Monday, April 23, 2007

Walking made easier

Cynthia T. Pegram
April 20, 2007
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Keith Richmond’s souvenir from a motorcycle crash about 14 years ago is the prosthetic right leg that replaced the one that had to be amputated.
Now the Lynchburg man hopes to change to a leg with a microprocessor knee - a technology that will let him walk on uneven surfaces and more naturally navigate stairs and ramps.
And that means hunting and fishing again.
“I had to quit all those activities,” said Richmond, 51, after the motorcycle accident, which caused the loss of his right leg and injuries to the other, as well as damage to his back.
He tried out the $30,000 Otto Bock C-Leg in Lynchburg this week.
“I like it,” said Richmond. “It’s going to take getting used to.”
Richmond and Wilbert Green of Ruther Glenn near Fredericksburg each got to use the C-Leg Wednesday at Excel Orthotics and Prosthetics on Langhorne Road. The C-Legs were brought to Lynchburg by manufacturer Otto Bock’s traveling team.
The two clients seemed intrigued and pleased in the results they were getting from the hydraulic technology controlled by a microprocessor.
Fifty times a second the hydraulics are fine-tuned so that the knee can react to subtle changes encountered by the attached foot.
It feels different, too.
“It has some resistance I’m not accustomed to on my other leg,” said Richmond, as he learned to adapt to the new mechanism’s style.
“The knee knows when to bend,” Douglas Walters explained in an interview. Walters is an orthotist and owner of the Roanoke-based Excel.
People have to learn to trust the knee - to step forward and have the knee move forward, lift up and extend.
“It kind of walks for you a little bit,” said Walters.
“Because the motion of walking is more normal, it’s also less wearing on the natural leg,” said Walters.
Currently, two or three companies manufacture microprocessor-control systems, said Joe McTernan of the Alexandria-based American Orthotic and Prosthetic Association, a nonprofit trade association.
McTernan, in a telephone interview, said the essential design of a hydraulic knee is a cylinder filled with fluid. A piston in the cylinder mimics the natural movement of the knee joint. The tension can be adjusted to allow the leg to swing with “more or less resistance.”
The microprocessor feature, said McTernan, makes thousands of readings, “and based on the readings, adjusts the fluid in the cylinder and automatically changes the rate at which the knee swings.”
The feedback is based on the person’s walking pattern, “so every time the patient swings the leg forward it is swinging at the most appropriate rate for the conditions at that moment in time.”
The technology is becoming more widely available, he said, and more insurance companies are willing to consider it an advancement in technology “as opposed to experimental technology.”
Fitting the devices takes extra training because the knee must be programmed using a computer, he said. Prescriptions for the legs come from the physician.
He noted that the average fluid-based prosthetic knee costs around $2,700. “The microprocessor is significantly more expensive,” he said.
McTernan doesn’t see microprocessor legs becoming the norm in the near future, however. The legs provide more stability, which is important for patients who fall a lot, he said.
Not everyone needs microprocessor technology. A person with an above-the-knee amputation that only transfers from the bed to a wheelchair doesn’t need it.
“We try to provide the patient what’s needed for his use level,” said Walters of Excel.
Keith Richmond is an active person.
Amy Richmond said that because her husband’s present prosthetic leg needs so much effort by his good leg in walking and standing, “he’s wearing that knee out,” she said. “This is going to save his left leg.”
The couple recently purchased a farm in Kentucky, where the new way of walking on uneven grounds - and hunting game - could be a great help.
On Wednesday, Wilbert Green of Ruther Glenn also seemed truly pleased with his trial run with the C-Leg.
The Vietnam-era veteran didn’t expect to get the chance. But, he’d done so well since last June after his amputation due to diabetes that his therapist suggested he consider a computerized leg.
“I’m like, ‘Yeah, right,’” said Green. “I don’t think the VA is going to give me a $30,000 leg.”
However, through some private funding, with Veteran’s Affairs supplementing a little, it looks like it might happen.
“I’m excited about it,” said Green, who tried out the leg in walking, sitting and stair situations. “With the old leg, I’d have to drag it.”
Although it’s less than a year since he’s used prosthesis, he’ll still have to re-learn his old way of walking.
The C-Leg can return some of that natural grace.
“With this, it’s designed not to think about it, just to walk,” said Green.
His wife Gwen said that his ability to walk so much earlier than expected after his surgery is because “he’s a very determined person.”
“He ran track for many years. That has a lot to do with that type of mind-set,” she said.
And she said, “It’s all about his faith in God, and what he believes God has in store for him.”
Jeff Honma, a certified prosthetist/orthotist, is based in Los Angeles and works with the Otto Bock company. He was doing the computer programming for the legs being tried out in Lynchburg.
The hardest part most people have in using the C-Leg, said Honma, is “not thinking about how the knee works, and not thinking about the walking.”
Then, after awhile, “Timing becomes second nature.”
Scott Moltzan, also with Otto Bock, has an above-the-knee amputation and has worn the C-Leg for seven years.
He doesn’t have to look down at the ground anymore, said Moltzan, as he walked down the sloping grassy area outside the Langhorne road office, head up. “I can look right at you.”

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