2017 - Military medicine provides ‘world-class solutions for combat casualties

Military medicine provides ‘world-class solutions for combat casualties’

By Military Health System Communications Office- Jan 17^th, 2017

Health.Mil-The official website of the Military Health System and the Defense Health Agency.

http://www.health.mil/News/Articles/2017/01/17/Military-medicine-provides-world-class-solutions-for-combat-casualties

Osseointegration, a process which attaches a prosthetic limb directly to the skeleton, can be an alternative option to traditional socket-based prosthetics for qualified patients. It is currently undergoing clinical trials at Walter Reed National Military Medical Center in Bethesda, Maryland. (U.S. Navy photo by Mass Communication Specialist 2nd Class Joshua D. Sheppard)

Experts across the Military Health System are collaborating with civilian researchers on an advanced alternative to socket-based prosthetics for some amputees. Osseointegration, a process that attaches the prosthesis directly to the skeleton, can improve comfort and mobility for qualified patients with amputations.

Navy Cmdr. (Dr.) Jonathan A. Forsberg, an orthopedic oncologist at Walter Reed National Military Medical Center in Bethesda, Maryland, and an investigator at the Naval Medical Research Center, said he treats patients who are newly injured and those who have been living with amputations for many years.

“Developing osseointegration as a capability within the Department of Defense makes good on our commitment to provide world-class solutions for combat casualties throughout the entire spectrum of care,” said Forsberg. Although clinical trials for osseointegration have been performed elsewhere around the world, the clinical trial at Walter Reed is the first of its kind to be performed in the United States.

The initial surgery for osseointegration attaches a fixture or implant onto or within the bone, and the bone takes about three months to grow into the implant. The second surgery prepares the soft tissue for an attachment, called an abutment, which protrudes through the skin. Similar to the way a dental implant is secured to the jaw bone, a prosthetic limb is attached directly to the abutment. (Courtesy graphic)

The Osseointegration Program within the Uniformed Services University of Health Sciences-Walter Reed Department of Surgery, is headed by Forsberg and Army Lt. Col. (Dr.) Benjamin Kyle Potter, chief of orthopedics at Walter Reed. They hope to improve function and quality of life while minimizing risk for these wounded warriors who have suffered visible and devastating injuries, said Potter.

“We’re unique here at Walter Reed and San Antonio within the military system to have these amputee centers of excellence,” said Potter. “This is one of several technologies that are here, or on the near horizon, and have the potential to dramatically improve the outcomes following amputation.”

A four-year Food and Drug Administration clinical trial began in October using the Osseointegration Prosthesis for the Rehabilitation of Amputees (OPRA) – one of two implants currently available. At the moment, the study involves patients with transhumeral, or above elbow, amputations. However, Walter Reed is also looking at transfemoral, or above knee, amputees, said Potter.

"Traditional socket-based prosthesis rely on soft tissue to transfer the weight of the load from the ground to the skeleton,” said Forsberg. “Osseointegration eliminates the need for soft tissue attachment.”

The initial surgery for osseointegration attaches a fixture or implant onto or within the bone, and the bone takes about three months to grow into the implant. The second surgery prepares the soft tissue for an attachment, called an abutment, which protrudes through the skin. Similar to the way a dental implant is secured to the jaw bone, a prosthetic limb is attached directly to the abutment. Over the next six months, the patient progressively transfers force to the skeleton in a controlled manner so that no loosening of any part occurs.

Earlier this year, the program’s first patient, former Marine Sgt. Michael Frazier, received another type of osseointegrated implant from Potter and Forsberg: the DoD-funded Compress® Transdermal Implant. In May 2011, Frazier stepped on an improvised explosive device in Trek Nawa, Afghanistan, losing both legs to the blast.

"Being in a wheelchair 24/7 started to take a toll on my mind and body, so I needed a change, to get up and walk again,” said Frazier, who medically retired in December 2012. He was walking around in about a month after the procedure, and felt more comfortable and confident, he said. “[The leg is] easier to put on and you have so much more control and feeling because it’s pretty much a part of your body.”

Many institutions are collaborating with Walter Reed’s osseointegration program, including the Office of Naval Research, Uniformed Services University of the Health Sciences, University of California - San Francisco, and several other universities.

"By centralizing osseointegration at one DoD institution, which is at Walter Reed right now, we are able to standardize certain processes – patient selection, evaluation, surgery, rehabilitation – before pushing it out to the rest of the DoD community,” said Forsberg.

DARPA provides groundbreaking bionic arms to Walter Reed

By Cheryl Pellerin, Defense Media Activity- December 28^th,2016

US Department of Defense.

https://www.defense.gov/News/Article/Article/1037447/darpa-provides-groundbreaking-bionic-arms-to-walter-reed

Dr. Justin Sanchez, director of the Defense Advanced Research Projects Agency’s Biological Technologies Office, fist-bumps with one of the first two advanced “LUKE” arms to be delivered from a new production line during a ceremony at Walter Reed National Military Medical Center in Bethesda, Maryland. (DoD photo)

WASHINGTON  — The Defense Advanced Research Projects Agency is making available to military amputees the first production versions of a groundbreaking upper-limb prosthesis, according to a DARPA press release. 

Dr. Justin Sanchez, director of DARPA’s Biological Technologies Office, delivered the first two advanced “LUKE” arms from a new production line during a ceremony yesterday – evidence that the fast-track DARPA research effort has completed its transition into a commercial enterprise, DARPA officials said. 

The ceremony took place at Walter Reed National Military Medical Center in Bethesda, Maryland. 

“The commercial production and availability of these remarkable arms for patients marks a major milestone in the [DARPA] Revolutionizing Prosthetics program and most importantly an opportunity for our wounded warriors to enjoy a major enhancement in their quality of life,” Sanchez said, “and we are not stopping here.” 

The RP program is supporting initial production of the bionic arms and is making progress restoring upper-arm control, he added. 

“Ultimately we envision these limbs providing even greater dexterity and highly refined sensory experiences by connecting them directly to users’ peripheral and central nervous systems,” Sanchez said. 

Arms for Service Members 

As part of the production transition process, DARPA is collaborating with Walter Reed to make the bionic arms available to service members and veterans who are rehabilitating after suffering upper-limb loss, DARPA says. 

LUKE stands for “life under kinetic evolution” but is also a passing reference to the limb that Luke Skywalker wore in Star Wars: Episode V, The Empire Strikes Back. 

The limbs are being manufactured by Mobius Bionics LLC, of Manchester, New Hampshire, a company created to market the technology developed by DEKA Integrated Solutions Corp., also of Manchester, under DARPA’s Revolutionizing Prosthetics program. 

The first production versions of “LUKE” arms, a groundbreaking upper-limb prostheses, were on display during a ceremony at Walter Reed National Military Medical Center. The Defense Advanced Research Projects Agency is collaborating with Walter Reed to make the bionic arms available to service members and veterans who are rehabilitating after suffering upper-limb loss. (DoD photo)

The prosthetic system allows very dexterous arm and hand movement with grip force feedback through a simple intuitive control system, DARPA says. 

The modular battery-powered limb is near-natural size and weight. Its hand has six user-chosen grips and an arm that allows for simultaneous control of multiple joints using inputs that include wireless signals generated by innovative sensors worn on a user’s feet. 

Revolutionizing Prosthetics 

The technology that powers prosthetic legs has advanced steadily over the past two decades but prosthetic arms and hands are a tougher challenge, in part because of the need for greater degrees of dexterity, DARPA says. 

When the LUKE arm first went into development, people who had lost upper limbs had to use a relatively primitive split-hook device that hadn’t changed much since it was introduced in 1912. 

DARPA launched the Revolutionizing Prosthetics program with a goal of getting U.S. Food and Drug Administration approval for an advanced electromechanical prosthetic upper limb with near-natural control that enhances independence and improves quality of life for amputees. LUKE received FDA approval less than eight years after the effort began, DARPA says. 

Under a recently finalized agreement between DARPA and Walter Reed, DARPA will transfer LUKE arms from an initial production run to the medical center for prescription to patients. Mobius Bionics will train the Walter Reed staff to fit, service and support the arms.