Advances in molecular biology, neurology and material science are all leading to implants that will be smaller, smarter, more stable and energy efficient. For example, the Wellcome Trust in the UK is trailing a silicon chip that sits directly on the brain of Alzheimer’s patients, stimulating them and warning of imminent episodes. Scientists and Brown University’s BrainGate programme are experimenting with using implants to translate thoughts into actions for people with neurological impairments, inserting a small chip with 100 needle-like wires into the part of the neocortex that controls movement, feeding signals to external robotic devices. The same technology, it is argued, could be used to allow people to control machines and devices outside the body through thought alone.

As well as providing enhanced cognition, the US military is looking at how similar approaches can be used to diminish sensitivity to pain and tiredness. While the Geneva and Hague conventions prohibit the use of torture, ethical questions are being raised about what you do with enhanced soldiers who feel little pain and don’t need sleep or food. As we change human biology and seek to create a super soldier, some are asking whether we will have to change the laws of war.

While in the past we have created add-on devices such as hearing aids, cochlear implants, glasses, infrared goggles and prosthetics in a bid to correct or improve our physical capabilities, recent advances in bioengineering, microelectronics and computing are all moving the art of the possible forward. Bionic limbs and exoskeletons developed by DARPA for the US military have not only enabled injured soldiers to regain functionality but also provide better-than-human performance. Most significantly wearable is becoming implantable. Outside the research labs, amateurs are bio-hacking their bodies. Starting a decade ago with the insertion of RFID tags between fingers and electromagnets into fingertips, data is now being generated, accessed and manipulated by humans. DIY cyborgs are upgrading their bodies without waiting for corporate bodes or authorities to say okay.

Retinal implants are another area of fast change. We are no longer talking about blurred black and white images but sharp, full colour and even high-resolution video. US firm Second Sight gained FDA approval back in 2013 for a bionic eye implant that wirelessly feeds data from a digital camera to a chip implanted on the retina that decodes the data into human vision. Over the next decade researchers expect to develop retinal chips that enable seeing in the dark. There are clearly risks when matching hard technology to soft tissue and brain-cells – from infection to toxicity – and therefore to date a lot of focus has been on external or replaceable technologies. Going forward however the material constraints of metal and silicon are being overcome.

Tissue engineering and stem cell research has already allowed us to grow and replace simple organ parts and tissue such as found in joints. Regeneration of body parts is happening in the lab and moving into medical facilities; 3D printing of biological tissue is allowing us to redesign nature. The ability to grow a whole organ means that we can start to design in the functionality we want rather than that others are born with. While the growth of cosmetic surgery and laser eye surgery has changed social perceptions about external physical enhancement, how the options for internal enhancement plays out will be more down to regulation and medical ethics.

It used to be that enhanced performance was down to education and fitness – to add nurture to what nature had provided. With the advances that have been made to restore natural capabilities to those born with, developed or acquired disability, it is clear that we are able to give many more a longer and more productive life. However, as we push the boundaries of what is natural and deploy the same technologies on the able-bodied to enter the world of cyborgs and super-humans, it is clear that science fiction is fast becoming fact. How far we go in the next decade will inevitably depend a lot on the development of technology and clinical practice; however it may just as much be moderated by ethics, regulation and a view of what society will accept.