Prosthetics and Related Technology

Spotlight on VA Research

In its longstanding role as a world leader in prosthetics research, VA's research program supports a broad portfolio related to amputations and prosthetics. In addition to continually developing improved materials and designs for prostheses, VA investigators are working to identify the best match for Veterans' prosthetic needs by collecting information such as how various prosthetic devices are used and how satisfied users are with each type.

Among those receiving prosthetics-related care in the VA system are many of the estimated 6 percent of wounded service members returning from Iraq who have lost a limb, and many other Veterans whose amputations were necessitated by diabetes, peripheral vascular disease, and other disorders. The total number of Veterans accessing VA health care for prosthetics, sensory aids, and related services has increased by more than 70 percent since 2000.

Developing More Lifelike Artificial Limbs

VA researchers constantly strive to improve the construction of prostheses, using leading edge technologies such as robotics, tissue engineering, and nanotechnology to create lighter limbs that closely mimic their natural counterparts. The integration of body, mind, and machine is a major guiding principle as VA specialists design and build artificial limbs that look, feel, and respond like natural arms and legs.

Important areas of VA research on amputation and artificial limbs include:

• Introducing the first powered ankle-foot prosthesis, which thrusts users forward with tendon-like springs and an electric motor. The prototype, developed collaboratively by VA researchers with researchers at MIT and Brown University, has shown important benefits in early studies-among them, patients expended less energy during walking, had better balance, and walked 15 percent faster.
• Studying how to best match prosthetic components with the needs of amputees, including those whose active lifestyles call for versatile, high-performance artificial limbs.
• Investigating different care strategies for residual limbs after surgery, which may improve understanding of wound care in general and could ultimately reduce the need for amputations. Already, wound healing that used to take weeks or even months can now occur far faster.
• Developing a family intervention program to teach service members' spouses alternative and complementary medicine techniques shown to lessen anxiety and pain associated with traumatic limb loss.
• Evaluating CT scans of diabetic feet to identify which foot types are at highest risk for the ulcers that often lead to amputation.
• Studying complex methods of tissue engineering for addressing tendon loss from military trauma or degenerative arthritis and for regenerating cartilage lost to trauma, disease, or aging.

Using Electrical Signals to Restore Function

More than 40,000 Veterans, and a total of more than 250,000 Americans, have serious spinal cord injuries and disorders that may interfere with brain signals that control muscle movement. Many others have become blind from the loss of "photoreceptors" in the eye. For Veterans with these and some other types of functional loss due to disease or injury, VA investigators hope to restore function with electrical currents delivered through means of a "neural prosthesis." undergo amputation.

Important areas of VA research in neural prostheses include:

• Investigating the use of electrical stimulation, delivered by devices implanted into the body like cardiac pacemakers, to enable Veterans with varying degrees of spinal cord injury to improve their ability to walk, control the movement of paralyzed limbs for grasping and releasing objects, and manage body functions such as bladder control and respiration. In a study of 32 chronic stroke patients, VA researchers found that functional neuromuscular stimulation significantly enhanced walking ability. The therapy, which involved delivering small currents to electrodes implanted in weak or paralyzed leg muscles, outperformed other therapies used in the trial, such as body-weight-supported treadmill training or special walking exercises.
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VA Prosthetics Research in the Real World

To ensure that no time is lost translating VA's groundbreaking research into life-improving advances in care, the VA Research and Development program relies on extensive collaboration among basic science researchers, clinician investigators, and rehabilitation specialists. VA has for the last several years conducted a series of "State of the Science—Research to Clinical Practice" workshops in cooperation with the Department of Defense and Walter Reed Army Medical Center on topics such as prosthetics, spinal cord injury, and wheelchair technology. Upcoming workshops are announced at www.herlpitt.org.

Publishing Advances in Prosthetics

To stay up to date on the latest in prosthetics and rehabilitation care, read VA's international, peer-reviewed Journal of Rehabilitation Research and Development (JRRD). For more than 40 years, this leading research journal has published current information in the field of rehabilitation medicine and technology, including original studies, topic reviews, and commentaries related to amputation, prosthetics, and many other topics. For more information, go to www.rehab.research.va.gov.