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New Technology Puts Amputees Back in the Game

Chris Johnson wears the iPed supramelleolar foot, a collaborative effort between Orthocare Innovations and College Park Industries.

By Stephanie Z. Pavlou

O&P Business News

The hockey player races across the ice, planning his next move. He sneaks around a defender and faces the goalie - his team's chance to win the game. In one swift move, he lifts his stick and shoots the puck past the goalie's outstretched glove into the top corner of the net. The crowd cheers.

The stadium clears and he follows his teammates off the ice. He sits on a bench in the locker room to remove his skates, his gear and his prosthetic arm.

This is not a description of the unlikely future, but of technology already on the market that makes it possible for amputees to remain active and competitive in sports. Several manufacturing companies specialize in these kinds of prostheses and many O&P practitioners work with patients to get them back on the ice, in the water or on the field.

Different kind of rehab
The best role models for amputees who want to get back in the game are active amputees. Manufacturers like Bob Radocy and Ron Farquharson entered the profession to provide a means for other amputees like themselves to return to sports and recreational activities. Others, like Brian Frasure, clinical manager for Ossur Americas in Aliso Viejo, Calif., became O&P practitioners after amputation to help amputees regain both their spirits and their physical abilities.

Chris Johnson
wears the iPed supramalleolar foot,
a collaborative effort between College
Park Industries and Orthocare Innovations. Image reprinted with permission of Chris Johnson of College
Park Industries and OrthoCare Innovations.

With a below-elbow amputation and an educational background in recreational therapy, Radocy, president and chief executive officer of TRS Inc. (short for Therapeutic Recreation Systems) in Boulder, Colo., has not only experienced, but studied, the benefit of recreational rehabilitation.

"Getting back into a sport or recreation that you love after a severe traumatic injury can change your entire attitude about your rehabilitation," Radocy said. "Sometimes it's the only spark in that person's life that gives them the motivation to go forward."

Participating in sports and other recreational activities - in essence, having fun - shows new amputees that they have not lost as much of their previous lives as they originally thought.

Funding for these products was not readily available until January 2007 when The Centers for Medicare and Medicaid Services (CMS) created L6704, which covers terminal attachment devices for sports, recreational and work activities. With this L-code, CMS acknowledged the value of this type of rehabilitation in patients' lives, Radocy told O&P Business News.

"For us, it was recognition of efforts we have made over the last 25 or 30 years," he said. "Getting people to realize that, especially with children, sports and recreation are a component of life and they are vital to the rehabilitation process."

The issuance of this code was "the most noteworthy recent development ... for the O&P industry in general, as far as upper extremity issues are concerned," Farquharson, president of Texas Assistive Devices LLC in Brazoria, Texas, said.

Current upper extremity devices
With the assortment of sports and recreational prostheses available now, amputees can find a device to suit any of their active needs. Although each of the prosthetic devices in this small market is different, all of the manufacturers share the same goal - to make life a little easier for their patients.

"Our thrust has been trying to make people bimanually functional and competitive, as opposed to just being participants in these kinds of things," Radocy said.

To this end, TRS has focused on identifying, and then replicating, the biomechanics involved in each particular sports activity. Radocy also set out to improve the componentry that allows for energy transfer in prostheses, so they would be able to complete the gross motor movement involved in most sports activities.

"Prostheses as they exist just don't allow for many degrees of freedom," he said. "Prostheses, to a great extent, have not been able to duplicate smoothly and functionally some of the simplest kinds of motions."

Randall Alley, BSc, CP, LP, FAAOP, CFT, chief executive officer of biodesigns inc. in Thousand Oaks, Calif., is an avid athlete, and attributes his interest in recreational prosthesis development to his love of sports. He has spent many years working on prosthetic interface designs to correct biomechanical shortcomings in traditional sockets that have changed little in decades.

The Hammerhead Kayak TD wrist action makes it suitable for a variety of rowing sports.
Image reprinted with permission of TRS.

"What you see is a rather generic encapsulation of the soft tissue," Alley said. "Some designs make room for muscle expansion, while others add stabilization to the lateral aspect of the femur, for example. Tibial designs go a bit further due to the surface proximity of the anterior aspect of the tibia, in effect forcing us to do something that resembles tibial control, but even here, this is only the tip of the iceberg."

Much of his recent work has been in creating interfaces that redefine functionality using an individualized set of parameters.

Others set out to solve everyday issues for amputees. Farquharson spent years after his amputation searching for devices to help him complete ordinary tasks like cooking, carpentry and mechanical work, which at the time involved a great deal of effort. This led him to create the Texas Assistive Devices line of tools, including the N-Abler II, a terminal device for upper extremity amputees that serves as an adaptive tool holder for a number of items, including recreational and sports adaptations.

"In the past, of the few sports and recreational items available, most were difficult to attach to the prostheses and had no feature to allow either flex or rotational positioning," Farquharson said.

For this reason, he designed the N-Abler II to allow for a quick disconnect from any of the tools in the product line. Furthermore, the N-Abler II offers patients 60° of flex and 360° of rotation so they can properly position these devices to complete any of the desired activities.

Current lower extremity devices
Lower extremity prosthetic design has developed more quickly than that for upper extremity amputees, and the race to incorporate the newest technology continues for both new and existing products.

The Cheetah, Ossur's sprinting foot that has gained notoriety as the prosthesis preventing Oscar Pistorius from participating in the Olympics, is not a new technological advancement, but an evolution of a product introduced in 1995, said Frasure.

"That has just been a slow evolution of the foot," he said. "Small changes in design, the way the carbon layers are put together and the amount of those layers, the shape of the foot itself ... the fine-tuned changes along the way that have helped advance the performance of the foot."

The carbon fiber layering and shape of the Cheetah results in high energy storage and return for the runner at toe off, anywhere from 85% to 90% efficient.

Frasure credits Team Ossur, a group of athletes sponsored by the company whose feedback on devices has propelled the technology forward.

Jay Martin, CP, LP, director of the Advanced Systems Group for Orthocare Innovations in Oklahoma City, who began his career as a practitioner, shifted his focus to research and development after realizing that his patients' level of function would increase with more advanced technology.

"I realized that there was a significant gap between the most advanced prostheses and the human body," Martin said.

He wanted to close that gap. He received research grants to develop some of these technologies and created Martin Bionics, which merged with Orthocare Innovations in March. For the past few years, his company has worked with College Park Industries to develop the iPed, a new lower extremity prosthesis that works to close that gap.

New developments
The field of sports and recreational prosthetics is ripe for innovative technology. New products are introduced continually for an array of amputee needs.

One example of the new technology available from TRS includes a hockey device like the one mentioned earlier. The Power Play is an entirely synthetic, high-performance, polyurethane-constructed device that accepts any type of hockey stick. This technology ensures the user both dynamic control over the device, as well as a measure of safety in such an aggressive sport.

"We were able to select formulas of synthetic polymers that allowed us to produce a design that has done that well," Radocy said.

He looks forward to putting to use that same technology to redesign some other devices in the TRS product line. Those that were mechanically constructed in the past will be modified to incorporate what he calls "living joints." These living joints offer the same range of motion, but also store energy, provide strength for the amputee and can be engineered to complete a variety of tasks, depending on the circumstances.

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