Healing Heroes: Prosthetics for Wounded Vets
Robert Kuenzi, Certified Prosthetist at the Center for the Intrepid, Brooke Army Medical Center, talks about a new running prosthesis for hip amputees.
How did you and Eduard first met?
Robert Kuenzi: I met him at one of our rehabilitation clinic sessions here where we do initial evaluations. The attending doctor decided that he was ready to get fitted for a prostheses to begin walking; that was in November of 2011. He had been injured a couple months before that. It was obviously a traumatic injury from a combat situation. His left leg was removed at the hip so he has no leg at all remaining. His right leg was badly injured and he lost some muscle and skin, but now that’s healed up and he is doing quite well.
So the whole hip was gone?
Robert Kuenzi: Yes, the entire femur was gone. His pelvis is still present and so we had to fit the prosthesis around his pelvis. The socket we made is basically a pelvic support for him while he walks. He has to bear weight through his ischial tuberosity, which is the bone that we feel when we sit on a hard chair. It also wraps around his pelvis for suspension so that it holds in place when he’s swinging the leg. That comes into play especially when he walks fast; it also stabilizes his torso against sideways movement. In order to use the prosthesis for walking with that type of prosthesis socket, he has to be able to activate it by pelvic motions. He has to do pelvic tilts every step and especially when he runs, it’s the only thing that makes it go. It’s very necessary for a person like him to have a very strong core and a strong back. His abdominals have to be very strong in order to walk very far.
When you met him you guys talked about goals. Can you talk about that?
Robert Kuenzi: During our initial meetings with new patients we do some physical assessment, but we also ask them what their goals are as far as walking or ambulating.
We ask if they like to participate in any kind of sports or other outside activities. We try to figure that out ahead of time so we know what our goals are for the program. Our goal is to get each person back to a life that they want to live even with the bad injury. For most people their first goal is to walk and obviously that’s our first goal too. In his case he decided he wanted to run and also he wanted to do hiking and walking on trails. For a person with a hip disarticulation amputation, that’s a very ambitious goal, because as I’ve looked into it, I’ve only found a few cases of people actually really attempting to run. About 25 years ago, ironically the year I started prosthetics, an article was published where a couple of prosthetists were describing a new prosthesis socket design that they were working on and they mentioned in the article that they had a patient who ran with a hop- skipping motion. They had a couple of other patients who they said were able to run step-over-step for short distances. That’s all I have found so far in looking into this. So Ed wanted to run and my initial reaction to that was that I would not put too much hope in being able to run. I wouldn’t say that’s a real achievable goal, but in the Center for the Intrepid we do have resources and we have the time to work on things like that. So we can push the envelope and we can try to figure out ways to make these goals happen. I worked with Ed to get his walking prosthesis started around the first of December 2011. With the help of his physical therapist, Alicia White, DPT, he quickly became proficient and within about three months he was walking around with minimal support from his arms. He had some training on going down steps, step-over-step, which is a pretty good trick for most amputees let alone a hip amputee. He was able to make that look pretty easy, so we knew we had a patient who was very strong and motivated. He was a very good patient in his rehab program. He worked out diligently and did everything the therapist wanted him to do. He was always very active and a very high participant in his therapy. Even after discharge from therapy he continued on his own. He went to a gym and worked out a lot. That’s really what pushed him to the point where he could run, that type of work out.
How much input did he have when you guys were making the prosthesis?
Robert Kuenzi: Most of the prostheses we make are quite interactive because we try to get feedback from the patient about things like the biomechanics of walking or the fit of the socket. All those things affect the patient's success, so we try to obtain their feedback constantly. He’s very good about that. Probably about June of last year he brought up discussions about running because we had a fairly well fitting prosthesis at the time. He said, “what about running?” So that whole subject came up again and I honestly had really hoped it would go away. He was persistent, though so I started to think of components for the foot and the knee and hip joints that would allow running with the hip prosthesis because there was no documentation of how one would go about making such a thing. Most of the people that had attempted it in the past just took their prosthesis that they were walking on and tried to run in it. That’s where we started also, but the knee and hip joints that he has on his walking prosthesis were microprocessor controlled and hydraulically controlled, and quite heavy. I did not feel that would be the best starting point for a running prosthesis. So we backed down the hip and knee components to a simpler hinge and a simple knee. Once we achieved a well fitted socket, we were able to duplicate that. Then we started assembling some components that would maybe let him run. This occurred right about September 2012. We assembled a prosthesis with the knee and hip joint in place and a running foot. It was so unstable he couldn’t even walk on it. So we started with a socket that was fitted to him for walking and experimented with some hip joint attachments, but we ended up directly attaching the pylon to the bottom of the socket. So we have a pylon that’s actually a flexible member that bends under his weight and gives a little bit of a flexing, whipping action. It all acts as a series of springs that deflects and then bounces and that’s what we’ve kind of ended up with. The position of all these things looks different; it’s not intuitively what I would have thought when I first started the project. We angled the upper section backward, but the feedback I got from Ed was, “that’s not doing the right thing it’s making me have to work too hard in my hip movement.” So I thought we’ll just angle it forward, and the further forward we moved it the better it felt to him. He was here just about every day for a month while we worked this out to get to the point where he could run a significant distance. Sometimes, we’d have to stop and order more parts because we were using components we don’t normally keep here because we don't typically use them.
So, this is something that you wouldn’t expect to work but is working well with him?
Robert Kuenzi: Yes.
Do you think this could help other people with the same kind of amputation?
Robert Kuenzi: Yes. A lot of the people that have this type of amputation have experienced either a traumatic injury or a cancer; bone cancer in young kids sometimes ends up with this level of amputation. When they survive that and go on with life, they are young still and strong. I really feel like they could benefit from seeing something like this. They could actually get something like this. It’s relatively inexpensive because we don’t use the expensive knee joint or hip joint. We used a fairly expensive foot, but it’s no more expensive than most energy storing composite feet. So it’s a matter of having enough funding or resources to make prosthesis, but it’s not going to be as expensive as the primary one used for everyday walking.
Are there any plans to move forward with this and make this more widely available to other people this design?
Robert Kuenzi: We’re working on an article that we will publish in our prosthetic-orthotic literature so that it can be available. I think there’s a news article in the works right now with one of our monthly publications gives out current orthotic and prosthetic news. I’ve had calls from a couple of other prosthetists who saw him running at the Army 10 Miler in Washington, DC in October and wanted to know what we did. So I explained the process to them verbally and I think they got the idea on what we had done. I think there will be other amputees who could benefit from knowing how this was done.
Now he’s running an eight minute mile?
Robert Kuenzi: I believe he’s clocked at 8:12 on a mile.
What did you say when you heard that?
Robert Kuenzi: I thought, "I can’t do that." So he’s very highly motivated, strong, and very fit. That’s another huge part of the equation that makes this work. What was remarkable to me was that we made this and had it ready about the 15th of September. His goal was to participate in the tough mudder event in Austin and that was October 6th.
That was 10 miles right?
Robert Kuenzi: I think it was around 12 miles with 28 obstacles interspersed throughout. He’d run a quarter-mile do an obstacle, maybe run 50 feet and do another one. It’s all in mud, basically. He was able to do that and what really struck me as remarkable was the way he could do that without much training running. I asked him one day how that came about, how he trained for running without much actual running. The most he ran was about a mile at a time before he did that big event. He went to the gym and did supersets and other weightlifting. It was such an intense workout that he was ready to run. His cardio was very good. His sound leg was very, very strong because it has to do most of the propulsion. It’s like running on one leg. That’s why I don’t think every hip amputee is going to be able to do this because not everybody is as dedicated to doing the hard work as Ed Lychic.
But it could help those who are?
Robert Kuenzi: Right, it’s possible for anybody who wants to do it. That’s kind of my message. You can do it if you put the effort in.
What is the difference between this and what we see others who are amputees who are running on them in major events?
Robert Kuenzi: The big difference is that it’s the level of which the leg is amputated. His is at the hip level. He has no remaining leg to activate the prosthesis. He has to use his torso and his pelvis. So it’s quite different in that respect. People who have a below the knee amputation have their hip and their knee joint and they can use a lot of the muscles in the leg to go ahead and do things like running. People with above the knee amputations have their hip joint and musculature around that to activate and propel themselves. In his case he doesn’t have that either.
So even if they have that little hip bone you feel here, that’s gone?
Robert Kuenzi: No he has that. It’s part of the pelvis, but there’s no leg bone left.
You yourself are an amputee?
Robert Kuenzi: Yes. I have a below the knee amputation from 39 years ago.I’ve lived with it most of my life. I don’t really consider myself that disabled. I’ve had what I consider a normal career. I worked as an engineer before I entered prosthetics and I have worked in prosthetics for 25 years. I’ve been able to keep up with the physical part of the work without too much trouble.
So it happened when you were a kid?
Robert Kuenzi: I was 19. It was a motorcycle injury.
Have you tried to run with one of the blades?
Robert Kuenzi: I’ve never had a special running prosthesis. I run, but it’s just with what I use for walking. I have a below the knee prosthesis, it’s great for walking and I do some jogging. I have a nice shock absorbing energy storing foot; so I have a good foot for running. It’s not as good as this, but it’s good.
Do you run with Ed?
Robert Kuenzi: I’ve not run with him yet, I don’t want to be left behind. In the Army 10 Miler, I think he was the 12th amputee to finish so he beat at least half of the other amputees, all of whom had lower levels of amputation. There were some other people who train here that were pretty competitive and wanted to make sure they at least beat him- so they weren’t shown up.
Do you tinker with it here?
Robert Kuenzi: If I need to adjust it I do, but it’s pretty well adjusted by now. Sometimes I’ll switch feet because I want a little different action. I have another prosthesis I use if I’m going to get in the water, like in a lake, for waterskiing.
Do you think you have a more unique perspective for your patients compared to others?
Robert Kuenzi: It’s a little bit of an advantage. There are quite a few prosthetists who are also amputees and I feel like there are lots of successful prosthetists who are not amputees. So is not essential, but sometimes for below the knee amputees I’ve experienced enough of the problems that can occur during a lifetime of using one that I can kind of relate to just about anything they’re up against. I’m sure there are some unique things I haven’t come across, but most of the common problems I’ve experienced and gotten through. So I can relate with them a little bit as far as what they’re going through.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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