Retired Army Sgt. Derek Weida checks out at the front desk of a prosthetic clinic in Las Vegas in April 2018. Weida was fitted for a new prosthetic leg to accommodate his growing leg muscle, due to weight training. (U.S. Air Force photo by Senior Airman Andrew Sarver)

‘Hey, Doc.’

To that end, prosthetics, new therapies and advanced pharmaceuticals have allowed commanders to bring people back for limited duty, maintaining their knowledge and experience. This has transformed the all-volunteer force over the last 10 years into a viable career even for some who have been grievously injured.

That includes staff and rear-area jobs, Smith said. If you were an E-4 or E-5 in the field, “and now you’re back in supply, you know how important it is to the guy at the pointy end that this works.”

Officers doing staff work who have lost a leg to an IED as a brigade commander, Smith added, can serve on a division staff and be much more sensitive to “the ambiguities of deployment” than someone not so familiar with combat. These wounded warriors now working new jobs provide a healthy sense of urgency, and often inspire those around them in their new duty stations. As a bonus, close monitoring of their continued rehabilitation has helped to further the technology.

“Historically, advances that have come in assistive technology, particularly in prosthetics and orthotics, and even in wheelchairs, have come mainly from folks with impairments or disabilities that are just not satisfied,” Pasquina said. “It’s like, ‘Hey, Doc — I know this is what ya’ got, but it ain’t good enough.’”

Pasquina added that he’s not picky about where a new technology originates, but said it’s incumbent upon military doctors to bring world-class treatments to American service members.

Osseointegration – a procedure that permanently, surgically anchors an artificial implant into a bone, which then grows over the implant – was developed in Sweden, for example. Like so many procedures described by Pasquina, it involves physicians from many disciplines: orthopedic and plastic surgeons, rehab and nursing specialists, prosthetists, psychiatrists, and more.

“We are all charged to go out and look, not just in the literature, but with our colleagues in the military, in civilian facilities, or in other countries,” he said. “We all now have a mission to bring the latest and greatest.”

Stand by

The use of prosthetics as part of bio-medicine will only increase, said Alan Hawk, manager of historical collections for the Defense Health Agency’s National Museum of Health and Medicine. The development of regenerative medicine, funded through the Defense Advanced Research Projects Agency (DARPA), holds promise for some patients sustaining nerve and vessel damage to retain a limb instead of having it amputated. The possibility of using stem cells to grow new skin is another example on the horizon, he said.

Nevertheless, Pasquina prefers to temper his enthusiasm for new prosthetic devices and procedures developed since he was a young officer in the Persian Gulf, 30 years ago.

“I get a little nervous when we celebrate too much the advances that have been made,” he said. “Despite how well many are doing, there are still many that continue to suffer. But [with new devices] we want to bring folks back and have these available for them, whether they were injured yesterday or 10 years ago. With advances in prosthetic technology in particular, many of the patients I take care of – from Vietnam, Gulf War I, ... training accidents – everybody can benefit from this technology.”

Pasquina also cited DARPA research, including an exoskeletal program employing robotics for people with paralysis or limb loss. Other groups are working on microprocessors built into prostheses that can sense the speed or actions of an individual, and adjust joint reaction in real time. All the while, motors and batteries are getting smaller, allowing for actuators in limb prosthetics for greater ease of movement.

He also spoke of a “brain-machine interface” where thoughts can lead to electrical signals picked up by a computer and translated into a motor, to manipulate a robotic hand. Even the restoration of a certain amount of sensation via prosthetics is on the table, he said, and there are prototypes for prosthetic fingertips that pick up on tactile stimulation and send impulses into the body that are perceived as touching.

“That’s really exciting,” Pasquina said.

“When we think about our hands, touch is as important in many aspects of our lives as is manipulating objects.”

Continuing next month: How 3D printing is re-writing what's possible in post-traumatic care.