Thread: Prostheses that work like real limbs

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Prostheses that work like real limbs
OPTIONS SHOW PROGRESS: Technology makes it easier for injured soldiers to lead lives without limits
CHRISTIAN HILL; THE OLYMPIAN
Published: 10/25/09 12:00 am | Updated: 10/25/09 12:28 am

A doctor posed a simple question to Army Maj. A.J. Tong during his recovery from severe injuries in Iraq.

“What do you want to do?” the doctor asked.

“Everything I did before,” Tong recalls responding.

Life had irrevocably changed for Tong, 33, who lives in Yelm. An especially lethal kind of roadside bomb hit him on a road to Baghdad on Aug. 18, 2007, blowing off his right leg below the knee and nearly killing him.

Questions lingered in Tong’s mind: Is my Army career over? Will I walk again?

His answer to the doctor’s question said it all. He chose to view his new life as an amputee as one of possibilities, not limitations.

For Tong and other soldiers who have lost limbs in combat, technological advances in prosthetics put his goal into the realm of the possible. Amputations aren’t the barrier they once were to physical training, participating in other high-level athletic pursuits – and continuing their military careers.

Already this year, Tong, now outfitted with a prosthesis, has completed a 26-mile march across high-desert terrain in New Mexico to commemorate the Bataan Death March. The march involved the forcible transfer of an estimated 75,000 American and Filipino prisoners of war by the Japanese during World War II.

And today, he will compete for a second time in the Marine Corps Marathon in and around Washington, D.C., using a handcycle, essentially an arm-powered bicycle.

“They don’t look at their amputation as something that is holding them back,” said Greg Davidson, a Puyallup-based prosthetist who works with Tong and several other service amputees. “They deal with it and move on.”

As of Oct. 1, the military has treated 928 service members who lost one or more limbs as a result of injuries in Afghanistan and Iraq, according to figures provided by Walter Reed Army Medical Center. Improved body armor and battlefield medical care are saving more lives, and the percentage of amputations is lower than in the Vietnam War. Amputations represent 2.2 percent of all injuries in the two current wars, compared with 3.6 percent in Vietnam, said Patricia Cassimatis, a spokeswoman at Walter Reed.

Prosthetic limbs even allow some of these service members to remain in the service.


EVOLVING TECHNOLOGY


The technology for artificial limbs has come a long way from heavy hardwood legs, and it continues to evolve.

Davidson said there has been a dramatic change since he graduated from the University of Washington in 1995.

Carbon fiber is increasingly popular because of its strength and light weight. Silicone and gel liners protect against blistering and other irritation that had prevented the prolonged and hard use of artificial limbs.

Davidson said the soldiers he works with are “pushing the boundaries” of the performance of their prostheses, and at the same time are helping him improve his skills so he can better meet the needs of other amputees. He has developed specific prostheses for the soldiers’ activities – running, cycling, even wakeboarding.

“It’s tough to make one (prosthesis) to do everything,” he said.

Davidson said the typical high-end below-knee prosthesis costs at least $13,000. The military and Department of Veterans Affairs, after the service member is discharged, pick up the tab.

The development of prosthetic technology has entered the realm of science fiction. The Department of Defense research and science office has pushed the boundary by committing more than $100 million toward the development of the most advanced artificial arm to date, a project known as Revolutionizing Prosthetics.

Joseph Miller, chief of prosthetics at Walter Reed, described as the “holy grail” the ability for amputees to one day use the same neurons that controlled their natural limb to manipulate the artificial replacement.

The challenge is to develop a man-made limb that is as close as possible to the real thing in terms of size, weight, control and power. Miller said amputees often don’t use their prostheses because they can easily adapt to life without a limb.

“If you build something that actually works for people, in theory, they’ll probably use it a lot more than they do now,” he said.


THE LONG ROAD BACK


No technology will ever replace the willpower and mental stamina required over months to hone an altered body into peak condition.

For Tong, a company commander assigned to the 3rd Stryker Brigade Combat Team, 2nd Infantry Division, the journey began in the final days of his brigade’s 15-month deployment. He was en route to Baghdad to sign over his equipment to the unit that would replace his when the roadside bomb detonated. He later was told he went into cardiac arrest twice because of blood loss.

Tong said that while he was recovering at a military hospital, he experienced depression and despair.

“Besides losing a family member, it’s probably the most devastating thing ever to happen to me,” he said.

Eventually, he realized that he couldn’t sit in a hospital bed forever and that he needed to get involved in life.

He set goals. The first was to rejoin his brigade at its homecoming ceremony. Hanging from the wall of his Yelm home is a framed front page from The News Tribune in Tacoma. The accompanying photo shows Tong in a wheelchair in front of the soldiers of his company in October 2007.

Another goal is to summit or circle Mount Rainier with the medic he credits with saving his life.

As he continues his efforts to stay in the Army, he has become an advocate for improving care to amputees, speaking publicly on their behalf. On Saturday, the eve of the marathon, he and a friend visited amputees at military hospitals in the Washington, D.C., area.

He credits other amputees with helping him recover.

“Having guys that have lived it, experienced it, they really were able to get you through it,” he said.

The experience of 1st Sgt. John Blue, of Olympia, another soldier with the 3/2, parallels Tong’s story in many ways. Blue’s vehicle was hit by a roadside bomb that tore through his Stryker armored vehicle Jan. 27, 2007, a short distance from where Tong was injured. His right foot was mangled, and he later elected to have an amputation below the knee because of concerns about “phantom pains.”

Blue recalled arriving at Walter Reed shortly after the explosion. The privates escorting him got lost in the maze of hallways. The powerful pain relief had worn off and his pain was intense.

Seeing soldiers with more serious injuries put things in perspective for Blue. He recalled seeing a soldier in a wheelchair who had lost both legs and one arm. He was rolling his wheelchair with one hand.

“He got to where he needed to go,” Blue said. “You see that kind of stuff and you’re like, ‘Man, I have nothing to complain about.’ ”

In July 2007, two months after he began learning to walk on his prosthetic leg, he ran his first 5-kilometer race. That fall, he competed in urbanathalons, which mix a road race with an obstacle course. He qualified to compete in the World Paratriathlon Championships in Australia this summer but couldn’t attend because of work commitments.

He learned in August that he had been selected for promotion to sergeant major, one of the Army’s highest enlisted ranks. Blue has returned to duty and is commandant of the Fort Lewis Warrior Training Academy, which hones soldiers’ combat skills, including hand-to-hand combat and marksmanship.

Prostheses also are assisting service members whose goal is not to cross a finish line but to be deemed fit for duty. As of early September, at least 133 amputee service members have returned to duty. At least 40 have returned to a combat theater, according to the Walter Reed statistics.

Davidson said one of his clients, who lost his arm below the elbow, was able to return to Iraq. Another soldier, a below-knee amputee, became an instructor at Fort Benning, Ga., home of the Army’s infantry training school.

Blue said one of his motivations for training is for his job, to ensure he can keep up with the young soldiers.

“I want to be able to say, ‘Let’s go running,’ and then I want to put the kibosh on them. ... I want them to work for it. I don’t want it to be easy.”

Christian Hill: 360-754-5427

chill@theolympian.com