New leg offers hope for more stable world

By Dan Mac Alpine
GateHouse News Service
Wed Jun 20, 2007, 07:04 PM EDT

Beverly -
At 51, Steve Cornell now prefers golf to track. He’ll be competing in a national tournament in Chicago next weekend. He’ll have to fit the tournament in between his jobs as a warehouse manager and an assistant lacrosse coach.
However, his hectic schedule won’t likely be the biggest challenge he faces.
Rather it’s this: Cornell stands on one leg and presses down and forward hard. The leg of titanium, aluminum and graphite collapses and Cornell has to grab onto a padded examination table in the Cummings Center offices of Cornell Orthotics & Prosthetics to keep from tumbling onto his face.
And that’s the threat Cornell faces — every step of his life.
Teresa Arnold, 45, climbs a set of three steps in the Cornell (no relation to Steve) offices. She uses a cane. She takes each step, one at a time. Step. Pause. Step. She grasps the rail, as if half expecting her prosthetic leg to collapse — as Cornell’s leg had done — sending her crumpling down the stairs in a heap.
Arnold, too, faces the threat — every step of her life.
Then a technician from Otto Bock, a German maker of prosthetic limbs, pulls out a new leg that would eliminate that threat permanently for both Cornell and Arnold.
Unfortunately, the new leg costs about $20,000 more than the old one, anywhere from $33,000 to $45,000, depending on individual needs.
The cost creates a barrier between patient need and insurance coverage.
The smart leg, equipped with computer sensors in the thigh and ankle, heel and toe, senses the terrain and automatically adjusts the hydraulic knee, controlling the fluid entering the mechanical joint, so it’s impossible to overload and can’t collapse.
Cornell tried. And tried. And tried. Using the same technique he used on his purely mechanical leg. Every time he lunged for the table. Every time the leg held and the move was unnecessary.
Trusting the computerized leg was also an issue for Arnold. Walking the length of an exercise room, between two parallel bars, she tentatively stepped, leaning on her cane, half expecting the leg to fold or be as inflexible as her old, mechanical leg.
Arnold lost her natural leg to a vascular birth defect that stills causes swelling in her thigh and saps some of the strength she needs to engage the mechanical hydraulic knee.
Cornell, who lost his natural leg at 12 while trying to hop a freight train, has no such issue.
“I’m hoping the new leg will have an ease of flexibility and need less force,” said Arnold. “That would be helpful. It would be less exhausting to use.”
Arnold didn’t quite break into a trot when fitted with the new leg. She wanted to use the cane, but there were moments, two or three steps in a row as she paced up and down the room’s length, when she forgot and the computerized knee flexed and Arnold almost lost her limp.
“The more she would use it the more she would learn to trust it, the less energy she would expend,” said Keith D. Cornell, owner of Cornell Orthotics & Prosthetics, who fits and constructs prosthetics from his office/factory. “I was hoping she could put the cane down, but she would need more time to do that. She got a taste of it and saw it’s possible to walk much better.”
For Arnold, the leg met her basic hopes.
“It’s exciting to have a component that will stand up and not use up so much physical effort with every step I take,” she said.
For Keith Cornell it’s such glimpses that he hopes will capture the medical community’s attention and, just as importantly, insurance companies who would pay for the computerized leg.
The Otto Bock, C-leg, so named for the computer language that drives it, uses technology that’s about 5 years old.
Newer Bluetooth computer technology makes it easier to program the C-leg. A few years ago, Jeff Honma, a clinical specialist with Otto Bock, would have had to connect his laptop to the C-leg with multiple wires in order to program the leg’s computer chips to adjust for the user’s individual gait. Now he now simply taps on a wireless keyboard.
“It’s a lot less cumbersome and faster,” said Honma.
Still, the basic technology remains the same.
“It’s proven technology, but still not widely available to patients. It’s not experimental,” said Keith Cornell who can see a way to improve his patients’ lives, but often can’t get past the glass wall of insurance coverage.
“Companies hesitate to cover newer prostheses because of cost or because medical necessity,” said Keith Cornell. “Both arguments are weak. Our field is a very small field and it is behind where it should be for getting the high-quality medical studies to show the efficacy of these devices. We are making progress.”
Hence the demonstrations in his office.
Just last year, Massachusetts passed a law that required prostheses to be covered at the same rate as all other medical expenses. So the policy coverage is uniform. Prior to the law, insurance companies covered prostheses at a lower rate when compared to other medical needs.
Still, the insurance companies decide what is medically necessary, deciding whether the newer technology makes enough of an improvement in patients’ lives to deserve coverage.
“It’s important to increase awareness,” said Kevin Cornell. “To let people know that these wonderful devices are out there and there’s still a lack of understanding of how they work. The demonstration showcases this technology and shows it’s tried and true and works very well.”
Steve Cornell needs no further convincing.
After taking the C-leg for a trial run —almost literally — around the Cummings Center grounds, he returned with an ear-to-ear grin.
Normally, he walks looking down at the ground to make sure his leg strikes properly and avoids uneven ground, potholes and other obstacles the would cause the knee to buckle and pitch him to the ground.
“I feel like a little kid in a toy store,” said Steve Cornell. “Trusting the knee not to buckle and then just walking step to step is so different. I can keep my eyes forward now and see the world around me.”
And with his insurance company picking up 80 percent of the cost, Steve Cornell figures he can afford the new leg.