Prosthetics pioneers

With time and determination, Minnesota National Guard Sgt. Darrell “J.R.” Salzman has learned to tie delicate trout flies with his mangled left hand and the shiny metal hook that serves as his right.

But he lacks patience for another prosthetic device — the so-called “Utah Arm” — that the Army gave him after he lost his right limb below the elbow to an enemy’s bomb in Iraq in December.

“I spend more time throwing it across the room than I do actually using it, and that’s no joke,” the 27-year-old from Menomonie, Wis. said during a physical therapy session at Walter Reed Army Medical Center in the District.

The myoelectric Utah Arm, made by Motion Control Inc. of Salt Lake City, has circuitry that reads muscle twitches as electric signals to open and close a hook or hand attachment. But its response time, even at less than a second, is so slow that Sgt. Salzman prefers an old-fashioned, “body-powered” prosthesis, controlled by a cable and rubber bands.

“I don’t like having to wait if I want to grab something,” Sgt. Salzman said, deftly opening his hook to remove a fuzzy black fly from a vise. “If I want to grab this woolly bugger here, I don’t want to have to wait; I want to just go and grab it.”

The Defense Department understands. It has contracted with a group of researchers and prosthetics manufacturers to build a thought-controlled arm at a cost of $30.4 million, part of at least $70 million the Defense Department and the Department of Veterans Affairs have committed since 2001 to develop better artificial limbs.

Dozens of companies — large and small, foreign and domestic — have received grants to invent and improve prostheses that will be used first by wounded warriors and eventually by the much larger number of civilian amputees.

Because the approximately 600 war amputees account for only a tiny fraction of the 1.9 million Americans living with lost limbs, leaders of the nation’s $900 million prosthetics industry say the government’s investment will be seen less on their balance sheets than in the sophistication of newfangled prostheses.

“That is, in my mind, almost like what the space program did,” said Thomas Kirk, president of Hanger Orthopedic Group Inc., the nation’s largest provider of prosthetic services.

Of course, the military and VA, which provides lifelong care for veterans, are buying more prosthetic products and services. For example, the VA said it spent $1.1 million last year on prosthetic devices and services, compared with about $529,000 in 2000.

“The military expenditure on prosthetics is obviously booming, and it represents a more and more significant part of our business, but it is still only a small part of our business,” said Ian Fothergill, clinical marketing manager for the North American division of Iceland-based Ossur hf., the world’s second-largest prosthetics manufacturer.

North American sales of all products by publicly traded Ossur last year totaled $156 million, or 62 percent of its worldwide sales, the company reported. That was up from 52 percent of worldwide sales in 2002, the year before the U.S.-led invasion of Iraq.

Ossur said sales of prosthetics grew by 12 percent worldwide and 17 percent in North America last year. Still, the company’s growth strategy relies more heavily on orthotics — braces and other assistive devices — to serve an aging population. Prosthetics are replacement parts for people who have lost limbs, feet or hands to disease or injury.

Wounded troops historically have helped push the boundaries of prosthetic technology by demanding more functional, durable, comfortable devices. These days, the military aims to restore functionality to the point that some troops have returned to battle — something virtually unheard of until now.

“We no longer have to be content just getting them on their feet; we can do more,” said Mr. Kirk of Bethesda-based Hanger Orthopedic.

Hanger, with nearly a quarter of the nation’s 2,700 prosthetic and orthotic patient care centers, had 2006 sales of $599 million. Its share price hit a nearly three-year high of $12.40 in April, and the company reported in May that sales at patient care centers that were open more than a year were growing at an annual rate of more than 2.5 percent.

Germany’s Otto Bock HealthCare, the world’s biggest manufacturer of prostheses, has wartime roots. The company’s founder and namesake “was considered a little bit like the Henry Ford of the prosthetic industry” for mass-producing devices for World War I veterans, said Brad Ruhl, vice president of sales at the company’s North American headquarters in Minneapolis. The privately held firm now has annual sales of about $500 million.

Bock’s C-Leg, a microprocessor-controlled knee joint introduced in the late 1990s, is the standard prosthesis issued to U.S. fighters who have lost a leg above the knee, according to the American Orthotics and Prosthetics Association. Celebrated by Doonesbury cartoonist Garry Trudeau, who gave one to wounded Iraq war veteran B.D., it costs $30,000 to $40,000 and is delivered and fitted by a certified prosthetist and equipped with a socket, liner and foot.

Otto Bock is also the commercial partner in the $30.4 million project at Johns Hopkins University in Baltimore to develop a thought-controlled arm by 2009. The project is funded by the Defense Department through its Defense Advanced Research Projects Agency, or DARPA.

The standard for upper-extremity amputees is the myoelectric arm, like Sgt. Salzman’s Utah Arm. Because far more people lose legs than arms — roughly three times as many, according to the Amputee Coalition of America — fewer private research dollars are devoted to replacing them. That is where the DARPA program comes in; without government help, “the potential demand is so small that the significant investment required to bring these types of devices to market would be insurmountable,” Mr. Ruhl said.