Herr – Designer of His Own Limbs

 Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

Yesterday, I was able to catch the interview on NPR’s Fresh Air of Hugh Herr by Terry Gross:  The Double-Amputee Who Designs Better Limbs  (photo credit)

It’s worth reading or listening to.  Here’s the beginning:

Hugh Herr's legs were amputated below his knees in 1982 after a climbing accident. From his knees down to the floor, he's completely artificial.

"I'm titanium, carbon, silicon, a bunch of nuts and bolts," he tells Fresh Air's Terry Gross. "My limbs that I wear have 12 computers, five sensors and muscle-like actuator systems that able me to move throughout my day."

But Herr doesn't just wear artificial legs. He designs them, too. As the director of the Biomechatronics Group at the MIT Media Lab, Herr and his team are responsible for creating prosthetic devices that feel and act like biological limbs. They are also one of the subjects in Frank Moss' new book, The Sorcerers and Their Apprentices: How the Digital Magicians of the MIT Media Lab are Creating the Innovative Technologies That Will Change Our Lives.

Moss, the former head of the MIT Media Lab, profiles several of the researchers who are working on inventions that could change the way we move, socialize and interact with computers.  ……….

Related posts:

Amputations, Prosthetics, and War (February 13, 2008)

Facial Prosthetics Restores Face (August 5, 2010)

Rejection  (December 1, 2010)

Facing Monday  (January 24, 2011)

Rebuilding the Face Injured by War (March 2, 2011)

Rebuilding the Face Injured by War

 Updated 3/2017-- photos and all links removed as many are no longer active and it was easier than checking each one.

Monday I happened to catch the NPR segment by Terry Gildea:  Rebuilding The Faces Of War 

And now, a story about the effects of war and violence in a different part of the world and how specialists are learning from it. The wars in Iraq and Afghanistan have created a need for innovative treatments for severe battle wounds. Service members often suffer injuries that disfigure and even eliminate parts of their face. At a Defense Department clinic in Texas, surgeons are restoring missing facial features and in a way they're restoring the identities of the wounded.

Texas Public Radio's Terry Gildea takes us to the clinic at Lackland Air Force Base in San Antonio. …

He's now working with doctors at the Maxillofacial Prosthetic Clinic at Wilford Hall Medical Center. Today his anaplastologist, Nancy Hanson, is fitting him with a new set of ears. …………..

……

The story notes that the Department of Defense has two such clinics.  It mentions  Lackland Air Force Base in San Antonio, TX but didn’t specify the other.  It took some “googling” but I finally found an article that mentioned the other one:

The maxillofacial prosthetics program is only one of two such programs in the Defense Department, said Col. (Dr.) Alan Sutton, the program’s director. The other program is at the National Naval Medical Center in Bethesda, Md., he said.

While looking for the second clinic, I found this 2008 article on Air Force Senior Airman Justin Jones who at the time was a maxillofacial prosthetic technician with 59th Dental Squadron here.  His job was to help service members who have suffered disfiguring facial injuries.  [Face of Defense: Airman Helps Injured Warriors 'Face' World]

and this article from August 3, 2010:  Air Force dental team helps patients ‘face’ the world, also featuring the MacKown Dental Clinic, which explains the process:

………Often most important to the patient is the restoration of function – speech, chewing and swallowing — in cases where injury or cancer to the mouth or jaws has occurred.

The team’s first step frequently starts in the stereolithography lab, located at MacKown Dental Clinic, which is one of only two located in the DoD.

Stereolithography is a rapid prototyping method, which allows the fabrication of anatomically accurate, three-dimensional epoxy and acrylic resin models from various types of medical data. There are myriads of data formats that can be assimilated, some of which include those from computed tomography, magnetic resonance imaging, and optical scanners.

“I can take a CT scan of a burn patient’s head and create an exact replica so our anaplastologist can build replacement ears and noses that will fit perfectly,” said Mr. Dave Carballerya, stereolithography lab supervisor. “This technology is also used to incorporate dental and craniofacial implants to enhance the doctors’ diagnosis and treatment planning.”

The team’s anaplastologist then works to create facial prosthetics for the patient.

Anaplastology is the art and science of restoring a malformed or absent part of the human body through artificial means. Again, Lackland is unique in that MacKown Dental Clinic employs the only certified clinical anaplastologist in the DoD, Ms. Nancy Hansen.

“Our patients are going through the traumatic experience of missing anatomical features,” said Ms. Hansen. “We get to see them blossom because they are given hope.”

Ms. Hansen begins by making an impression of the area of the missing anatomy. Prosthetic noses, ears, jaws, even eyes can be made with silicone or hard resin. Many steps are taken to give the prosthesis a realistic look.   …………

Rejection

Updated 3/2017-- photos and all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

Doctor Richard Edwards, a chiropractor from Oklahoma and the nation's third double hand transplant, was recently in the news again.  This time it a report that he “may lose the fingertips on his right thumb and pinkie because his body started to reject the new limbs.”

Dr. Edwards’ surgery was live tweeted when it was done in August by Louisville surgeons at The Jewish Hospital Hand Care Center.

Jeff Kepner, the first patient in the United States to receive two hands simultaneously, experienced an episode of rejection which was dealt with successfully.

Rejection is never a good thing in a transplant patient not matter which organ or part transplant.  Even though I applaud the advances being made, we must always consider the cost of the proposed treatment and ask if there a better option for this individual?

Hand or arm transplantation is not possible for all.  A missing arm can bring (social) rejection to the individual as it did for this woman, Tammy Chinander (photo credit, shown with her daughter Krystal).  [H/T from @vpmedical]

The Rudd native lost her arm at the age of 2 when she caught it in a wringer washing machine. The arm was amputated above the elbow.

For years, she managed with an arm with a hook, but at the age of 31, she decided she was through with it.

"I got tired of it hanging there," she said. "It wasn't working. It looked bad. My son was scared of it."

 

The best choice for her turned out to be a German-manufactured Otto Bock DynamicArm, typically $75,000 to $100,000 in cost which will be paid by her insurance.

Chinander's goal is to get the new arm to work as well as her other arm. Right now, it takes serious concentration to use it.

"I'm going through the second part of my life learning to do everything two-handed," she joked.

…..Krystal could not hold back the tears as she described what it is like for them.

"Getting that first two-armed hug from your mom that you see all the other kids getting is really wonderful," she said.

 

 

REFERENCES

Hand Transplant Fact Sheet: History and Evolution of Hand Transplantation;  UPMC/University of Pittsburgh Schools of the Health Sciences 

Transplantation — A Medical Miracle of the 20th Century; Peter J. Morris, F.R.S.; N Engl J Med 2004; 351:2678-2680December 23, 2004

Immunosuppression and Rejection in Human Hand Transplantation; Schneeberger S, Gorantla VS, Hautz T, Pulikkottil B, Margreiter R, Lee WP;  Transplant Proc. 2009 Mar;41(2):472-5.

Facial Prosthetics Restores Face

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active.

This is an amazing story of restoring a face using surgery and prosthetics. I learned of it through the AMA News article by Carolyne Krupa: Medical team gives Oregon woman a new face.

A surgeon and two maxillofacial experts in prosthetics help a 27-year-old mother, disfigured by a shotgun blast, appear more normal to her young son.

Krupa tells the story and then links to this one:
REBUILDING CHRISSY STELTZ'S FACE: A Special Report by The Oregonian – chronicles the story from the beginning with a list of articles written through the years and a nice timeline slideshow which includes this one.

Other recent news stories regarding facial prosthetics
Military's Facial Prosthetic Program Transforms Injured Troops
Miracle Army Lab Gives Soldiers Their Faces Back
If you are interested in learning how to make such prosthetics, check out these sources
The Facial Prosthetics Training Program (John Hopkins)
International Anaplastology Association
University of Illinois Biomedical Visualization