Amputee's prosthetic limbs spark tech debate

UNION-TRIBUNE
May 19, 2008

ANDREW YATES / Getty Images
Oscar Pistorius was born without fibulas and had his legs amputated below the knee at 11 months old.

Double-amputee sprinter Oscar Pistorius won his appeal Friday and can compete for a place in the Beijing Olympics.

Oscar Pistorius literally does not have a leg to stand on, but he runs as if he were fleeing a fire.

The world's swiftest amputee sprinter is so fast that he has forced the sports world to wonder whether he's working with a disability or an edge; whether technology has trumped the human condition with advances in prosthetics; and what all of that might mean to races down the road.

The Blade Runner, as Pistorius is known, is where the interests of compassion and competition collide. The 21-year-old South African was born without fibulas and had his legs amputated below the knee at 11 months old. He has adapted so well to his artificial lower limbs, however, particularly to the cutting-edge “Cheetahs” developed in Iceland, that the international track federation (IAAF) has sought to legislate him out of its able-bodied competitions, including the Summer Olympic Games of Beijing.

Pistorius prevailed on appeal last week, but the Court of Arbitration for Sport was careful to frame its decision in the narrow terms of existing evidence rather than setting a broad precedent. Hollywood's “Iron Man” might be fiction, but scientific enhancement is indisputable fact.

“I think the principle is that you have some kind of fairness in competition,” said Dr. Lawrence Hinman, who teaches Ethics at the Frontiers of Science at USD. “The empirical question is: Do the prosthetic limbs give someone an unfair advantage? Eventually, they will. . . .

“My own feeling is to say, unless it's pretty clear that this gives him an unfair advantage, that he should be allowed to compete.”

AdvertisementGerman Professor Gert-Peter Brueggemann, who began testing the J-shaped, carbon-fiber “Cheetahs” for the IAAF last November, says Pistorius' advantage is already significant. Brueggemann's data indicates Pistorius' limbs use 25 percent less energy than able-bodied runners to run at the same speed and that Pistorius requires 30 percent less mechanical work to lift his body.
“I did not expect it to be so clear,” Brueggemann told Die Welt.

What Brueggemann considers to be clear, though, Robert Gailey continues to find murky. Gailey, a physical therapist at the University of Miami, told The New York Times last year that a prosthetic leg returns only about 80 percent of the energy absorbed in a stride, compared with as much as 240 percent for a normal leg. Gailey questions, too, whether the IAAF's concerns are based on competitive advantages or cosmetic appearances.

Unlike Lasik eye surgery or arthroscopic joint repairs, prosthetic limbs are not easily concealed when worn with a track suit. Each of these innovations is intended to enhance performance, but only the prostheses alters a sprinter's silhouette.

“Part of what makes it a little more difficult for Pistorius is the prosthetics look incredibly impressive,” Hinman said. “It's that futuristic design. If they looked like wooden legs, there wouldn't be any question.”

Should Pistorius qualify for the Summer Games, he would become the first amputee to compete in an Olympic track event. Yet it's worth noting that gymnast George Eyser won three gold medals in the 1904 Summer Games in St. Louis while operating on a wooden leg. San Diego State's Marla Runyan, legally blind, became the first Paralympian runner to compete in the Olympic Games and finished eighth in the 1,500 meters in the 2000 Games of Sydney.

“I think the Paralympians kind of get short shrift,” said swimming executive Mike Lewis, who once managed Paralympic sports for the U.S. Olympic Committee. “These are world-class athletes. They train as hard. They have the same level of commitment. It's not merely a feel-good achievement.”

Lewis, who earned degrees from UCSD and San Diego State, admits to being “conflicted” about scientific shortcuts. Yet instead of viewing the technology in isolation, Lewis looks at the totality of the Paralympic athlete's experience, at the “totally different variables” that enter into their equations.

“Biomechanically, there is that purported advantage (to prosthetic limbs),” Lewis said. “But that's for the device itself. At the end of the day, it's the user who sits on top of that device.”

By any standard, Pistorius is an extraordinary case. He owns the world Paralympic record at 100, 200 and 400 meters, and his best times at 100 and 200 meters (10.91 and 21.58 seconds) are better than those run by the women's gold medalists at the 2004 Summer Games in Athens.

Though he has yet to meet Olympic men's qualifying standards at any distance, Pistorius could still be chosen to represent South Africa in the relays.

“It's genuinely a tough case,” Hinman said. “Even if it didn't (make a decisive difference), he might get better. It's hard to know which you credit to the prosthetic device and what you credit to incredible determination.

“There are plenty of people with that same level of determination who don't get so far.”

Though the race is not always to the swiftest, neither should it be appropriated by the smartest engineer. Much as Oscar Pistorius is an inspiration, he also poses a problem.

Disabled Iraq War vet eyes spot in 2008 Paralympics

By Sal Ruibal, USA TODAY
COLLEGE PARK, Md. — As the swimmers begin to take their places at the start line, they nervously adjust their caps and tug at their swimsuits.
Melissa Stockwell walks across the wet tile floor to her lane, bends to stretch her back, then carefully removes her left leg.

Balancing on her right leg, she crouches as the starter raises the gun, then explodes into the water as the gun's sharp crack echoes across the wide expanse of University of Maryland Natatorium.

Stockwell's muscled arms churn butterfly strokes through the water, her stars-and-stripes swim cap bobbing down the lane.

Her left leg, crafted from carbon fiber and titanium, goes unnoticed in the poolside clutter of warm-up jackets, wet towels, wheelchairs, metal crutches and folding blind canes.

At the U.S. Paralympics Open Swimming Championships last weekend, normal was a relative term for the this international group of athletes whose physical conditions range from missing legs and arms to dwarfism to blindness.

On April 13, 2004, Army 1st Lt. Stockwell was leading a supply convoy through the city when her unprotected Humvee was blown into a guardrail by a roadside bomb.

Her left leg was torn away just below the knee, but infection soon ravaged her leg. Surgeons had to saw off the damaged tissue, leaving her with just six inches of limb.

"I didn't feel bad for myself," Stockwell, 27, says. "I was glad it was me and not someone else."

After several months of recovery and rehabilitation, Stockwell walked away from the Army with a Purple Heart medal, medical retirement papers in her file and a prosthetic leg attached to the stump she affectionately calls, "Little Leg."

Since then, the former competitive gymnast, diver and rower has rediscovered her athleticism.

Just four months after she was wounded, she powered a handbike to a finish at the New York City Marathon.

An ROTC graduate of the University of Colorado, she also returned to the Rocky Mountains to relearn how to ski.

She and husband Dick, who was also an Army officer and was in Baghdad when she was wounded, moved to Chicago, where she began swimming in Lake Michigan as training for triathlons.

"I was drawn to swimming because I didn't have to wear a prosthetic to do it," she says.

Now she's one of 17 wounded Iraq veterans aiming for a spot in the 2008 Beijing Paralympics with the support of a U.S. Olympic Committee program that strives to turn warriors into competitive athletes. She's the only swimmer in the group and one of two women (Kerry Miller competes in volleyball).

The program — funded by the USOC, Visa and McDonald's — is not just about elite athletes with Paralympics potential. More than 400 veterans are involved at levels more recreational than Olympian.

"Making the Paralympics team is a great goal," says John Register, associate director of outreach development for the U.S. Paralympics Team, "but the benefits of playing sports go far beyond competition."

U.S. Paralympics Swimming Team director Julie O'Neill says Stockwell has been making "remarkable progress" but has not yet secured a spot on the squad for Beijing.

Stockwell will need to post global competitive times at the U.S. Paralympics Swimming Team Trials in April to accomplish that goal.

She's focused on making the team, but she also sees the rewards she's already reaped.

"I'd love to have my leg back," says Stockwell, who also learned how to fit other amputees with prosthetics. "But the things I have been able to do have been valuable to me. I live a great life, I have no regrets and don't want to go back to what was before.

"This happened for a reason, and it really doesn't matter if I have a leg or not — I can still do whatever I want to do."

Insurance firms deny amputees new limbs

Coalition pushes bill to mandate coverage
By CLAUDIA PINTO • Staff Writer • May 10, 2008


Since Paul Dale's artificial leg started failing,he has suffered falls, injuring an elbow, pulling both shoulders and breaking a rib.

But Dale's insurance company won't pay to replace the prosthesis.


"I think I deserve the same standard of life as anyone else," said the Columbia man, who lost the majority of his left leg to bone cancer in 1983.

Morgan Sheets, the Amputee Coalition of America's national advocacy director, says Dale's story is a common one.

She said insurance companies often deny people access to an artificial limb by allowing only one prosthesis per lifetime, labeling the more expensive computerized limbs as experimental or capping the benefit at $1,000 or $5,000 when the average cost is $8,000 to $15,000.

The Knoxville-based Amputee Coalition of America is pushing for federal legislation, dubbed the Prosthetic Parity Act of 2008, which would force insurance companies to cover prostheses just as they would cover other critical medical care.

Mary Thompson, spokeswoman for BlueCross BlueShield of Tennessee, said the company doesn't have coverage limits on prosthetic devices and opposes a mandate.

"While the intention of state and federal health-care mandates is usually good, they have significantly increased the cost of health care in Tennessee and the nation, almost always for the privately insured," Thompson said.

Sheets said that when artificial limbs are fully funded it adds only about 25 cents per month to insurance premiums.

"People get insurance to cover catastrophic events. What is more catastrophic than losing a limb?" Sheets said. "I think the general public just assumes that if they lose a limb they'll get a prosthesis, and right now that's not happening."

Limbs allow active lives
Ten states have passed prosthetic parity insurance laws. Sixteen others, including Tennessee, have similar proposed legislation.

"Right now, it's hung up in subcommittee. I don't suspect we'll be able to get it done this year," said Mike Alder, a lobbyist for the Tennessee Orthotics Prosthetics Facilities Inc. "There will be a renewed effort next year."

Alder said the insurance industry is resisting the legislation to control costs, but he argues that providing artificial limbs will be more cost effective in the long run.

"To confine someone to a wheelchair after losing a limb is a sedentary lifestyle," Alder said. "Your health is not going to get better by sitting. People can return to very active lives with prosthetic devices."

Sheets said it isn't known how many people are denied artificial limbs each year.

According to the coalition, there are roughly 1.9 million people with limb loss in the U.S.

Sheets said being denied an artificial limb could have devastating results: People sometimes end up losing their jobs and become confined to wheelchairs.

"They want to be able to do the same things everyone else does," Sheets said. "They want to be able to run around with their kids. They want to drive."

Amputee needs new leg
Dale said these days a rock or a slope could throw him off balance and send him toppling over. He uses a C-Leg, a high-tech prosthesis that uses batteries and a computer chip to better replicate the movements of a real leg. The computer in the leg is malfunctioning and the battery won't stay charged.

"I need a new leg to have a decent way of life," he said.

Dale said his insurance company, BlueCross BlueShield of Georgia, wouldn't pay for a new leg because it's considered experimental.

However, BlueCross BlueShield of West Virginia paid for the exact same prosthesis for Dale eight years ago.

Cynthia Sanders, spokeswoman for BlueCross BlueShield of Georgia, said she couldn't comment on Dale's situation specifically because of privacy issues, but she did say that scientific studies on the advantages of computerized prosthetic devices are limited.

"We will continue to review peer-reviewed medical literature and make changes as evidence warrants," Sanders said.

Sheets said the real issue is insurance companies don't want to pay. A new C-Leg for Dale would cost roughly$45,000.

"That's a ploy being used by insurance companies for the more expensive items," Sheets said. "Medicare has been paying for C-Legs for 10 years. Medicare doesn't cover anything that's experimental."

Dale, 64, said he needs the high-tech leg because he's active. He works 40 hours a week, cuts his own grass and restores old cars in his spare time.

Dale said he has looked into getting his artificial leg fixed, but factory officials said the damage is too costly to repair."I'm not asking for an upgrade," Dale said. "I just want a replacement for what I've got."

Contact Claudia Pinto at 259-8277 or cpinto@tennessean.com.

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