Office of Research & Development

VA research on

Prosthetics/Limb Loss


Introduction

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.

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 given the responsibility to provide artificial limbs and appliances to World War I Veterans.

Today, VA's Prosthetics and Sensory Aids Service is the largest and most comprehensive provider of prosthetic devices and sensory aids in the world. Although the term "prosthetic device" may suggest images of artificial limbs, it actually refers to any device that supports or replaces a body part or function.

VA provides a full range of equipment and services to Veterans, ranging from items worn by the Veteran, such as artificial limbs and hearing aids; to those that improve accessibility, such as ramps and vehicle modifications; to devices surgically placed in the Veteran, such as hips and pacemakers.

The department has more than 70 locations at which orthotics and prosthetics are custom-fabricated and fitted, using state-of-the-art componentry. A list of VA orthotic and prosthetic providers can be found here. VA also has more than 600 contracts with accredited orthotic and prosthetic providers to ensure access to care is provided near Veterans' homes. Each VA facility that is eligible for certification is accredited through the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) and/or the Board of Certification/Accreditation (BOC).

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Selected Major Accomplishments in VA Research

  • 1947: Introduced the first mobility and orientation rehabilitation-training program for blinded Veterans
  • 2007: Unveiled the first powered ankle-foot prosthesis, as part of a team with researchers at MIT and Brown University
  • 2009: Launched 3-year optimization study of the DEKA arm, as clinical partner with DEKA and DARPA
  • 2013:
    • Reported on new technology to help restore the sense of touch for those who have lost an upper limb and use an artificial hand
    • Began the first human study in the U.S. to investigate osseointegrated prosthetics, a system that allows a prosthetic leg to be attached directly to the remaining bone of an amputated lower limb
  • 2014:
    • FDA approved clinical use of the DEKA arm
    • Published a study of amputees' and clinicians' feedback using the DEKA arm, the first prosthetic arm capable of performing multiple simultaneous powered movements
  • 2015: Invented a wheelchair allowing users to crank up the push rims to a standing position, providing them with increased functionality and independence
  • 2016: Determined that knee replacement surgery could benefit some patients aged 85 and older
  • 2017: The MEBot robotic wheelchair, developed by a VA investigator, won the "Best New Concept" award in an international design competition

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New, Ongoing, and Published Research

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 developing 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.

If you are interested in learning about joining a VA-sponsored clinical trial, visit our research study information page.

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➤ VA research centers

Many, but not all, of the latest innovations and discoveries in prosthetics research in the U.S. take place at VA centers. These centers generally work in close partnership with affiliated universities and other institutions, as well as commercial partners and other federal agencies.

VA's Advanced Platform Technology Center, in Cleveland, develops new technologies to help Veterans who have difficulties controlling bodily movements or sensory problems, and those who have lost limbs. Team members create new assistive and restorative technologies for dissemination within the rehabilitation community and commercialization by outside manufacturers.

The Center for Functional Electrical Stimulation, also in Cleveland, uses controlled electrical currents to help paralyzed muscles work again. The center focuses on the application of electrical currents to either generate or suppress activity in the nervous system. This technique is known as functional electrical stimulation (FES). FES can produce and control the movement of otherwise paralyzed limbs for standing and hand grasp, to activate visceral bodily functions such as bladder control or respiration, create perceptions such as skin sensibility, stop undesired activity such as pain or spasm, and facilitate natural recovery and accelerate motor relearning.

The Center for Wheelchairs and Associated Rehabilitation Engineering, part of the Human Engineering Research Laboratories (HERL) in Pittsburgh, has made important contributions to the design of wheelchairs, seating systems, and other mobility systems. HERL is a collaboration between the VA Pittsburgh Healthcare System and the University of Pittsburgh. Researchers at the center have been instrumental in developing novel innovations in wheelchair design—together, they hold 25 patents related to wheelchair design and assistive technologies. Innovations developed at the center range from using newer, lighter materials that make wheelchairs easier to maneuver to robotic extensions that can reach objects for the wheelchair's user. One example under development is the MEBot, a wheelchair that has six wheels, an onboard computer and software, and an array of high-tech sensors and actuators that help the user navigate uneven terrain.

The Center for Limb Loss and MoBility in Seattle is a research group focused on helping Veterans who have either lost a limb or experience leg and/or foot impairment by enhancing their ability to move around their environment. Research at the center aims to reduce the effects of functional and anatomical limb loss by exploring diseases that lead to impaired limb function and by developing state-of-the-art technologies for studying the foot. Research focuses on two groups of Veteran: those with musculoskeletal impairment at the foot and ankle, where pain and limitations in mobility are the key issues, and those at risk of lower limb amputation due to diabetes and foot ulceration, where loss of the foot or leg is a major concern.

The center's prosthetic engineering research focuses on limitations in mobility and discomfort experienced by all groups of Veterans with lower-limb amputation—including those with amputation secondary to peripheral vascular disease and diabetes; aging combat-injured Vietnam Veterans; and young, active Veterans who lost a limb through traumatic injury serving in Afghanistan or Iraq. This research compares existing prosthetic technologies and develops innovative new approaches.

The VA Center for Neurorestoration and Neurotechnology in Providence, Rhode Island, supports research into the development of brain-computer interfaces to help restore function in Veterans who are paralyzed, have experienced limb loss, or have difficulties in thinking or communicating. The center is a collaboration between the Providence VA Medical Center, Brown University, Butler Hospital, Lifespan, and Massachusetts General Hospital. CfNN seeks to develop, test, and implement new therapies and technologies that restore function for Veterans with disorders affecting the nervous system.

BrainGate is one such research project. Researchers have developed a neural interface system for individuals with paralysis that uses a small sensor implanted in the brain to record neural activity associated with intended arm movements.

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➤ 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.

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 programs to teach caregivers complementary and alternative techniques to lessen the anxiety and pain associated with limb loss; and evaluating CT scans of diabetic feet to identify those patients who are at the highest risk for ulcers and amputation.

Ankle-foot prosthesis—In 2007, VA collaborated with researchers at MIT and Brown University to introduce a powered ankle-foot prosthesis that uses tendon-like springs and an electric motor to move users 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, originally sold as the BiOM ankle and now marketed as the Empower ankle, is available for Veterans using VA care and active-duty service members.

Osseointegration study—VA sponsored the first human study in the United States to investigate osseointegrated prosthetics, a system that allows a prosthetic limb to be attached through the skin directly to the remaining bone of the amputated limb. The study involved surgically implanting specially designed and coated titanium implants into the thigh bone of amputees who had lost their knee and lower leg. Once the bone grew into the implant, the prosthesis was attached directly to the metal connector of the implant without the need for a prosthetic socket to cover the remaining limb.

Ten amputees participated in the study at the George E. Wahlen VA Medical Center in Salt Lake City. Based on preliminary findings, the investigators say this research has the potential to improve amputees' mobility, function, and overall quality of life. A version of this implant for above-the-elbow amputees is currently in development.

DEKA/LUKE arm—VA researchers and colleagues collected data on the DEKA advanced prosthetic arm over four years at four VA sites—New York; Tampa; Long Beach, California; and Providence, Rhode Island—and at the Center for the Intrepid, a military rehabilitation site in San Antonio, Texas. The study findings have been published in a number of journal articles, including two in 2014 in VA's Journal of Rehabilitation Research and Development.

The arm was developed by DEKA Integrated Solutions Corporation, based in Manchester, New Hampshire, with funding from the Defense Advanced Research Projects Agency (DARPA), through its Revolutionizing Prosthetics Program. It is the first prosthetic arm capable of performing multiple simultaneous powered movements.

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 care system. The DEKA arm is now available to the public as the LUKE arm, manufactured by Mobius Bionics.

In a 2014 study led by researchers from the Providence VA Medical Center and Brown University, 24 upper-limb amputees were fitted with a second generation (Gen 2) DEKA arm, and 13 were fitted with a third-generation arm (Gen 3). After being trained on its use, they were surveyed about their experiences.

In all, 79 percent of Gen 2 and 85 percent of Gen 3 users indicated that they either wanted to receive, or might want to receive, a DEKA arm. In addition, 95 percent of Gen 2 users and 91 percent of Gen 3 users indicated that they were able to perform new activities they had been unable to perform with their existing prosthetic device.

In July 2017, two Veterans became the first VA patients to receive the arm for daily use.

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➤ Blind restoration and rehabilitation

In 2016, approximately 130,428 Veterans in the U.S. were legally blind and more than 1 million Veterans had low vision that caused a loss of ability to perform daily activities, according to VA's Blind Rehabilitation Service.

Those figures are expected to increase as more Veterans from the Korean and Vietnam conflict eras develop vision loss from age-related diseases such as macular degeneration, diabetic retinopathy, and glaucoma. VA has also seen an increase in the number of Veterans who served in Afghanistan and Iraq who have experienced vision loss due to blast exposure and trauma.

In 1947, VA researchers introduced the first mobility and orientation rehabilitation training program for blind persons. Today, VA's Center for Visual and Neurocognitive Rehabilitation, based at the Atlanta VA Health Care System, conducts research in visual rehabilitation, neurocognitive rehabilitation (i.e., improving brain function from injury), and retinal and neural repair to prevent and mitigate vision loss resulting from injury or disease. The center has a number of projects to help train blind people and those with low vision find their way around independently with greater ease. Investigators also work on projects related to improving access to eye care for Veterans living in rural regions.

Examples of projects include: "Bridging Animal and Human Models of Exercise-Induced Visual Rehabilitation," "Spatial Cognitive Training in Visual Impairment," "Acute Exercise Effects on Word Learning in Aging and Stroke-induced Aphasia," "Improving Access to Eye Care for Veterans—Spread Grant; VA Innovation Initiative," and "Dopamine Treatments for Diabetic Retinopathy."

In addition, the VA's Center for Prevention and Treatment of Visual Loss focuses on research to provide the earliest detection of vision loss. The goal is to prevent vision loss due to eye diseases such as glaucoma, radiation damage, and traumatic brain injury. The center is evaluating new diagnostic tools that provide better access to care through telemedicine and automated analysis using portable devices by non-eye care providers. Research is focused on novel interventions such as identifying which neurotrophic growth factors (i.e., proteins associated with growth and survival of neurons) are most effective at preventing vision loss.

Examples of projects include: "Therapy of Nocturnal Intraocular Pressure Elevation Causing Glaucoma Progression," "Automated Assessment of Optic Nerve Edema with Low-Cost Imaging," "Chronic Effects of Blast Injury: Analyses of Alzheimer Related Pathology," "Stem Cell Therapy for Glaucoma," and "Visual Sensory Impairments and Progression Following Mild Traumatic Bain Injury."

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➤ Using electrical signals to restore functioning

Many 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 that 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 functioning with electrical currents delivered through a neural prosthesis. A neural prosthesis is an electronic device that connects with the nervous system and supplements or replaces functions lost by diseases or injury.

VA's Advanced Platform Technology Center (APT), located at the Cleveland VA Medical Center, and the Center for Neurorestoration and Neurotechnology at the Providence VA Medical Center are working on a number of projects to extract signals from the brain's cortex for controlling assistive devices and detecting and diagnosing dysfunctional cortical activity. Some of their projects are described here and here.

Conveying a sense of touch—Researchers at the Advanced Platform Technology Center have developed a new kind of implanted electrical nerve interface that can convey a sense of touch on a prosthetic hand. They learned in 2014 that the implants continued to work after 24 months, and as of this writing they continue to work.

Sensors in the prosthetic hand measure the pressure applied as the hand closes around or presses against something. These measurements are converted into specially coded electrical signals and sent through wires to surgically implanted electrodes around nerves in the forearm and upper arm.

When the electrical signals reach the nerves, they are transmitted to the brain through healthy neural pathways not affected by the amputation. The brain interprets the sensation signals as if they had come from a normal hand. These researchers have since been funded by DARPA to further advance the work. Watch this video to learn more.

Electrical stimulation and spinal cord injuries—In 2015, researchers at VA's APT Center and Case Western Reserve University completed a 10-year clinical trial to test a surgically implanted electrical stimulation system in people with spinal cord injuries. During the surgery, electrodes are implanted in muscles of the trunk and legs, and leads are connected to a stimulator.

By stimulating muscles, the system activates muscles to allow for standing, better balance, and exercise. Patients are given functional training and rehabilitation using the stimulation system, and are prescribed a course of exercise. Lab tests focus on strength, balance, and patients' abilities with or without the system.

In 2017, researchers in Cleveland followed up on 22 spinal cord-injured patients an average of six years after they received implantation surgery, to determine whether the devices were still functioning and useful years after they were first implanted.

They found that 60 percent of the patients still used their neuroprostheses for exercise and other activities for more than 10 minutes per day. Early (first generation) implants still functioned correctly in almost 90 percent of the recipients of those devices. Second-generation implants, with slightly improved technology, still functioned in 98 percent of recipients. Overall, 94 percent of the participants in the study were satisfied with their prostheses.

In another 2017 study, Cleveland researchersfound that a lower-limb exoskeleton that combined an implanted neurosensor with an exoskeleton to stabilize and support users restored the ability to take steps in three individuals with complete paralysis. They believe that this approach is feasible for individuals with paraplegia and should be developed further.

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➤ BrainGate

VA has played a major role in supporting the development of BrainGate. The system, spearheaded by researchers at the Providence VA Medical Center in Rhode Island and Brown University, relies on microelectrodes implanted in the brain to pick up neural signals.

The electrodes are placed in a part of the brain that controls voluntary movement. They send signals to an external decoder that translates them into commands for electronic or robotic devices, such as an iPad or robotic arm.

The research team developing BrainGate hopes to create a technology that will restore movement, control, and independence to people with paralysis or limb loss from conditions including amyotrophic lateral sclerosis (ALS), stroke, and spinal cord injury.

BrainGate studies—In 2011, a research team consisting of VA, Brown University, Harvard University, and Massachusetts General Hospital researchers successfully implanted electrodes in the brains of volunteers with paralysis affecting their arms and legs. The system allowed them to control robot arms with their thoughts, and they could continue to control a computer cursor accurately more than 1,000 days after the electrodes were initially implanted.

In 2015, the BrainGate team reported the system could allow point-and-click communication by someone with incomplete locked-in syndrome, which can be caused by a spinal cord injury. In locked-in syndrome, patients are fully conscious but unable to move any muscles except for those that control eye movement. They can see, hear, smell, taste, and even feel, but may be unable to speak or vocalize at all. Those with incomplete locked-in syndrome can make small movements of the head, fingers, and toes.

Another 2015 BrainGate study found that volunteers using the system were able to acquire "targets" on a computer screen, such as letters on a keyboard, more than twice as quickly as in previous studies, thanks to advances in the system.

The BrainGate team is now studying whether the system can be effective as a means of natural, intuitive control of prosthetic limbs, or as a way to help patients move their own paralyzed limbs. The latter work is being carried out in partnership with the Cleveland FES Center.

A 2017 proof-of-concept study demonstrated that this combination of FES and BrainGate was successful in a quadriplegic Navy Veteran, who used electrodes implanted in his brain and in the muscles of his paralyzed arm and hand to use his own thoughts to control his arm and hand. This video shows how the system works, and how it offers potential help to people with paralysis in the future. The BrainGate team is currently working on the next generation of their system that will be fully implanted and wireless so it can be used at home without the assistance of a technician.

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➤ Hip and knee replacement

Age and knee replacement—In 2016, researchers at the Iowa City VA Health System and the University of Iowa looked at whether knee replacement (total knee arthroplasty) is safe for Veterans aged 85 or older.

The researchers combined and analyzed data from 22 past studies to see whether they could make a determination on the risks and benefits of the procedure for older patients.

They found that while the available evidence suggested slight increases in mortality and complications for older patients, several of the studies reported that both older and younger patients were highly satisfied after surgery, and were able to function better.

The team therefore concluded that age alone should not rule out such surgery.

Hip and knee replacement not followed by increased physical activity—In 2017, a researcher with the Durham VA Medical Center and others published a literature review of previous studies that found that while patients often have large reductions in pain and increased physical function and quality life after total hip or knee replacement, there were no corresponding increases in physical activity after six months, and only modest increases after a year. The researchers hypothesized that the lack of physical activity may be behavioral, since a sedentary lifestyle is hard to change.

Racial gaps in use of knee replacements—African American patients shown an informational video about knee replacement surgery were 85 percent more likely to undergo the surgery than those who did not view the video, according to a 2016 study conducted by researchers at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia.

According to the researchers, African Americans are significantly less likely to have knee replacement surgery to relieve pain from arthritis, largely due to lack of knowledge about the treatment. The researchers concluded that this low-cost, patient-centered intervention could increase the use of an effective orthopedic procedure among minority patients.

A 2017 study by VA researchers also found that African American Veterans were less likely to undergo knee replacement surgery. Over a 10-year period, rates of knee replacements were much lower for black Veterans than white Veterans. Hispanic Veterans had the same rates of knee replacement as white Veterans. The researchers stated that the study shows the importance of developing ways to reduce racial differences in Veteran health care usage.

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➤ Wheelchair technology

MEBot robotic wheelchair—HERL is developing a robotic wheelchair called MEBot that can go up and down curbs and steps and maintain a level seat over uneven terrain—giving Veterans who use wheelchairs for mobility unprecedented freedom and independence both outdoors and inside homes, shops, and offices. The wheelchair has traction control; anti-skid braking; and powered seat functions, including tilt, recline, leg-rest, and elevation.

It has six wheels, an onboard computer and software, and an array of high-tech sensors and actuators. It is designed to navigate smoothly over gravelly or muddy roads, uneven slopes, wet grass, and other difficult terrain—and should allow users to avoid getting stuck on snow and ice.

The MEBot is now being tested at the center's lab, and may be commercially available within a few years. In 2017, the MEBot won "Best New Concept" in the Blackwood Design Awards competition in Scotland, an international competition that seeks to discover and recognize brilliant innovations in independent living and accessibility. Watch a video of the MEBot here.

Waterproof, motorized wheelchair—Researchers at HERL have also developed the PneuChair, a motorized wheelchair that uses a tank of compressed air instead of batteries as an energy source. The chair weighs about 80 pounds and takes just 10 minutes to recharge. The PneuChair can go about 3 miles before the tank must be charged again—about one the third the distance that an electronic wheelchair can go on a fully charged battery. It was developed, in part, to be used at a water park for people with disabilities, but could also be used at beaches or pools. The design is simpler than an electronic wheelchair—lacking much of the software and electronics that are typically used for motorized chairs.

Improved standing wheelchair—In 2015, a group at the Minneapolis VA Medical Center reported they had made improvements to the traditional standing wheelchair to help improve the ability of paralyzed Veterans to function. The researchers modified commercially available standing wheelchairs by adding a drive wheel that allows the push rim to rise so patients can reach it when they stand.

In existing models, patients who can't reach the push rim in the standing position are forced to sit before they can boost the chair and move themselves to a new location. The new chair, which is not yet available commercially, also keeps at least four of the chair's six wheels on the ground at all time, increasing both stability and maneuverability.

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➤ Exoskeletons

VA's Center on the Medical Consequences of Spinal Cord Injury is located at the James J. Peters VA Medical Center in the Bronx, New York. The center's mission is to improve Veterans' quality of life and increase their longevity by preventing and intervening in the secondary medical consequences that result from having a spinal cord injury. These consequences can include bone and muscle loss, and metabolic and cardiovascular changes. 

Researchers at the center continue to study an Israeli technology that allows people with paralysis to stand, walk, and climb stairs, called ReWalk. ReWalk 6.0 is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with spinal cord injury to stand upright, walk, and turn. On their first day using the device, most people can stand and take a few steps, although it takes practice and training to use it properly.

Participants in past studies have lost fat tissue, their bowel function has improved, and their diabetes symptoms have been reduced. The center is now conducting a further trial on ReWalk's impact on mobility, bowel function, and cardio-metabolic health. The four-year study, involving 160 paralyzed Veterans with spinal cord injury at 10 VA medical centers, is examining the impact of the robotic exoskeleton on home and everyday life. Enrollment is expected to be completed in August 2020.

In 2014, ReWalk version 6.0 was approved for sale in the United States. In 2015, VA announced it would provide the device to eligible Veterans who could benefit from it.

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➤ Dentures

Dentures can bring back the smile of those who have lost teeth because of aging, injury, and disease. Many denture wearers, however, must cope with a condition called dental stomatitis (thrush), in which the gums under the denture become sore and inflamed due to infection from a fungus known as candida.

VA researchers at the South Texas VA Health Care System are developing a new type of denture that fights stomatitis. The denture releases, over time, a drug that kills the candida fungus. In lab tests whose results were published in 2016, the experimental product showed strong action against candida for up to 30 days, after which the device can be recharged with a fresh dose of drugs. More testing will be required, including a clinical trial, before the product is commercially available.

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More on Our Website

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Selected Scientific Articles by Our Researchers

Changes in physical activity after total hip or knee arthroplasty: a systematic review and meta-analysis of 6 and 12 month outcomes. Hammett T, Simonian A, Austin M, Butler R, Allen KD, Ledbetter L, Goode AP. Physical activity did not change at six months, and a small to moderate improvement was found at 12 months post-surgery, despite large improvements in quality of life, pain, and physical function. Arthritis Care Res (Hoboken). 2018 Jun;70(6):892-901.

Long-term performance and user satisfaction with implanted neuroprostheses for upright mobility after paraplegia: 2- to 14-year follow up. Triolo RJ, Bailey SN, Fogiyano KM, Kobetic R, Lombardo LM, Miller ME, Pinault G. Implanted lower-limb neuroprostheses can provide lasting benefits that recipients value. Arch Phys Med Rehabil. 2018 Feb;99(2):289-298.

Systematic review of measures of impairment and activity limitation for persons with upper limb trauma and amputation. Resnik L, Borgia M, Silver B. Cancio J. Few performance measures were recommended for patients with limb trauma and amputation. Arch Phys Med Rehabil. 2017 Sep;98(9):1863-1892.

Racial and ethnic differences in total knee arthroplasty in the Veterans Affairs health care system, 2001-2013. Hausmann LRM, Brandt CA, Carroll CM, Fenton BT, Ibrahim SA, Becker WC, Burgess DJ, Wandner LD, Bair MJ, Goulet JL. Black-white differences in total knee arthroplasty appear to be persistent in VA, even after controlling for potential clinical cofounders. Arthritis Care Res (Hoboken). 2017 Aug;69:1171-1178.

A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia. Chang SR, Nandor MJ, Li L, Kobetic R, Foglyano KM, Schnellenberger JR, Audu ML, Pinault G, Quinn RD, Triolo RJ. A self-contained muscle-driven exoskeleton is a feasible intervention to restore stepping in individuals with paraplegia due to spinal cord injury. J Neurogen Rehabil. 2017 May 30:14(1):48.

Restoration of reaching and grasping movements through brain-controlled muscle stimulation in a person with tetraplegia: a proof-of-concept demonstration. Ajiboye AB, Willett FR, Young DR, Memberg WD, Murphy BA, Miller JP, Walter BL, Sweet JA, Hoyen HA, Keith MW, Peckham PH, Simeral JD, Donoghue JP, Hochberg LR, Kirsch RF. A report on an individual with high-cervical spinal cord injury who coordinated reaching and grasping movements using his own paralyzed arm and hand through implanted functional electrical stimulation and an intracortical brain-computer interface. Lancet. 2017 May 6;389(10081):1821-1830.

Effect of a decision aid on access to total knee replacement for black patients with osteoarthritis of the knee: a randomized clinical trial. Ibrahim SA, Blum M, Lee GC, Mooar P, Medvedeva E, Collier A, Richardson D. A decision aid increased rates of total knee replacement among black patients. JAMA Surg. 2017 Jan 18;152(1);e164225.

Starting a new conversation: engaging Veterans with spinal cord injuries in discussion of what function means to them, the barriers/facilitators they encounter, and the adaptations they use to optimize function. Hill JN, Balbale S, Lones K, LaVela SL. Patients with spinal cord injuries highlight the concept of "normality," facilitators and barriers to function, and adaptations to optimize function. Disabil Health J. 2017 Jan:10(1):114-122.

Pilot testing of a variable stiffness transverse plane adapter for lower limb amputees. Pew C, Klute GK. A transverse rotation adapter with variable stiffness capability could be useful to help reduce stresses for a lower-limb amputee that result in soft tissue breakdown and discomfort. Gait Posture. 2017 Jan;51:104-108.

Proposed pedestrian pathway roughness thresholds to ensure safety and comfort for wheelchair users. Duvall J, Sinagra E, Cooper R, Pearlman J. Many public pathways are sufficiently rough to result in harmful vibrations and discomfort for wheelchair users. This study suggests a pathway roughness index threshold to protect wheelchair users against discomfort and possible health risks due to vibration exposure. Assist Technol. 2016 Sep 2:1-7. (Epub ahead of print)

Rechargeable anticandidal denture material with sustained release in saliva. Malakhov A, Wen J, Zhang BX, Wang H, Geng H, Chen XD, Sun Y, Yeh CK. A new denture material holds promise for long-term management of denture stomatitis. Oral Dis. 2016 Jul;22(5):391-8.

The effects of advanced age on primary total knee arthoplasty: a meta-analysis and systematic review. Kuperman EF, Schweizer M, Joy P, Gu X, Fang MM. Existing data supports offering total knee arthoplasty to select geriatric patients, although the risk of complications may be increased. BMC Geriatr. 2016 Feb 10;16:41.

Clinical translation of a high-performance neural prosthesis. Gilja V, Pandarinath C, Blabe CH, Nuyujukian P, Simeral JD, Sarma AA, Sorice BL, Perge JA, Jarosiewicz B, Hochberg LR, Shenoy KV, Henderson JM. Measured more than one year after implant, the BrainGate neural cursor-control system showed the highest published performance achieved by a person to date, more than double that of previous pilot clinical trial participants. Nat Med. 2015 Oct;21(10):1142-5.

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Prosthetics Fact Sheet

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