USA — Better Prosthetics Coming for Wounded Warriors

FORT DETRICK, Md. — From devel­op­ing a new micro­proces­sor-con­trolled pros­thet­ic leg to a non-chaf­ing sock­et device, the Telemed­i­cine and Advanced Tech­nol­o­gy Research Cen­ter here is mak­ing big strides in advanc­ing pros­thet­ic sci­ence to improve wound­ed war­riors’ qual­i­ty of life.

The cen­ter, tucked away at this west­ern Mary­land post, reach­es out to a broad spec­trum of researchers at uni­ver­si­ties, hos­pi­tals, and small busi­ness­es to pro­mote next-gen­er­a­tion, cut­ting-edge pros­thet­ic tech­nolo­gies.

“The objec­tive is to help amputees and trau­mat­i­cal­ly wound­ed ser­vice­mem­bers return to the high­est lev­el of func­tion­al­i­ty that they are capa­ble of,” said Troy Turn­er, who man­ages the center’s advanced pros­thet­ics and human per­for­mance port­fo­lio.

“We do this with the under­stand­ing that it is real­ly their ini­tia­tive and their moti­va­tion that gets them there,” he said. “But we want to make sure that there is noth­ing we can do to help them get there that is left undone.”

One of the center’s biggest tri­umphs to date is the X2 micro­proces­sor leg, devel­oped by Otto Bock Health­Care with TATRC fund­ing. The new “C‑leg,” being test­ed by above-the-knee amputees at Wal­ter Reed Army Med­ical Cen­ter in Wash­ing­ton, uses a micro­proces­sor to con­trol the knee’s hydraulic func­tions. This, in turn, gives the wear­er more flex­i­bil­i­ty to change speeds or direc­tions with­out sac­ri­fic­ing sta­bil­i­ty.

The device takes the advanced com­put­er­ized leg to a new lev­el, Turn­er explained, enabling users to walk back­ward or up and down ramps, and even to swim.

“In its lat­est iter­a­tion, some­body would actu­al­ly be able to wear it water-ski­ing and even surf­ing, because of how weath­er­proof and amenable it is to hos­tile envi­ron­ments,” he said.

Focused pri­mar­i­ly on the low­er extrem­i­ties – which Turn­er said account for 80 per­cent of wound­ed war­riors’ limb loss­es – the cen­ter is fund­ing a vari­ety of research pro­grams aimed at improv­ing not just leg, but also knee, ankle and foot pros­the­ses.

One promis­ing pro­gram is aimed at devel­op­ing a robot­ic ankle that will give users more flex­i­bil­i­ty to move over dif­fer­ent types of ter­rain, with a motor that pro­vides a “spring” after each step.

Oth­er pro­grams are tack­ling what Turn­er calls the biggest gap in pros­thet­ic devel­op­ment: the sock­et itself.

The hard, plas­tic cups cur­rent­ly used as sock­et devices can be painful to wear­ers, chaf­ing when the sur­round­ing mus­cles swell or the wear­er sweats. “Even the best-fit­ting sock­et can be painful,” Turn­er said.

No one-size-fits-all solu­tion is avail­able, because every limb is dif­fer­ent. “So there is a uni­ver­sal prob­lem, but the way it’s addressed has to be indi­vid­u­al­ly,” Turn­er said.

Along with the sock­et, researchers are explor­ing new lin­ers and sleeves that pro­vide a bet­ter, more com­fort­able fit for pros­thet­ic devices. “Any time you are going to put a body part into a hard plas­tic cup and leave it all day, you are going to have chaf­ing and swelling, and the intro­duc­tion of mois­ture in there will cause addi­tion­al fric­tion,” Turn­er said.

Two promis­ing research pro­grams under way, one in Los Ange­les and one in Boston, are explor­ing ways to pro­vide more com­fort­able sock­ets that use breath­able or wick­ing mate­ri­als to pre­vent mois­ture buildup.

“Both of these projects, if suc­cess­ful, will result in sock­ets that are very non­tra­di­tion­al, and in some cas­es, don’t oper­ate or even look like tra­di­tion­al sock­ets,” Turn­er said. Among con­cepts being explored is a sock­et that’s pli­able and flex­i­ble when there’s no weight on it, but goes rigid to pro­vide sup­port when the wear­er stands.

As the Telemed­i­cine and Advanced Tech­nol­o­gy Research Cen­ter advances these tech­nolo­gies, Turn­er said, the ulti­mate goal is to pro­vide com­fort­able, adapt­able pros­thet­ics that oper­ate almost intu­itive­ly, rec­og­niz­ing what the user wants them to do and respond­ing on cue.

“We want to try to cre­ate the capa­bil­i­ty of the device to behave the way the user wants it to behave, and to under­stand what the user wants it to do,” he said.

The cen­ter is explor­ing dif­fer­ent approach­es toward achiev­ing what Turn­er calls “user intent con­trol.” One involves putting a minia­ture sen­sor on the mus­cle or even inject­ing it direct­ly into the mus­cle to pick up elec­tri­cal sig­nals and relay them direct­ly to the pros­thet­ic device. “If we are able to do that, we can tell that pros­thet­ic device to do some­thing,” Turn­er said.

“Achiev­ing that is a mat­ter of inte­grat­ing all these capa­bil­i­ties [being devel­oped] into a sys­tem and putting it all togeth­er,” he said. “And that’s a lot of our job – cre­at­ing aware­ness and serv­ing a lit­tle bit as an infor­ma­tion clear­ing­house to help bring it all togeth­er and help [researchers] under­stand what oth­er peo­ple are doing.”

Bring­ing togeth­er a research com­mu­ni­ty can add up to big promise for wound­ed war­riors, he said. “If you put yours with theirs,” he said, “this one-plus-one could equal three.”

With a vast port­fo­lio, and many research efforts under way simul­ta­ne­ous­ly, Turn­er con­ced­ed that some­times it seems “like we are going in a lot of direc­tions.”

“But the thing that binds it all togeth­er is our mis­sion of bring­ing togeth­er as much as pos­si­ble – what­ev­er rev­o­lu­tion­ary con­cepts and tech­nol­o­gy we can – to help the warfight­er achieve the high­est lev­el of func­tion­al­i­ty pos­si­ble,” he said. “Our goal is to help them come back to as close to a nor­mal life as pos­si­ble.”

Marine Sgt. Adam Kisielews­ki, who lost his left arm and his right leg from the knee down dur­ing an explo­sion at a boo­by-trapped school near Fal­lu­jah, Iraq, in August 2005, said he’s excit­ed about the pos­si­bil­i­ties the cen­ter is open­ing up for him and his fel­low wound­ed war­riors.

Kisielews­ki served until recent­ly as a project offi­cer in the center’s pros­thet­ics depart­ment, pro­vid­ing unique, per­son­al insights into the projects under way.

“It’s great to pro­vide input, to be able to get the broad pic­ture of every­thing that is going on [in the research are­na] and to see what is going to be avail­able in the next cou­ple of years,” he said.

“When I see some of the stuff com­ing out, I get real­ly excit­ed,” Kisielews­ki added. “It is going to do a lot to increase the stan­dard of liv­ing that the guys are going to have when they come back from war with real­ly seri­ous wounds.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)