Near the end of the documentary “Augmented,” Jim Ewing slips on a bionic foot. Ewing, who had recently had one of his feet amputated, wiggles around the prosthetic, able to control it seamlessly. “It feels like there’s a foot there,” he says, unable to hide his astonishment.
“Augmented,” which charts the surgical and technological innovations behind Ewing’s groundbreaking below-the-knee amputation, is not short on these open-mouthed moments. Everything about his operation and subsequent treatment was unprecedented — the below-the-knee procedure was named the Ewing amputation, as the now-58-year-old was the first to undergo it, and the first amputee to test out the cutting-edge prosthetic.
“To be able to witness Jim control the robotic device with his brain . . . we knew that we had something that would make for a good narrative story,” said Matthew Orr, the film’s director. “The film really does try to strike a balance between pushing a narrative story but also being true to the science and letting the science shine.”
The 90-minute documentary premieres Feb. 23 at 9 p.m. on PBS as part of the science series, “Nova,” a production of GBH. (The film is a “Nova” production by Stat, a subset of Boston Globe Media. When he was making the film, Orr was the director of multimedia and creative for Stat, a role he has since left. “Augmented” was also included in the 2019 GlobeDocs Film Festival.)
The film follows Ewing’s procedure, which Dr. Matthew Carty performed at Brigham and Women’s Faulkner Hospital in July 2016. However, the focus is Ewing’s regular visits to the MIT Media Lab, where a team led by Hugh Herr works to develop bionic limbs. Herr had both of his legs removed below the knee when he was 17 after he got frostbite during an ice-climbing trip on Mount Washington. Ewing, also a climber, met Herr in the 1980s through the climbing community.
Ewing injured his ankle while climbing in 2014; a 50-foot fall from a Cayman Islands cliff left him unable to walk without excruciating pain. Ewing reached out to Herr to inquire about his experiences as an amputee at the same time that Herr was looking for a subject for the surgical procedure that he and Carty had devised. “Long story short, six months later, I was patient number one,” said Ewing, who lives in Maine.
“I didn’t have anything to lose and potentially everything to gain,” said Ewing, who agreed to participate in the documentary to raise attention and funding for the procedure. “It definitely gave me my life back.”
The documentary explains how the Ewing amputation iterates the standard procedure, which “hasn’t changed in at least 200 years,” Carty said. Muscles work in tandem; when one stretches, another contracts. These connections give people the ability to “sense where your body is in space,” Carty said, allowing people to perform tasks like walking downstairs or grabbing a cup without having to look.
In typical amputations, these muscular relationships are severed. This means that amputees can no longer sense where their “phantom limb” is in their environment, leading to discomfort or pain in some patients. What is different about the technique used in the Ewing amputation (which is still in clinical trials) is that it relinks the normally severed muscles. This makes it so amputees can “still perceive their limb being there in space,” Carty said. The Ewing amputation, he said, has now been performed more than 30 times, with variations on the procedure for other limbs, as well as revision surgery for existing amputees.
But Ewing’s journey, as the documentary chronicles, doesn’t end with the surgery. The long-term hope for the procedure is that people with Ewing amputations will be able to further adapt to the bionic limbs shown in the film, which Herr’s team is developing at MIT. When the film shows Ewing wearing a bionic foot, Carty explains how it mimics an attached limb through electrodes that send signals back and forth between the man and the machine. The foot is, for all intents and purposes, controlled by his brain.
For now, these bionic limbs are not commercially available, but Orr wanted the documentary to show the potential of the technology. “We’re going to be able to give people limbs that are not made of flesh and bone, but carbon, fiber, and metal,” he said. “There’s going to be a time, at some point in the future, when it’s not going to make a difference what you’re made out of.”
The end of the documentary shows Ewing returning to the site of his injury. Outfitted with a bionic foot specifically designed for the sport, Ewing confidently scales a cliff. Later, in a TED Talk, Herr introduces Ewing as “the first cyborg rock climber.”
Despite Ewing’s improved quality of life, the documentary points out that the ethics of this emergent technology are murky. In the film, a bioethicist, Keisha Ray, raises questions of equity — who will get access to the advanced limbs? This issue is brought into sharper focus when it becomes clear that people could use these bionics “to run faster, to jump higher, to do all kinds of things that you can’t even imagine today,” as Herr opines in the film.
“You’d be able to maybe even go beyond innate human abilities,” said Orr. “That’s exciting, and also a little scary.”
Whether these developments are encouraging or fearsome, one thing seems certain, as Herr says as the final line of “Augmented”: “I really feel that we’re just getting started.”