means. That can
improve your mobility,particularly if you stretch
after these interventions. Orthe physical therapy. Right?
Often folks go home from a,like, a knee surgery like yours.
They're not necessarily walkingenough or soldier soles,
shoulder injury or or repair.And now you can put on the VR
(09:16):
headset and kinda gamify thosemovements and those exercises.
So we'll get you back up to fullstrength and mobility and, and
give you a healthier, happierlife.
Dr. Moira Gunn (09:25):
I don't know
about you, but if it's a game, I
kinda forget that I'm doing whatI'm doing and I just do it. You
know? It's like, oh, that'sfine. That's fine. If you can do
that, you're actually morelikely to do the exercises.
Dr. Daniel Kraft (09:39):
Well, that's
the whole one of the holy
grails. The hardest thing acrosshealth and medicine is often
behavior change. We know we'resupposed to walk a bit more, eat
a little bit less, have moresocial connection, maybe do our
mindfulness. But it's reallyhard to get people to to often
engage in gamification, whetherit's badges or points or just
making it a fun actual game in aVR headset can really get folks,
(10:00):
much more on track both forprevention diagnostics and
therapy and is gonna be part ofthis new sort of super
convergent world of of of healthand medicine.
Dr. Moira Gunn (10:08):
No. Earlier you
were referring to the ability
for our brain to control one oranother of these great
inventions you've been talkingabout. Is that really where
we're going with this? Nothaving to turn this on and move
these things? We literally cando it with our brain.
Dr. Daniel Kraft (10:25):
Well, the
world of brain computer
interfaces or BCI is reallyaccelerating. Right? We've had,
for the last decade or so, theability for research teams to
put a small chip on the cortexof the brain for folks who are
often quadriplegic and enablethem just by thinking to control
a cursor or now control athree-dimensional robotic limb,
(10:46):
for example. And that's, youknow, still in research phases,
but those are getting more andmore capable to the point where
they're adding in what's calledsomatosensation so that you're
not only maybe thinking as aquadriplegic and you can control
that robotic limb, but you canfeel and, the touch, the
temperature, body position. Sothe the the neuroengineering
(11:06):
combining so that someone who'sgot a severe disability like
quadriplegia can literallyinteract and feel their
environment.
So that's a very excitingcomponent that several folks are
working on. And there are newcompanies, one's called Science
Corporation founded by Max Hodakthat is is trying to build sort
of biohybrid neural interfaces.The problem with a lot of these
sort of chips in the brain is itdestroys some of your neurons, a
little tiny spikes that go intothe brain or even the neural
(11:29):
like element puts these littlefilaments that are, into the
brain of the patient. Nowthere's this idea of actually
having cells in their, axonsgrow from the surface into the
brain and start to interface. Sothat's in the early research
stages and moving to clinicaltrials and might be this brave
new world of transhumanism wherewe'll start to hook our brains
up to, neural connections.
(11:51):
And that will, again, start toenable the disabled, that start
to maybe even super enable us,those of us who have normal
brains, but can sort of augmentthem with new connections to the
world and to our bodies.
Dr. Moira Gunn (12:01):
Well, think
about all the people with
diabetes who have neuropathieswhere they can't feel their
extremities, portions of theirextremities, and even more
difficult, they can't feel heat.And so extreme heat, which is
often what we dangerouslyencounter, for instance, when
we're cooking, and extreme coldcausing even more damage.
Dr. Daniel Kraft (12:24):
Right. There
are folks trying to sort of
rewire the the neural system sothat you can appreciate those.
There are folks in the digitalhealth space that are making
special special socks that canpick up hot spots or injuries
early. That's a huge area of ofchallenge for folks who have
severe diabetes, and goes backto this issue of mobility. Many
of the folk those folks oftenhave peripheral vascular disease
(12:45):
and some need amputations aswell.
So I think there's a brave newworld of, you know,
understanding mobility,optimizing it, and for those
folks who have lost it, givingthem back that capability, which
is so intrinsic to our our ourhuman nature.
Dr. Moira Gunn (12:58):
Well, Daniel,
thanks so much for coming in.
Look forward to seeing you soon.
Dr. Daniel Kraft (13:02):
Thanks, Mara.
Keep on moving.
Dr. Moira Gunn (13:04):
TechNation
Health chief correspondent,
doctor Daniel Craft, is thefounder and chair of NextMed
Health on the web atnextmed.health and
digital.health. More informationabout Daniel at
danielcraftmd.net.