David Warner, MD, PhD, known as Dave by the children he served and admired, is a 1995 graduate of Loma Linda University School of Medicine. He entered medical school with a wealth of knowledge about computers and a valuable network of contacts with people in aerospace, the military, and entertainment. Warner matched existing computer technologies with health care in ways never before conceived. A participant in Loma Linda's MD/PhD program, Warner focused on the physiological basis of information processing. Applications of his research enabled his team of researchers to develop procedures, using off-the-shelf technologies, to help severely handicapped patients achieve goals never before thought possible. It was technology transfer with a heart. Warner studied the neurological system as an information processing network, a link between the mind and the outside world.
By using human-computer interface technologies—including electronic sensors to measure the movement of the eyes and the activation of facial muscles—a severely handicapped person could move a cursor on a computer terminal by moving the eyes and could ask the computer to initiate commands by clenching the jaw, smiling, or raising the eyebrows.
With this emerging technology, such a person would be able to access on-line services such as Google, eBay, and Yahoo! Such capabilities would give these patients access to the world of research, travel, entertainment, and possibly to the development of international relationships. They would become citizens of the Information Culture. Many handicapped people no longer would have to be institutionalized. With advanced human-computer interfaces, including the use of computers with voice recognition, such a person could conceivably become an attorney or by the use of Computer Aided Drafting—an architect.
As a student physician, David Warner first transferred technology from a NASA subcontractor to health care with the VPL DataGlove. The DataGlove had fiber optics in the fingers. When the fingers were bent, movement was sensed by the fiber optics and translated to numerical values by a computer. He first used the DataGlove in medical applications to measure the frequency, duration, and intensity of Parkinson's tremors. It provided objective, quantifiable measurements and comparisons for neurologists to use in determining a Parkinsons patient's response to therapy and time.
Then Warner applied this technology to help patients who could no longer talk turn hand gestures into speech. By using sign language, a patient using the DataGlove could generate a computer-synthesized English-speaking "voice" to communicate with his caregivers. If the patient's loss of speech was sudden, resulting from a stroke, for example, Warner programmed the computer to "talk" from simple hand gestures, such as holding up one to five fingers for five different computer-synthesized voice messages ("I'm thirsty." "I need to go to the bathroom." "I'm having trouble breathing," etc.).
The DataGlove was then used to permit rehabilitation patients wearing it to move virtual objects around on a computer terminal. They could pull virtual levers, turn virtual wheels, and move virtual boxes around on the computer monitor, developing hand/eye coordination and fine motor skills with very little strength.
Recovery from injury often depends on a set of repetitive exercises. The rigors of rehabilitation can be difficult, especially for children. Interactive interface technology, such as virtual reality, fosters motivation because patients are having fun. "Without exception we find that this technology engages the mind to interact. And that's a great thing," said Warner. "In rehabilitation the problem a lot of times is not that we can't rehabilitate them physiologically. It's the psychological capacity that blocks them. They don't want to do it. They're depressed. They've lost function. But now we give them something fun to do. They think they're having fun—we know they're rehabilitating."
Warner set up a research laboratory, dubbed "The Center for Really Neat Research," and later, the Human Performance Institute—all while completing medical school. His work was mostly unfunded, out-of-pocket, low-cost efforts, using his own computers and self-designed software, or computers and software he borrowed from sympathetic sources, including volunteer programmers. This software converted electrical impulses and other inputs into computer commands.
For example, the software would read the electrical activity created by movement in a patient's muscle. Fast-changing voltages were received by digital signal processors and determined how much energy was being expended in relation to time. When the computer detected a change in voltage, specially designed software converted those changes into computer commands. The harder the muscle worked, the greater the differences in the voltages.
During each session the patient was wired up for a variety of activities so that different muscle groups got a chance to work out. The system provided a mechanism for the patient's improvement to be monitored objectively and documented. Mike Fredholm, one of Warner's adult patients, acknowledged that the technology could increase the amount of time he would spend exercising his muscles.
However, Warner and those who saw this technology's potential felt frustrated.
"It's not sanctioned, supported, or refundable by insurance," said Warner. "We're able to make a difference, but unable to use it routinely."
But that didn’t stop him. Warner was on a mission to do the most possible good with any available resources—leading by example. He was leading the effort to alter patient outcome and outlook whenever possible by using interactive information technologies.