Biotechnology - Modern technology offering better solutions for limb

One of the most disheartening tragedies of war is that long after hostilities cease, those who survive sometimes do so with permanent scars and lifelong disabilities.

When one thinks of the Civil War, for instance, an enduring image is the injured soldier crabbing his way home with a crude crutch to replace his missing leg. Loss of limbs remains a fearful accompaniment to military conflict, even through the war in Iraq.

But today's technology has gone a long way toward helping these unfortunate victims of war.

The Smithsonian Museum of American History in Washington recently presented a program entitled Artificial Parts: Reinventing the Human Body to a crowded audience, sprinkled with amputees, both civilian and military, who came to hear about the latest in computerized prostheses.

Ralph Urgolites, director of the orthotic and prosthetic section at the Walter Reed Army Medical Center, the Washington institution at the forefront of efforts to restore function to those who suffer missing limbs, discussed modern technologies, taking us into territories once considered the realm of science fiction. The latest prosthetic arms, for example, take advantage of electrical activity in the remaining muscles.

Using advanced computerized technology, they enable the user to bend the elbow and grasp objects firmly and rigidly, such as that necessary for catching a ball, slowly so as to open a jar, or even tenderly to grasp a delicate wine glass. All that is necessary to initiate the movement is the patient's thoughts, which are then transmitted to the prosthetic arm. Although such advances are theoretically possible with leg prostheses as well, as yet there is no computerized artificial foot on the market.

Another speaker, Van Phillips, himself an amputee, is the inventor of a remarkable line of prostheses. His Flex Foot, which he devised in 1990, was especially designed to enable amputees to walk or run comfortably enough to actually forget they were wearing a prosthesis. Phillips then gave an amazing demonstration. He removed the left leg prosthesis he uses for everyday activity and attached his cheetah leg, the Flex Foot made for running or other sporting activities. He then sprinted up one side of the auditorium, across the back and down the opposite side to return to the stage, just as an Olympic contender might do.

Although the Flex Foot would win no prizes for stylishness, appearance has not been neglected in other prostheses. For female amputees, there is a foot that has a separation between the big toe and the remaining four toes to allow the use of a sandal. The toes are even designed with realistic toenails which can be polished. Other slender female limbs are available which, when covered with a special stocking, can allow the fitting of a stylish shoe to the artificial foot and be imperceptible to the untrained eye.

Bethesda-based Hanger Inc., founded by a Confederate soldier who lost his leg in battle, remains another innovator for the treatment of amputees. The company developed a system, named Insignia, which uses a laser scanner to produce an accurate, three-dimensional model of the area of the body to which a prosthetic device must conform.

Until the development of this system, models had to be made using a plaster cast. Such plaster castings are not only very messy and bothersome to patients, they can be frightening to children. Insignia's laser scanner requires little or no physical contact, so it can be used even while a patient is in bed following surgery, or for infants whose squirming makes plaster casting especially difficult.

The entire system can fit into a case no larger than a standard carry-on airline bag. Patients who cannot travel to a Hanger patient care center can be scanned at home, in the hospital or in a nursing home or other rehabilitative facility.

The greatest advantage to patients is the fact that devices made with the use of Insignia are much better fitting and comfortable. The scans are accurate within one millimeter, and the three-dimensional features give detailed surface information which is often lost through traditional methods. In addition, the scans produce a permanent record which can be used for later refitting and adjustments.

Robert S. Coplan, M.D., M.P.H., has spent a half century studying, practicing and writing about medicine and issues facing the health care and biotechnology industries.

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