Arms and Legs

I am starting to hearing more stories about the treatment of amputees returning from Iraq and Afghanistan. One is good but most are seriously distressing.

I will start with the good. Here is a short talk by Dean Kamen (inventor of the Segway - better known as one of the archetypal solutions in search of a problem). On the other hand, he was asked to come up with a solution for double shoulder disartics and appears to have done so. http://www.ted.com/talks/view/id/82

High technology for arms is possible because, most of the time, arms don't do anything so power consumption is manageable. High technology also makes sense because arms, to be useful, have to do complicated things. Many arm amputees just don't bother with a prosthesis because, with one arm, life is inconvenient but manageable. As you can imagine, however, being a double arm amputee is very difficult.

The situation with prosthetic legs is much less satisfactory. They are much more basic but the need for two is overwhelming.

High, and expensive, technology is OK but is much less important than fit and lack of pain in use. There have been studies showing that an old fashioned, but well fitting, peg leg using modern socket technology has most of the functionality needed to exist in the modern world. So technology is a bonus but is not, by itself, sufficient.

Unfortunately there are all too few prosthetists who really understand the simple concept that "IT'S NOT SUPPOSED TO HURT". Of course, it will hurt if you push it really hard all day but that is a different story. Natural legs have the same problem.

The other problem is that amputees do not really become good partners until about their third leg - three or four years down the line when they understand the feeling of a well fitting socket - so having a prosthetist who has the skills to work with new amputees is critical. If the stump ("residual limb" for the politically correct) is untidy as a result of emergency combat area surgery, then the skills of the prosthetist will be sorely taxed.

There are now Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) systems that can augment the skills of pretty ordinary practitioners but that is not as sexy - to the bureaucracy - as the latest and greatest computerized knee or energy storing foot.

Unfortunately the situation now is that the prosthetists are not of high quality, there is resistance to adopting modern tools that can improve the fit, and there is too much emphasis on the "sexy" components that, while important, are the lowest priority when it comes to getting leg amputees back in the world and functioning.

Those who have been grievously wounded in our service deserve a lot better than they are getting.