Adapting to life without a foot or leg can be a daunting task, but the spectators and runners who lost at least one limb in the Boston Marathon bombings last week will be aided in their recovery by advances in prosthetic limb technology.
It's technology that could have at least some victims up and running again before the next race.
“It’s something that can be done,” said Dr. Anthony Jacob, medical director of the Rehabilitation Institute of Ohio — a 45-bed rehab facility at Miami Valley Hospital. “Prosthesis can be customized for a wide range of activities, even running.”
First, however, more than a dozen injured marathon amputees must come to grips with the emotional as well as physical toll of the April 15 bomb attacks, which killed three people and injured more than 260. Marie Dean of Huber Heights knows the challenges ahead. Her left lag was amputated below the knee nearly three decades ago after a motorcycle accident.
“It’s a big adjustment,” said Dean, who was 36 when a speeding car clipped the motorcycle she was riding, tossing her 30 feet into a drainage ditch, nearly severing her left foot and mangling her leg. “I was an extremely healthy and happy young woman when I lost my leg. So my heart goes out to those people (Boston bombing victims) because I know they’re going through a life-changing event.”
Twenty nine years later, Dean said she leads an active, fulfilling life, visiting friends and family, running daily errands, even riding her bicycle occasionally with a prosthetic leg recently fitted with a new socket that makes it more comfortable for her to walk.
“I have a very good gate, and a lot of people can’t tell that I have a prosthesis,” she said.
Dean’s prosthesis is a byproduct of the rapid advancements prosthetic limb technology gleaned from decades of treating thousands of veterans who have lost limbs in the wars in Iraq and Afghanistan, said Glenn Schober, clinical manager at Optimus Prosthetics in Dayton.
‘Six Million Dollar Man’
In addition to lighter weight and more durable materials, that latest wave of advancements in prosthetic limbs includes motorized knees and ankles that can actively assist amputees in standing and walking and adjust to different terrains.
“The microprocessor technology has improved so much, and the battery technology has improved so much that we really aren’t that far away from The Six Million Dollar Man,” said Schober, referring to the popular 1970s TV series.
Most modern day prosthetic limbs have shock absorbers built in to the units to reduce the impact on knee and hip joints, and newer models even have hoses that suck excess air out of the socket to create an airtight seal.
“With previous technology, they (amputees) would always be moving up and down a little in the socket, which was pounding on their limb,” Schober said. “Now, they’re more locked into that prosthesis, so they are going to feel greater comfort and greater control over their prosthesis.
“The whole industry is making everything so that amputees can be more comfortable, more mobile and more functional,” he said.
But getting to the point of being fitted with the latest high-tech gear can be a long, arduous journey, according to Jacob, who said it normally takes about two weeks for surgical incisions to heal, barring complications, then several more weeks for swelling at the amputation site to subside so it can be fitted to the socket of a prosthesis.
Once a permanent prosthesis is in place, rehabilitation could last up to a year and involves re-learning basic tasks, such as walking and standing up, and also re-learning to sense the limb, he said.
“If it’s a leg amputation, you have to re-learn how to tell whether the foot is on the floor or off the floor because the brain is no longer getting feedback from the foot about where the foot is,” Jacob said. “It takes about four to six weeks to become completely coordinated.”
Afterwards, rehabbing amputees will undergo strength and conditioning training similar to that of the long-distance runners in the marathon, many of whom suffered the cruel irony of losing their limbs shortly after crossing the finish line in the early afternoon on Patriots’ Day.
“When you talk about walking with a prosthesis, it requires a lot more energy than walking with a normal leg,” said Jacob, noting that it can take as much as 20-60 percent more energy to resume walking with a prosthetic, depending on whether the leg was amputated above or below the knee. “So many of these people, since they are in better physical health, will heal faster and have less complications than people who have amputations because of diabetes or some other health problem.”
Heroic work in Boston
The fact that so many runners and spectators survived the blasts and most amputees kept enough of their limbs to be fitted with a prosthesis was a testament to battlefield training of many of the emergency workers on site and the surgical techniques developed to treat blast wounds in decades of war, said Dr. Safet Hatic II, an orthopedic surgeon with Orthopedic Associates of Southwest Ohio.
Hatic said blast wounds are often the most difficult to treat because victims typically suffer massive tissue damage and other traumatic injuries that cause severe blood loss.
“If we don’t have blood supply, we no longer have a viable limb,” he said.
Less than 20 percent of amputations in United States are associated with traumatic injuries and even a smaller percentage are associated with blast injuries, according to Hatic, who has no doubt the loss of life an limb would have been exponentially greater if not for the presence of doctors and nurses staffing medical stations at the race who had emergency training in battlefield techniques.
“In terms of limb salvage, limb preservation and our management of soft tissue injuries, there were a lot of things working in the patients benefit,” he said. “There was a first-rate team there and ready. One minute they were taking care of dehydrated runners, the next minute they’re performing triage at a mass casualty scene. But because of them a lot of these patients made it.”
Grasping and learning to appreciate the fact that she survived a life-altering tragedy was the first step on the long road to recovery for Jackie Kastle of Dayton. Her right leg was amputated below the knee as a result of a motorcycle accident with a drunk driver in August 2011.
“What I would say to the victims of the Boston bombings is don’t let the anger and the hurt get to you because it will eat at you and stop the healing process,” Kastle said. “Just focus on being alive because it could always be worse.
“The way I look at it is I lost a piece of myself, but I didn’t die, and that’s what I focus on,” she said. “I still have family and friends, including four wonderful kids. They are the reason I kept making myself get up everyday. And I’m thankful for that.”