Report in Nov 2004 shows 365 amputees

Trip Report
Department of Defense
Human Factors Engineering Technical Advisory Group (DOD HFE TAG) Meeting #52 – 01-04 November, 2004


The second speaker was Dr. Denise V. Gobert, Director of Research for the US Army Military Amputee Research Program, Walter Reed Army Medical Center. Dr. Gobert spoke on The US Army Amputee Patient Care Program: Optimizing Recovery After Traumatic Limb Loss. This program has as its goal the optimization of recovery following traumatic loss. In Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), there have been 7,730 personnel wounded and 1,109 personnel lost. On the battlefield, one of the first things learned by the soldiers there is that “Kevlar saves lives.” Also, the medical care in theater is much better than in the past. But, if a soldier is wounded, he or she spends three to five days in Germany following air evacuation. In Germany a large medical team is made available, staffed with 18 different disciplines. Due to the different types of injuries being experienced today, innovative research is required to optimize care. Of the 365 amputees being tracked by the center, 88% are male, 75% are Army (followed by the US Marines). The average is 25 years (+/- 5.5 years) and 35 % of the injuries are to the upper extremity.

Extreme physical challenges are faced by amputees. The center’s view is to have a training plan, teach the amputee how to use what remains, manage pain and provide counseling. The ultimate goal is maximum independence through training, prostheses, self-care and leisure pursuit. The best technologies are being used today, including:
· Microprocessor-controlled knees
· Dynamic response (high energy return) prosthetic feet
· Speed sensor prosthetic hands (Otto back sensor hand)
· Myo-electric limb system
· Gait analysis and static digital capture
· Utah-3
· Vacuum-assisted sockets

Rehabilitation challenges fall into several areas:
· Materials: lighter, waterproof movable wrist (flex/extend). Currently, the control strings break too easily.
· Fit: Improved socket fit to fit contours and limbs better. Thinner materials. Socket design, trans-radial and wrist disarticulation.
· Function: Feedback mechanisms need individual digit motion, sensory feedback (temperature, pressure, etc.)
· Operability: range of motion, more natural function
· Reliability: Better power systems, increased reliability
· Control: myo-electric implants. Thought control.
· Durability: Silicon hands break down and tear too easily.
· Training: 3-D virtual reality programs for training, reaching, manipulating, feeding and military specific tasks.

In rehabilitation therapy, the goal is to get the amputee back to duty as soon as possible. So, there is emphasis placed on regaining the abilities to run, jump, climb, march and operate weapons. Clinical gait evaluation is used to help restore a natural gait. EMG is monitored to support training and learning how to take control of muscles. Heterotopic ossification occurs after injuries where bone grows randomly due to the disruption; this bone must be removed.

The amputee center conducts collaborative research with the Veterans Administration, US Army Telemedicine and Advance Technology Research Center, US Army Natick Soldier Center and USA Army Research Institute of Environmental Medicine. They are exploring collaboration with DARPA on their exoskeleton system, microprocessor controlled limbs and implantable rice-size stimulators and sensors for pain control and sensing or amplification of muscle activity. They are working with the University of Utah on brain-machine interface. They are monitoring Sarcos Labs work on next-generation control systems for individual digit control.

A new $10B building for amputee training and research is planned at Walter Reed, with the opening planned in the fall of 2005.