Brendan Marrocco Only Soldier to Lose All Four Limbs and Survive;
Heat of Bomb Instantly Cauterized His Wounds By David Martin
Sooner or later it had to happen - a soldier losing all four limbs and
yet surviving. It happened to Brendan Marrocco on Easter Sunday of 2009
in Iraq, when his vehicle tripped a roadside bomb.
"It just took both arms, my left leg off completely and my right leg
was still attached a little bit," Marrocco said, "and killed my gunner -
my best friend."
Then there's that nasty scar on his neck.
Brendan Marrocco, 23, works with a trainer at Walter Reed Army Medical
Center in Washington, DC. Marrocco, the first quadruple amputee of the
wars in Iraq and Afghanistan to survive, lost both arms and legs to a
roadside bomb in Iraq on Easter Sunday, 2009. (CBS)
"Yeah, I severed my carotid artery," Marrocco said. "That alone
should have killed me."
Carotid artery severed, both arms and left leg completely off - why
didn't he bleed to death? The answer is a gruesome irony: the heat of
the blast instantly cauterized the same wounds it had caused.
"I was barely bleeding from them," Marrocco said. The same weapon
that took half his body saved his life. Just barely.
"I wasn't expected to live," Marrocco recalled. "I died three times
and came back." No pulse. "Flat-out dead."
Advanced Arm Dynamics not only builds prosthetic
upper limbs, but helps its patients get their lives back to normal
By Nick Peterson
The Times, May 13, 2010
When you first see Chino Acosta, there is
nothing unusual that catches your eye — even if you know beforehand that
he is missing an arm.
Then you look him up and down, and you see it. His
left hand. It looks a little different, but only slightly. If it was his
right hand, you wouldn’t hesitate shaking it.
But it’s his left hand, and he can do some amazing
things with it.
Acosta has a dynamic arm — an electronic
prosthesis, created by Tigard’s Advanced Arm Dynamics — an arm that
helps him lead a fairly normal life.
And he likes it a lot.
“One of the things I like about it is for driving,”
Acosta says, making a motion like he’s holding onto a steering wheel
with his artificial hand. “Driving is really comfortable.”
Acosta lost his hand in a job-related accident six
years ago. After some reconstructive surgery that didn’t produce the
results he was hoping for, he decided to have his arm amputated just
below the elbow. Then he came to Advanced Arm Dynamics and they built
him the arm he now uses — a myoelectric prosthesis that has rotation at
the wrist and an open-close function for the hand. And it looks
surprisingly natural.
Acosta’s face lights up with a little, sly smile as
he rotates his hand 360 degrees — something those of us with natural
hands can’t do.
The “skin” on his prosthetic hand and forearm is
made of silicone and painted to match Acosta’s natural skin. The forearm
even has hair taken from his other arm embeded in it.
The only problem, Acosta jokes, is that in the
summertime it doesn’t tan like his real arm.
The hand looks uncannily real, right down to the
veins on the top of the hand and the fingernails — which, by the way,
never need clipping.
The movement of the hand is limited. It is fixed in
a cupped, gripping shape, looking like it’s constantly ready to grab
something. Besides the unlimited rotation, its basic movement is to open
and close.
Those movements are controlled by the flexing of
two basic muscles in Acosta’s forearm. The twitching of one muscle
causes the hand to open and the twitching of another muscle causes it to
close. A quick flexing of respective muscles causes the hand to rotate
one way or the other.
Acosta said learning to use the arm was relatively
easy and only took a couple of weeks. Training begins with a computer
program that uses myotraining and simulation software to virtually
imitate the movement of the prosthetic hand.
“Before they even think about making you this,” he
says, motioning toward his prosthetic arm, “they train you on the
computer. By the time you get this, you just put it on, and no problem.”
Getting back to normal
Mac Lang, the clinical director and prosthetist of
the Adavanced Arm Dynamics Northwest Center of Excellence in Tigard,
says the company exclusively specializes in upper limb prosthetics. And
one of the things that sets the company apart from other prosthetic
providers is its emphasis on long-term rehabilitation.
“We provide the prosthesis, but we also provide the
rehabilitation for the patient to work that prosthesis into their
everyday life,” says Lang.
The clinic’s occupational therapy room is equipped
with various real-life objects which patients can train on to get used
to using their limb.
“Something as simple as stacking cones may not be
exciting or fun, and they often get tired of doing it here 100 times,”
Lang said. “Then they go out to Starbucks and have to pick up a cup of
coffee and because they’ve done it here 100 times, it takes the anxiety
away of having to do it in public in an uncontrolled setting.”
Lang says a typical patient for them is one who,
like Acosta, lost a limb in a job-related accident.
Advanced Arm Dynamics (AAD), an upper
extremity prosthetics provider, recently played a role in the 30th
Annual Texas History Day Contest; albeit, one behind the scenes.
When the business was approached by a group
of 8th graders from a Texas middle
school who were creating a play on the history of innovation in
prosthetics to perform as their submission for the contest, the AAD team
was more than happy to help. They worked
with the students over a period of months, which included showing them
various prosthesis and how they work, introducing them to patients,
providing a tour of the facilities and lab, and even lending them four
prosthetic arms to use when performing their play.
After first winning their school and the Dallas
Fort-Worth regional competitions, the students were among the 1,000
students out of 45,000 who were allowed to compete at the state-level
this past weekend at the 30th Annual Texas
History Day Contest, the official affiliate of the National History
Program, which was held at the Texas State History Museum in Austin. The students
received 4th place out of the 45,000 state competitors.
The theme of this year’s Texas History Day was
“Innovation in History.” For their submissions, students in 6th
through 12th grade had a choice of submitting performances,
Web sites, historical papers, documentaries
or exhibits in accordance with the theme.
Texas History Day, the official Texas affiliate of
the National History Day program, is a
yearlong education program that culminates in an annual state-level
history fair for students in grades six through twelve. It provides an
opportunity for
students to develop their knowledge of history and their critical thinking,
analytical reading and writing, presentation, media design, and public
performance skills through creative and original papers, performances,
documentaries, web sites or exhibits.
The Texas State Historical
Association coordinates the Texas competition, which involves over
45,000 young Texans statewide. The 2010 event was co-hosted by the Bob Bullock Texas State History Museum and The University of Texas at
Austin College of Education.
Over 1,000 students participate in the state level History Day contest
with approximately 60 students representing Texas at National History
Day each year in Washington, D.C.
I recently had the unique opportunity to travel
down to Guadalajara to participate in the first annual International
Forum on Biomedical Engineering
at the Tecnológico de Monterrey campus Guadalajara. I have known the
Director of the Biomedical
Engineering department, Dr. Misael Caballero, for the past four
years. In 2006, we had the opportunity to collaborate together on a
prosthetic case involving a patient who sustained wrist disarticulation
amputations on both her right and left arm. Earlier
this year Dr. Caballero invited me to speak at this conference on the
topic of Advancements in Upper Limb Prosthetic Technology. And although
my Spanish is pretty non-existent, I decided this would be an excellent
opportunity to teach about our field and
provide exposure to not only the advancements in technologies but also
the advancements that have been made in therapy and psychosocial
considerations for those patients dealing with an upper limb amputation.
So, my tickets were purchased and I was on my way
for this adventure. My past experience with Mexico involved beaches and
margaritas so I was unsure of what to expect going to Guadalajara.
Upon my arrival, I met with Dr. Caballero and
one of his students, Ana HeRay and was taken to my hotel. On the ride
to the hotel, I was informed that I would be the first speaker and that I
should be prepared for around 100 participants. Once at the hotel I
was able to put my finishing touches on the
presentation for the next morning.
The next day, Ana picked me up to take me to the
University. Once there, I was given a tour of the exhibit hall which
included approximately 15 vendors from various aspects of the health field including
such companies as Arthrex and Stryker.
Dr. Caballero personally introduced me to the representatives from each
of these companies. I quickly realized that the entire conference was
student driven and on a very high level! I was incredibly impressed by
the professionalism of the student workers
and by the overall feel of the conference.
It was then off to get prepared for the opening
ceremonies and the presentation at 10:00 sharp. Some very influential
people were in attendance including the president of the university and
the Minster of Health for the county of Jalisco.
The venue for the meeting was an outdoor gymnasium that held
approximately 1,000 chairs. Five 40” LCD screens were positioned around
the audience as the main projector was unfortunately not bright enough
to show on the main screen. The presentation went
very well and we had approximately 900 + attendees during the lecture
which was amazing!
After lunch, Ana and another student by the name of
Eduardo gave me a tour around the campus. I have a new appreciation
for what the field of biomedical engineering means in Mexico and I am hopeful
that a few of the students will be interested
enough to consider the field of upper limb prosthetics as a career that they
can bring to Mexico. We had a Gala dinner that evening which included
lectures by Intel on their venture into Guadalajara.
The next day was full of more lectures
(unfortunately in Spanish which did not bode well for this Texan!) as
well as a repeat lecture from me to those students that were not able to
attend the original lecture. It was then off to the airport
for a quick flight back to Dallas.
I truly enjoyed my time in Guadalajara and was very
impressed by the hospitality of the students and Dr. Caballero. I am
looking forward to this becoming a common conference that we can be a
part of in the future and hope that we can help
influence the career choices of some of these students as they begin to
understand the nature of prosthetics and how it relates to their
degree. This was an excellent opportunity to showcase the philosophy of
Advanced Arm Dynamics and I am grateful to Dr.
Caballero for his invitation to participate in this event.
Rob Dodson, C.P.O., L.P.O. Upper Extremity Specialist Advanced Arm Dynamics
- "The military's Purple Heart award is hard-earned.
Service members must be wounded or killed in battle to receive the honor.But when a Springfield soldier received his Purple Heart six
months ago, he didn't even know it. He was in a medically-induced coma when the
award was pinned to his pillow.First Lieutenant Mark Wise never dreamed of receiving a
Purple Heart. He hoped he would come out of battle in Afghanistan without one
but now that he has he says he's grateful to wear this badge of honor...."
WATCH THE VIDEO of Advanced Arm Dynamics patient Lt. Mark
Wise featured on ABC 7 News in Washington, DC.
ERIC JONES sat in a middle seat on a recent flight from the New York area to Florida, but he wasn’t complaining. Instead, he was quietly enjoying actions that many other people might take for granted, like taking a cup of coffee from the flight attendant or changing the channel on his video monitor. These simple movements were lost to Mr. Jones when the fingers and thumb on his right hand were amputated three years ago. But now he has a prosthetic replacement: a set of motorized digits that can clasp cans, flimsy plastic water bottles or even thin slips of paper.
“Pouring a can of soda into a cup — that is a mundane daily action for most people, but to me it is a very big deal,” said Mr. Jones, who lives with his family in Mamaroneck, N.Y. “I slip my bionic fingers on like a glove, and then I have five moveable fingers to grasp things. It’s wonderful to have regained these functions.”
Mr. Jones’s prosthesis, called ProDigits, is made by Touch Bionics in Livingston, Scotland. The device can replace any or all fingers on a hand; each replacement digit has a tiny motor and gear box mounted at the base. Movement is controlled by a computer chip in the prosthesis.
ProDigits was released commercially last December, said Stuart Mead, the chief executive of Touch Bionics. About 60 patients have been fitted worldwide, he said, and some have been wearing it for three or four years. The cost is $60,000 to $75,000, including fitting and occupational therapy.
The technology used by Touch Bionics is based on prostheses that the National Health Service in Scotland developed for children there who suffered effects of the drug thalidomide, he said. The company, founded in 2003 as a spin-off from the health service, adapted the technology from custom prostheses into ones that could be produced commercially. It had funding from investors including Archangel Informal Investment and the Scottish Co-investment Fund.
The company’s first product, released two and a half years ago, was the i-Limb Hand, an entire hand that opens and closes and can grasp objects. It has been a success, Mr. Mead said, with more than 1,200 patients fitted with it in 40 countries.
The company then turned to creating ProDigits. “We decided to develop the technology to mechanize not just a hand, but individual fingers,” he said. “We always knew that it would be the bigger market — more people lose individual digits than lose entire hands — but also the most challenging technically."
The individual, motorized fingers are a new and promising development in the field, made possible in part by miniaturization of components, said John Miguelez, founder and president of Advanced Arm Dynamics of Redondo Beach, Calif. The company specializes in prosthetics for hands and arms for, among others, soldiers returning from Afghanistan and Iraq at Walter Reed Hospital in Washington. “More voltage and current can be applied to the motors,” he said, “creating increased speed and force.”
Dr. Douglas G. Smith, a professor of orthopedic surgery at the University of Washington and Harborview Medical Center in Seattle, agreed. “Motors are getting stronger and smaller, and the batteries are thinner and smaller, too,” he said, making it possible to fit mechanical components into the space formerly occupied by a finger.
Eric Jones has been wearing a ProDigits prosthetic for 18 months. The artificial fingers are slightly larger than the originals, but that is not a problem, he said. “The fingers look cool,” he said. A switch on the side turns the power on and off, and he charges the digits overnight, as he would a cellphone
Mr. Jones starts the action by flexing or relaxing a muscle in the palm of his hand. Sensors built into the prosthesis pick up the signals sent by the muscles and send the message to the computer chip that controls the motor. The artificial fingers stop closing when they detect resistance, said Karl Lindborg, professional services director for Touch Bionics.
A single, outstretched prosthetic finger can operate a microwave oven or a cellphone; a finger and a thumb can hold a chess piece; three or more fingers can grasp a sphere. Mr. Jones said the fingers also provided a touch of class. “I can grasp a wine glass with my bionic fingers,” he said. “My pinkie and ring finger curve under the bowl very elegantly.”
PRODIGITS may be opened and closed not only by sensors that pick up muscle contractions, but also by dime-size pads put at the base of the fingers to detect pressure exerted by remnant bone. “If you can wiggle the bones in your palm, Mr. Miguelez explained, “that wiggle can be translated into controls to open and close the fingers.”
Robert J. Green of Bel Air, Md., who lost the fingers and thumb on his dominant left hand last year, operates his ProDigits in just that way. He uses his prosthetic fingers, for example, to write with a pen or a pencil. The artificial digits have actually improved his handwriting, he said, and he likes their appearance, too. “I look something like Arnold Schwarzenegger in ‘The Terminator,’ ” he said.
Recently, AAD and T Minus Five joined
together to host the second annual Amputee Ski Weekend in McCall, Idaho. AAD patients Tom
Seibert, Connor Howe and Bernie Diamond (left) along with Dan Conyers were among the
participants. Skiers were provided adaptive equipment donated by
AWeSOMe, Adaptive Wilderness Sports of McCall along with instructors. Skiers and
snow boarders arrived from California, Texas, Oregon, Arkansas,
Idaho, and Utah to participate.
The AWeSOMe group at Brundage Mountain in McCall, Idaho
has been working for years to bring recreational opportunities to local
residents, mostly youngsters diagnosed with autism, cerebral palsy and other medical
conditions. The Ski Weekend event attracted teens, adults and retirees with
upper and lower limb amputation.
Mary Seibert, founder of T Minus Five
organized the event. The Seibert family founded T Minus 5 after their son, Tom,
lost a hand in a wakeboarding accident as a teen. The name of the group stands
for “Tom minus his 5 fingers” and represents Tom’s
desire to continue in his pursuit of an active outdoor lifestyle.
Once upon a time, not so long ago, only a relatively small ratio of
the population had experienced limb loss or amputation, and only a few
dedicated manufacturers and individuals with limited resources focused
on research and development of new prosthetic solutions...READ MORE
John Miguelez, CP, FAAOP, points out that funding DARPA-developed high-tech prostheses might not be as difficult as we think.
"Ten years ago, when the C-Leg� first appeared, people feared that
it was way too expensive for a knee system, and insurance companies
wouldn't pay for it," Miguelez says. "It may not be the standard knee
being fit today, but it's certainly mainstream, and a lot of patients
have access to it."
Making a case for reimbursement for high-dollar high-tech items is
not difficult, Miguelez believes. "As long as that emerging technology
is medically necessary, and we can document that it will have a
positive impact on the patient's medical outcomes, insurance companies
are, to a certain extent, required to fund the treatment. It's really
all in the approach."
As the provider of upper-extremity prosthetic services for Walter
Reed Army Medical Center (WRAMC), Washington DC, Miguelez is involved
in the beta testing of new DARPA-developed technology designed to
benefit recovering amputee soldiers. "It's a very aggressive plan that
has developed a new upper-extremity prosthetic system and new controls
in just four years," Miguelez says. "Although some really impressive
new technology has appeared over the last ten years, we have never seen
it evolve to this degree this quickly."
Miguelez describes another DoD benefit in the making. He is one of
several prominent experts nationwide who have been commissioned to
write specialized chapters for a book titled Care of the Combat Amputee
-which should be available in early 2008.
"This is something else that has not happened historically-a
gathering of experts sharing their knowledge and experience for the
benefit of our prosthetic patients."
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