7.3.25

Episode Transcript

Speaker 1 (00:01):
Welcome. This is Rebecca Shore for Radio Eye and today
I will be reading the Smithsonian magazine dated July August
twenty twenty five. As a reminder, RADIOI is a reading
service intended for people who are blind or have other
disabilities that make it difficult to read printed material. Please
join me now for the first article titled can a

(00:23):
Medical device Restore Your Balance? Nearly two million people worldwide
have lost the simple ability to feel steady. Now, researchers
have developed an experimental medical implant that promises to restore
the sensory machinery responsible for balance. By Sushma Sabramanian. People

(00:44):
with thestibular disorders have trouble maintaining balance or other problems
with vision, touch, and body positioning. Twenty percent of people
experience vertigo at some point in their lives. A new
medical device works like a cochlear implant and has shown
impressive results treating vestibular disorders For almost four years, Richard

(01:07):
Stephens's brain felt as if it were jiggling around inside
his skull. If he turned his head, his vision wobbled
for a few seconds before it became steady again. To cope,
he had to constantly pause to stabilize himself and make
every movement deliberately to avoid getting a headache. Though he
initially had to be in a wheel chair, he trained

(01:28):
himself to walk around with a cane, and even to
keep working his job as an employee benefits counselor, though
he had to be driven there. Stephens already knew what
ailed him bilateral vestibular loss. He no longer had function
in the sensory machinery responsible for balance. The involuntary movement
of his vision was a common symptom. The trouble had

(01:51):
begun after a motor scooter accident. The hospital treated him
with antibiotics, and, as happens in rare cases, the medication
and damaged the hair cells in his inner ear that
detected his body's motion. Simple tasks like eating popcorn during
a movie were out of reach, and he was prone
to falling. He lost tens of pounds of muscle, no

(02:14):
longer able to do his fitness training. His condition was irreversible,
so he was prepared to deal with it for the
rest of his life. It was just mind over matter
that you knew the sidewalk was not moving, and it
was just your vision making it look like it was moving,
he said, I just progressed to the point that I
could do things, but it was with severe restrictions. Most

(02:35):
people can't imagine losing their sense of balance completely, but
simply walking around depends on the vestibular system. It sends
messages to the brain that combine with other information such
as vision, touch, and an internal understanding of body position
called proprioception. The invisible nature of this system makes it

(02:57):
hard to recognize. We take it for granted until it
goes awry. While only about one point eight million people
worldwide have severe vestibular loss, partial loss is extremely common.
Some twenty percent of people experience vertico at some point,
and falling is the number one cause of death from

(03:18):
injury in the elderly because people lose their sense of
balance as they age. I'd argue there's no area of
medicine where there's a bigger discrepancy between the number of
people who suffer from a problem and the number of
providers who are trying to take care of those patients,
says Jeffrey D. Charon, director of the Balance and Falls

(03:38):
Center at the University of California, San Francisco. In twenty sixteen,
Stephens took friend's advice to reach out to hospitals that
were researching potential cures. He emailed Charlie Della Santina, an
inner ear specialist who is also an electrical engineer, a
biomedical engineer, and a neurophysiology and director of the Johns

(04:01):
Hopkins Vestibular neuro Engineering Lab. Dellasentina called him half an
hour later. There is hope, Stephens remembers Della Santina telling
him around this time, Della Santina had received FDA approval
for a trial designed to test a new inner ear
implant to restore balance. Stephens would be the very first

(04:24):
person in the world to take one home with him
to test out. Stephens felt like he had nothing to
lose when he traveled from his home in South Lake, Texas,
to Baltimore for his surgery. A vestibular implant is a
device that measures motion using a censor that's attached to
the side of a patient's head with a magnet. It

(04:45):
conveys information using a series of electrical impulses that get
transmitted directly to the vestibular nerve through a device placed
in the inner ear. By passing the damaged ear cells,
the system looks and functions much like a cop Clear implant,
which restores hearing. When Stephens went back three weeks later

(05:05):
to have the implant activated, Deles and Tina warned him
that it would take time to adjust to it, but
right there in the office, Stephens felt as though there
was an electrical current firing through parts of his brain
that controlled his sense of balance. He noticed that his
eyes weren't darting around as usual, and he was stumbling less,

(05:26):
though he still needed the security of his walking stick,
and his wife, Susan next to him as they made
their way to their car. I turned to her and said,
it's almost like it's normal, he recalled. The couple spent
the week end in nearby Annapolis, where they walked along
the Chesapeake Bay and ate grabs. Stephens folded up his

(05:47):
walking stick to experiment without it, and when his wife
reached for his hand, he told her he was okay.
When they were in the car, he didn't have to
close his eyes to keep his vision from bouncing around.
While the shaky sensation didn't go away completely, the scene
in front of him didn't appear to swing several feet
as usual, just a few inches, which he could manage.

(06:10):
On Sunday night, while the couple was sitting in bed,
the hotel room suddenly looked to him like it had
turned upside down. Disoriented, Stevens fell over on to his
wife as she sat next to him trying to type
on her computer. She told him it wasn't funny, but
it was no joke. It looked to him as though
the room was flipping back and forth, and he had

(06:33):
to hold on to the comforter to keep himself from
falling off the bed. When the movement stopped, he called Dellisantina,
who sympathetically reassured him that it would take some time
for his brain to accept the new inputs and that
they could talk about it at his appointment the next day.
Bearwith it, Della Santina told him it's a learning curve

(06:55):
because almost all creatures need to sense gravity. Our ability
to balance has ancient origins. Even plant roots know how
to grow into the earth, while stems know to move
up toward the light. That might be considered a rudimentary
vestibular system. As soon as there were animals that could move,
they needed to keep themselves stable and reflexively adjust their

(07:18):
heads and eyeballs like a steady cam. A jellyfish has
mechanisms called hair cells that, when brushed up against beach sand,
tell it where it's tilted in relation to gravity. A
fish has a line of hair cells that help it
turn into the flow of water and control its oxygen absorption.

(07:39):
The vestibular system of reptiles and mammals relies on the
movement of hair cells within the watery landscape of the
inner ear organs. Two inner ear structures called otolith sensors
detect both head motion and the pull of gravity, while
three structures called semi circular canals specialize and sensing quick

(08:01):
head rotations, driving a reflex that keeps our eyes and
vision steady and clear. Fundamentally, the system works by detecting
the movement of fluid within your inner ear. Is just
an internalized version of the ocean that you have learned
through millennia of evolution to carry around with you. Tellysantina

(08:21):
says scientists have never seen the cells inside a living
person's inner ear. The tiny system is embedded in the
densest bone in the body, deep within the base of
the skull. Accessing it would risk damaging it. You know
how Lincoln is on a penny, says Konstantina M. Stankovic,
an ear and skull based surgeon at Stanford University whose

(08:45):
lab is developing methods to excess these cells. The size
of the human cochlia, the organ of hearing, in cross section,
is the size of Lincoln's upper face on a penny,
and the total fluid volume in the s The entire
human inner ear is the equivalent to three rain drops,
like the three legs of a stool. The vestibular system works,

(09:09):
along with our senses of touch and vision to keep
us stable. There are fail safes when any part of
the system doesn't work. If we lose function in one ear,
the other can mostly handle the job. Even if we
lose most function in both ears, the brain can amplify
whatever weak signals still come from the ears, combining them

(09:30):
with vision and other senses to tell us which way
is up and how we're moving through the world. But
all of those fail safes are slower and less reliable
than the vestibular reflexes that normally keep the eyes, head
and body upright and steady. Evolutionarily, balance came before hearing.

(09:52):
Only later did the same kinds of cells that allowed
animals to sense gravitational pull adapt for sensing by rations
through the snail shaped cochleia, our organ of hearing, but
treatments for hearing loss preceded those for balance issues. The
first cochlear implant was placed in nineteen sixty one, while

(10:13):
the first vestibular implant was tested in two thousand seven
by a teen at the University of Geneva in Switzerland
and Maystreet University in the Netherlands. For the vestibular field,
it's been a bit longer because we don't understand the
functioning that well. It's an invisible sense, an automatic sense,

(10:34):
says Angelica Perez Fornos, a senior lecturer at Geneva University Neurocenter,
which pioneered the vestibular implant. We have the success of
the cochlear implants to inspire us to move forward and say, okay, yes,
we can maybe do something. The Geneva patients had hearing

(10:55):
loss as well as vestibular malfunction. Scientists didn't want to
risk damaging a patient's hearing by trying a vestibular implant
on its own, but they wanted to test whether cochlear
and vestibular implants could work in the same way. Initial
tests showed that the system gave patients more controlled eye

(11:16):
movements in the lab. Over time, the vestibular implant became
more complex with additional electrodes, though it still stimulates only
the semi circular canals of the inner ear to steady
a patient's gaze. By then, Della Santina was already at
work on a device that was solely for a vestibular

(11:37):
loss and secure enough that a patient could wear it
long term. To an onlooker, some one with a vestibular
disorder can appear clumsy or awkward or drunk, which adds
a level of embarrassment to what's already a serious physical impairment.
In the TV series Arrested Development, a character played by

(11:58):
Eliza Minnelli made the condition into a running gag. It's
not easy to explain a balanced disorder to the average person,
let alone to a doctor. The Geneva Research group did
one small study that found patients took an average of
three years to receive a diagnosis after their first symptoms appeared.

(12:20):
Many described being misunderstood by their doctors, who sometimes hesitate
to acknowledge a condition they can't treat. In recent years,
research in the vestibular field has exploded. Along with the
exciting developments on a vestibular implant, a whole other field
of gene research could soon help patients with genetic hearing

(12:42):
and vestibular problems, replacing the mutated gene with a healthy copy.
Effective treatments, Perez Pornos says, could also make doctors take
these cases more seriously and diagnose patients faster, because there's
finally a clear reason to do so. Our understanding of
the field also helps patience a lot, because they're not

(13:05):
ignored any more. Perez Bornos says, when I visited Della
Santina's lab, he was getting ready to meet with the
patient who would become an implantee the following day. Michel Bernass,
a woman in her fifties from Waterford, Michigan, lost her
vestibular function slowly for reasons she still doesn't know. She

(13:27):
simply became more unsteady over time and fell more often.
Through testing, she learned that her balance function was nearly gone,
but because she's been able to compensate using vision, other
people have a hard time understanding her condition. I tell
them that I feel dizzy and off balance. That if
I were to fall, I couldn't catch myself. That I'm

(13:49):
not able to help myself once it starts, she told me.
And you know, they really don't get it. People don't
believe you, and that can be tough. Another trial participant
named Michael Le Framboise, a maple syrup farmer from Orwell, Vermont,
lost hearing in one ear in his twenties and the
other in his fifties. To day, he is in his

(14:12):
sixties and he doesn't know the reason he lost balance. Initially,
he suffered from debilitating nausea, and while his body eventually
got over that discomfort, he could never manage to focus
his eyes unless he was completely still. He said he
went from doctor to doctor trying to figure out what
was wrong with him, before landing on an ear, nose

(14:34):
and throat specialist who suggested he get involved in medical
trials for a vestibular system treatment. He received his implant
four years ago, and he said it improved his visual
focus by about fifty percent. That's been enough for him
to resume most of his daily tasks. I watched la
from Boise perform various timed exercises, standing on a balance beam,

(15:00):
walking in a straight line on the floor and practicing
standing on one foot with varying levels of electric stimulation.
When he took a break, I told him how hard
it was to understand, as some one who's never had
a vestibular issue, what the loss of balance would feel like,
because he seemed to be doing quite well. Let me

(15:21):
show you, he said, looking at me steadily, look at
my eyes when I turn off the prosthesis. He removed
the magnets that connected the prosthesis to his head, and
his eyes began shaking back and forth uncontrollably. I'm back
to where I started. Della Santina has said he would
make time for me to go through balance testing too,

(15:44):
so I could see what the patient's experience. They were
also in need of some control subjects who didn't come
in with balance disorders. He'd mentioned something about a rotary chair.
I asked Laffram Boys what I should expect, and he
warned me about it. It's worse when your vestibular system
is working, he said. You'll know that you're spinning and

(16:07):
you'll get sick. But without it working, you don't realize
you're spinning. You just feel the breeze. Della Santina came
in a few seconds later, telling me the team was
ready for me, so I stepped out into the hall
for them. The researchers had me subtract numbers while standing
in awkward positions and walking on a line of tape

(16:29):
on the floor. After getting the lamb's first perfect score
on my balance and gait test, I sat down in
the chair. It was a large contraption that looked like
an airline pilot's seat. Once I was strapped into the harness,
I had to maintain a straightforward gaze so that the
researchers could measure my eye movements. Soon I felt myself spinning,

(16:52):
my eyes shifting back and forth, trying to make sense
of what my body was doing. After a few moments,
I got used to the sensation and stopped feeling the
motion so much. When the chair stopped a minute later,
I felt as though I was being jerked back the
opposite way. I've seen that happen sometimes, said Evan Vesper,

(17:14):
a pH d student in biomedical engineering. He compared my
inner ear to a spinning coffee cup that stops abruptly.
The fluid continues to spend for a while longer after
the container is standing still. The feeling only started to
go away after they spun me around in the other
direction for a minute. A wave of nausea hit me.

(17:37):
Once I stood up to walk again, it took a
few minutes to dissipate. To be in balance is much
more than avoiding falls or walking in a straight line.
I realized it is to feel in alignment. It affirms
us to ourselves. Before Della Santina went to medical school,

(17:59):
he completed his pH d in bioengineering at the University
of California, Berkeley, where he helped manufacture silicon electrodes to
study hearing and balance. Once he became a doctor, he
started helping patients with hearing and balance laws. The first
cochlear implants were rudimentary, but feedback helped to improve them.

(18:22):
To day, they helped not only people with near zero hearing,
but also those with less severe hearing loss. Yet, these
patients need some time to adjust to them. The sounds
they hear might seem electronic or robotic at first, It
can be months before the brain learns how to take
in this new input and interpret it in a useful way.

(18:46):
When Stephens fell over in bed that first weekend, Dele
Santina suspected the same process was occurring in his balance system.
Your brain is thinking, what the heck is going on,
Della Santina reassured his patient. It has to adapt to
that and learn how to interpret these new inputs. We

(19:08):
know that people get really good at that with repeated practice.
Because Stephens had spent years coping by the time he
got his implant, he knew what to do. He lay
down to rest for the night, and the next morning
he sat in the back seat of the car and
closed his eyes or looked sideways out the window. If

(19:29):
he looked straight ahead, his entire field of vision would
bounce every time the car went over a pothole or
accelerated at a green light. At the clinic, Della Santina
put Stephens through the usual set of tests. He applied
different patterns of electrical impulses to the vestibular nerve and
asked Stephens what he felt. A vestibular implant can't exactly

(19:54):
replicate the complex patterns and organic vestibular nerve receives, each
of which a particular direction, speed, and timing of head motion,
but a technician can usually find a pattern that feels
natural enough for the patient's brain to accept as a
useful signal. After Stephens went home with his device, his

(20:17):
improvement was steady. The main benefit for Stephens and the
other patients who received the implant after him seems to
be an improved ability to walk independently. None of the
patients are using the canes or walker's they came in with.
Dellasantina said it's been five years since implantation and the

(20:38):
tremors in Stephens's eyes are becoming much rarer. He says
he's return to about seventy five percent of his typical functionality.
He was able to restore his driver's license. He even
started resuming some of his strength training and running, and
is in better physical shape than most sixty somethings. His

(21:00):
old cane is permanently hanging on the coat rack at
his gym, where it's been for years. I think running
is about as challenging a task as we could ask
any one to do. Della Santina says, every time your
heel hits the ground, everything you see is bouncing. He
marvels that Stephens is now able to carry out this

(21:22):
complex activity again thanks to a device that sends signals
to his inner ear. It's really amazing. Next. When The
Whiz debuted on Broadway fifty years ago, it sparked a
brand new day for audiences. How the remarkable musical transformed

(21:43):
a beloved folk tale into a celebratory vision for the
future of Black America. By Kayla Randall, Digital Editor, Museums.
When Dwandaling Reese was a kid in the nineteen seventies,
her mother took her to see the original Broadway production
of The Whiz, the ground breaking all black stage adaptation

(22:06):
of The Wonderful Wizard of Oz. Watching Stephanie Mills play
the role of Dorothy and telling this story from this
point of view, it made an impact, recalls Reese, who
is now the Associate Director for the Humanities at the
Smithsonian's National Museum of African American History and Culture. The

(22:27):
musical not only reimagined the story with black characters, but
it also carved out its own identity with new songs
written by, among other artists, the composer Charlie Smalls and
the R and B legend Luther Vandross. From Eeson Down
the Road, a soulful take on follow the Yellow Brick Road.
To Everybody Rejoice, a brand new day. The latter song,

(22:52):
like many Van Dross classics, is jubilant, and its exaltations
of liberation and hope take on special mess when sung
by black characters, speaking to the long struggle for freedom.
The show, directed by the Trinidad born American actor and
dancer Jeffrey Holder, who also designed the costumes, earned seven

(23:15):
Tony Awards, including Best Musical, Best Direction, and Best Costume Design.
Sidney Lumette's nineteen seventy eight film version, starring Diana Ross,
Richard Pryor, and Michael Jackson, further cemented the story as
a part of American pop culture. Essential to the Whiz was,

(23:36):
of course, the Whiz played on Broadway by Andre Deshields.
This character was modern, He could move to soul music,
and he had something to say. Rhese says. He wore
a tight white jumpsuit, boots, and a spectacular emerald lined cape.
With that cape and collar, Deshields says in an interview

(23:57):
with Smithsonian, he's a superhero. Deshields now seventy nine, brought
his electric style and charisma to the character. His famous
introductory number is so you wanted to meet the Wizard
and Deshield's Whiz with somebody every one would want to meet.
Even fifty years later, fresh off reprising a Tony winning

(24:20):
role in Hadestown in London's West End, Deshields remembers the
creative joy of bringing the Whiz to life. That's the
deliciousness of being an actor, he says. You become a chef.
You get into that kitchen and you see what you've
got in your cupboard. You take a little of this
and a little of that, a pinch of this and

(24:43):
a pinch of that, a morsel of this and a
morsel of that, and you throw it in altogether and
you make something new, different, exciting, surprising, and medicinal. Underneath
the whizzes Bravado, Deshields says he's just as low lost
as young Dorothy, who only wants to get back home.

(25:04):
He wears the mask of an all powerful wizard to
hide the fact that he's an ordinary person. He discovers
that by helping Dorothy and her friends realize that they
had the brains, heart and courage they sought all along,
he is also empowering himself. Turns out he really was
the Whiz all along too. A big part of the

(25:27):
show's identity is its distinctive look. Holder, describing his inspiration
for the stage production in an interview years later, said
I wanted to make it an American fairy tale, and
as Rhese points out, the Whiz costumes esthetic fits squarely
in the realm of afro futurism, an artistic movement that

(25:49):
blends Black history with science fiction, fantasy, and other speculative elements.
It also often specifically represents the African diaspora. At the
heart of afro futurism, says Stephen Lewis, Curator of Music
and Performing Arts at the museum, is wanting to celebrate

(26:09):
and affirm not only African American culture, but different Black
cultures around the world. Reece has previously described Holder's costume
design as embodying his interest in African heritage, his own
Caribbean upbringing, and his eventual diasporic perspective, which made the
Whiz a down to earth folk interpretation of the original material.

(26:34):
For example, Holder's tin man, which is also in the
museum's collection, brings various influences together. His oil can was
fashioned from a Dominican percussion instrument known as a guira.
His hat was a skillet, and his beer can and
scrap metal suit looked as though it was collected straight
from the streets of American cities. Holder's designs feel rooted

(26:58):
in the past while in new horizons. As Deshields puts it,
you cannot know where you're going if you do not
know where you're coming from. And for a man who
famously escapes Oz in a hot air balloon, the Whiz
is fittingly dressed. His costume is a flight jumpsuit. It's
a spacesuit, Rees says, symbolizing an endeavor that literally and

(27:21):
figuratively exemplifies reaching new heights, that liberation of aspiring towards space.
That's a very clear message. Reflecting on Afrofuturism's special resonance
for black audiences, Deshields zooms in on one word imagination.
His Whiz character, he says, created a persona to make

(27:43):
it in the land of Oz, just as people do
in reality. Our strongest tool for survival is the imagination.
This concludes readings from the Smithsonian Magazine for today. Your
reader has been Rebecca Shore. Thank you, thank you for listening,
and have a great day.