“I Was A One-Sided Person”

VA researchers join forces at the Manhattan VAMC to help a Veteran who lost his arm 40 years ago. The Gen-3 DEKA Arm System was developed for the Department of Defense which collaborated with VA Research on a VA-funded optimization study to incorporate design feedback from thirty-five volunteer amputees. The goal is to produce the world’s most advanced prosthetic arm system to help improve the lives of veterans and service members.

Power Prosthetics Propel Service Members to Better Lives

By Terri Moon Cronk

American Forces Press Service

BETHESDA, Md., April 27, 2012 – Marine Corps Cpl. Garrett Carnes was on a clearing mission in Afghanistan‘s southern Helmand province in February when he stepped on a pressure plate that exploded and cost him both legs.

Two months later, the former squad leader was fitted with prosthetic legs -- one with the X2 microprocessor power knee, and the new combination of a bionic foot and ankle at Walter Reed National Military Medical Center here.

Carnes, 22, called his first steps “motivating.” The gift of being able to walk so soon exceeded his expectations. “Mentally, it feels good to get back on my feet,” he said, taking steps on a slightly elevated ramp with parallel bars to grasp. “It’s a little awkward, like a baby who’s learning to walk.”

Such steps are taken every day at Walter Reed’s prosthetics gait lab, where rapidly changing technology is giving active-duty service members the chance to walk again and, in some cases, return to duty, said Dr. Charles Scoville, chief of amputee services in the orthopedics and rehabilitation department.

First considered impossible to design, the X2 and higher grade X3 knees have provided a new way of life for above-the-knee amputees, Scoville said. New microprocessors have five sensors, compared with the original C-Leg, which had two.

Now, a combination of gyroscopes, accelerators and hydraulics provide the knee with greater stability, mobility and versatility by recognizing actions, officials said. The multiple sensors can determine when the wearer wants to sit down or go up and down ramps and stairs, all without presetting the limb with a remote device, as required by the former technology.

The first prosthetic limbs, Scoville said, had mechanical knees that were neither limber nor conducive to the warfighter. The wearer had to swing the leg outward and project himself forward to walk.

The Biom ankle -- a combination foot and ankle prosthetic that works with the X2 or X3 knee and is specifically designed for returning warfighters -- is the newest device that enables flexibility.

Scoville describes the knee and ankle/foot combination as more intuitive than older versions.

“It does the work for you,” he said. By replacing the once-rigid prostheses, the new, lighter and user-friendly limbs allow enough flexibility to stand on one leg, and step or walk backward without falling, he said.

Army Staff Sgt. Billy Costello demonstrated his knee, foot and ankle flexibility by sitting on the floor and stretching to pull his foot toward him. He also lost a leg by stepping on an improvised explosive device while on a clearance mission.

“We had just taken out 19 IEDs,” he said. “I found one more the hard way.”

Costello was another patient who progressed faster than his doctors expected. Soon to be discharged, he is an intern at the FBI Academy in Quantico, Va. and plans to enter the National Guard when he returns to North Carolina.

“I still want to support the guys,” he said, adding that he would deploy if his medical condition allows it, but quickly added he doesn’t want to be a “liability” to his unit.

“The vast majority of patients won’t return to active duty,” Scoville said. “Our goal is to bring them to their highest level of function.”

Scoville said 1,453 troops with severe limb loss have been fitted with prostheses since December 2001 and of those, some 300 service members returned to duty, with 53 redeploying to Iraq and Afghanistan.

“We view patients as tactical athletes,” Scoville said. “They don’t have an off-season and they don’t know when their next game will be."

Marine Corps Cpl. Rory Hammill plans to resume his active lifestyle once he’s discharged from active-duty. Before an accident in Marja, Afghanistan claimed one of his legs, he was a runner, snowboarder and surfer, all of which he hopes to resume he said, close to the level of ability he once had.

These service members are just a few of the 200-250 patients who are fitted with prosthetic limbs each month at Walter Reed, said David Laufer, chief of orthotics and prosthetics services. By contrast, he added, the civilian sector produces about the same number per year. In addition to limbs, the lab also creates hands that can move fingers, with such dexterity that they can operate a computer mouse and perform other daily tasks. Designing and developing hands is the lab’s niche, Laufer said, noting that work is ongoing to enable hands to act intuitively like ankles, feet and knees.

Far fewer hands are made in the lab than legs. “The standard of care is shifting,” Scofield said. “It’s made a significant impact on the wounded warriors who live with these advances. We want people to know we’re restoring their lives.”

DOD Working Toward Fully Functional Prosthetic Arms

By Rob McIlvaine

NATIONAL HARBOR, Md.  — A robotic arm, dubbed “Luke,” after the Jedi with the mechanical hand, served as the centerpiece for a Jan. 31 discussion here regarding advancements in prosthetics.

The robotic arm is a Defense Advanced Research Projects Agency-funded project, in partnership with the Department of Veterans Affairs. The goal of the project is to restore functionality for individuals with upper extremity amputations. The project is still in development.

“The original goal for the program, back when we got started in 2005, was to create, within this decade, a fully functional motor and sensory upper limb that responds to direct neural control,” said Dr. Stewart Coulter, during the 2012 Military Health System Conference at the Gaylord National Hotel and Convention Center, from Jan. 30 to Feb. 2.

Coulter, who serves as the general manager at DEKA Research and Development Corporation in Manchester, N.H., also has the role of product manager for the revolutionizing prosthetic arm system to provide improvements in functionality and usability for wounded warriors and others.

The DEKA arm has 10 degrees of movement, and features moving fingers, wrist, elbow and shoulder. All those parts move with electric motors, which are controlled by the user with signals from a foot-based controller.

But Coulter said it’s easy to confuse the advances being made in prosthetics with science fiction.

“A lot of people have seen, for instance, the Terminator movies, and sometimes forget that those aren’t actually real,” Coulter said.

The standard for prosthetic arms up until now has been “two to three degrees of freedom,” Coulter said, which is not much different than a prosthetic arm that features a hook.

“You see the hand open and close, you’re seeing elbow flex, you might see a wrist rotate but not much more than that,” Coulter said. “You’re seeing low torque, but you’re not seeing any feedback to the user.”

In addition to degrees of freedom in prosthetic movement, Coulter said work being done to combine multiple individual prosthetic movements into single, more fluid movements. He also said there is work being done to find better ways to attach prosthetics to the user’s body.

“These are the three areas that need to be resolved,” he said. “If you can’t address making the arm have the capability, if you can’t address the control seam part, if you can’t address how you attach it to them, it won’t do any good to address two of the three.”

The various grips are also important.

“If you want to be able to use a drill, there’s a whole different grip,” Coulter said. “So now we have a grip that will let you close the index finger independently like that. And you ought to see somebody’s face light up who hasn’t used a drill in 20 or 30 years.”

One of the hard parts about this, he said, is finding a way to control a system, given the fact there’s now 10 degrees of freedom in the arm.

“Current ones are done with myoelectric controls, so they’ll use residual muscles and it’s very difficult to do that,” he said. With the DEKA arm, they are using foot-based controls.

“This provides a pretty good level of control, without relying on someone else to do it, relying on a joy stick, or relying on using their other arm to control it,” he said.

Coulter said his team works very closely with a number of people who have used the arm system, and he says they’ve let the team know what works, and what needs to be fixed.

“We’ve done clinical studies over the life of the program to improve design and to confirm we got it right,” he said. They now have more than 4,000 hours of use time on versions of the arm system.

“This has really given us the experience with the people who’ll have to use it,” he said.

Coulter said it’s fun to have a group of engineers sit and design something but even more fun to have people use it.

“It’s been tremendous to work with them and give them the chance to say what activities they want to do,” he said. “We’ve let five people take it home for two weeks, see what they think of it, come back and tell us what’s going on.”

The feedback, he said, has been very positive.

“They want to do the things that are important to them, such as, going out to a restaurant and eating with chopsticks or a fork, playing golf, holding a trumpet and playing it, leaning up on a lamppost with an outstretched arm, holding a baseball, or reaching up to the top shelf and picking up a glass of water and holding it level as it’s brought down to drink,” he said.

“To hear them say, ‘Yes, I can use this for things I couldn’t get done before,’ is exactly what we’re pushing for here,” Coulter said.

This article first appeared on Army.mil.

WRNMMC Uses New, Brain-Controlled Prosthetic Arm

By Sarah Fortney, Walter Reed National Military Medical Center Public Affairs

Bethesda, Md. (NNS) -- A new prosthetic arm - operated by an individual's thoughts - was used by wounded warriors at the Walter Reed National Military Medical Center (WRNMMC) for the first time Jan. 24.

With nearly as much dexterity as a natural limb, 22 degrees of motion, and independent movement of fingers, the Modular Prosthetic Limb (MPL) was developed as part of a four-year program by the Johns Hopkins University Applied Physics Laboratory (APL), along with WRNMMC and the Uniformed Services University of the Health Sciences (USU). On Jan. 24, a wounded warrior began using the nine-pound device, maneuvering its metallic fingers and wrist.

"We've been working with [the APL] since the start of this project and we're very excited about the opportunity [to have] our first individual using this hand," said Col. (Dr.) Paul Pasquina, chief of Orthopaedics and Prosthetics at WRNMMC and director for the Center of Rehabilitation Sciences at USU. "We believe very strongly that those who are willing to put their lives in harm's way deserve the very best. Through this revolutionizing project, we've worked with the greatest manufacturers across the globe to come up with modern solutions to loss of an upper limb."

Pasquina explained the limb is controlled by surface electrodes, which pick up electric signals generated by the muscles underneath the skin, then convert those patterns in electrical signals into a robotic function.

"We wanted to make [the MPL] as intuitive as possible. Normally, when you move your hand, you think about moving your hand, and a signal comes down from your brain, goes down through your spinal cord, out through your limb and activates muscles in your hand to open or close [the hand]," Pasquina said.

With an amputee, the nerves traveling down the spinal cord are still intact, and they're still connected to some of the muscles in the arm, Pasquina said. "What we try to do is pick up the electrical signals of the muscles that still exist in the arm and interpret those, convert them to a computer signal to then drive a robotic limb," he said. "When an individual is thinking about closing their hand, muscles will activate and the prosthetic limb will respond accordingly."

Pasquina noted the potential future of this limb. Engineers seek to use electrodes underneath the skin for an electrical signal with much higher fidelity. Researchers also look to explore other mechanisms to rewire nerves.

"There are folks working very hard on electrical sensors that can go directly on nerves, and electrical sensors that can be embedded in the brain," he said. "It's very exciting to see that research and we've been privileged to partner with a lot of folks working on that. I think there's still a lot to be learned on how the human body can integrate with computers and computer interface, and I think the sky's the limit in terms of what we will do over the next five to ten years."

The next logical phase in the MPL's development is to incorporate sense of touch, and apply this technology to prosthetic legs in the future, said Cmdr. Jack Tsao, director of the Traumatic Brain Injury Programs for Navy Medicine's Bureau of Medicine and Surgery. A neurologist who also assisted in the project, Tsao said fortunately many amputees have expressed interest and seem willing to participate and help advance this research.

"What I think is fantastic is that we actually, because of this study, now have another option to treat amputees," said Tsao.

Before being fitted to use the device, Tsao explained amputees must first go through "training," using the Virtual Integrated Environment (VIE), which records an individual's muscle movements. By collecting their muscle data, the MPL is then suited for the individual. This gives the amputee time to learn how to use the device, fit them for it, then see how they work with it, he said.

Air Force Tech Sgt. Joe Delauriers, the first patient at WRNMMC to begin using the MPL, described the device as "pretty comfortable," and said he is grateful for the opportunity to be involved with the project.

"It's really fun working with the hand and [exciting] to see what's going to be coming in the future," said Delauriers. "Any input I can put into the program, to help them out, and future amputees, it's an honor for me. It's very rewarding."

Four months ago, Delauriers was injured by an IED blast in Afghanistan, which caused him to lose both his legs and part of his left arm. He said it's an indescribable feeling to be where he is today, thanks to advancements in care.

"I'm living off base, I'm driving, [and] I'm living with my [infant] son. I'm able to hold him without any open wounds, infections," he said. "They do such a great job here, with therapy. It's just amazing." The Airman said he can only imagine what these advancements will lead to in another decade.

"The technology is only going to keep getting better," said Tsao. "If guys like Joe can regain function, this would be revolutionizing to their lives, especially in the multiple limb amputees. Any degree of function and independence you can give back to someone is the most important thing." Pasquina also expressed his enthusiasm for this development, stating that he can recall when the device was merely a sketch on paper.

"It's something I still find amazing," Pasquina said. He is also amazed by the stories of the wounded warriors making such strides in their recovery.

"Time after time, you see people not only recover, but thrive after severe injuries, and they're inspirational to all of us, to us as medical staff who have the honor of taking care of them. It's humbling to be a part of that," he said.

Pasquina added that he'll continue his efforts to make this technology available to all service members and the population at large.

"The hand in itself is so important in terms of one's independence. Your ability to dress yourself, feed yourself, do self-grooming and hygiene is extremely important," said Pasquina. "Many of our injured service members were highly functioning, highly independent, had a great amount of responsibility. To now find themselves in a situation where they have an impairment or disability, that makes them less independent is something that not only affects them physically, but affects them emotionally. Anything we can do to [help] them be more independent and to regain that sense of self is something we're fully committed to doing and very excited about the opportunities that this presents."

Bionic Leg Makes Amputee Faster on His Feet

This powered prosthetic is better at anticipating the next move

Craig Hutto considers himself part bionic man. In 2005, doctors amputated his leg after a shark attacked him during a fishing trip off the Florida Gulf Coast.

"I was 16 years old at the time," recalls Hutto. "My brother heard me yell: 'What was that?' He saw something take me under; he saw the back fin of the shark. There was so much tissue damage and so much flesh gone that it was just irreparable."

Two years later and game for a challenge, Hutto became the test pilot for a unique and powerful new prosthetic leg being developed by mechanical engineer Michael Goldfarb and his team at Vanderbilt University. The effort was kick-started by a grant from the National Science Foundation (NSF).

"We were able to develop an early prototype that demonstrated that you could have a leg that was light enough and could deliver biomechanical levels of torque and power," says Goldfarb.

Version 1.0 evolved into a more streamlined version 2.0, which is computer controlled, with advanced range of motion in the joints. Version 2.0 was funded by the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health.

"This is a battery that powers everything," explains Goldfarb, holding up the latest version and pointing to the various components. "You have a motor that drives the knee joint, another motor that drives the ankle joint. There is a whole computer board that essentially tells the motors what to do with the joints."

In Goldfarb's lab, Hutto straps on the prosthetic and "walks the walk" on a treadmill--each step recorded by an array of cameras to help engineers improve the mechanics, electronics and software.

Brian Lawson, a mechanical engineer and member of Goldfarb's team, says what makes this prosthetic stand out is the on-board computer. "What I think makes people think that it's bionic is the computing capability that infers what the user is trying to do and works synergistically with the user to provide the torque at the right time."

The prosthetic leg is designed to respond to cues from the wearer. For example, when Hutto goes from walking to climbing stairs, he gives a signal and the bionic leg responds. "I kind of kick my thigh back just a little bit," says Hutto, "and just that little movement tells it, 'Hey you're about to walk upstairs,' and it switches mode into the stair ascent."

To reduce the risk of injury, Goldfarb's team has intentionally programmed a slight delay into the leg's computer to make sure the wearer and the prosthetic stay in perfect step with each other, and to make walking easier. "The leg can move with you," says Goldfarb.

Hutto confirms it takes less effort to walk compared to the prosthetic he currently wears. "With my leg, it's harder because it's always a step behind. I'm having to use my hip to swing my leg through, whereas the Vanderbilt Powered Prosthetic, when it toes off, the power swings the leg through and so I'm not having to use my hip to swing it through."

Goldfarb says after years of work, they have sold their technology to a major prosthetic manufacturer. "We'll know in the next few years if these are going to come onto the market and really gain a lot of traction," he says.

Meanwhile, Hutto, inspired by the three nurses who saved him from bleeding to death, is studying to become a nurse and looking forward to one day walking tall on the bionic leg that he helped make a reality.

Miles O'Brien, Science Nation Correspondent

Ann Kellan, Science Nation Producer

New Knee Helps Amputees Return to Front Lines

By Terri Moon Cronk
American Forces Press Service

BETHESDA, Md., Jan. 10, 2012 – A sophisticated prosthetic knee with a newly designed microprocessor is giving many wounded warriors with above-the-knee amputations the chance to return to active duty, military medical officials here reported.

Wounded warriors who had such severe limb loss in the early days of the Iraq and Afghanistan wars were fitted with a prosthetic, rehabilitated and medically retired in most cases, amputee services officials at Walter Reed National Military Medical Center said.

That was before 2004, when the Defense Department contracted with a prosthetics company to design a “military grade” microprocessor-controlled prosthetic knee to return these skilled veterans to duty when possible, officials said.

As a result, troops who have returned to duty wearing the Genium X2 prosthetic knee during the past three years include members of the Navy’s SEALS, the Army’s Golden Knights parachute team and infantrymen on the front lines, said David Laufer, chief of orthotics and prosthetics services.

“We wanted to enable any wounded soldier who has the willingness and ability to go back on active duty,” he said. “We’re not trying to force soldiers, Marines or sailors to go back on active duty after an amputation. We want to give them the opportunity to stay on active duty, and not be limited by their prostheses.”

The impact of these service members returning to the combat theater is more far-reaching than the extensive skills and experience they bring with them, clinic staff members said, noting that other service members can gain a new perspective on wounded warriors when they fight side-by-side with those wearing the newly designed prosthetic knee.

“They see them bring forward what they already know and realize they can do the jobs they were doing before they were injured,” said Charles Scoville, chief of amputee services in the medical center’s orthopedics and rehabilitation department.

“They learn to respect [those wearing the prosthetic knee], and realize, ‘He’s not going to hold us back or get us killed,’” he said. “It also shows them if they are injured, they will be taken care of.”

Laufer said the new devices are on back order, because the company that manufacturers them can’t keep up with growing demand.

One, the X2, was an instant hit when the first few patients got the opportunity to try it out as a prototype three years ago, Scoville said. At the time, the next-generation knee, the X3 that is scheduled to debut this summer, was still in the design phase.

“We were so impressed by the X2 prototype,” Scoville said. “We told the company, ‘We need these now.’”

At first considered “impossible” to design, the X2 has provided a new way of life for above-the-knee amputees, Scoville said. The new microprocessor has five sensors, compared with the original C-Leg, which had two, said Zachary Harvey, a certified prosthetic orthotist.

A combination of gyroscopes, accelerators and hydraulics form the knee’s greater stability, mobility and its versatility by “recognizing” actions, Harvey said.

Multiple sensors recognize when the wearer wants to sit down or go up and down ramps and stairs, he explained, all without being preset with a remote device, as required by former technology.

Harvey said the X2 is intuitive to learn. “It feels natural to walk on, in comparison to some other knees,” he said.

The X2 also enables wearers to rapidly switch from a walk mode into a run without changing settings, he said. “The X2 knee picks up on the change, kicks in and swings out a little faster into a run,” he explained.

In addition, the X2 features a protective cover in the event of falls and other minor accidents. “It's a qualitative and quantitative leap,” Laufer said, comparing it to the two-sensor unit on the C-Leg.

Marine Corps 1st Lt. James Byler, a 26-year-old infantryman who was wounded in Afghanistan more than a year ago, said he got used to the X2 almost immediately. A double amputee above the knees, Byler was fitted with a C-Leg for several months before receiving an X2 for one leg and a power knee on the other leg for his own comparison.

Unlike the X2, the power knee propelled him forward and was complicated because he had to focus on the knee, which was hard to do while walking, he said.

When Byler went to the X2 model on both knees, “the feeling was pretty immediate,” he said.

“I don’t think there’s any knee that compares to the X2,” Byler added. “It feels more natural than the others.”

The effect on his rehabilitation, Byler said, has been dramatic.

“It was only recently that guys like me with the really high amputations [realized] we could walk at all,” he said. “It took a lot of time and effort just to get up and walk.”

Byler said he’s decided to retire from the military, because as a double above-the-knee amputee, he doesn’t want to be a liability. But that doesn’t stop him and some of his fellow patients from putting on their X2 knees prostheses to visit newly injured patients who are bedbound. He and his friends tell the new patients it’s the X2 they want to get, and not anything else.

“I can walk on the X2 and not even think about it,” Byler said. “That’s the goal.”

Specialized Prosthetics Being Developed for Active Duty SEALs

By Mass Communication Specialist 2nd Class (SW/AW) Sarah E. Bitter, Naval Special Warfare Command Public Affairs

SAN LUIS OBISPO, Calif. (NNS) -- The Naval Special Warfare (NSW) Foundation and Quality of Life Plus (QL+) teamed-up to create prosthetic limbs for active duty SEALs.

The QL+ team is made up of two three-man teams of graduate level students who build the specialized prosthetics. The California Polytechnic State University San Luis Obispo based project began January 2010 and the first prototypes are scheduled to be delivered to the SEALs in December.

An East Coast based SEAL is receiving a prosthetic leg and a West Coast SEAL is receiving a prosthetic hand. The project combines biomedical engineering with mechanical engineering, creating state of the art multi-purpose biomechanical prosthetic limbs.

"The principle behind this project is to improve the quality of life for the wounded in the line of duty," said Mark Donald, NSW foundation. "What we are doing here is taking a SEAL who has to deploy with two prosthetic legs, one for swimming and one for running, and creating one leg for him."

The East Coast based SEAL was conducting a July 2007 mission in Iraq, when he lost part of his leg to an improvised explosive device (IED). He refused to succumb to his injuries and did not want his career as a Navy SEAL to end.

"After two years of battling with the doctors, they told me that I would have to amputate part of my leg, and that would be the end of my naval career," said the SEAL. "I have wanted to be a SEAL ever since I can remember and I refused to let this end my career, so I battled to stay active. I was also told by the doctors that I would not be able to walk for a year and a half; in nine months, not only was I walking, I was also running.

"I have been working with these guys [NSW foundation and QL+] since January of this year, and I am scheduled to receive the first prototype prosthetic leg in December of this year," said the SEAL.

NSW is a maritime component of U.S. Special Operations Command and the Navy's special operations force. The community is composed of more than 6,700 personnel, including 2,300 SEALs, 600 special warfare combatant-craft crewmen (SWCC), along with military support personnel, Reserve components, and civilian staff.

SEALs and SWCC focus on missions involving unconventional warfare, direct action, combating terrorism, special reconnaissance, foreign internal defense, information warfare, security assistance, counter-drug operations, personnel recovery and hydrographic reconnaissance.