Prosthetics giving patients more flexibility, hope

In some ways, Von Ferber and Kirk Arnold are mirror images of each other.

Both are big, physically active men. Both love to ride motorcycles. And both are missing their right hands and use prosthetics as substitutes.

They also typify most Americans who have had hand or upper-arm amputations in two other significant ways. They are male, as almost all upper-extremity amputees are, and they lost their hands in a work accident and a traffic accident.

"Most of these amputations occur for two reasons," explained Dr. Joseph Imbriglia, a hand surgeon with the Wexford, Pa.-based Hand and UpperEx Center. "They come from work injuries, working with saws, box cutters, log splitters and heavy equipment, or they come from automobile accidents or motorcycle accidents, and both are overwhelmingly among males."

Earlier this month, University of Pittsburgh Medical Center announced it had performed the region's first hand transplant, on a 24-year-old Marine whose right hand was blown off in a training accident.

While hand transplants are the most dramatic solution for victims of these accidents, prostheses will probably always be the first-line treatment for people with amputations because they are less expensive and don't carry the risks that accompany a lifetime of taking immunosuppressive drugs.

Ferber, 49, of Shaler, Pa., is one of 630 people in the world using the iLimb myoelectric hand prosthesis made by Touch Bionics, of Scotland.

Like other myoelectric devices, it has a sleeve that fits over the person's stump, with electrical contacts on the inside that can pick up signals from the person's muscles and use them to control the hand. Unlike many other prosthetics, the iLimb's hand has individually moveable fingers, wrist and thumb.

Ferber lost his right hand and half of his forearm in a motorcycle accident two years ago when a van doing a U-turn pinned him against a guardrail and dragged him along the metal railing for 230 feet.

Arnold, 52, lost his hand and most of his forearm in a work accident 14 years ago. While he was operating a printing press in Weirton, W.Va., his arm was pulled into the moving rollers on the press. Within seconds, it looked as though the rest of his body would follow.

"I figured I had one last chance," he recalled, "so I just pulled as hard as I could and I guess I bent my arm back and snapped the bones off and it just tore my arm off."

Arnold also relies primarily on a myoelectric prosthesis, although he occasionally wears an older-style prosthesis operated by a harness that goes around his shoulders. He can operate the prosthetic hands on that device by hunching or pulling back his shoulders.

Over the years, he has amassed an array of prosthetic hands to attach to the wrist of his false forearm. They range from a two-piece gripper known as a Greifer to a lifelike hand encased in a brown glove to an old-fashioned hook.

Arnold has a custom-made hand-arm prosthesis for motorcycle riding that is based on a World War II-era design, in which the fingers and thumb are made of springs, so they can easily be pulled off the bike handle in an emergency.

"I ride a stock Harley," he said with a grin. "I ride good, and I ride long." His wife sits behind him on the cycle, he said, and he pulls a trailer as well.

Ferber would dearly love to ride again himself ­­­- in fact, he thinks his desire to climb back on a motorcycle might be one reason he was turned down when he applied for a hand-transplant - but he has not mastered his prosthetic hand well enough to attempt that yet.

While the sleek black iLimb he wears has individual motors for each finger and the thumb, it is not yet equipped with sensors to control each digit.

"I feel that with the iLimb, the sky's the limit," Ferber said.

"It gives me hope that I possibly could ride a motorcycle ... there's a chance to do the things I used to do, maybe a little slower, but there are possibilities."

Doctors say that 40 percent of men in their 20s and 30s who have amputations refuse to use prosthetics. The primary reason: the devices lack a sense of touch, Imbriglia said.

"What we have been unable to do thus far with prosthetics is to create that ability to feel, and that's why if someone amputates his hand, it's much better to sew it back on if you can because that hand has a chance to feel."

But if that can't be done, prosthetics users can become very skilled at working with what doctors and engineers have given them.

At Imbriglia's office recently, Arnold used his two-piece Greifer to delicately pinch and lift a penny.

But even with all his varied attachments, Arnold said, he probably uses his prosthetic only about 30 percent of the time.

"I wear it to do what I have to do and then I take it off," he said. "It's a tool."

Arnold and Ferber will need a lifetime of medical care.

Ferber said he would love to work again, to have a sense of purpose. But he not only has to find a job that can be adapted to his disability, but one that provides ample health benefits. In the meantime, he has applied for Social Security disability. Arnold lives on workers' compensation, which paid for his prosthetics.

Another necessity for both men: A sense of humor.

After demonstrating how he wears a sleeve with a locking pin to secure the prosthetic arm to his stump, Arnold remembered an earlier prosthetic arm that didn't attach so firmly.

"I'd be standing at the store ready to check out and my arm would just fall on the ground, and I'd just look up and say, 'Geez, I hate when that happens.'"