CINXE.COM

<!doctype html> <html lang="en"> <head>  <meta http-equiv="X-UA-Compatible" content="IE=edge"><script type="text/javascript" src="/cf_scripts/cfclient/cfclient_main.js"></script> <script type="text/javascript" src="/cf_scripts/cfclient/cffunctions.js"></script> <meta charset="utf-8"> <meta name="language" content="en"> <meta name="creator" content="Department of Veterans Affairs, Veterans Health Administration, Office of Chief Research and Development Officer"> <meta name="language" content="en"> <meta name="subject" content="VA R&D Outreach and Education"> <meta name="keywords" content="VA R&D Research Programs, HSR&D, QUERI, Rehabilitation, Clinical, Biomedical, BLR&D, CSR&D, RR&D, Centers of Excellence"> <meta name="description" content="VA ORD Research Topics"> <meta property="article:published_time" content="#updateDate#" /> <meta name="type" content="General Information">  <title>Prosthetics/Limb Loss</title>  <link href="/css/2020-update.css" media="all" rel="stylesheet" type="text/css"> <link href="/css/VAMC-styles.css" media="all" rel="stylesheet" type="text/css"> <script type='text/javascript'> var _$mainheader_3_func = function(){ var self = this; var variables = {}; self.__init_3 = function () { var localdivstruct = globalDivStruct; var __output_var = ''; var tmpVarArray = {}; if((__$cf.__arrayGet(cfclient,"properties","width",true) <= 600)) { mobileSize = ('yes') ; localdivstruct.outputvar += " <link href=\"\/css\/mobile.css\" media=\"screen\" rel=\"stylesheet\" type=\"text\/css\"> "; localdivstruct.outputvar += " <a href=\"\/topics\/\">View all Research Topics pages<\/a> | <a href=\"\/default.cfm\">ORD Home Page<\/a> "; } return ''; } }; function __startPage__$mainheader_3() { document.write("<div id='__cfclient_3'></div>"); window.ispgbuild = false; setTimeout(function(){if(!cfclient.isCFClientReady()) throw "Your client-side CFML code has encountered an initialization error. The required plugins cannot be loaded successfully within the timeout period.";},10000); cfclient.init({loadAPIPlugin:false,loadDeviceDetectionPlugin:true,loadServerPlugin:false,enableDebugLog:false,ajaxScriptSrcPath:'cf_scripts/scripts/'}, function(){ var clientDivStruct = {divId:"__cfclient_3",outputvar:""}; globalDivStruct = clientDivStruct; try{ _$mainheader_3 = new _$mainheader_3_func(); _$mainheader_3.__init_3(); } catch (__eArg) { if (__eArg !== "$$$cfclient_abort$$$"){ throw __eArg; } } __$cf.__flush(clientDivStruct); } ); } __startPage__$mainheader_3(); </script>  <link href="/css/custom.css" media="all" rel="stylesheet" type="text/css"> <link href="/css/print.css" media="print" rel="stylesheet" type="text/css"> <link href="/css/VAMC-styles.css" media="all" rel="stylesheet" type="text/css"> <link href="/css/template_styles_edited.css" media="all" rel="stylesheet" type="text/css"> <link href="//www.va.gov/va_files/2012/styles/image_gallery.css" media="all" rel="stylesheet" type="text/css">  <link href="/css/slide-menu-ns.css" media="all" rel="stylesheet" type="text/css">  <link href="/css/slide-menu-custom.css" media="all" rel="stylesheet" type="text/css">  <link href="/css/tabs.css" media="all" rel="stylesheet" type="text/css">      <script src="/scripts/code.jquery.com_jquery-3.7.1.js" type="text/javascript"></script> <script src="/scripts/jquery-tools-min.js" type="text/javascript"></script> <script src="//www.va.gov/va_files/2012/scripts/tabs.js" type="text/javascript"></script> <script src="//www.va.gov/va_files/2012/scripts/script.js" type="text/javascript" ></script>  <script language="JavaScript" type="text/javascript"> function externalLink() { alert('This link leaves the VA Office of Research & Development website. The appearance of this hyperlink does not constitute endorsement by VA of this website or the information, products or services contained therein.'); } </script> <script async type="text/javascript" src="https://dap.digitalgov.gov/Universal-Federated-Analytics-Min.js?agency=VA" id="_fed_an_ua_tag"></script> <script type="text/javascript"> function toggle(id, id2) { var n = document.getElementById(id); if (n.style.display != 'none') { n.style.display = 'none'; document.getElementById(id2).setAttribute('aria-expanded', 'true'); } else { n.style.display = ''; document.getElementById(id2).setAttribute('aria-expanded', 'false'); } } </script> <script async type="text/javascript" src="/scripts/2013-left-nav.js"></script> <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css"> <meta name="viewport" content="width=device-width"> <script type="text/javascript" src="/cf_scripts/cfclient/jquery.js"></script> </head><body> <div id="skiplink"> <a href="#main-content">skip to page content</a></div> <div class="header"> <div class="usabanner"> <div class="usa-inner"> <div class="veteran-crisis-line" id="openVeteranCrisis"> <img class="va-crisis-line-arrow" src="https://prod-va-gov-assets.s3-us-gov-west-1.amazonaws.com/img/arrow-right-white.svg" aria-hidden="true" alt="Open Crisis Line info"> <span style="postion:relative; margin-left: 20px; font-size:15.5px; width: 300px; z-index: 1;">Talk to the <strong>Veterans Crisis Line</strong> now </span> </div> <img src="https://prod-va-gov-assets.s3-us-gov-west-1.amazonaws.com/img/tiny-usa-flag.png" height="19" alt="U.S. flag" style="float:left; margin-right:4px; padding-left: 10px;"><div style="width:520px!important; padding-top: 3px; font-size: 11px;" > An official website of the United States government <button style="font-size: 11px; border: 0px; background: #f1f1f1;" aria-controls="gov-banner" onclick="toggle('gov-banner', 'TLink1')" id="TLink1"><span class="usa-dropdown">Here's how you know <i onclick="myFunction(this)" class="fa fa-chevron-down"></i></span></button> </div> </div> <div id="gov-banner" aria-expanded="false" style="display: none;"> <div class="gov-banner-inner"> <div class="clear"><br><br></div> <div class="gov-banner-left"> <div style="float:left; margin-right: 10px; min-height: 80px;"><img src="https://prod-va-gov-assets.s3-us-gov-west-1.amazonaws.com/img/icon-dot-gov.svg" alt="Dot gov" width="40" height="40"></div> <div class="usa-media_block-body"> <p> <strong>The .gov means it's official.</strong> <br> Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. </p> </div> </div> <div class="gov-banner-right"> <div style="float:left; margin-right: 10px; min-height: 80px;"><img class="usa-banner-icon usa-media_block-img" src="https://prod-va-gov-assets.s3-us-gov-west-1.amazonaws.com/img/icon-https.svg" alt="SSL" width="40" height="40" ></div> <div> <p> <strong>The site is secure.</strong> <br> The <strong>https://</strong> ensures that you're connecting to the official website and that any information you provide is encrypted and sent securely. </p> </div> </div> <div class="clear"></div> </div> </div> </div> <div class="blueheader"> <div class="va-logo-header-wrapper"> <div class="va-logo-inner" style="float: left;"> <a href="https://www.va.gov" class="va-header-logo" target="_blank"> <img src="https://prod-va-gov-assets.s3-us-gov-west-1.amazonaws.com/img/header-logo.png" alt="Go to VA.gov" title="Go to VA.gov"> </a> </div> <div class="profile-nav" style="padding-top: 50px;"> <div class="searchdropdown" > <button onclick="searchdropdownFunction()" class="searchbutton"><i class="fa fa-search" style="color: white; font-size: 14px;"></i> Search ORD</button> <div id="searchDIV" class="searchDropdown-content"> <form accept-charset="UTF-8" action="https://search.usa.gov/search" id="search_form" method="get"> <div style="margin:0;padding:0;display:inline"> <input name="utf8" type="hidden" value="✓" /></div> <input id="affiliate" name="affiliate" type="hidden" value="va_ord" /> <label for="query">Enter Search Term(s):</label> <input autocomplete="off" class="usagov-search-autocomplete" id="query" name="query" type="text" /> <input name="commit" type="submit" value="Search" /> </form> </div> </div> <div class="contactDropdown"> <button class="contactbutton" formtarget="_blank" onClick="closeSearch(); parent.open('//www.va.gov/contact-us/')" value='click here to visit VA Contact Us page'><i class="fa fa-question-circle" style="color: white; font-size: 14px;"></i> Contact VA <i class="fa fa-external-link" style="color:white; font-size:10px;"></i></button> </div> <div style="clear:all;"></div> </div> </div> <div class="va-main-nav-header" style="border:0px solid yellow; height:50px;"> <div class="vatopnav" style="margin: 0 auto; width:960px; border-top:1px solid white;"> <a href="https://www.va.gov/" target="_blank">Veterans Benefits and Health Care <i class="fa fa-external-link" style="color:white; font-size:12px;"></i></a> <a href="https://www.va.gov/about_va/" target="_blank">About VA <i class="fa fa-external-link" style="color:white; font-size:12px;"></i></a> <a href="https://www.va.gov/find-locations/" target="_blank">Find a VA Location <i class="fa fa-external-link" style="color:white; font-size:12px;"></i></a> </div> </div> </div> </div> <div id="modal-crisisline" class="modal" role="alertdialog"><div class="modal-content"> <div class="modal-body"><span class="close">×</span><h1 class="modal-title">We're here anytime, day or night — 24/7</h1><p>If you are a Veteran in crisis or concerned about one, connect with our caring, qualified responders for confidential help. Many of them are Veterans themselves.</p><ul class="va-crisis-panel-list"><li><i class="fa fa-phone va-crisis-panel-icon" aria-hidden="true"></i> <a href="tel:18002738255">Call <strong>800-273-8255 and press 1</strong></a></li><li><i class="fa fa-mobile-alt va-crisis-panel-icon" aria-hidden="true"></i><a href="sms:838255">Text <strong>838255</strong></a></li><li><i class="fa fa-comments va-crisis-panel-icon" aria-hidden="true"></i> <a class="no-external-icon" href="https://www.veteranscrisisline.net/ChatTermsOfService.aspx?account=Veterans%20Chat">Start a confidential chat</a></li><li><i class="fa fa-deaf va-crisis-panel-icon" aria-hidden="true"></i> <a href="tel:18007994889">Call TTY if you have hearing loss <strong>800-799-4889</strong></a></li></ul><br> <br> <p>Get more resources at <a class="no-external-icon" href="https://www.veteranscrisisline.net/">VeteransCrisisLine.net</a>.</p> </div> </div></div> <script async type="text/javascript" src="/scripts/2020-update.js"></script>  <div id="bg-main"> <div id="bg-middle-effect"> <div id="site-wrapper">  <div> <div style="background-color:white;"> <div id="mainContentWrapper" style="width: 920px; height: 60px;"> <a name="content-wrapper" id="content-wrapper"></a>   <div id="breadCrumbPath" style="font-size: 11px!important;"> <a href="/default.cfm">ORD Home</a> » <a href="/topics">Topics</a>  » Prosthetics/Limb Loss </div>   <table border="0" cellpadding="0" cellspacing="0" width="100%" style="border:none !important; margin-bottom: 4px!important;"> <tr valign="top" style="border:none !important;"> <td valign="top" style="border:none !important;"><h1>Office of Research & Development</h1></td> <td valign="top" style="border:none !important;"> <script> function PrintPage() { window.print(); } </script> <img src="/images/print_icon2.gif" width="55" height="20" alt="print icon" align="right" style="cursor:pointer; " onClick="PrintPage()" target="_blank" /> <a href="https://public.govdelivery.com/accounts/USVHA/subscriber/new?topic_id=USVHA_702" target="_blank"><img src="/images/signup.gif" alt="sign up for VA Research updates" align="right"></a> <br></td> </tr> </table>  </div>  <div id="container" style="clear:both; min-height: 840px; "> <div id="leftNavContainer">  <div id="leftNav"> <nav> <ul class="accordion" style="margin-left:-5px; padding-top:0px;"> <li><a href="/default.cfm">ORD Home</a></li> <li><a href="#"><span></span>About Us</a> <ul class="sub-menu"> <li><a href="/about/default.cfm">Overview</a></li> <li><a href="/about/crado.cfm">Leadership</a></li> <li><a href="/about/strategic_priorities.cfm">Strategic Priorities</a></li> <li><a href="/about/strategic_plan.cfm">Strategic Plan</a></li> <li><a href="/about/budget.cfm">Annual Research Budget</a></li> <li><a href="#"><span></span>Funded VA Research Projects</a> <ul class="sub-sub-menu"> <li><a href="/about/funded_research/default.cfm">All</a></li> <li><a href="/about/funded_research/projects-FY2025.cfm">FY2025</a></li> <li><a href="/about/funded_research/projects-FY2024.cfm">FY2024</a></li> <li><a href="/about/funded_research/projects-FY2023.cfm">FY 2023</a></li> <li><a href="/about/funded-projects-FY2022.cfm">FY 2022</a></li> <li><a href="/about/funded_research/projects-FY2021.cfm">FY 2021</a></li> <li><a href="/about/funded_research/projects-FY2020.cfm">FY 2020</a></li> <li><a href="/about/funded_research/projects-FY2019.cfm">FY 2019</a></li> <li><a href="/about/funded_research/projects-FY2018.cfm">FY 2018</a></li> <li><a href="/about/funded_research/projects-FY2017.cfm">FY 2017</a></li> </ul> </li> <li><a href="/about/find_research_projects.cfm">Find VA Research Articles and Projects</a></li> <li><a href="/about/history.cfm">Historical Accomplishments</a></li> <li><a href="#"><span></span>Awards & Career Milestones</a> <ul class="sub-sub-menu"> <li><a href="/about/awards/default.cfm">Overview</a></li> <li><a href="/about/awards/all.cfm">All Awards</a></li> <li class="element-hidden"><a href="/about/awards/awardee.cfm">hidden</a></li> <li><a href="/isrm/shared_docs/pecase.cfm">PECASE Award</a></li> </ul> </li> <li><a href="/about/research_communications.cfm">VA Research Communications</a></li> <li><a href="/resources/ORD_Admin/ord_contacts.cfm">ORD Contact Information</a></li> <li><a href="/about/national_directory.cfm">ACOS/AO Directory</a></li> <li class="element-hidden"><a href="/about/national_directory_byCity.cfm">hidden</a></li> <li class="element-hidden"><a href="/about/national_directory_name.cfm">hidden</a></li> <li><a href="/about/employment.cfm">Employment</a></li> <li><a href="/about/fellowships.cfm">Fellowships</a></li> </ul> </li> <li><a href="#"><span></span>Programs</a> <ul class="sub-menu"> <li><a href="/programs/default.cfm">All Programs</a></li> <li><a href="#"><span></span>Investigators, Scientific Review, and Management</a> <ul class="sub-menu"> <li><a href="/isrm/default.cfm">Overview</a></li> <li><a href="#"><span></span>Actively Managed Portfolios</a> <ul class="sub-sub-menu"> <li><a href="/isrm/amp/default.cfm">Overview</a></li> <li><a href="/isrm/amp/military_exposures.cfm">Military Exposures</a></li> <li><a href="/isrm/amp/pain_opiod.cfm">Pain and Opioid Use</a></li> <li><a href="#"><span></span>Precision Oncology</a> <ul class="sub-sub-menu"> <li><a href="/isrm/amp/precision_oncology/default.cfm">Overview</a></li> <li><a href="/isrm/amp/precision_oncology/lpop.cfm">Lung Cancer</a></li> <li><a href="/isrm/amp/precision_oncology/popcap.cfm">Prostate Cancer</a></li> <li> <a href="/isrm/amp/precision_oncology/compl.cfm">Computer Vision and Machine Learning in Precision Oncology</a></li> </ul> </li> <li><a href="/isrm/amp/suicide_prevention.cfm">Suicide Prevention</a></li> </ul> </li> <li><a href="#"><span></span>Broad Portfolios</a> <ul class="sub-sub-menu"> <li><a href="/isrm/broad_portfolios.cfm">Overview</a></li> <li><a href="#"><span></span>Brain, Behavioral and Mental Health </a>  <ul class="sub-sub-menu"> <li><a href="/isrm/csrd/default.cfm">Overview</a></li> <li><a href="/isrm/csrd/barnwell.cfm">Barnwell Award</a></li> <li><a href="/isrm/shared_docs/career_dev.cfm">Career Development</a></li> <li><a href="/isrm/csrd/confidentiality.cfm">Certificates of Confidentiality</a></li> <li><a href="/isrm/csrd/biospecimens-collection.cfm">Collection of Biospecimens</a></li> <li><a href="/isrm/csrd/contacts.cfm">Contacts</a></li> <li><a href="/isrm/csrd/csp.cfm">Cooperative Studies Program (CSP)</a></li> <li><a href="/isrm/csrd/newsletter/default.cfm">CSRD Newsletter</a></li> <li><a href="/isrm/csrd/data-monitoring.cfm">Data Monitoring</a></li> <li><a href="/isrm/csrd/nonveterans.cfm">Enrollment of Non-Veterans</a></li> <li><a href="/isrm/csrd/director.cfm">Leadership</a></li> <li><a href="/isrm/csrd/merit_review.cfm">Merit Review</a></li> <li><a href="/isrm/csrd/ppi.cfm">PTSD Psychopharmacology Initiative</a></li> <li><a href="/isrm/shared_docs/rcs_awards.cfm">Research Career Scientist</a></li> <li><a href="/isrm/csrd/sheep.cfm">ShEEP</a></li> <li><a href="#"><span></span>VA CURES</a> <ul class="sub-sub-menu"> <li><a href="/isrm/csrd/va_cures/default.cfm">Overview</a> <li><a href="/isrm/csrd/va_cures/va-cures-1.cfm">VA CURES-1</a> </ul> </li> </ul> </li>  <li><a href="/isrm/hsrd.cfm">Health Systems Research</a></li> <li><a href="#"><span></span>Medical Health</a> <ul class="sub-sub-menu"> <li><a href="/isrm/blrd/default.cfm">Overview</a></li> <li><a href="/isrm/shared_docs/career_dev.cfm">Career Development</a></li> <li><a href="/isrm/blrd/clinician_bridge.cfm">Clinician Bridge Funding</a></li> <li><a href="/isrm/blrd/csi.cfm">Clinician Scientist Investigator Award</a> </li> <li><a href="/isrm/blrd/contacts.cfm">Contacts</a></li> <li><a href="/isrm/blrd/dmrs.cfm">Distinguished Medical Research Scientist</a></li> <li><a href="/isrm/blrd/director.cfm">Leadership</a></li> <li><a href="/isrm/blrd/merit_review.cfm">Merit Review</a></li> <li><a href="/isrm/blrd/middleton.cfm">Middleton Award</a></li> <li><a href="/isrm/blrd/notable_investigators.cfm">Notable Investigators</a></li> <li><a href="/isrm/shared_docs/rcs_awards.cfm">Research Career Scientist</a></li> <li><a href="/isrm/blrd/sheep.cfm">ShEEP</a></li> </ul> </li> <li><a href="/isrm/rrd.cfm">Rehabilitation Research, Development and Translation</a></li> </ul> </ul> </li> </li> <li><a href="/programs/enterprise_optimization.cfm">Enterprise Optimization</a></li> <li><a href="#"><span></span>Enterprise Protections, Regulatory, Outreach, and Systems</a> <ul class="sub-sub-menu"> <li><a href="/programs/epros/default.cfm">Overview</a></li> <li><a href="/programs/epros/findpro.cfm">FIND Pro</a></li> <li><a href="/programs/epros/policies.cfm">Human Subjects Research Policies and Guidance</a></li> <li><a href="/programs/epros/privacy_officer.cfm">ORD Privacy Officer</a></li> <li><a href="/programs/ePROS/animal_research.cfm">Animal Research</a></li> <li><a href="#"><span></span>Research Education and Training</a> <ul class="sub-sub-menu"> <li><a href="/programs/ePROS/education/default.cfm">Overview</a></li> <li><a href="/programs/ePROS/education/ord_training/researcher_training.cfm">Researcher Training</a></li> <li><a href="/programs/ePROS/education/ord_training/committee-members.cfm">Committee Member Training</a></li> </li> <li><a href="/programs/ePROS/education/citi.cfm">CITI Administration</a></li> <li><a href="#"><span></span>Webinars</a> <ul class="sub-sub-menu"> <li><a href="/programs/epros/education/webinars/default.cfm">Upcoming</a></li> <li><a href="/programs/epros/education/webinars/archives.cfm">Past Sessions</a> </li> </ul> </li> </ul> </li> <li><a href="/programs/epros/regulatory.cfm">Research Policy and Regulatory</a></li> <li><a href="#"><span></span>VA Central IRB</a> <ul class="sub-sub-menu"> <li><a href="/programs/epros/vacentralirb/default.cfm">Overview</a></li> <li><a href="/programs/epros/vacentralirb/administration.cfm">Administration</a></li> <li><a href="/programs/epros/vacentralirb/irb_submissions.cfm">IRB Submissions</a></li> <li><a href="/programs/epros/vacentralirb/facility_nformation.cfm">Facility Information</a></li> <li><a href="/programs/epros/vacentralirb/sop.cfm">Standard Operating Procedures</a></li> <li><a href="/programs/epros/vacentralirb/roster.cfm">VA CIRB Membership and Meetings</a></li> <li><a href="/programs/epros/vacentralirb/resources.cfm">Resources</a></li> </ul> </li> </li> <li><a href="#"><span></span>Other IRB Information</a> <ul class="sub-sub-menu"> <li><a href="/programs/epros/irb_relationships.cfm">IRB Relationships in the VA</a></li> <li><a href="/programs/epros/nci_irb.cfm">NCI IRB Information</a></li> <li><a href="/programs/epros/CDC-IRB-TPOXX-EAIND-Program.cfm">CDC IRB TPOXX EAIND Program</a></li> </ul> </li> <li><a href="#"><span></span>VA Innovation and Research Review System (VAIRRS) </a> <ul class="sub-sub-menu"> <li><a href="/programs/epros/vairrs/default.cfm">About Us</a></li> <li><a href="/programs/epros/vairrs/data.cfm">Data Shoutouts</a></li> <li><a href="/programs/epros/vairrs/ambassador.cfm">Ambassador Program</a></li> <li><a href="/programs/epros/vairrs/vepa.cfm">Enterprise Partnership Award</a></li> <li><a href="/programs/epros/vairrs/faq.cfm">FAQs</a></li> <li><a href="/programs/epros/vairrs/did-you-know.cfm">Did You Know?</a></li> <li><a href="/programs/epros/vairrs/dashboards.cfm">Dashboards</a></li> <li><a href="#"><span></span>Training</a> <ul class="sub-sub-menu"> <li><a href="/programs/epros/vairrs/training/default.cfm">Training Opportunities</a></li> <li><a href="/programs/epros/vairrs/training/training_resources.cfm">Training Resources</a></li> <li><a href="/programs/epros/vairrs/training/irbnet-topics.cfm">IRBNet Topics</a></li> <li><a href="/programs/epros/vairrs/training/vaiirs_university.cfm">VAIRRS University</a></li> <li><a href="/programs/epros/vairrs/training/webinars.cfm">VAIRRS Webinars</a></li> </ul> </li> <li><a href="/programs/epros/vairrs/newsletter/default.cfm">VAIRRS News</a></li> <li><a href="/programs/epros/vairrs/contact.cfm">Contact</a></li> </ul> </li> <li><a href="#"><span></span>VA Electronic Determination Aid (VAEDA)</a> <ul class="sub-sub-menu"> <li><a href="/programs/epros/vaeda.cfm">Overview</a></li> <li><a href="/programs/epros/vaeda-faq.cfm">FAQs</a></li> </ul> </li> </ul> </li> <li><a href="/programs/other.cfm">Other Programs</a></li> </ul> </li> <li><a href="#"><span></span>News and Publications</a> <ul class="sub-menu"> <li><a href="/pubs/default.cfm">Overview</a></li> <li><a href="#"><span></span>VA Research Currents</a> <ul class="sub-sub-menu"> <li><a href="/currents/default.cfm">Recent Articles</a></li> <li><a href="/currents/archive.cfm">Archive</a></li> </ul> </li> <li><a href="/in_brief.cfm">News Briefs</a></li> <li><a href="/pubs/ord-history.cfm">VA Research: A Historical Look</a></li> <li><a href="/pubs/pubs_individual.cfm?Category=Gulf%20War%20Reports">Gulf War Reports</a></li> <li><a href="/pubs/brochures.cfm">Brochures for Print</a></li> <li><a href="/pubs/order_brochure.cfm">Order Brochures</a></li> <li><a href="/events.cfm">Events</a></li> <li><a href="#"><span></span>Research Week</a> <ul class="sub-menu"> <li><a href="/researchweek/default.cfm">Overview</a></li> <li><a href="/researchweek/resources.cfm">Resources</a></li> <li><a href="/researchweek/kickoff.cfm">2024 Kickoff Event</a></li> <li><a href="/researchweek/kickoff-2023.cfm">2023 Kickoff Event</a></li> <li><a href="/researchweek/future-dates.cfm">Future Dates</a></li> <li><a href="/researchweek/contacts.cfm">Contact</a></li> </ul> </li> </ul> </li> <li><a href="#"><span></span>Research Topics</a> <ul class="sub-menu"> <li><a href="/topics/default.cfm">All Topics</a></li> <li><a href="/topics/oef-oif.cfm">Afghanistan & Iraq</a></li> <li><a href="/topics/alzheimers.cfm">Alzheimer's Disease and Related Dementias</a></li> <li><a href="/topics/arthritis.cfm">Arthritis</a></li> <li><a href="/topics/cancer.cfm">Cancer</a></li> <li><a href="/topics/cardio.cfm">Cardiovascular Disease</a></li> <li><a href="/topics/caregivers.cfm">Caregivers</a></li> <li><a href="/topics/cih.cfm">Complementary and Integrative Health</a></li> <li><a href="/topics/covid-19.cfm">COVID-19</a></li> <li><a href="/topics/depression.cfm">Depression</a></li> <li><a href="/topics/diabetes.cfm">Diabetes</a></li> <li><a href="/topics/gastro.cfm">Gastrointestinal Health</a></li> <li><a href="/topics/genomics.cfm">Genomics</a></li> <li><a href="/topics/gulfwar.cfm">Gulf War Veterans</a></li> <li><a href="/topics/healthcare_delivery.cfm">Health Care Delivery</a></li> <li><a href="/topics/health_equity.cfm">Health Equity</a></li> <li><a href="/topics/hearing.cfm">Hearing Loss</a></li> <li><a href="/topics/hep-c.cfm">Hepatitis C</a></li> <li><a href="/topics/homelessness.cfm">Homelessness</a></li> <li><a href="/topics/infectious_diseases.cfm">Infectious Diseases</a></li> <li><a href="/topics/informatics.cfm">Informatics</a></li> <li><a href="/topics/kidney_disease.cfm">Kidney Disease</a></li> <li><a href="/topics/mental_health.cfm">Mental Health</a></li> <li><a href="/topics/multiple_sclerosis.cfm">Multiple Sclerosis</a></li> <li><a href="/topics/obesity.cfm">Obesity</a></li> <li><a href="/topics/pain.cfm">Pain Management</a></li> <li><a href="/topics/parkinsons.cfm">Parkinson's Disease</a></li> <li><a href="/topics/ptsd.cfm">Posttraumatic Stress Disorder (PTSD)</a></li> <li><a href="/topics/prosthetics.cfm">Prosthetics</a></li> <li><a href="/topics/respiratory.cfm">Respiratory Health</a></li> <li><a href="/topics/rural_health.cfm">Rural Health</a></li> <li><a href="/topics/sci.cfm">Spinal Cord Injury</a></li> <li><a href="/topics/sud.cfm">Substance Use Disorders</a></li> <li><a href="/topics/suicide.cfm">Suicide Prevention</a></li> <li><a href="/topics/tbi.cfm">Traumatic Brain Injury (TBI) </a></li> <li><a href="/topics/vietnam.cfm">Vietnam Veterans</a></li> <li><a href="/topics/visionloss.cfm">Vision Loss</a></li> <li><a href="/topics/womens_health.cfm">Women's Health</a></li> </ul> </li> <li><a href="#"><span></span>For Veterans</a> <ul class="sub-menu"> <li><a href="/for_veterans/default.cfm">Joining a Research Study</a></li> <li><a href="/for_veterans/volunteering-faq.cfm">Research Participation FAQ</a></li> <li><a href="/for_veterans/safeguarding_vets.cfm">Safeguarding Information</a></li> <li><a href="/for_veterans/find_studies.cfm">Find VA-sponsored clinical trials near you</a> </li> <li><a href="#"><span></span>VA Research in Action</a> <ul class="sub-sub-menu"> <li><a href="/research_in_action/default.cfm">All Summaries</a></li> </ul> </li> </ul> </li> <li><a href="#"><span></span>For VA Research Community</a> <ul class="sub-menu"> <li><a href="/resources/default.cfm">Overview</a></li> <li><a href="#"><span></span>Funding</a> <ul class="sub-sub-menu"> <li><a href="/funding/default.cfm">Funding Home</a></li> <li><a href="/funding/electronic-submission.cfm">Electronic Submission</a></li> <li><a href="/funding/rfa.cfm">Notices of Special Interest and Requests for Applications</a></li> <li><a href="/funding/cdp.cfm">Career Development</a></li> <li><a href="/funding/diversity.cfm">Diversity</a></li> <li><a href="/funding/jit.cfm">Just-In-Time Process (JIT)</a></li> </ul> </li> <li><a href="#"><span></span>Policies and Guidance</a> <ul class="sub-menu"> <li><a href="/resources/policies/default.cfm">Overview</a></li> <li><a href="/resources/policies/general_admin.cfm">General Administration</a></li> <li><a href="/resources/policies/research.cfm">Research</a></li> <li><a href="/resources/policies/faq-search.cfm">Research FAQs</a></li> <li><a href="/resources/policies/human_resources/default.cfm">Human Resources</a></li> <li><a href="/resources/policies/outside_compensation.cfm">Outside Compensation</a></li> <li><a href="/resources/policies/handbooks.cfm">ORD Program Guides, VHA Directives, Handbooks</a></li> <li><a href="/resources/policies/pub_notice.cfm">Publication Notification</a></li> <li><a href="/resources/policies/public_access.cfm">NIH Manuscript Submission for VA Investigators</a></li> </ul> </li> <li><a href="/resources/centralized_positions.cfm">Centralized Positions (GS-14 & Above)</a></li> <li><a href="/resources/RPPR.cfm">Federal-wide Research Performance Progress Report</a></li> <li><a href="/resources/ssn.cfm">SSN Data Requests</a></li> <li><a href="/resources/oasc.cfm">Conducting Staff Surveys</a></li> <li><a href="/resources/sig.cfm">Special Interest Groups</a></li> <li><a href="/resources/va-npc-affiliate-toolkit.cfm">VA/NPC/Affiliate Collaboration Toolkit</a></li> <li><a href="#"><span></span>ORD Admin Resources</a> <ul class="sub-sub-menu"> <li><a href="/resources/ORD_Admin/default.cfm">Admin Resources Home</a></li> <li><a href="/resources/ORD_Admin/ord_contacts.cfm">Central Office Contacts</a></li> <li><a href="/resources/ORD_Admin/clinical_trials.cfm">Clinical Trials Registration and Submission</a></li> <li><a href="/resources/ORD_Admin/congressional_info.cfm">Congressional Requests</a></li> <li><a href="/resources/ORD_Admin/field_conference.cfm">Field Conference Calls</a></li> <li><a href="/resources/frac/default.cfm">Field Research Advisory Committee</a></li> </ul> </li> </ul> </nav> </div>   <div id="left-col-content"> </div>   </div>   <div id="innerContentWrapper" style="position: relative; "> <div class="clear"></div> <span style="position:absolute;"><a name="main-content" id="main-content"></a></span> <div class="clear"></div> <div id="innerContent" style="position:relative; ">  <h3> <em>VA research on</em></h3> <h2 style="font-size: 1.65em;" class="page-title">Prosthetics/Limb Loss</h2>  <div width="400px" style="border-radius:10px; border: 1px solid black; padding:14px!important;"> <ul> <li> <a href="#intro">Introduction</a></li> <li> <a href="#major">Selected Major Accomplishments in VA Research</a></li> <li style="font-size:12px"> <a href="#research">New, Ongoing, and Published Research</a> <ul> <li style="font-size:12px"> <a href="#research1">VA research centers</a></li> <li style="font-size:12px"> <a href="#research2">Amputation and artificial limbs</a></li> <li style="font-size:12px"> <a href="#research3">Blind restoration and rehabilitation </a></li> <li style="font-size:12px"> <a href="#research4">Using electrical signals to restore functioning </a></li> <li style="font-size:12px"> <a href="#research5">BrainGate</a></li> <li style="font-size:12px"> <a href="#research6">Hip and knee replacement</a></li> <li style="font-size:12px"> <a href="#research7">Wheelchair technology </a></li> <li style="font-size:12px"> <a href="#research8">Exoskeletons </a></li> <li style="font-size:12px"> <a href="#research9">Dentures </a></li> </ul> </li> <li style="font-size:12px"> <a href="#more">More on Our Website</a></li> <li style="font-size:12px"> <a href="#articles">Selected Scientific Articles by Our Researchers</a></li> </ul> </div> <br> <h2 id="intro">Introduction</h2> <p>In 1862, Congress appropriated $15,000 for the purchase of artificial limbs for soldiers and seamen disabled in the service of the United States, to be expended under the direction of the Surgeon General of the United States.</p> <p>In 1866, the War Department (now the Department of Defense) was authorized to provide Union Veterans with transportation to and from their homes to a place where they could obtain their artificial limbs or devices, and to furnish those Veterans with new artificial limbs or devices every five years.</p> <p>VA's involvement in providing prostheses to Veterans began in 1921, when the Veterans Bureau, a predecessor agency to the Department of Veterans Affairs, was given the responsibility to provide artificial limbs and appliances to World War I Veterans.</p> <p>Today, VA's <a href="http://www.rehab.va.gov/psas/index.asp" target="_blank">Prosthetics and Sensory Aids Service</a> is the largest and most comprehensive provider of prosthetic devices and sensory aids in the world. Although the term "prosthetic device" may suggest images of artificial limbs, it actually refers to any device that supports or replaces a body part or function.</p> <p>VA provides a full range of equipment and services to Veterans, ranging from items worn by the Veteran, such as artificial limbs and hearing aids; to those that improve accessibility, such as ramps and vehicle modifications; to devices surgically placed in the Veteran, such as hips and pacemakers.</p> <p>The department has more than 70 locations at which orthotics and prosthetics are custom-fabricated and fitted, using state-of-the-art componentry. A list of VA orthotic and prosthetic providers can be found <a href="http://www.prosthetics.va.gov/psas/OandP.asp" target="_blank">here</a>. VA also has more than 600 contracts with accredited orthotic and prosthetic providers to ensure access to care is provided near Veterans' homes. Each VA facility that is eligible for certification is accredited through the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) and/or the Board of Certification/Accreditation (BOC).</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h2 id="major">Selected Major Accomplishments in VA Research</h2> <ul> <li><strong>1947:</strong> <a href="http://www.hines.va.gov/services/blind/hbrhistory.asp" target="_blank">Introduced</a> the first mobility and orientation rehabilitation-training program for blinded Veterans</li> <li><strong>2007:</strong> Unveiled the first <a href="http://www.ncbi.nlm.nih.gov/pubmed/18002631" target="_blank">powered ankle-foot prosthesis</a>, as part of a team with researchers at MIT and Brown University</li> <li><strong>2009: </strong>Launched 3-year optimization study of the DEKA arm, as clinical partner with DEKA and DARPA</li> <li><strong>2013:</strong> <ul> <li><a href="http://www.cleveland.com/healthfit/index.ssf/2013/12/prosthetic_hand_with_sense_of.html" target="_blank">Reported</a> on new technology to help restore the sense of touch for those who have lost an upper limb and use an artificial hand</li> <li><a href="https://projectreporter.nih.gov/project_info_description.cfm?aid=9652669&icde=41979261&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC&pball=" target="_blank">Began</a> the first human study in the U.S. to investigate osseointegrated prosthetics, a system that allows a prosthetic leg to be attached directly to the remaining bone of an amputated lower limb</li> </ul> </li> <li><strong>2014:</strong> <ul> <li>FDA approved clinical use of the DEKA arm</li> <li>Published a study of amputees' and clinicians' feedback using the DEKA arm, the first prosthetic arm capable of performing multiple simultaneous powered movements</li> </ul> </li> <li><strong>2015:</strong> <a href="http://www.startribune.com/new-wheelchair-gives-paralyzed-veterans-chance-to-stand-on-own/290607961/">Invented</a> a wheelchair allowing users to crank up the push rims to a standing position, providing them with increased functionality and independence</li> <li><strong>2016:</strong> <a href="http://www.ncbi.nlm.nih.gov/pubmed/26864215">Determined</a> that knee replacement surgery could benefit some patients aged 85 and older</li> <li><strong>2017: </strong>The MEBot robotic wheelchair, developed by a VA investigator, <a href="http://www.herl.pitt.edu/news-events/mebot-wins-blackwood-design-award">won</a> the "Best New Concept" award in an international design competition</li> </ul> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h2 id="research">New, Ongoing, and Published Research</h2> <p>To help meet the lifestyle and medical needs of Veterans who have lost limbs, VA researchers develop and test a wide variety of prosthetic devices. VA's goal is to offer Veterans prosthetics that will restore them to their highest possible level of functioning within their families, communities, and workplaces.</p> <p>Some VA researchers are working on developing high-functioning artificial limbs that are very similar to their natural counterparts. Others are working on advanced wheelchair designs that promote mobility and independence for wheelchair users and make it easier to use a wheelchair.</p> <p>Still other VA researchers are using functional electrical stimulation and other technologies to help those with weak or paralyzed muscles, and developing and testing state-of-the-art adaptive devices to help those with vision or hearing loss.</p> <div width="100%" style="border-radius:10px; border:1px solid #d5e6f8; padding:14px!important; background-color:#e0f1fa;"> <p>If you are interested in learning about joining a VA-sponsored clinical trial, visit our research study <a href="/for_veterans/find_studies.cfm">information page</a>.</p> </div> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research1">➤ VA research centers</h3> <p>Many, but not all, of the latest innovations and discoveries in prosthetics research in the U.S. take place at VA centers. These centers generally work in close partnership with affiliated universities and other institutions, as well as commercial partners and other federal agencies.</p> <p>VA's <a href="http://www.aptcenter.research.va.gov/" target="_blank">Advanced Platform Technology Center</a>, in Cleveland, develops new technologies to help Veterans who have difficulties controlling bodily movements or sensory problems, and those who have lost limbs. Team members create new assistive and restorative technologies for dissemination within the rehabilitation community and commercialization by outside manufacturers.</p> <p>The <a href="http://www.fes.research.va.gov/" target="_blank">Center for Functional Electrical Stimulation</a>, also in Cleveland, uses controlled electrical currents to help paralyzed muscles work again. The center focuses on the application of electrical currents to either generate or suppress activity in the nervous system. This technique is known as functional electrical stimulation (FES). FES can produce and control the movement of otherwise paralyzed limbs for standing and hand grasp, to activate visceral bodily functions such as bladder control or respiration, create perceptions such as skin sensibility, stop undesired activity such as pain or spasm, and facilitate natural recovery and accelerate motor relearning.</p> <p>The Center for Wheelchairs and Associated Rehabilitation Engineering, part of the <a href="http://www.herl.pitt.edu/" target="_blank">Human Engineering Research Laboratories</a> (HERL) in Pittsburgh, has made important contributions to the design of wheelchairs, seating systems, and other mobility systems. HERL is a collaboration between the VA Pittsburgh Healthcare System and the University of Pittsburgh. Researchers at the center have been instrumental in developing novel innovations in wheelchair design—together, they hold 25 patents related to wheelchair design and assistive technologies. Innovations developed at the center range from using newer, lighter materials that make wheelchairs easier to maneuver to robotic extensions that can reach objects for the wheelchair's user. One example under development is the <a href="/currents/0216-2.cfm">MEBot</a>, a wheelchair that has six wheels, an onboard computer and software, and an array of high-tech sensors and actuators that help the user navigate uneven terrain.</p> <p>The <a href="http://www.amputation.research.va.gov/" target="_blank">Center for Limb Loss and MoBility</a> in Seattle is a research group focused on helping Veterans who have either lost a limb or experience leg and/or foot impairment by enhancing their ability to move around their environment. Research at the center aims to reduce the effects of functional and anatomical limb loss by exploring diseases that lead to impaired limb function and by developing state-of-the-art technologies for studying the foot. Research focuses on two groups of Veteran: those with musculoskeletal impairment at the foot and ankle, where pain and limitations in mobility are the key issues, and those at risk of lower limb amputation due to diabetes and foot ulceration, where loss of the foot or leg is a major concern.</p> <p>The center's prosthetic engineering research focuses on limitations in mobility and discomfort experienced by all groups of Veterans with lower-limb amputation—including those with amputation secondary to peripheral vascular disease and diabetes; aging combat-injured Vietnam Veterans; and young, active Veterans who lost a limb through traumatic injury serving in Afghanistan or Iraq. This research compares existing prosthetic technologies and develops innovative new approaches.</p> <p>The VA <a href="https://www.providence.va.gov/research/CfNN/index.asp" target="_blank">Center for Neurorestoration and Neurotechnology</a> in Providence, Rhode Island, supports research into the development of brain-computer interfaces to help restore function in Veterans who are paralyzed, have experienced limb loss, or have difficulties in thinking or communicating. The center is a collaboration between the Providence VA Medical Center, Brown University, Butler Hospital, Lifespan, and Massachusetts General Hospital. C<em>f</em>NN seeks to develop, test, and implement new therapies and technologies that restore function for Veterans with disorders affecting the nervous system.</p> <p><a href="https://www.providence.va.gov/research/CfNN/Focus_Area_1.asp" target="_blank">BrainGate</a> is one such research project. Researchers have developed a neural interface system for individuals with paralysis that uses a small sensor implanted in the brain to record neural activity associated with intended arm movements.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research2">➤ Amputation and artificial limbs</h3> <p>The technology involved in creating artificial limbs has come a very long way since the Civil War. Today's VA researchers use leading-edge technologies such as robots and nanotechnology to create lighter limbs that integrate body, mind, and machine to look, feel, and respond like real arms and legs. They are also studying ways to best match prosthetic components with amputees' needs, including those whose active lifestyles mean they need high-performance prosthetics.</p> <p>Other researchers are looking at new ways to care for what remains of limbs after surgery; enabling wounds to heal far more quickly than ever before; developing programs to teach caregivers complementary and alternative techniques to lessen the anxiety and pain associated with limb loss; and evaluating CT scans of diabetic feet to identify those patients who are at the highest risk for ulcers and amputation.</p> <p><strong>Ankle-foot prosthesis</strong>—In 2007, VA collaborated with researchers at MIT and Brown University to introduce a <a href="http://www.ncbi.nlm.nih.gov/pubmed/18002631" target="_blank">powered ankle-foot prosthesis</a> that uses tendon-like springs and an electric motor to move users forward. Studies have shown that patients using the powered ankle-foot expend less energy while walking, have better balance, and walk 15 percent faster. The device, originally sold as the <a href="http://biom-chicago.com/" target="_blank">BiOM ankle</a> and now marketed as the Empower ankle, is available for Veterans using VA care and active-duty service members.</p> <p><strong>Osseointegration study</strong>—VA sponsored the first human <a href="http://grantome.com/grant/NIH/I01-RX001208-04" target="_blank">study</a> in the United States to investigate osseointegrated prosthetics, a system that allows a prosthetic limb to be attached through the skin directly to the remaining bone of the amputated limb. The study involved surgically implanting specially designed and coated titanium implants into the thigh bone of amputees who had lost their knee and lower leg. Once the bone grew into the implant, the prosthesis was attached directly to the metal connector of the implant without the need for a prosthetic socket to cover the remaining limb.</p> <p>Ten amputees participated in the study at the George E. Wahlen VA Medical Center in Salt Lake City. Based on preliminary findings, the investigators say this research has the potential to improve amputees' mobility, function, and overall quality of life. A version of this implant for above-the-elbow amputees is currently in development.</p> <p><strong>DEKA/LUKE arm</strong>—VA researchers and colleagues collected data on the DEKA advanced prosthetic arm over four years at four VA sites—New York; Tampa; Long Beach, California; and Providence, Rhode Island—and at the Center for the Intrepid, a military rehabilitation site in San Antonio, Texas. The study findings have been published in a number of journal articles, including two in 2014 in VA's <a href="http://www.rehab.research.va.gov/jour/2014/511/pdf/contents511.pdf" target="_blank"><em>Journal of Rehabilitation Research and Development</em>.</a></p> <p>The arm was developed by DEKA Integrated Solutions Corporation, based in Manchester, New Hampshire, with funding from the Defense Advanced Research Projects Agency (DARPA), through its Revolutionizing Prosthetics Program. It is the first prosthetic arm capable of performing multiple simultaneous powered movements.</p> <p>The U.S. Food and Drug Administration approved the DEKA Arm System in May 2014, paving the way for the device to be manufactured, marketed, and made available in the VA health care system. The DEKA arm is now available to the public as the LUKE arm, manufactured by Mobius Bionics.</p> <p>In a 2014 <a href="http://www.ncbi.nlm.nih.gov/pubmed/24286806" target="_blank">study</a> led by researchers from the Providence VA Medical Center and Brown University, 24 upper-limb amputees were fitted with a second generation (Gen 2) DEKA arm, and 13 were fitted with a third-generation arm (Gen 3). After being trained on its use, they were surveyed about their experiences.</p> <p>In all, 79 percent of Gen 2 and 85 percent of Gen 3 users indicated that they either wanted to receive, or might want to receive, a DEKA arm. In addition, 95 percent of Gen 2 users and 91 percent of Gen 3 users indicated that they were able to perform new activities they had been unable to perform with their existing prosthetic device.</p> <p>In July 2017, two Veterans became the first VA patients to receive the arm for daily use.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research3">➤ Blind restoration and rehabilitation</h3> <p>In 2016, approximately 130,428 Veterans in the U.S. were legally blind and more than 1 million Veterans had low vision that caused a loss of ability to perform daily activities, according to VA's <a href="http://www.rehab.va.gov/PROSTHETICS/blindrehab/BRS_Coordinated_Care.asp" target="_blank">Blind Rehabilitation Service</a>.</p> <p>Those figures are expected to increase as more Veterans from the Korean and Vietnam conflict eras develop vision loss from age-related diseases such as macular degeneration, diabetic retinopathy, and glaucoma. VA has also seen an increase in the number of Veterans who served in Afghanistan and Iraq who have experienced vision loss due to blast exposure and trauma.</p> <p>In 1947, VA researchers introduced the first mobility and orientation rehabilitation training program for blind persons. Today, VA's <a href="http://www.varrd.emory.edu/" target="_blank">Center for Visual and Neurocognitive Rehabilitation</a>, based at the Atlanta VA Health Care System, conducts research in visual rehabilitation, neurocognitive rehabilitation (i.e., improving brain function from injury), and retinal and neural repair to prevent and mitigate vision loss resulting from injury or disease. The center has a number of projects to help train blind people and those with low vision find their way around independently with greater ease. Investigators also work on projects related to improving access to eye care for Veterans living in rural regions.</p> <p>Examples of projects include: "<a href="https://clinicaltrials.gov/ct2/show/NCT02911805" target="_blank">Bridging Animal and Human Models of Exercise-Induced Visual Rehabilitation</a>," "<a href="http://grantome.com/grant/NIH/I21-RX002243-02" target="_blank">Spatial Cognitive Training in Visual Impairment</a>," "<a href="http://grantome.com/grant/NIH/I21-RX002238-02" target="_blank">Acute Exercise Effects on Word Learning in Aging and Stroke-induced Aphasia</a>," "<a href="http://www.varrd.emory.edu/research/" target="_blank">Improving Access to Eye Care for Veterans</a>—Spread Grant; VA Innovation Initiative," and "<a href="http://grantome.com/grant/NIH/I01-RX002615-01" target="_blank">Dopamine Treatments for Diabetic Retinopathy</a>."</p> <p>In addition, the VA's <a href="https://www.vision.research.va.gov/" target="_blank">Center for Prevention and Treatment of Visual Loss</a> focuses on research to provide the earliest detection of vision loss. The goal is to prevent vision loss due to eye diseases such as glaucoma, radiation damage, and traumatic brain injury. The center is evaluating new diagnostic tools that provide better access to care through telemedicine and automated analysis using portable devices by non-eye care providers. Research is focused on novel interventions such as identifying which neurotrophic growth factors (i.e., proteins associated with growth and survival of neurons) are most effective at preventing vision loss.</p> <p>Examples of <a href="https://www.vision.research.va.gov/Current_Research_Projects.asp" target="_blank">projects</a> include: "<a href="http://grantome.com/grant/NIH/I01-RX001481-04" target="_blank">Therapy of Nocturnal Intraocular Pressure Elevation Causing Glaucoma Progression</a>," "<a href="http://grantome.com/grant/NIH/I01-RX001786-01A2" target="_blank">Automated Assessment of Optic Nerve Edema with Low-Cost Imaging</a>," "<a href="http://grantome.com/grant/NIH/I01-RX000952-05" target="_blank">Chronic Effects of Blast Injury: Analyses of Alzheimer Related Pathology</a>," "<a href="https://www.ncbi.nlm.nih.gov/pubmed/28384726" target="_blank">Stem Cell Therapy for Glaucoma</a>," and "<a href="https://cenc.rti.org/Research-Studies/CENC0056P-Visual-Sensory-" target="_blank">Visual Sensory Impairments and Progression Following Mild Traumatic Bain Injury</a>."</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research4">➤ Using electrical signals to restore functioning</h3> <p>Many Veterans have serious spinal cord injuries and disorders that may interfere with the brain signals that control muscle movement. Others have become blind from the loss of photoreceptors (cells that are responsible for detecting light and therefore enable us to see) in the eye.</p> <p>For Veterans with these and some other types of functional loss, VA investigators hope to restore functioning with electrical currents delivered through a neural prosthesis. A neural prosthesis is an electronic device that connects with the nervous system and supplements or replaces functions lost by diseases or injury.</p> <p>VA's <a href="https://www.aptcenter.research.va.gov/" target="_blank">Advanced Platform Technology Center</a> (APT), located at the Cleveland VA Medical Center, and the Center for Neurorestoration and Neurotechnology at the Providence VA Medical Center are working on a number of projects to extract signals from the brain's cortex for controlling assistive devices and detecting and diagnosing dysfunctional cortical activity. Some of their projects are described <a href="https://www.aptcenter.research.va.gov/programs/neural/" target="_blank">here</a> and <a href="https://www.providence.va.gov/research/CfNN/Focus_Area_1.asp" target="_blank">here</a>.</p> <p><strong>Conveying a sense of touch—</strong>Researchers at the <a href="https://www.aptcenter.research.va.gov/" target="_blank">Advanced Platform Technology Center</a> have developed a new kind of implanted electrical nerve interface that can convey a <a href="http://www.cleveland.com/healthfit/index.ssf/2013/12/prosthetic_hand_with_sense_of.html" target="_blank">sense of touch</a> on a prosthetic hand. They learned in 2014 that the implants continued to work after 24 months, and as of this writing they continue to work.</p> <p>Sensors in the prosthetic hand measure the pressure applied as the hand closes around or presses against something. These measurements are converted into specially coded electrical signals and sent through wires to surgically implanted electrodes around nerves in the forearm and upper arm.</p> <p>When the electrical signals reach the nerves, they are transmitted to the brain through healthy neural pathways not affected by the amputation. The brain interprets the sensation signals as if they had come from a normal hand. These researchers have since been <a href="http://www.darpa.mil/news-events/2015-02-08" target="_blank">funded</a> by DARPA to further advance the work. Watch this <a href="https://www.youtube.com/watch?v=J0yUhd1pj_Q" target="_blank">video</a> to learn more.</p> <p><strong>Electrical stimulation and spinal cord injuries—</strong>In 2015, researchers at VA's <u>APT Center</u> and Case Western Reserve University completed a 10-year clinical <a href="http://clinicaltrials.gov/show/NCT00004445" target="_blank">trial</a> to test a surgically implanted electrical stimulation system in people with spinal cord injuries. During the surgery, electrodes are implanted in muscles of the trunk and legs, and leads are connected to a stimulator.</p> <p>By stimulating muscles, the system activates muscles to allow for standing, better balance, and exercise. Patients are given functional training and rehabilitation using the stimulation system, and are prescribed a course of exercise. Lab tests focus on strength, balance, and patients' abilities with or without the system.</p> <p>In 2017, researchers in Cleveland followed up on 22 spinal cord-injured patients an average of six years after they received implantation surgery, to determine whether the devices were still functioning and useful years after they were first implanted.</p> <p>They <a href="https://www.ncbi.nlm.nih.gov/pubmed/28899825" target="_blank">found</a> that 60 percent of the patients still used their neuroprostheses for exercise and other activities for more than 10 minutes per day. Early (first generation) implants still functioned correctly in almost 90 percent of the recipients of those devices. Second-generation implants, with slightly improved technology, still functioned in 98 percent of recipients. Overall, 94 percent of the participants in the study were satisfied with their prostheses.</p> <p>In another 2017 study, Cleveland researchers<a href="https://www.ncbi.nlm.nih.gov/pubmed/28558835" target="_blank">found</a> that a lower-limb exoskeleton that combined an implanted neurosensor with an exoskeleton to stabilize and support users restored the ability to take steps in three individuals with complete paralysis. They believe that this approach is feasible for individuals with paraplegia and should be developed further.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research5">➤ BrainGate</h3> <p>VA has played a major role in supporting the development of <a href="http://braingate2.org/" target="_blank">BrainGate</a>. The system, spearheaded by researchers at the Providence VA Medical Center in Rhode Island and Brown University, relies on microelectrodes implanted in the brain to pick up neural signals.</p> <p>The electrodes are placed in a part of the brain that controls voluntary movement. They send signals to an external decoder that translates them into commands for electronic or robotic devices, such as an iPad or robotic arm.</p> <p>The research team developing BrainGate hopes to create a technology that will restore movement, control, and independence to people with paralysis or limb loss from conditions including amyotrophic lateral sclerosis (ALS), stroke, and spinal cord injury.</p> <p><strong>BrainGate studies—</strong>In 2011, a research team consisting of VA, Brown University, Harvard University, and Massachusetts General Hospital researchers successfully implanted electrodes in the brains of volunteers with paralysis affecting their arms and legs. The system allowed them to control robot arms with their thoughts, and they could continue to control a computer cursor accurately more than 1,000 days after the electrodes were initially implanted.</p> <p>In 2015, the BrainGate team <a href="http://www.ncbi.nlm.nih.gov/pubmed/25385765" target="_blank">reported</a> the system could allow point-and-click communication by someone with incomplete locked-in syndrome, which can be caused by a spinal cord injury. In locked-in syndrome, patients are fully conscious but unable to move any muscles except for those that control eye movement. They can see, hear, smell, taste, and even feel, but may be unable to speak or vocalize at all. Those with incomplete locked-in syndrome can make small movements of the head, fingers, and toes.</p> <p>Another 2015 BrainGate <a href="http://www.ncbi.nlm.nih.gov/pubmed/26560357" target="_blank">study</a> found that volunteers using the system were able to acquire "targets" on a computer screen, such as letters on a keyboard, more than twice as quickly as in previous studies, thanks to advances in the system.</p> <p>The BrainGate team is now studying whether the system can be effective as a means of natural, intuitive control of prosthetic limbs, or as a way to help patients move their own paralyzed limbs. The latter work is being carried out in partnership with the Cleveland FES Center.</p> <p>A 2017 proof-of-concept <a href="https://www.ncbi.nlm.nih.gov/pubmed/28363483" target="_blank">study</a> demonstrated that this combination of FES and BrainGate was successful in a quadriplegic Navy Veteran, who used electrodes implanted in his brain and in the muscles of his paralyzed arm and hand to use his own thoughts to control his arm and hand. This <a href="https://www.youtube.com/watch?time_continue=40&v=OHsFkqSM7-A" target="_blank">video</a> shows how the system works, and how it offers potential help to people with paralysis in the future. The BrainGate team is currently working on the next generation of their system that will be fully implanted and wireless so it can be used at home without the assistance of a technician.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research6">➤ Hip and knee replacement</h3> <p><strong>Age and knee replacement—</strong>In 2016, researchers at the Iowa City VA Health System and the University of Iowa <a href="http://www.ncbi.nlm.nih.gov/pubmed/26864215" target="_blank">looked</a> at whether knee replacement (total knee arthroplasty) is safe for Veterans aged 85 or older.</p> <p>The researchers combined and analyzed data from 22 past studies to see whether they could make a determination on the risks and benefits of the procedure for older patients.</p> <p>They found that while the available evidence suggested slight increases in mortality and complications for older patients, several of the studies reported that both older and younger patients were highly satisfied after surgery, and were able to function better.</p> <p>The team therefore concluded that age alone should not rule out such surgery.</p> <p><strong>Hip and knee replacement not followed by increased physical activity—</strong>In 2017, a researcher with the Durham VA Medical Center and others published a literature <a href="https://www.ncbi.nlm.nih.gov/pubmed/28898559" target="_blank">review</a> of previous studies that found that while patients often have large reductions in pain and increased physical function and quality life after total hip or knee replacement, there were no corresponding increases in physical activity after six months, and only modest increases after a year. The researchers hypothesized that the lack of physical activity may be behavioral, since a sedentary lifestyle is hard to change.</p> <p><strong>Racial gaps in use of knee replacements—</strong>African American patients shown an informational video about knee replacement surgery were 85 percent more likely to undergo the surgery than those who did not view the video, according to a 2016 <a href="https://www.ncbi.nlm.nih.gov/pubmed/27893033" target="_blank">study</a> conducted by researchers at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia.</p> <p>According to the researchers, African Americans are significantly less likely to have knee replacement surgery to relieve pain from arthritis, largely due to lack of knowledge about the treatment. The researchers concluded that this low-cost, patient-centered intervention could increase the use of an effective orthopedic procedure among minority patients.</p> <p>A 2017 <a href="https://www.ncbi.nlm.nih.gov/pubmed/27788302" target="_blank">study</a> by VA researchers also found that African American Veterans were less likely to undergo knee replacement surgery. Over a 10-year period, rates of knee replacements were much lower for black Veterans than white Veterans. Hispanic Veterans had the same rates of knee replacement as white Veterans. The researchers stated that the study shows the importance of developing ways to reduce racial differences in Veteran health care usage.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research7">➤ Wheelchair technology</h3> <p><strong>MEBot robotic wheelchair—</strong>HERL is <a href="http://www.ncbi.nlm.nih.gov/pubmed/26562492"target="_blank">developing</a> a robotic wheelchair called MEBot that can go up and down curbs and steps and maintain a level seat over uneven terrain—giving Veterans who use wheelchairs for mobility unprecedented freedom and independence both outdoors and inside homes, shops, and offices. The wheelchair has traction control; anti-skid braking; and powered seat functions, including tilt, recline, leg-rest, and elevation.</p> <p>It has six wheels, an onboard computer and software, and an array of high-tech sensors and actuators. It is designed to navigate smoothly over gravelly or muddy roads, uneven slopes, wet grass, and other difficult terrain—and should allow users to avoid getting stuck on snow and ice.</p> <p>The MEBot is now being tested at the center's lab, and may be commercially available within a few years. In 2017, the MEBot <a href="http://www.herl.pitt.edu/news-events/mebot-wins-blackwood-design-award" target="_blank">won</a> "Best New Concept" in the Blackwood Design Awards competition in Scotland, an international competition that seeks to discover and recognize brilliant innovations in independent living and accessibility. Watch a video of the MEBot <a href="http://www.herl.pitt.edu/news-events/mebot-wins-blackwood-design-award" target="_blank">here</a>.</p> <p><strong>Waterproof, motorized wheelchair</strong>—Researchers at HERL have also developed the <a href="http://www.herl.pitt.edu/news-events/pneuchair-unveiled-water-park" target="_blank">PneuChair</a>, a motorized wheelchair that uses a tank of compressed air instead of batteries as an energy source. The chair weighs about 80 pounds and takes just 10 minutes to recharge. The PneuChair can go about 3 miles before the tank must be charged again—about one the third the distance that an electronic wheelchair can go on a fully charged battery. It was developed, in part, to be used at a water park for people with disabilities, but could also be used at beaches or pools. The design is simpler than an electronic wheelchair—lacking much of the software and electronics that are typically used for motorized chairs.</p> <p><strong>Improved standing wheelchair—</strong>In 2015, a group at the Minneapolis VA Medical Center <a href="http://www.startribune.com/new-wheelchair-gives-paralyzed-veterans-chance-to-stand-on-own/290607961/" target="_blank">reported</a> they had made improvements to the traditional standing wheelchair to help improve the ability of paralyzed Veterans to function. The researchers modified commercially available standing wheelchairs by adding a drive wheel that allows the push rim to rise so patients can reach it when they stand.</p> <p>In existing models, patients who can't reach the push rim in the standing position are forced to sit before they can boost the chair and move themselves to a new location. The new chair, which is not yet available commercially, also keeps at least four of the chair's six wheels on the ground at all time, increasing both stability and maneuverability.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research8">➤ Exoskeletons</h3> <p>VA's <a href="http://www.rehab.research.va.gov/cent/bronx.html" target="_blank">Center on the Medical Consequences of Spinal Cord Injury</a> is located at the James J. Peters VA Medical Center in the Bronx, New York. The center's mission is to improve Veterans' quality of life and increase their longevity by preventing and intervening in the secondary medical consequences that result from having a spinal cord injury. These consequences can include bone and muscle loss, and metabolic and cardiovascular changes. </p> <p>Researchers at the center continue to study an Israeli technology that allows people with paralysis to stand, walk, and climb stairs, called <a href="http://rewalk.com/" target="_blank">ReWalk</a>. ReWalk 6.0 is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with spinal cord injury to stand upright, walk, and turn. On their first day using the device, most people can stand and take a few steps, although it takes practice and training to use it properly.</p> <p>Participants in past studies have lost fat tissue, their bowel function has improved, and their diabetes symptoms have been reduced. The center is now conducting a further <a href="https://clinicaltrials.gov/ct2/show/NCT02658656" target="_blank">trial</a> on ReWalk's impact on <a href="https://clinicaltrials.gov/ct2/show/NCT02314221?term=spungen&rank=1" target="_blank">mobility</a>, bowel function, and cardio-metabolic health. The four-year study, involving 160 paralyzed Veterans with spinal cord injury at 10 VA medical centers, is examining the impact of the robotic exoskeleton on home and everyday life. Enrollment is expected to be completed in August 2020.</p> <p>In 2014, ReWalk version 6.0 was approved for sale in the United States. In 2015, VA <a href="http://www.militarytimes.com/story/military/benefits/veterans/2015/12/17/va-provide-robotic-legs-paralyzed-vets/77470074/" target="_blank">announced</a> it would provide the device to eligible Veterans who could benefit from it.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h3 id="research9">➤ Dentures</h3> <p>Dentures can bring back the smile of those who have lost teeth because of aging, injury, and disease. Many denture wearers, however, must cope with a condition called dental stomatitis (thrush), in which the gums under the denture become sore and inflamed due to infection from a fungus known as candida.</p> <p>VA researchers at the South Texas VA Health Care System are developing a new type of denture that fights stomatitis. The denture releases, over time, a drug that kills the candida fungus. In lab tests whose results were <a href="https://www.ncbi.nlm.nih.gov/pubmed/26855200" target="_blank">published</a> in 2016, the experimental product showed strong action against candida for up to 30 days, after which the device can be recharged with a fresh dose of drugs. More testing will be required, including a clinical trial, before the product is commercially available.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h2 id="more">More on Our Website</h2> <ul> <li><a href="/currents/1117-leg-implants-for-paralysis-work-long-term.cfm">Study: Leg Implants for paralysis work long-term</a>, <em>VA Research Currents</em>, Nov. 9, 2017</li> <li><a href="/in_brief.cfm">Lower-extremity neuroprostheses continue to function in the long term</a>, <em>VA Research News Briefs</em>, Oct. 4, 2017</li> <li><a href="/pubs/varqu/fall2017/rory-cooper-named-2017-aaas-fellow.cfm"> Rory Cooper named 2017 AAAS fellow</a>, <em>VA Research Quarterly Update</em>, Fall 2017</li> <li><a href="/in_brief.cfm">Hip or knee replacement usually not followed by boost in physical activity</a>, <em>VA Research News Briefs</em>, Sept. 12, 2017</li> <li><a href="/currents/0517-fova.cfm">On the Hill: VA researchers visit D.C. to show latest rehab technology,</a> <em>VA Research Currents</em>, May 30, 2017</li> <li><a href="/currents/0517-rewalk.cfm">Standing tall: Trial aims to pinpoint benefits for paralyzed Vets of robotic walking system,</a> <em>VA Research Currents</em>, May 11, 2017</li> <li><a href="/currents/0117-1.cfm">Building a better denture: Antifungal model would beat back infection that vexes denture wearers</a>, <em>VA Research Currents</em>, Jan. 11, 2017</li> <li><a href="/pubs/varqu/winter2017/6.cfm">Building a better artificial limb</a>, <em>VA Research Currents</em>, Winter 2017</li> <li><a href="/in_brief.cfm">Educational intervention targets racial gaps in use of knee replacements</a>, <em>VA Research News Briefs</em>, Dec. 1, 2016</li> <li><a href="/in_brief.cfm">Pedestrian pathway roughness thresholds for wheelchair user safety and comfort</a>, <em>VA Research News Briefs,</em> 2, 2016</li> <li>Video: <a href="/news/features/DEKA.cfm">"I was a one-sided person": The DEKA Arm, a VA Research partnership with DoD</a></li> <li>Video: <a href="https://youtu.be/0LmeWXMpRRI">Prosthetics research</a></li> <li>Video: <a href="https://youtu.be/2H49ZjeQ_dM">MEBot wheelchair</a></li> <li>Video: <a href="https://youtu.be/2jqhHiGVWb8">PneuChair</a></li> </ul> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> <h2 id="articles">Selected Scientific Articles by Our Researchers</h2> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28898559" target="_blank">Changes in physical activity after total hip or knee arthroplasty: a systematic review and meta-analysis of 6 and 12 month outcomes</a>. Hammett T, Simonian A, Austin M, Butler R, Allen KD, Ledbetter L, Goode AP. Physical activity did not change at six months, and a small to moderate improvement was found at 12 months post-surgery, despite large improvements in quality of life, pain, and physical function. Arthritis Care Res (Hoboken). 2018 Jun;70(6):892-901.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28899825" target="_blank">Long-term performance and user satisfaction with implanted neuroprostheses for upright mobility after paraplegia: 2- to 14-year follow up.</a> Triolo RJ, Bailey SN, Fogiyano KM, Kobetic R, Lombardo LM, Miller ME, Pinault G. Implanted lower-limb neuroprostheses can provide lasting benefits that recipients value. Arch Phys Med Rehabil. 2018 Feb;99(2):289-298.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28209508" target="_blank">Systematic review of measures of impairment and activity limitation for persons with upper limb trauma and amputation</a>. Resnik L, Borgia M, Silver B. Cancio J. Few performance measures were recommended for patients with limb trauma and amputation. Arch Phys Med Rehabil. 2017 Sep;98(9):1863-1892.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/27788302" target="_blank">Racial and ethnic differences in total knee arthroplasty in the Veterans Affairs health care system, 2001-2013</a>. Hausmann LRM, Brandt CA, Carroll CM, Fenton BT, Ibrahim SA, Becker WC, Burgess DJ, Wandner LD, Bair MJ, Goulet JL. Black-white differences in total knee arthroplasty appear to be persistent in VA, even after controlling for potential clinical cofounders. Arthritis Care Res (Hoboken). 2017 Aug;69:1171-1178.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=A+muscle-driven+approach+to+restore+stepping+with+an+exoskeleton+for+individuals++with+paraplegia." target="_blank">A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia</a>. Chang SR, Nandor MJ, Li L, Kobetic R, Foglyano KM, Schnellenberger JR, Audu ML, Pinault G, Quinn RD, Triolo RJ. A self-contained muscle-driven exoskeleton is a feasible intervention to restore stepping in individuals with paraplegia due to spinal cord injury. J Neurogen Rehabil. 2017 May 30:14(1):48.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28363483" target="_blank">Restoration of reaching and grasping movements through brain-controlled muscle stimulation in a person with tetraplegia: a proof-of-concept demonstration.</a> Ajiboye AB, Willett FR, Young DR, Memberg WD, Murphy BA, Miller JP, Walter BL, Sweet JA, Hoyen HA, Keith MW, Peckham PH, Simeral JD, Donoghue JP, Hochberg LR, Kirsch RF. A report on an individual with high-cervical spinal cord injury who coordinated reaching and grasping movements using his own paralyzed arm and hand through implanted functional electrical stimulation and an intracortical brain-computer interface. Lancet. 2017 May 6;389(10081):1821-1830.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/27893033" target="_blank">Effect of a decision aid on access to total knee replacement for black patients with osteoarthritis of the knee: a randomized clinical trial</a>. Ibrahim SA, Blum M, Lee GC, Mooar P, Medvedeva E, Collier A, Richardson D. A decision aid increased rates of total knee replacement among black patients. JAMA Surg. 2017 Jan 18;152(1);e164225.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/27424945" target="_blank">Starting a new conversation: engaging Veterans with spinal cord injuries in discussion of what function means to them, the barriers/facilitators they encounter, and the adaptations they use to optimize function</a>. Hill JN, Balbale S, Lones K, LaVela SL. Patients with spinal cord injuries highlight the concept of "normality," facilitators and barriers to function, and adaptations to optimize function. Disabil Health J. 2017 Jan:10(1):114-122.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/27744248" target="_blank">Pilot testing of a variable stiffness transverse plane adapter for lower limb amputees.</a> Pew C, Klute GK. A transverse rotation adapter with variable stiffness capability could be useful to help reduce stresses for a lower-limb amputee that result in soft tissue breakdown and discomfort. Gait Posture. 2017 Jan;51:104-108.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/27588607" target="_blank">Proposed pedestrian pathway roughness thresholds to ensure safety and comfort for wheelchair users</a>. Duvall J, Sinagra E, Cooper R, Pearlman J. Many public pathways are sufficiently rough to result in harmful vibrations and discomfort for wheelchair users. This study suggests a pathway roughness index threshold to protect wheelchair users against discomfort and possible health risks due to vibration exposure. Assist Technol. 2016 Sep 2:1-7. (Epub ahead of print)</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/26855200" target="_blank">Rechargeable anticandidal denture material with sustained release in saliva</a>. Malakhov A, Wen J, Zhang BX, Wang H, Geng H, Chen XD, Sun Y, Yeh CK. A new denture material holds promise for long-term management of denture stomatitis. Oral Dis. 2016 Jul;22(5):391-8.</p> <p><a href="http://www.ncbi.nlm.nih.gov/pubmed/26864215" target="_blank">The effects of advanced age on primary total knee arthoplasty: a meta-analysis and systematic review.</a> Kuperman EF, Schweizer M, Joy P, Gu X, Fang MM. Existing data supports offering total knee arthoplasty to select geriatric patients, although the risk of complications may be increased. BMC Geriatr. 2016 Feb 10;16:41.</p> <p><a href="http://www.ncbi.nlm.nih.gov/pubmed/26413781" target="_blank">Clinical translation of a high-performance neural prosthesis</a>. Gilja V, Pandarinath C, Blabe CH, Nuyujukian P, Simeral JD, Sarma AA, Sorice BL, Perge JA, Jarosiewicz B, Hochberg LR, Shenoy KV, Henderson JM. Measured more than one year after implant, the BrainGate neural cursor-control system showed the highest published performance achieved by a person to date, more than double that of previous pilot clinical trial participants. Nat Med. 2015 Oct;21(10):1142-5.</p> <p style= "text-align:right; margin-bottom: 0px; margin-top: 5px; color:#385f90; border-bottom:dotted 1px #385f90; font-size: 12px;"><a href="#top">top</a></p> </div>   <div id="tier4RightContent" style="position: absolute; right: 0px; padding-top: 0px; "> <div id="innerRightContent"> <div class="rightcol_box"> <h4>Prosthetics Fact Sheet</h4> <a href="/pubs/docs/va_factsheets/Prosthetics.pdf" target="_blank"><img alt="fact sheet thumbnail" src="/images/fact_sheets/Prosthetics.jpg" width="150" height="195"><br> <p> Download PDF </p></a> </div>  <div class="rightcol_box"> <h4>Related Articles</h4> <p style="font-size:12px; margin-right:10px; margin-left:10px"> <a href="/currents/0421-VA-engineering-research-center-posts-another-invention-prosthetic-hook-mouse.cfm"><img alt="thumbnail" src="/images/research-currents/apr21/hook-mouse-sm.jpg" width="165" alt="VA engineering research center posts another invention: prosthetic hook mouse">VA engineering research center posts another invention: prosthetic hook mouse</a> </p> <p style="font-size:12px; margin-right:10px; margin-left:10px"> <a href="/currents/1120-VA-scientist-experimenting-with-blood-sugar-to-power-prostheses-implantable-devices.cfm"><img alt="thumbnail" src="/images/research-currents/nov20/RichardWeir-sm.jpg" width="165" alt="Alternative fuels">Alternative fuels</a> </p> <p style="font-size:12px; margin-right:10px; margin-left:10px"> <a href="/currents/0620-VA-scientists-testing-new-technology-to-absorb-moisture-increase-comfort-with-prostheses.cfm"><img alt="thumbnail" src="/images/research-currents/june20/myoelectric-arm-sm.jpg" width="165" alt="VA scientists testing new technology to absorb moisture, increase comfort with prostheses">VA scientists testing new technology to absorb moisture, increase comfort with prostheses</a> </p> <p style="font-size:12px; margin-right:10px; margin-left:10px"> <a href="/currents/0220-Study-probes-user-satisfaction-with-upper-limb-prostheses.cfm"><img alt="thumbnail" src="/images/research-currents/feb20/RobertLewis-sm.jpg" width="165" alt="Study probes user satisfaction with upper-limb prostheses">Study probes user satisfaction with upper-limb prostheses</a> </p> </div>  <div class="rightcol_box"> <h4>VA Research in the News</h4> <ul> <li><a href="https://www.nytimes.com/2017/12/05/opinion/morgans-wonderland-waterpark-kids-play.html" target="_blank">A place to play, on wheels or feet</a>, <em>The New York Times</em>, Dec. 5, 2017</li> <li><a href="https://www.eurekalert.org/pub_releases/2017-11/sfn-etr111017.php" target="_blank">Engineering tomorrow's responsive, adaptable neuroprosthetics and robots</a>, <em>EurekAlert,</em> Nov. 14, 2017</li> <li><a href="https://www.nytimes.com/2017/07/02/nyregion/for-two-veterans-a-freedom-restored-for-independence-day.html" target="_blank">For two Veterans, a freedom restored for Independence Day</a>, <em>The New York Times,</em> July 2, 2017</li> <li><a href="https://futurism.com/military-funding-for-prosthetics-help-more-than-just-soldiers/" target="_blank">Military funding for prosthetics helps more than just soldiers</a>, <em>Futurism</em>, June 12, 2017</li> <li><a href="https://www.npr.org/sections/health-shots/2017/03/28/521665654/paralyzed-man-uses-thoughts-to-control-his-own-arm-and-hand" target="_blank">Paralyzed man uses thoughts to control his own arm and hand</a>, <em>National Public Radio</em>, March 28, 2017</li> <li><a href="https://www.rdmag.com/article/2016/10/reinstating-feel-artificial-limbs-amputees" target="_blank">Reinstating feel in artificial limbs for amputees</a>, <em>R&D Magazine</em>, Oct. 28, 2016</li> <li><a href="http://www.technologyreview.com/s/601275/from-star-wars-to-real-life-new-prosthesis-transforms-lives/" target="_blank">From Star Wars to real life: new prosthesis transforms lives</a>, <em>MIT Technology Review</em>, April 19,</li> <li><a href="https://www.darpa.mil/news-events/2014-05-09" target="_blank">DARPA-funded DEKA Arm System Earns FDA Approval</a>, <em>Defense Advanced Research Projects Agency</em>, May 2014</li> </ul> </div> <div class="rightcol_box"> <h4>VA and other U.S. Government Online Resources</h4> <ul> <li><a href="/services/rrd.cfm">VA Rehabilitation R&D Service</a></li> <li><a href="http://fescenter.org/" target="_blank">Cleveland Center for Functional Electrical Stimulation</a></li> <li><a href="http://www.rehab.research.va.gov/cent/bronx.html" target="_blank">VA Center on the Medical Consequences of Spinal Cord Injury</a></li> <p>VA <a href="http://www.aptcenter.research.va.gov/" target="_blank">Advanced Platform Technology Center</a></li> <li><a href="https://www.providence.va.gov/research/CfNN/index.asp" target="_blank">The Center for Neurorestoration and Neurotechnology</a>, Providence VA Medical Center</li> <li><a href="http://www.rehab.va.gov/PROSTHETICS/blindrehab/BRS_Coordinated_Care.asp" target="_blank">Blind Rehabilitation Service</a>, Department of Veterans Affairs</li> <li><a href="http://www.rehab.va.gov/psas/index.asp" target="_blank">Prosthetics and Sensory Aids Service</a>, Department of Veterans Affairs</li> <li><a href="https://www.benefits.gov/benefits/benefit-details/306" target="_blank">Veterans Prosthetic Appliances</a>, Benefits.gov</li> <li><a href="https://www.medicare.gov/coverage/prosthetic-devices.html" target="_blank">Prosthetic devices</a>, Medicare.gov</li> <li><a href="http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/" target="_blank">Implants and Prosthetics</a>, U.S. Food and Drug Administration</li> </ul> </div>  <div class="clear"></div> </div>  <div class="clear"></div> </div>   <div class="clear"></div> </div>   <br style="clear: both" /> <br clear="all">  <div style="bottom:0; margin-left:30px; margin-top:30px; font-weight:bold; padding-top:10px; border-top:1px solid #cccccc;" id="footerBlock"> Questions about the R&D website? <a href="mailto:HSRDWeb.Boston@va.gov" style="color:#0B6CB2 !Important;">Email the Web Team</a> <span style="font-size:10px; font-weight:normal;"> <br> <br> Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.</span> </div> </div>   <div class="clear"> </div> </div> <div class="clear"> </div> </div> <div class="clear"></div> </div> </div> <div class="clear"></div>  <div id="footer-effect" style="height: auto;"> <div id="footer" class="noIndex"> <div class="col"> <h4>Veteran programs and services</h4> <ul > <li><a href="https://www.va.gov/homeless/" target="">Homeless Veterans</a></li> <li><a href="https://www.va.gov/womenvet/" target="">Women Veterans</a></li> <li><a href="https://www.va.gov/centerforminorityveterans/" target="">Minority Veterans</a></li> <li><a href="https://www.patientcare.va.gov/lgbt/" target="" rel="noopener noreferrer">LGBTQ+ Veterans</a></li> <li><a href="https://www.ptsd.va.gov" target="" rel="noopener noreferrer">PTSD</a></li> <li><a href="https://www.mentalhealth.va.gov" target="" rel="noopener noreferrer">Mental health</a></li> <li><a href="https://www.va.gov/adaptivesports/" target="">Adaptive sports and special events</a></li> <li><a href="https://www.va.gov/outreach-and-events/events/">VA outreach events</a></li> <li><a href="https://www.nrd.gov" target="_blank" rel="noopener noreferrer">National Resource Directory</a></li> </ul> </div>  <div class="col"> <h4 >More VA resources</h4> <ul> <li><a href="https://www.va.gov/find-forms/">VA forms</a></li> <li><a href="https://www.accesstocare.va.gov/" target="_blank" rel="noopener noreferrer">VA health care access and quality</a></li> <li><a href="https://www.va.gov/ogc/accreditation.asp">Accredited claims representatives</a></li> <li><a href="https://www.mobile.va.gov/appstore/" target="_blank" rel="noopener noreferrer">VA mobile apps</a></li> <li><a href="https://www.va.gov/statedva.htm">State Veterans Affairs offices</a></li> <li><a href="https://www.va.gov/landing2_business.htm">Doing business with VA</a></li> <li><a href="https://www.va.gov/jobs/">Careers at VA</a></li> <li><a href="https://www.va.gov/outreach-and-events/outreach-materials/">VA outreach materials</a></li> <li><a href="https://www.va.gov/welcome-kit/">Your VA welcome kit</a></li> </ul> </div>  <div class="col"> <h4>Get VA updates</h4> <ul> <li><a href="https://www.news.va.gov/" target="_blank" rel="noopener noreferrer">VA news</a></li> <li><a href="https://www.va.gov/opa/pressrel">Press releases</a></li> <li><a href="https://public.govdelivery.com/accounts/USVA/subscriber/new/" target="_blank" rel="noopener noreferrer">Email updates</a></li> <li><a href="https://www.facebook.com/VeteransAffairs" target="_blank" rel="noopener noreferrer">Facebook</a></li> <li><a href="https://www.instagram.com/deptvetaffairs/" target="_blank" rel="noopener noreferrer">Instagram</a></li> <li><a href="https://www.twitter.com/DeptVetAffairs/" target="_blank" rel="noopener noreferrer">Twitter</a></li> <li><a href="https://www.flickr.com/photos/VeteransAffairs/" target="_blank" rel="noopener noreferrer">Flickr</a></li> <li><a href="https://www.youtube.com/user/DeptVetAffairs" target="_blank" rel="noopener noreferrer">YouTube</a></li> <li><a href="https://www.va.gov/opa/socialmedia.asp">All VA social media</a></li> </ul> </div>  <div class="col"> <h4 style="font-size: 1.1rem; margin-bottom: 8px!important;">In crisis? Get help now</h4> <ul style="margin-bottom: 10px!important;"> <li><a href="https://www.veteranscrisisline.net/">Veterans Crisis Line</a></li> </ul> <h4 style="font-size: 1.1rem; margin-bottom: 8px!important;">Get answers</h4> <ul style="margin-bottom: 10px!important;"> <li><a href="https://www.va.gov/resources/">Resources and support</a></li> <li><a href="https://www.va.gov/contact-us/">Contact us</a></li> </ul> <h4 style="font-size: 1.1rem; margin-bottom: 8px!important;">Call us</h4> <ul style="margin-bottom: 10px!important;"> <li> <a href="tel:18006982411">800-698-2411</a></li> <li><a aria-label="TTY: 711" href="tel:+1711">TTY: 711</a></li> </ul> <h4 style="font-size: 1.1rem; margin-bottom: 8px!important;">Visit a medical center or regional office</h4> <ul style="margin-bottom: 10px!important;"> <li> <a href="https://www.va.gov/find-locations/">Find a VA location</a></li> </ul> </div>  <br clear="all"> <div style="margin: 20px;color: white;"> <hr color="#fff" style=" color:white; "> <br> <h4>Language assistance</h4> <a href="https://www.va.gov/asistencia-y-recursos-en-espanol" lang="es" hreflang="es"> Espanol</a>  |  <a href="https://www.va.gov/tagalog-wika-mapagkukunan-at-tulong" lang="tl" hreflang="tl"> Tagalog</a>  |  <a href="https://www.va.gov/resources/how-to-get-free-language-assistance-from-va/" lang="en" hreflang="en"> Other languages</a></div> <div style="margin: 20px;color: white;"> <hr color="#fff" style=" color:white; "> <br> <a href="https://www.section508.va.gov" rel="noopener noreferrer">Accessibility</a>  |  <a href="https://www.va.gov/resources/your-civil-rights-and-how-to-file-a-discrimination-complaint/">Civil Rights</a>  |  <a href="https://www.va.gov/foia/">Freedom of Information Act (FOIA)</a>  |  <a href="https://www.va.gov/oig/">Office of Inspector General</a>  |  <a href="https://www.va.gov/opa/Plain_Language.asp">Plain language</a>  |  <a href="https://www.va.gov/privacy-policy/">Privacy, policies, and legal information</a>  |  <a href="https://www.va.gov/privacy/">VA Privacy Service</a>  |  <a href="https://www.va.gov/ormdi/NOFEAR_Select.asp">No FEAR Act Data</a>  |  <a href="https://www.usa.gov/" target="_blank" rel="noopener noreferrer">USA.gov</a>  |  <a href="https://www.va.gov/performance-dashboard/">VA performance dashboard</a>  |  <a href="https://www.va.gov/veterans-portrait-project/">Veterans Portrait Project</a> </div> <div id="sub-footer"> <p>U.S. Department of Veterans Affairs  |  810 Vermont Avenue, NW Washington DC 20420</p> <p class="small-print"> Updated/Reviewed: 2021-1-15 </p> </div>  </div>  </div>    <script type="text/javascript"> //<![CDATA[ var usasearch_config = { siteHandle:"va_ord" }; var script = document.createElement("script"); script.type = "text/javascript"; script.src = "//search.usa.gov/javascripts/remote.loader.js"; document.getElementsByTagName("head")[0].appendChild(script); //]]> </script> </body></html>