Limb Loss in Iraq Puts Focus on High-Tech Prosthetics
Many viewers who tuned into the Athens Olympics coverage got their first glimpse of what looked like bionic legs during Paralympics highlight reels. The sight of athletes with sleek-looking graphite and titanium replacement limbs gracefully illustrated just how far technology and design have advanced the capabilities of people with amputations.
Replacement hands can be fitted with connections to nerve endings in biceps and triceps, making it possible to control hand grips by clenching and relaxing muscles. Replacement feet designed for running and climbing as well as walking enable soldiers to regain critical functions for daily life and, in some cases, return to active duty.
In January 2007, the 500th US soldier of Operation Iraqi Freedom, with injuries that required amputation, returned to the United States. Like those who battled thousands of years ago, as well as world-class athletes, today’s soldiers continue to inspire the development of new solutions to the ancient problem of replacing lost limbs.
Need for Wholeness
Cave paintings from ancient cultures and stories written in ancient languages document early evidence of amputees and attempts at creating prosthetics. Throughout history, losing limbs has left individuals searching for replacements for three key reasons:
- A sense of wholeness
Egyptians, Grecians, and Romans constructed the first well-documented prostheses for warriors injured in battle, as well as for those born with deformities. Modern day design and technology, to a large degree, still follow the efficient principles set out by those historic cultures, who portrayed amputees not only in society’s midst but also among god-like creatures. For generations, basic peg legs and hand hooks dominated the options for amputees, including soldiers.
The beginning of the Industrial Revolution fueled the development of more refined prosthetic devices. Meanwhile, the US government’s funding of prosthetics for all soldiers who lost limbs in the Civil War—30,000 in the Union Army alone—gave rise to a new generation of entrepreneurs. Updated designs were consistently being created, including limbs with independently moving joints, springs, and rubber feet.
Since the earliest recorded stories of battle, the challenges of creating effective prosthetics brought together disparate experts. In the Dark Ages, craftsmen who built armor also shaped artificial limbs made of metal. Woodworkers created lighter prosthetic devices designed for the relatively few survivors of major trauma.
Many advances came from the ingenuity of wounded soldiers themselves. The first aluminum prosthesis, for example, was constructed by English aviator Marcel Desoutter, an amputee who sought design help from his brother, an aeronautical engineer. And in 1946, after increased US injuries in World War II, the Surgeon General supported the creation of the professional organization now known as the American Orthotics and Prosthetics Association, which develops standards, educational programs, and important relationships between doctors.
As the military spared no expense in ensuring the best quality of life for injured soldiers, universities around the country took on the challenge of building better prosthetics. In addition, the Veterans Administration helped launch the Artificial Limb Program, which established research laboratories responsible for improved socket design, better materials, and more advanced prosthetic joints, including knees.
Varied Risk Factors
While soldiers remain the highest profile recipients of high-tech prosthetics, they represented only a fraction of the more than 1.6 million Americans living without limbs in 2000. According to the Amputee Coalition of America’s National Limb Loss Information Center, most amputees (excluding those with missing fingers and toes) are aged 65 and older. All of the following reasons rank higher than trauma as reasons for ]]>amputation]]> :
- ]]>Diabetes]]> and other causes of vascular diseases
- Birth defects
Still, much technological development remains focused on replacement limbs for soldiers, in part because of the relative youth of these men and because they want to get back to work.
At facilities such as the Walter Reed Army Medical Center in Washington, the first stop for many soldiers injured in Iraq, amputees work with a team of specialists, including surgeons and psychiatrists, who help them transition into new lives both physically and emotionally.
Computer imaging allows doctors to create custom-made plastic sockets that attach onto existing limbs perfectly. New battery-powered graphite and titanium artificial legs—some costing as much as $100,000—include built-in microprocessors, or tiny computers, that give patients more control over their stride than ever before. One of the most advanced new models, the “C-leg,” features computerized sensors to adjust stride speed nearly instantaneously.
Modern prosthetic arms and hands look more natural and function more naturally, with fast-moving electric models that allow for gripping and grabbing.
As researchers continue to improve and upgrade prosthetic devices, patients continue to gain more control and flexibility, along with an ever-expanding list of special options.
Despite all of the technological advances, the single most important factor in effective use of prosthetics is how well the artificial limb can be made to fit. No amount of computer technology can replace a well-designed socket connecting what remains of the real limb with the artificial one. This process is highly dependent on expert skill in prosthetics and physical therapy/rehabilitation. To ensure that our aging population—as well as our veterans—continue to get maximum benefit from technology, we will need to continue to attract able persons to rehabilitation professions and offer them personal and financial rewards that will keep them in the workforce.
Because of the wide range of prosthetic devices available, amputees need to be well-informed about their options. Often, the choice between battery-powered or body-powered devices and specific limb styles and materials depends on variables like:
- Level of amputation
- Activity level
- Types of desired activities
Despite technology, adjusting to life without a limb, or limbs, remains physically and psychologically exhausting. Still, countless families and loved ones value having soldiers not only home, but able to live relatively free of the burdens that perpetually plagued amputees in the past: pain, embarrassment/conspicuousness, and long-term limitations.
American Academy of Orthotists and Prosthetists
Amputee Coalition of America
National Amputation Foundation
Dotinga R. Prosthetic technology offers hope for Iraq amputees. HealthDay News website. Available at: http://healthinfo.cedars-sinai.edu/healthnews/healthday/040319HD517993.htm . Accessed August 2004.
Marks LJ, Michael JW. Science, medicine, and the future: Artificial limbs. British Medical Journal. 2001;323:732-735.
National Limb Loss Information Center FAQ. Amputee Coalition of America website. Available at: http://www.amputee-coalition.org/nllic_faq.html . Accessed February 2007.
Northwestern University Medical School/Prosthetic Education. History and prosthetics. Amputee Research Foundation of America website. Available at: http://www.amputeeresource.org/History%20and%20prosthetics.htm . Accessed August 2004.
Knickman JR, Snell EK. The 2030 problem: caring for aging baby boomers. Health Serv Res. 2002;37(4):849-84.
Lake C, Dodson R. Progressive upper limb prosthetics. Phys Med Rehabil Clin N Am. 2006;17(1):49-72.
McGuigan FX, Forsberg JA, Andersen RC. Foot and ankle reconstruction after blast injuries. Foot Ankle Clin. 2006;11(1):165-182.
Last reviewed July 2008 by ]]>Lawrence Frisch, MD, MPH]]>
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