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ROBOTIC LIMBS RESTORE MOBILITY FOR DISABLED VETS

by Kelly Von Lunen

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Dan Cotton, co-founder of Horizon Orthotic & Prosthetic Experience, examines
Vietnam vet Robert Saul’s prosthetic leg. The special
vacuum pump socket
allows for a secure fit.

Robert Saul served in the Army Reserve’s 842nd Quartermaster Company as a senior heavy truck driver in Vietnam from 1968-69. The field delivery unit was from Kansas City, Kan., and went to northern I Corps as a unit.

While in-country, Saul sustained an injury to his right foot and presumably was exposed to Agent Orange. He returned home with his unit but soon began using a cane. His first amputation of one toe wasn’t until September 2009, and he underwent a below-the-knee amputation in January 2010 due to osteomyelitis (bone infection) presumed to be related to Agent Orange exposure.

“The amputation saved my life,” Saul said. “Now I kind of wish they’d taken it off years ago.”

Saul is rated as 70% disabled by VA for his leg, as well as diabetes and ischemic heart disease related to Agent Orange exposure. The nerves and muscles in his hands and lower arms also are damaged. He describes his prosthetic, which is secured to his residual limb by a vacuum pump, as “like getting your old leg back.”

When Saul volunteers to speak to new amputees at the Kansas City VA Medical Center, he always stands the whole time. “It helps to inspire them,” he said. “I help them understand this is not the end. There is hope after the amputation.”

After Saul’s toe amputation, he received the nickname “Bobby 9 Toes.” The moniker stuck, even today. A life member and judge advocate for VFW Post 6603 in Blue Springs, Mo., Saul participates in the Missouri District 5 honor guard.

Other than the 15 minutes it takes him to put on his prosthetic leg in the morning, Saul lives his life as actively as anyone. “I’ve got two five-speed cars and two six-speed cars,” he said. “And I ride motorcycles. I still ride.”

Less than four months after his amputation, Saul walked two miles in a Memorial Day parade in Blue Springs on his temporary prosthesis.

“I’ve been doing that for years with my Post, and I haven’t missed a year,” he said.

‘I JUST LOST MY HAND. OVER.’

Prostheses are as important to veterans of the wars in Iraq and Afghanistan as they are warriors from past eras. Army Sgt. 1st Class Leroy A. Petry was assigned to D Co., 2nd Bn., 75th Ranger Regt., on May 26, 2008, in Afghanistan. A staff sergeant at the time, he flew with some 60 Rangers into Paktia province in a rare daytime raid.

In a firefight as soon as they landed, Petry was shot in both legs but found cover with two fellow Rangers. One grenade exploded nearly on top of them, and then Petry saw another on the ground between him and the others. He picked it up to throw it away from them, but the grenade exploded in his right hand and severed it.

While the bones of his forearm poked through the skin, Petry applied a tourniquet with the other hand. Then he radioed in: “We’re still taking heavy contact. We’re getting small-arms fire. I just lost my hand. Over.”

For his actions, which likely saved the lives of himself and his fellow Rangers, Petry received the Medal of Honor in July 2011. When Petry accepted the medal from President Obama, he shook the president’s hand with his own state-of-the-art prosthesis.

The bionic hand includes a list of fallen Rangers inscribed on it, including Army Spc. Christopher Gathercole, who died the day of the grenade incident.

IT’S A GREAT HAND’

The number of veterans using VA health care for prosthetics, sensory aids and related services increased more than 70% from 2000-09.

Dan Cotton, prosthetist and co-founder of Horizon Orthotic & Prosthetic Experience in Overland Park, Kan., says approximately 95% of the prostheses he fits are for lower extremities. (Horizon contracts with VA.) The primary cause for amputation, particularly among veterans, is diabetes.

Cotton explained that the ideal prosthesis varies by individual based on health and functional level. Likewise, some people need aggressive rehab and therapy, whereas others can quickly return to a normal lifestyle.

“For a C-Leg (which has a knee controlled by a microprocessor) we don’t put one of those on someone who can barely stand,” he said. “That’s just not appropriate. That person needs a prosthesis that will have more stability that would allow him or her to be more safe standing or transferring to a chair. There also are folks who may be best served with no prosthesis, such as someone with a severe heart condition.”

In addition to Otto Bock’s C-Leg, Ossur’s Power Knee—a battery-powered prosthetic with embedded sensors that predict and react to movement—has been touted as a promising option for new amputees.

Petry’s prosthetic arm has attachments for golf and a set of culinary knives. He says he hasn’t found too many things he needs assistance with. In order to stay in the Army, he joined the Special Operations Command in Florida.

In coordination with his doctor and prosthetist, Petry elected to shorten his residual forearm to take away the wrist so that he could use a motorized prosthesis.

“It’s a great hand,” Petry said. “It’s got a couple sensors built in underneath the casting right above the skin. What’ll happen is, every muscle contraction you make will send signals up to the hand. Each finger, when it meets resistance, it will stop. So you got more dexterity to grab round shapes and stuff like that.”

This particular hand has modes for pinching and grasping. After occupational therapy, Petry can control his robotic hand with the same signals he used to control his own hand with before. When meeting new people—which he does often as a Medal of Honor recipient—Petry is able to use his right hand to shake and greet them. He lives normally with his wife and their four children.

“I’m fortunate they have this type of medical technology,” he said. “I thought I was going to end up with a set of hooks—and I got those as well. But when they handed me a prosthetic hand that functions pretty darn close to a real thing, I was ecstatic.”

COMPUTERIZED AND POWERED LIMBS

In Iraq and Afghanistan, some 90% of wounded veterans survive their injuries, according to the Pew Research Center in 2010. Among the nearly 50,000 wounded troops, more than 1,200 veterans of the current wars are amputees. In addition, about 5,000 veterans lose legs to disease or accidents each year, according to the New York Times.

Col. Jennifer Menetrez, director of the Center for the Intrepid at Brooke Army Medical Center in San Antonio, Texas, said that 20% of amputations among Iraq and Afghanistan veterans are to upper limbs, and approximately 20% of amputees have two or more amputations.

“Necessity is the mother of invention,” Col. Geoffrey Ling, a neurosurgeon who has done six tours in Afghanistan and Iraq, told the New York Post. “In peacetime, the military does not have the money to spend as it does during war. When the war breaks out, you’re able to spend money on research and development.”

One military-funded prosthetic research project is nicknamed “Luke” (for Luke Skywalker) and is an arm that is controlled by a foot switch. Another arm prosthesis would be controlled by a person’s own nervous system.

A partnership between Indiana University and Ohio State University—Indiana-Ohio Center for Traumatic Amputation Rehabilitation Research—has been studying 500 Vietnam-era veterans with traumatic amputations. Although there are differences between Vietnam and younger vets, all need to reintegrate into the community, adapt to limb loss, find work and remain active.

VA and MIT researchers collaboratively developed a prototype for the first powered ankle-foot prosthesis. The prototype thrusts users forward with tendon-like springs and an electric motor. Patients in early studies expanded less energy during walking, had better balance, and walked 15% faster than before.

“It’s wild—like you’re on one of those moving walkways in the airport,” said Garth Stewart, an Army veteran who lost his left leg below the knee in Iraq.

In 2009, VA provided some 150 veterans with above-the-knee amputations a computerized leg that allows them to walk in a more natural way.

The Defense Advanced Research Projects Agency has been working on prosthetic arms since 2006. In September 2011, a volunteer controlled an advanced mechanical arm with brain signals alone.

Surgeons in Europe have been working on osseointegration for more than a decade. The procedure involves surgically implanting a portion of the prosthesis directly into the amputee’s residual limb. While range of motion and control can improve as a result, the surgery has not been approved for use in the U.S. because infection rates are too high.

The first hand transplant in the U.S. was completed in 1999, but only about a dozen have been done since then. The military has invested $70 million into research on regenerative medicine. Marine Cpl. Isaias Hernandez lost 70% of his right thigh muscles when a mortar exploded in Afghanistan. Doctors injected a growth-promoting substance extracted from pig bladders. The procedure has been successful so far, and amputation has not been required.

NOT ALL HIGH-TECH

Not all amputations and prosthetic fittings are seamless. Marine Lance Cpl. Jorge Ortiz was serving with the 3rd Bn., 5th Marines, in Afghanistan on Jan. 15, 2011. He lost both of his legs above the knees, four fingers from his left hand and the thumb of his right hand when a buried explosive device went off.

However, leg bone growth protruding through one of the stumps required additional surgery—leaving him in further pain as he recovered at the Polytrauma Rehabilitation Center at the VA hospital in Palo Alto, Calif.

Some amputees actually choose traditional over robotic prostheses. “Futuristic and high-tech prosthetics are very cool, but in many cases a low-tech device is the best,” wrote amputee Ty Wilson on his blog, Active Amputee.

Wilson explained that a reliable, nonmechanical prosthesis may be best for someone who uses the device on a limited basis, someone who uses a special prosthesis for a sport, an individual who is frequently exposed to the elements or when funding is not available.

VA pays for prosthetic devices for veterans with service-connected amputations. However, veterans who face the loss of a limb later in life due to accidents or non-service-connected diseases are not eligible for VA assistance.

In fact, most limb loss in the general public—to include veterans and military retirees—is due to vascular issues. These individuals must bill their care to private insurance, Medicare or Medicaid, or pay out of pocket.

Kendra Calhoun, president of Amputee Coalition of America, estimates that some 43,000 veterans are amputees. Of those, 40% are due to traumatic accidents, whereas 60% are preventable—complications from obesity, smoking, infections, diabetes, poor safety or peripheral arterial disease. Among amputees, 93% use some sort of prostheses an average of 12 hours per day.

An artificial limb can cost more than $100,000. “The challenge of prosthetics is that we are putting dead things on living people,” below-the-knee amputee and prosthetist Rick Riley told Popular Mechanics. “If the leg hurts you, I don’t care how technologically advanced all the components are, the amputee will have a hard time wearing it day to day.”

This isn’t to say that these nonmechanical devices haven’t improved over the years. Materials such as silicone gels and urethanes have replaced hard plastics and wool of the past. Sport prostheses can be made from carbon fiber.

While there may be a limit to how lifelike a replacement limb can get, advancements in prosthetics over even the last 20 years are making life better for those who need them.

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