April 18, 2013 -- The patients who lost limbs as a result of the Boston Marathon bombings might benefit from the lessons learned in treating soldier amputees injured in Iraq and Afghanistan.
"It's no longer the peg leg mentality," said Matt Albuquerque, president of Next Step Orthotics and Prosthetics, which, coincidently, has an office in Newton, Mass., just a few miles from the Boston Marathon route.
"The misconception is that we are still fitting people with wooden legs, but with the science of prosthetic limbs evolving so quickly in the past 20 years or so, we've gone from wood to robotics," he said.
Albuquerque said that advancements in prosthetic technology often take place during wartime, with the government funding most of the ongoing research.
For example, one prosthetic currently making its way through Food and Drug Administration trials, the Deka arm, was developed by Segway inventor Dean Kamen, thanks to an $18.1 million grant from the Defense Advance Research Project Agency, the defense department's research fund.
Affectionately dubbed "Luke" after the Star War's character Luke Skywalker, the robotic arm was designed to restore functionality to soldiers with upper extremity amputations. The goal of the project has been a thought-controlled arm-and-hand prosthesis that performs, looks and feels like a natural limb.
Nearly 700 people in the United States -- most of them wounded soldiers -- have already been fitted with a prosthetic ankle called the iWalk BiOM. It's considered the first truly "bionic" prosthetic because it is packed with a sophisticated array of computer chips, gyroscopes and a motor. This, according to Dr. Austin Fragomen, an orthopedic surgeon who is a limb salvage and limb deformity correction specialist at the Hospital for Special Surgery in New York City, allows it to operate in much the same way as a flesh and blood human ankle.
"It's a huge improvement over older style leg prosthetics, which are essentially hinged springs incapable of sensing subtle shifts in movement," Fragomen said. "It's similar to what's been available for above-the-knee prosthetics, but they've applied a more advanced technology to the ankle."
Fragomen, who also works with the Wounded Warrior Project, said the advantages of the BiOM are most apparent during tasks like climbing up and down hills, which, he noted, is one of the most difficult skills for an amputee.
"The BiOM senses changes in incline and decline and makes adjustments accordingly. You can fine tune the movements from an app on your cell phone in real time until it's right," he said.
But the benefits of these new generation bionic limbs go beyond the technological advancements. Fit and comfort have also come a long way.
Prosthetics now fit better, Albuquerque said, largely thanks to new and improved interfaces that insert between the remaining limb and the prosthetic. One type, a suspension sleeve, suspends the socket of the prosthetic. The other type, a liner, provides a layer of padding or cushioning for the residual limb. Both now come in an array of materials and can be customized to the prosthetic and the user.
Companies such as Next Step are certified "prosthetists," trained in the design, fabrication and fitting of artificial limbs. It works closely with vascular surgeons, physical therapists and primary care physicians to fit amputees with the appropriate components, and to ensure the prosthetic works with the remaining natural limb and functions smoothly.
It takes six to eight weeks from the time of the first fitting for an amputee to adjust to a new prosthetic, Fragomen said. How quickly people get up and moving depends upon their age and the location of the amputation site, as well other injuries they have sustained. For a double amputee, it may take a bit longer to master the balance and stability that goes with adjusting to life with two prosthetic limbs.
While the government usually picks up the entire tab for the cost of a war veteran's prosthetic, this is not the case when an amputation is the result of an accident or attack, such as the Boston bombings.
Prosthetics are covered by 70 to 75 percent of employer-sponsored insurance plans, and 19 states have passed laws requiring private insurers to provide appropriate access to prosthetic care, according to a study conducted by the Society of Human Resource Management in 2011. Those who don't have adequate insurance coverage can expect to pay up to $40,000 per limb, not including hospital stays and rehabilitation costs.
It's possible that some of the Boston bombing victims who are marathoners will consider owning two sets of prosthetics: One for everyday use and one for running.
"Cheetah" blades, such as those worn by South African sprinter Oscar Pistorius, are designed primarily for athletic activities. Each blade is custom-built for the individual from high-performance carbon fiber at a cost of about $10,000 each.
Albuquerque hopes that any runner who lost one or even two legs in the Boston Marathon blasts will one day finish the race on prosthetic limbs.
"You can say what you want about him, but Pistorius showed that technology has gotten to the point where someone who is missing both their limbs can run in the Olympics against able-bodied people," he said. "Not that everyone can get to that point, but it paints a picture of hope for amputees out there that the possibilities are endless."