Researchers and students at St. Petersburg J. E. Hanger College of Orthotics and Prosthetics in Florida are working with the Combat Wounded Veteran Challenge to research and develop improvements for prosthetic devices.

The Combat Wounded Veteran Challenge (CWVC) is a program for injured veterans and service members that provides rehabilitative opportunities through high-adventure outdoor challenges. When the program’s founder, retired Navy Captain David Olson, approached Arlene Gillis, LPO, CP, MEd, the orthotics and prosthetics program director at St. Petersburg College, about a potential partnership, she immediately accepted his offered.

The mission of the CWVC is to challenge, research and inspire, and the first trip that Gillis arranged for the group to join was a summit to the peak of Mt. Kilimanjaro, the tallest mountain in Africa, in February 2013.

“When Dave came to my office to ask me to help them, it took me less than 5 minutes to agree to go climb a mountain in Africa with less than 60 days to prepare,” Gillis told O&P Business News. “I quickly realized that these men deserve our help, and I was willing to put any available resources forward to help them complete their mission.”

 

McCauley makes a plantarflexion adjustment to the prosthetic swim leg prior to the 50-meter case study.

 

McCauley measures the plantarflexion angle the prosthetic swim foot just before underwater navigation dives off Fleming Key.

Images: The Combat Wounded Veterans Challenge Team 

McCauley makes a plantarflexion adjustment to the prosthetic swim leg prior to the 50-meter case study.McCauley measures the plantarflexion angle the prosthetic swim foot just before underwater navigation dives off Fleming Key.Images: The Combat Wounded Veterans Challenge TeamAfter the initial trip to Mt. Kilimanjaro, Gillis and her students accompanied the group on an 8-day trek through the Grand Canyon, as well as on a 6-day glacier climb in Alaska.

“It benefits our students and graduates because they get to interact with these amazing men and women that have served our country and have a can-do attitude,” Gillis said. “They get to see the things they deal with outside of what they might deal with in a typical office environment.”

During these trips, Gillis and her students provide prosthetic support for the group while also conducting case studies on amputee movement and prosthetic performance during extreme circumstances.

 

John Kremer, a bilateral transtibial amputee, pushes forward during his 50-meter swim with his underwater prostheses as McCauley films his technique with one of seven underwater cameras.

 

McCauley gets a close up view of the high density foams used in one of the clinical trials.

John Kremer, a bilateral transtibial amputee, pushes forward during his 50-meter swim with his underwater prostheses as McCauley films his technique with one of seven underwater cameras.McCauley gets a close up view of the high density foams used in one of the clinical trials.”They challenge themselves in a way most individuals don’t, and they keep pushing themselves to get there. They need their prosthetic providers to give them the support to accomplish their goals,” Gillis said. “The students have been setting baseline information so when we start doing research in the future, we will have some data and move forward to help develop different componentry.”

Underwater prostheses

Most recently, Gillis traveled with the CWVC to the Florida Keys where they worked with SCUBAnauts International, a local group offering underwater exploration opportunities to young divers, on a coral restoration project. While there, Gillis and Michael McCauley, LCO, BEP, who graduated from St. Petersburg College in 2011, conducted research on underwater prosthetics and how amputees move in water.

 

Billy Costello, an Army staff sergeant with the 3rd Special Forces Group and a right transfemoral amputee, enjoys the USNS Vandenburg off Looe Key during a recreational swim.

“There is limited research on amputees swimming or underwater prosthetics. I think I found about four articles,” McCauley said. “So I wanted to create a baseline of amputees swimming with and without their prosthetic legs.”

McCauley instructed the amputees to swim 50 meters in a pool, and monitored their blood pressure and heart rate before and after the swim. They were also videotaped underwater in the coronal, sagittal and transverse planes.

“We set up camera footage in the pool and filmed them swimming in all three planes, so now I can gain an idea about how energy efficient they are swimming with and without their legs,” McCauley told O&P Business News.

The amputees were observed and filmed while scuba diving in the ocean, as well as while wearing different styles of fins.

“I am now diving into the research from all the case studies I came up with, and I am finding out little by little as I put it all together that a lot of them are surprisingly more energy efficient without their prosthetic legs. They might be faster in most cases with them, but not energy efficient. So how can we combine the best of both worlds into one?” McCauley said. He said the amputees reported the split fins were more comfortable and easier to use, “and the stats show they were also more energy efficient for the amputee when comparing the use of prostheses with different fins,” he added.

McCauley hopes this case study will enhance the development of underwater prostheses.

“This case study is going to give us a baseline,” McCauley said. “Once we put it on paper and understand it, we can start to look into developing prototypes for different feet and knees and focus on alignment and suspension.”

According to McCauley, an underwater prosthesis would also be advantageous for therapy purposes in addition to its practical benefits.

“When we stand an amputee up for the first time on parallel bars, gravity is working completely against them. They are fighting to stand up and be stable,” McCauley said. “If we can get water legs fabricated and get insurance to cover them, physical therapists [could use them] at pools and have new amputees do their first steps in water.”

Billy Costello, an Army staff sergeant with the 3rd Special Forces Group and a right transfemoral amputee, enjoys the USNS Vandenburg off Looe Key during a recreational swim.McCauley expects to return to the same trip next year to conduct more research and reassess the abilities of the group members.

“The next step for me is to analyze all the information I have, and compare and contrast,” McCauley said. “I have a transfemoral amputee, several transtibials and a couple of bilateral transtibial amputees. I can compare them to each other, and I have 250 gigabytes of video of them swimming in the ocean and ascending and descending to analyze.”

He also hopes to have a prototype prosthesis ready for next year to test on the swimmers.

“We can hopefully get a prototype ready and take it to the Keys and actually intervene with the patients, exchange out components and compile more statistics that way,” McCauley said. “Because now we have a baseline, with every piece of information — if I have them swim 50 meters again next year — I’ll be able to compare exactly and see how energy efficient they become.”

Future research

St. Petersburg College intends to add a course to its curriculum focusing on the partnership with CWVC, and eligible students will be chosen for future expeditions through the course. Future trips include a schooner sail training challenge expedition in the Florida Keys, a packrafting challenge in Alaska and a trip to Argentina to summit Aconcagua, the highest mountain peak in the Americas.

“These challenges help veterans form camaraderie as they face new challenges and help to inspire other Americans and new combat wounded veterans,” Gillis said. “The potential is there for the students’ case studies to influence new designs and the development of new components to help amputees return to activities they may not even be aware they can return to.”

Gillis also wants to raise funds to purchase a plot of underwater land in the Keys for the CWVC and SCUBAnauts to perform coral restoration every year.

“The challenge, research and inspiration piece of the CWVC is really what’s phenomenal to me,” Gillis said. “We can raise awareness about the profession, and we can raise the spirits of other amputees. It gives them hope.” — by Megan Gilbride