United States Department of Veterans Affairs
 Health Care
High Tech Lab to Optimize Care for Veterans with Prosthetics
Three men in laboratory
Physical Therapist Dr. Leif Nelson (left), Army Veteran John Crouch, and Prosthetist Neil Carbone assess Crouch's new prosthetic.
Photo by Alex Villaluz, volunteer

“The VA has had the means to provide our veterans with cutting edge prosthetic appliances for years. Now we have added the ability to maximize how our veterans function with these devices.” Dr. Leif Nelson, Prosthetics Clinical Coordinator, is describing a new high tech “Gait and Motion Analysis Lab” opening at VA’s Manhattan campus.

Nelson explains that in the past, clinicians assessed how well an artificial limb was working based mostly on listening to what the patient had to say and observing the patient as he or she walked.

Now, making decisions about how well a prosthesis is functioning is based on very sensitive high tech equipment that includes cameras discreetly installed on the walls of a large, modern gray lab.

Force panels are installed in the floor where the exact amount of pressure of a patients’ step can be measured precisely.

Neil Carbone, Lead Prosthetist for the VA Brooklyn and St. Albans, N.Y. campuses, adds that, “There are a wide range of prosthetics to choose from and the goal is to tailor the prosthetic device to meet each Veteran’s needs.

“With the new gait lab, we can analyze the Veteran’s gait deviations and develop a rehab plan to help them feel and look more natural and symmetric.

“And contrary to what might be expected, the newest high tech models are not just for the youngest, most athletic patients. Many of our Vietnam era and older Veterans are active, and if having a cutting edge microprocessor or carbon fiber prosthesis helps them walk around the neighborhood safely and efficiently, that’s what we want to provide them.”

Man with prosthetic leg
High tech imagery gives VA doctors a very precise view of a Veteran’s gait while walking on the panels the Gait and Motion Analysis Lab.
Photo by Alex Villaluz, volunteer

No Words to Describe It

It’s not just science for Carbone: “This is one of the most gratifying careers that somebody can have. To give back to someone that lost the ability to walk or use their hand is like no other. There are no words to describe that. To give back to our service men that served our country.”

Army Veteran John Crouch is one of the first Vets to benefit from the new technology. Following a motorcycle accident with numerous complications and surgeries, Crouch elected to have a leg amputation. Now, 18 months later, thanks to his own courage and the support of VA Prosthetics experts, he gets around New York by subway and goes biking in Maine.

Most recently, he was fitted with the new prosthetic foot in the photo above.

As Dr. Nelson points out, “When a Veteran loses a limb or both their limbs, how well they walk in terms of gait and balance affects their general sense of well being.”

Patients like Crouch are fitted with small reflective markers placed on joints for tracking movements such as knee motion, pelvic rotation, trunk rotation, and arm and leg swing and foot placement. He then paces back and forth across the panels as the computer records his motions.

“Recording baseline information allows us to see the difference made with a new prosthetic. Modifications can then be made as we calibrate the prosthetic,” said Carbone.

Newer prosthetic knees utilize a microprocessor to control the hydraulic pistons which in turn control the resistance within the knee. The patient’s weight, height and activity level are processed by the computer to calibrate a particular knee.

The new technology measures gait in prosthetic patients and those who have Parkinson’s, multiple scleroses, spinal cord injury or joint replacements. It also allows for assessments of how effectively a patient is managing to propel a wheel chair or perform specific functional or sport activities.

The Ability to be Independent

Dr. Nelson explains the benefits of the new technology: “It’s well established that being functionally independent is largely based on our ability to be independent in ambulation or wheeled mobility.

“This is a key component to rehabilitation, but motion is nearly impossible to objectively measure in the clinic setting. We now have state-of-the-art technology to allow us to critically analyze how our Veterans are moving and to literally pinpoint dysfunctions to allow clinicians to optimize the care they provide.”

After the new lab opens in mid-December, the goal, at first, is to try to see at least five Veterans a week.

The new gait and motion lab will enable VA staff to improve care by taking the guess work out of prescribing orthotics, prosthetics and assistive devices for our Veterans with disabilities encompassing nearly every diagnosis, including amputations, strokes, traumatic brain injuries, multiple sclerosis, and Parkinson’s disease.

As Dr. Nelson concludes, “Whether it’s a microprocessor prosthetic knee, a wearable functional electric stimulation unit, or a lightweight titanium wheelchair, we want our veterans to maximize their functional potential and reach their personal goals.”