Prosthetic Progress
Prosthetic limb technology has advanced tremendously in both form
and function. The improvement and enhancement of prosthetic devices is
a multi-service, Department of Defensewide priority.
by Kenya McCullum, MMT Correspondent
When Frederick Downs Jr., chief prosthetics and clinical logistics officer at the Veterans Health Administration, helps amputees find the best prosthetic limbs to replace the ones they lost on the battlefield, it’s not just a job for him. He wants the best for amputees because he knows exactly what they’re going through: For the last 40 years, since he lost his arm in Vietnam, he has been an above-elbow amputee himself and knows what veterans need.
“One of my goals when I became the director was to make sure that anything that’s available in the marketplace is available to America’s veterans,” he said. “We have met that goal, and whatever technology is there, we have vets in place wearing it in all likelihood.”
And the technology that is made available to veterans is nothing short of amazing. Over the years, amputees have gained access to technologies that allow them to resume active lifestyles. This is especially important for the younger veterans that have been wounded in current conflicts. Instead of being forced to live the rest of their lives without running, swimming, hiking and other physical activities they enjoy, veterans can now choose a prosthesis that will give them the quality of life they deserve.
“The more active a soldier or a veteran is, the wider the range of devices they’ll be interested in,” Downs said. “What we’re looking at is the holistic health of the individual, and these devices are what they need to regain their independence and mobility. It’s what gives them dignity, and they can take care of themselves—so these are extremely important and they shouldn’t be limited by cost, which is what it used to be in the old days.”
In addition to giving veteran amputees the freedom to choose a wide range of products, the VA also makes the process convenient for them. When patients come in for a new or replacement prosthetic limb, they work with amputee clinic teams that help them find the best products to suit their needs. Oftentimes the patients will already know about what products and technologies they would like to try, but if they don’t, the teams have amassed a great deal of knowledge—from sources like professional journals, educational seminars, trade shows and a network of medical centers and prosthetists—to help patients make a decision.
Once the veterans have picked out the product they want, they get the limb from one of the contractors that has partnered with the VA to service patients. With over 600 contractors to choose from, veterans have the opportunity to get their limbs fabricated by a company that is close to them, making the process more convenient.
“Rather than make the veteran go to the VA Medical Center to get the limb fabricated, we allow them to go to a prosthetist located in their neighborhood or their area so that it’s convenient to them. It’s like your car—if your car breaks down, you don’t want to take it over 100 miles to get it fixed. You want to take it where it’s as close and convenient as you can, and that’s the same with these devices,” said Downs. “You’re relying upon them for your independence and your mobility, and so you want it fixed or repaired quickly and efficiently with somebody you know.”
This large network of prosthetists also gives patients the chance to find one they connect with on a personal level, as well as a proximal one. This is a very personal relationship and it’s important to the amputee clinic teams that patients feel comfortable with the contractor they choose.
“The relationship between the amputee and the prosthetist is like chemistry— they either have it or they don’t. It’s like a marriage. You have to get along with your prosthetist because it’s a very personal relationship,” Downs added. “They’re working with you personally and they’re trying to fit this mechanical device to you—it takes a real artist to do that, and you want dignity during that process.”
But Downs points out that this process does not end once the veteran has received a limb. If patients have any questions, concerns or problems, the VA is there to completely support them. “Once a veteran comes into the VA to receive an artificial limb, we take care of them for their rest of their [lives]. We have a long-lasting relationship with these individuals and it’s our duty to make sure that they’re taken care of,” Downs said.
RESEARCH: THE DOOR TO INNOVATION
Part of the reason that the VA is able to take care of amputees for the rest of their lives is thanks to the constant research that opens the door to innovative new products. One of the organizations involved in this research is the Defense Advanced Research Projects Agency (DARPA), which is currently running the Revolutionizing Prosthetics initiative—a program that is focused on innovations in prosthetic arm technology.
One part of the initiative is the Revolutionizing Prosthetics 2009 Program, which is a four-year project to create a neurallycontrolled artificial limb—a product that would give upper-extremity amputee patients full motor and sensory capabilities that make the prosthetic look, feel and perform like a real limb. This technology will help amputees actually feel the world around them with the prosthesis for up to 18 hours per day. In addition, this prosthesis will have environmental tolerance for heat, cold and humidity and will be designed to function for at least ten years of use.
Another part of DARPA’s initiative that will benefit amputees is the Revolutionizing Prosthetics 2007 program—a project that is developing a prosthetic arm that will be designed with near-human strength. Patients that will eventually use this arm will be able to easily resume their active lifestyles because the prosthesis will include a large range of motion, along with a lot of strength, endurance and dexterity.
Another agency working to introduce innovation in prosthetic technology is the Telemedicine & Advanced Technology Research Center (TATRC)—part of the U.S. Army Medical Research & Materiel Command (USAMRMC)—which runs the Advanced Prosthetics and Human Performance Portfolio. Among the state-of-the-art technology that TATRC is developing is a robotic prosthetic ankle, which will improve amputees’ ambulation, and a computer-controlled robotic knee that will allow patients to walk and run under several conditions.
There is also work being done on the military hospital level— where the technology meets the soldier. Walter Reed Army Medical Center (WRAMC), for example, works with companies to improve existing products to make them the best they can be for patients. As a result, this clinical optimization program enhances products that soldiers are interested in and makes them better for all amputees.
“We have a large cohort of patients and when one patient sees another patient with a new product, everybody tends to want that. The clinical optimization program allows us to order four or five of that new product, try it on a few patients, get feedback through different questionnaires and then kind of come to a rationale or decision making as to whether it’s a product that’s going to enhance the quality of care here at Walter Reed,” said Joe Miller, chief of the prosthetic and orthotic service for the Integrated Department of Orthopedics and Rehabilitation for Walter Reed Army Medical Center and the National Naval Medical Center. “Some manufacturers have been very responsive and basically made us one or two custom items for us, which has then spurred on kind of an addition to their product line.”
DEVELOPMENT: THE NEW PRODUCTS BORN FROM INNOVATION
There are several companies that bring all of the innovative prosthetic limb research together and make it a reality for patients. Among the companies manufacturing state-of-the-art prosthetic limbs are Freedom Innovations, Ohio Willow Wood, Otto Bock HealthCare and Touch Bionics.
FREEDOM INNOVATIONS
Much like Fred Downs Jr. at the VA, for Curt Colier—the vice president of Clinical Services and Business Development at Freedom Innovations—the quality of prosthetic limbs affects him very personally as a certified prosthetist and an amputee himself. He began using the company’s prosthetic feet components, and he believed in the product so much that he began to work for the company.
“What I found in this particular design of a foot was that I had a large range of motion, but at the same time I had the appropriate resistance I needed in walking. As an amputee, you’re losing efficiency with losing parts of your body so you really have to be as efficient as possible biomechanically to live a full life, and I think this product enabled that for me.”
Among the feet that Freedom Innovations manufactures is the Renegade product line, which has technology that helps amputees walk and run by absorbing energy and redirecting it. In addition, the feet have a carbon fiber shock design that makes the product durable, reliable and maintenance free for the user.
Another innovative product sold by the company is the Plié MPC Knee, a microprocessor- controlled knee that receives data about the change in the user’s gait at the rate of 1,000 times per second—making walking a smother, more stable process.
OHIO WILLOW WOOD
Ohio Willow Wood is a fourth-generation family business that began in 1907 after founder William E. Arbogast—who became a bilateral amputee after a train accident two years earlier—could not find prosthetics that were comfortable for him and started making them himself out of willow wood.
Since then, the company has had a strong emphasis on the comfort of their customers, making products that give them both the technologies that they need and the comfort that is necessary to live with them.
“You want that prosthesis to feel almost like it’s a part of them. It’ll never be—it’s almost like wearing dentures—but if we can somehow connect the prosthesis to the amputee, so that when they take a step, that prosthesis is there with them, that’s a huge advantage,” said Ohio Willow Wood’s Clinical Director Jeff Denune. “If you think about it, we only have so many steps throughout our day to take, whether we’re able bodied or amputated. We focus on what we can do to make sure that the steps amputees take they choose, and they’re not sitting down or taking the prosthesis off because of discomfort and fatigue. I think we’re taking a little different approach. You see a lot of companies today that are doing some great things, but the focus is on gadgets. We’re trying to figure out what we can do to help patients be more comfortable and more secure in their prosthesis—and make it more a part of them.”
Among the family of products that are designed to make amputees as comfortable as possible are the Alpha Liners, which are made to protect an amputee’s residual limbs by acting as a cushion or barrier between the socket of the prosthetic and that limb. Thanks to the products’ thermoplastic elastomer gel—which contains Vitamin E and is easy on the skin—patients can be more comfortable with their prosthetic, while keeping their residual limbs clean and safe.
In addition, Ohio Willow Wood also makes a line of prosthetic feet, such as the Pathfinder Foot—a product that has a bearing system that helps improve gait by allowing the user the option of inversion and eversion of the foot.
And when it comes to wounded soldiers, Ohio Willow Wood has made their comfort a priority. For soldiers who are going back to the battlefield, the company supplies a maintenance kit that allows them to make adjustments to their prosthetic limbs during times they are not able to visit a medic. Also, the prosthetic products themselves are not used on any soldier if they have not been tested for the public and deemed as safe first.
“We try not to put anything on any active military person that has not been tested for the public. If it’s ready for the public, then we know it’s been tested and we feel we can put our name on it and stand behind it,” said Denune. “If it isn’t, the last thing I want to do is get a call and find out somebody was killed because maybe something failed. We tend to not put anything too extreme or exotic on anybody that we don’t feel is ready to be sold.”
OTTO BOCK HEALTHCARE
For the last 50 years, German-based Otto Bock HealthCare has been selling quality prosthetic limb technology to amputees in the United States. One of the most popular products used by many soldiers and veterans is the company’s C-Leg microprocessor knee. Through this technology, amputees can easily slow down or speed up while walking or running, travel up or down hills, and walk up or down steps with no problems. Thanks to its fast technology—which analyzes the users’ gait and anticipates what they will do next—an amputee can travel seamlessly without worrying about falling down.
“It’s like having a certified prosthetist doing adjustments for you fifty times per second. What it means for the patient is that it gives them a real sense of security because when they’re putting the foot down and they need it to be stable, there’s high resistance so the knee won’t buckle and it won’t fall down,” said Todd Anderson, vice president of Professional and Clinical Services. “The number one thing that amputees fear is falling. Most amputees fall at an average of once a month and when they get this C-Leg, they don’t fall for years in some cases.”
TOUCH BIONICS
In July 2007, Touch Bionics introduced the i-Limb Hand, which is the first multi-articulating hand on the market. With this prosthetic, each digit on the hand is run by an individual motor, which allows each finger to move individually—making day-to-day activities easier for amputees.
“Whether it’s being able to use your prosthetic hand to enter a code on an ATM or to be able to put a key into a lock and lock it, those were all functions that were virtually impossible with previous myoelectric hands,” said Mark Ford, Touch Bionics’ director of U.S. sales and marketing. “All of those things are real-life scenarios for people that previous myoelectric hands were not able to do. It really aids the amputee in being able to get back to a regular, normal daily living where they can work in a workplace and go on about the normal daily activities that [they] have.”
In addition, the company manufactures Prosthetic Digits, or ProDigits, which are individually powered fingers for partialhand amputees.
“Quite a few of the amputees that are coming back from Iraq and Afghanistan are the results of IED explosives, and sometimes those are instances where the patients will lose parts of their fingers and parts of their hands,” said Ford. With ProDigits, a partial hand amputee can have the same benefits of those who have a full prosthetic hand. ♦