Amputees in High Heels: VA Research Zeroes in on Quality of Life

The first non-custom made prosthetic that can be used with high heel shoes, shown above, was created by a team of undergraduate engineering students at Johns Hopkins University. (Kenneth Lam/The Baltimore Sun via AP)
The first non-custom made prosthetic that can be used with high heel shoes, shown above, was created by a team of undergraduate engineering students at Johns Hopkins University. (Kenneth Lam/The Baltimore Sun via AP)

Researchers from the Department of Veterans Affairs have played roles in a number of scientific and medical breakthroughs that have had a profound impact on modern life: the liver transplant, the nicotine patch and artificial lungs, to name just three.

And now, as they seek to meet the needs of an increasingly diverse population of wounded and disabled veterans from the current era of war, VA design experts say they're going beyond barebones medical needs and aiming to help vets live more comfortably, with technology adapted to their lifestyle and interests. It's work that requires them to listen to veterans more closely and involve them and their feedback in the development process to a greater extent than ever before.

One example of this work can be seen at the Office of Research and Development of the Department of Veterans Affairs, where they've come up with a 3D-printed ankle and foot device for a prosthetic leg to give amputees adjustable heels.

Thanks to this research, stilettos are no longer out of the question for veteran amputees. Outside researchers at Johns Hopkins University and elsewhere have developed similar devices, but Dr. Andrew Hansen of the Minneapolis VA Healthcare System said the VA's "Shape & Roll" prosthetic foot is unisex.

"This study focused on high heels, but the results work just as well for cowboy boots," Hansen said in a VA release.

The adjustable-heel prosthetic was an example of VA's commitment to research in areas that haven't been pursued by the private sector, said Dr. Rachel Ramoni, the VA's chief research and development officer.

"Actually, there's a couple of things going on with 3D printing; you can print a foot for every type of shoe," Ramoni told Military.com.

The foot-ankle prosthetic also demonstrates a willingness at the VA to take feedback from wounded and disabled veterans themselves on what they need to accommodate the lifestyles they wish to return to or pursue, she said.

Ramoni also cited current research into upper-arm prosthetics for women as an example of this work.

"That's a small segment of the population; it's a small market," Ramoni said. "It's not an area where somebody would say 'Well, it's an obvious money making opportunity.' So it might not be good business, but it's the right thing to do."

The other challenge with research on upper-arm prosthetics for women is that so little work has been done in the field previously, Ramoni said.

"The sizing of the prosthetic is a big deal," she said, and "we don't know about women's upper arm satisfaction, because all of the surveys were designed for men."

The work on adjustable heels and the upper-arm prosthetic research are among more than 2,000 projects involving 3,400 researchers now underway at the Office of Research and Development. ORD operates on a budget of about $722 million from the VA, supplemented by contributions from the National Institutes of Health, the Department of Defense and others, for a total of about $1.5 billion, Ramoni said.

The money is being spent with a new emphasis on listening to vets regarding where they want the research to go, Ramoni said.

A Disabled Vet Tackles Design

Dr. Rory Cooper was an Army sergeant in Germany in 1980 when he lost the use of his legs from spinal cord injuries in a bicycle accident.

He now is a director and senior research career scientist for the Human Engineering Research Laboratories, a VA Rehabilitation Research and Development Center and home of the VA Technology Transfer Assistance Program.

Cooper is also a Paralyzed Veterans of America distinguished professor at the University of Pittsburgh. As such, he is an advocate for what leaders in his field call "participatory action engineering," or, more simply put, listening to the people you're trying to help.

Cooper said his frustration with the ivory-tower approach to human engineering grew out of his own experience trying to get a better wheelchair.

"I was trying to solve some of my own problems," he said of his approach to design research. He found that he and other veterans often were in "isolation" from the researchers.

Cooper said that surveys and talking to the veterans themselves are "ways to initiate the design process, rather than having somebody sitting at their desk or surfing their computer, trying to understand what you want."

Designers and researchers should "start by asking [the veterans] ... to prioritize," Cooper said.

He said his current research was focused on robotics, artificial intelligence and what he called "adaptive reconditioning technology" to help veterans participate in sports and recreation.

One such example: a robotic bed. One of the little-known everyday problems for disabled veterans, and their caregivers, is getting in and out bed, Cooper said.

"If you don't have the use of your arms or legs, or you're weakened, that's a huge problem," he said.

The bed is currently a work in progress, but Cooper said the initial thought was to have a "chair-into-bed kind of a docking system, and the chair kind of puts you into the bed while a conveyer pulls you into the bed."

A Secret Weapon: Veterans

The VA has a major advantage over the teaching hospitals and the private sector in conducting wide-ranging tests and surveys that require huge numbers of volunteers, said Ramoni, the VA's chief research officer.

"Veterans are absolutely core to our program," she said. "Our program is able to make these discoveries because of the thousands of VA patients volunteering here," and "what we do is driven by their needs."

Outside researchers, she said, often ask how they can learn from current VA practices and how VA scientists get so many people involved in the development process.

"We say what we have is not something you can learn; that you have a population of veterans who want to continue to serve their fellow veterans and the entire nation by participating in these studies," Ramoni said. "It's just amazing to me how committed veterans are to continuing to serve and continuing to make discoveries that will help everybody."

The Next Big Breakthrough

Ramoni noted that VA's ongoing Million Veteran Program (MVP) on genome research has now enrolled more than 670,000 veteran volunteers, to make it by far the world's largest genome database.

In the program, begun in 2011, participants donate blood, from which DNA is extracted. Then a baseline and periodic follow-up surveys track the veterans' military careers, and their health and lifestyles.

The research seeks to determine whether the genetic information in the database could hold keys to preventing and treating diseases.

"We believe MVP will accelerate our understanding of disease detection, progression, prevention and treatment by combining this rich clinical, environmental and genomic data," former VA Secretary Dr. David Shulkin said.

The MVP research opened the possibility for determining whether genetic factors were contributors to PTSD and Gulf War illness, Ramoni said.

Many veterans shared the same experiences in the same places in combat, and others were in the same places in the Gulf War; some developed PTSD and Gulf War illness, others didn't, Ramoni said.

"The question we all ask is, why is that? Are there genetic markers for PTSD susceptibility, or are there genetic markers for Gulf War illness? Genes might help reveal that," she said.

-- Richard Sisk can be reached at Richard.Sisk@Military.com.

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