Office of Research & Development

Prosthetics/Limb Loss

Prosthetics icon

VA has long been a world leader in prosthetics research. Our researchers are continually developing improved materials and designs for prostheses. They are also trying to better meet the needs of Veterans who need to use prostheses by learning how different components are actually used by those who require them, and how satisfied Veterans are with the prostheses they have been given.

Among those receiving prosthetics-related care from VA are many of the estimated 6 percent of wounded service members returning from Iraq and Afghanistan who have lost a limb, and many other Veterans who required amputations because of diabetes and other disorders. The total number of Veterans using prosthetics, sensory aids, and related services from VA has increased by more than 70 percent since 2000.

Many of the latest innovations and discoveries in prosthetics research in the United States take place at VA centers of excellence. For example, VA's Center for Advanced Platform Technology, located in Cleveland, develops new technologies to help Veterans with motor and sensory problems and those who have lost limbs.

The Center of Excellence in Functional Electrical Stimulation, also located in Cleveland, uses controlled electrical current to make paralyzed muscles work again. The Center of Excellence in Wheelchairs and Associated Rehabilitation Engineering in Pittsburgh has made important contributions toward the design of wheelchairs, seating systems, and other mobility systems. And the Center of Excellence for Limb Loss Prevention and Prosthetic Engineering in Seattle focuses not only on helping those who have already undergone an amputation, but on preventing limb loss in the first place, namely among those coping with complications from diabetes.

Finally, the VA Center of Excellence for Neurorestoration and Neurotechnology in Providence, R.I. supports research and development on brain-computer interfaces for people with paralysis or limb loss. Researchers there also evaluate new prosthetic limbs, and develop new ways to help people regain function in their limbs.

Selected Major Accomplishments

  • Finding that delivering small currents to electrodes can significantly improve walking in stroke patients
  • Being part of a team that developed the first powered ankle-foot prosthesis
  • Developing technology that promises to enable people to control prostheses or assistive devices with their thoughts
  • Conducting rigorous research on the DEKA advanced prosthetic arm

Selected Milestones and Major Events

Overview

In 1862, Congress appropriated $15,000 for the purchase of artificial limbs for soldiers and seamen disabled in the service of the United States, to be expended under the direction of the Surgeon General of the United States.

After the end of the Civil War, in 1866, the War Department (now the Department of Defense) was authorized to provide Union Veterans with transportation to and from their homes to a place where they could obtain their artificial limbs or devices, and to furnish those Veterans with new artificial limbs or devices every five years.

VA's involvement in providing prostheses to Veterans began in 1921, when the Veterans Bureau, a predecessor agency to the Department of Veterans Affairs, was give the responsibility to provide artificial limbs and appliances to World War I Veterans.

Today, providing state-of-the-art prosthetics care for Veterans is one of VA's top priorities. To help meet the lifestyle and medical needs of Veterans who have lost limbs, VA researchers develop and test a wide variety of prosthetic devices. VA's goal is to offer Veterans prosthetics that will restore them to their highest possible level of functioning within their families, communities, and workplaces.

Some VA researchers are working on producing high-functioning artificial limbs that are very similar to their natural counterparts. Others are working on advanced wheelchair designs that promote mobility and independence for wheelchair users, and make it easier to use a wheelchair.

Still other VA researchers are using functional electrical stimulation and other technologies to help those with weak or paralyzed muscles, and developing and testing state-of-the-art adaptive devices to help those with vision or hearing loss.

Amputation and artificial limbs

The technology involved in creating artificial limbs has come a very long way since the Civil War. Today's VA researchers use leading edge technologies such as robots and nanotechnology to create lighter limbs that integrate body, mind, and machine to look, feel, and respond like real arms and legs. They are also studying ways to best match prosthetic components with amputees' needs, including those whose active lifestyles mean they need high-performance prosthetics.

Recently, a VA team working with researchers at MIT and Brown University introduced a "powered ankle-foot prosthesis, " which uses tendon-like springs and an electric motor to move people forward. Studies have shown that patients using the powered ankle-foot expend less energy while walking, have better balance, and walk 15 percent faster. The device is now available for Veterans using VA care and active-duty service members. It is also on the market commercially.

Other researchers are looking at new ways to care for what remains of limbs after surgery, enabling wounds to heal far more quickly than ever before; developing a family intervention program to teach caregivers complementary and alternative techniques to lessen the anxiety and pain that is associated with limb loss; and evaluating computed tomography (CT) scans of diabetic feet to identify the types of feet that are at the highest risk for ulcers.

Today, VA is sponsoring the first human study in the United States to investigate osseointegrated prosthetics. Osseointegration firmly anchors implants in place by integrating implanted material in living bone. The current study involves implanting specially designed and coated titanium sockets into the femurs of amputees who have lost much of their leg. The bone of the residual limb should grow into the implant.

After healing is complete, users should have better control of their prosthetic leg, and it should also be easier to put the leg on, and take it off.

In the area of upper-limb prosthetics, VA researchers and colleagues collected data on the DEKA advanced prosthetic arm over four years at four VA sites—New York, Tampa, Long Beach, Calif., and Providence, R.I.—and at the Center for the Intrepid, a military rehabilitation site in San Antonio, Tex. The study findings have been published in a number of journal articles, including two earlier this year in VA's Journal of Rehabilitation Research and Development.

The arm was developed by DEKA Integrated Solutions Corporation, based in Manchester, N.H., with $40 million in funding from the Defense Advanced Research Projects Agency (DARPA), through its Revolutionizing Prosthetics Program.

The U.S. Food and Drug Administration approved the DEKA Arm System in May 2014, paving the way for the device to be manufactured, marketed, and made available in the VA health system.

Using electrical signals to restore functioning

More than 40,000 Veterans have serious spinal cord injuries and disorders that may interfere with the brain signals that control muscle movement. Others have become blind from the loss of photoreceptors (cells which are responsible for detecting light and therefore enable us to see) in the eye.

For Veterans with these and some other types of functional loss, VA investigators hope to restore functions with electrical currents delivered through a neural prosthesis. A neural prosthesis is an electrical or mechanical device that connects with the nervous system and supplements or replaces functions lost by diseases or injury.

In 2006, VA researchers found that delivering small currents to electrodes implanted in weak or paralyzed leg muscles significantly enhanced walking ability in stroke patients. A research team consisting of VA, Brown University, Harvard University, and Massachusetts General Hospital researchers recently successfully implanted electrodes in the brains of volunteer research subjects whose arms and legs were paralyzed that allowed them to control robot arms with their thoughts, and found that those electrodes continued to work 1,000 days after the sensors were implanted.

Another research team in Cleveland has developed a new kind of computer interface that can convey a sense of touch on a prosthetic hand. They also learned that the implants continued to work after 18 months.

Centers of excellence

VA supports a wide array of research in engineering and technology to improve the lives of Veterans with disabilities. Several centers of excellence provide environments for investigators to collaborate with and mentor young scientists. The centers are organized around specific areas of investigation critical to the rehabilitation of Veterans with disabilities.

Within the centers, research is being carried out on a number of cutting-edge technologies, including advanced wheelchair designs. VA is also looking at ways to regrow vital nerve connections and body tissues and to prevent limb loss.

Also at the centers, VA researchers are creating advanced prosthetic limbs that are controlled by computer microprocessors, which will allow the patient's own brain to direct movement. Other researchers are looking at how the body can rehabilitate or repair itself after a stroke or a TBI. Still others are looking at new therapies for spinal cord injury and the medical complications that spinal cord injured Veterans often develop.

Finally, VA's Journal of Rehabilitation Research and Development publishes cutting-edge research and provides information on biomedical and engineering advances that enhance the quality and relevance of VA rehabilitation research. The journal accepts articles on prosthetics, orthotics, and orthopedics; spinal cord injury and other neurological disorders; communication, sensory, and cognitive aids; geriatric rehabilitation; and functional outcomes research.

More on our Website

International Prize to BrainGate team, VA Research Currents, Winter 2013-14

Veterans with spinal cord injury re-enter the workforce, VA Research Currents, Fall 2013

Preventing pressure ulcers for wheelchair users, VA Research Currents, Summer 2013

Trial yields hope for blast-related auditory problems, VA Research Currents, February 2013

VA plays role in another brain-computer breakthrough, VA Research Currents, February 2013

Video: Prosthetics Research

Video: "I was a one-sided person": The DEKA Arm, a VA Research partnership with DoD

Video: Anklebot: VA Researchers Aim to Help Stroke Patients improve their gait

Brochure: Prosthetics and Related Technology

Prosthetics/Limb Loss

Rehabilitation R&D Service

Journal of Rehabilitation Research & Development

APT Center (VA Center for Advanced Platform Technology)

VA Center of Excellence in Functional Electrical Stimulation

VA Center of Excellence in Wheelchairs and Associated Rehabilitation Engineering

Selected Scientific Articles by our Researchers

Bionic ankle-foot prosthesis normalizes walking gait for persons with leg amputation. Herr HM, Grabowski AM. Using a bionic ankle foot prostheses results in metabolic energy costs, preferred walking velocities, and biomechanical patterns not significantly different from people without an amputation. Proc Biol Sci. 2012 Feb 7;279(1728):457-64.

Do users want to receive a DEKA Arm and why? Overall findings from the Veterans Affairs Study to optimize the DEKA Arm . Resnik L., Latlief G., Klinger SL, Sasson N, Walters LS. The DEKA arm is a new upper-limb prosthetic enabling amputees to perform a wide range of tasks, which VA is testing for the Department of Defense. Most users either wanted to receive, or might want to receive, the new prosthetic. Prosthet Orthot Int, 28 Nov 13, epub ahead of print.

Neural control of cursor trajectory and click by a human with tetraplegia 1000 days after implant of an intracortical microelectrode array. Simeral JD, Kim SP, Black, MJ, Donoghue JP, Hochberg LR. A neural interface system based on an intracortical microelectrode array can provide repeatable, accurate point-and-click control of a computer interface to an individual with tetraplegia 1000 days after implantation of this sensor. J Neural Eng, 2011 Apr; 8(2):025027.

A randomized controlled trial of functional neuromuscular stimulation in chronic stroke subjects . Daly JJ, Roenigk K, Holcomb J, Rogers JM, Butler K, Gansen J, McCabe J, Fredrikson E, Marsolais EB, Ruff RL. Stroke patients receiving functional neuromuscular stimulation have a significant advantage in improving gate components and knee flexion coordination after stroke. Stroke, 2006 Jan;37(1):172-8.

VA and other U.S. Government Online Resources

VA Center of Excellence for Neurorestoration and Neurotechnology, U.S. Department of Veterans Affairs, Providence VA Medical Center

Prosthetics and Sensory Aids Service, U.S. Department of Veterans Affairs

Revolutionizing Prosthetics, Defense Sciences Office, U.S. Department of Defense