Two area amputees fitted with bionic ankles

GRAND FORKS - Wyatt Halvorsen strode effortlessly down a hallway with a gait so even and natural that, if you didn't see it, you wouldn't know he was walking on a man-made foot and ankle -- a device so technologically advanced, it provides energy like his own lower leg once did.

The 35-year-old rancher from rural Northwood, N.D., was trying out his new motorized BiOM Ankle System at Altru's Rehabilitation Center in Grand Forks. At the end of the hallway, Brian Frasure, an employee of the company that makes the device, was "tuning" it specifically for Halvorsen. He adjusted the settings that control ankle stiffness, power, timing and "slow walk" on a computer-programmed tablet.

Halvorsen lost part of his right leg, below the knee, 13 years ago in a forklift accident.

He and Kevin Moyer, a farmer from Warroad, Minn., are the first recipients in the Upper Midwest to be fitted with the state-of-the-art prosthesis that replicates the function of the muscle and tendon. It is designed to reduce fatigue and pain, improve stability and balance, and improve overall quality of life.

"That's outstanding," Halvorsen said. "I don't feel like I'm vaulting."

What makes the BiOM ankle unique is its ability to push up and propel the user forward, hence the need to specially program the device based on the movement and physical characteristics, such as height and weight, of the individual.

"With its motors and sensors, it automatically propels you," said Paul Edman, manager of prosthetics/orthotics at Altru. "The energy is coming from the battery, not the body."

Meanwhile, Moyer, 35, went through the paces, walking at varying speeds up and down the hallway with his bionic ankle.

"I think it's too much," he said. "It seems like it's pushing me forward."

"Pushing you forward, not picking you up?" asked Frasure, a certified prosthetist, as he touched the tablet screen.

"Is it fluid?" asked Ken Gaulke, certified prosthetic technician at Altru, motioning smoothly with his hand.

"Yeah, it's fluid," Moyer said.

Like Halvorsen, Moyer lost his lower right leg below the knee in a 2005 construction accident and, coincidentally, is also married and the father of two young children.

Since losing his lower leg eight years ago, he has gone through several prostheses. Most were "passive" models which, instead of propelling him, tended to "shock or slap you, heal to toe," with each step.

"There's a night-and-day difference," he said of the BiOM. "It's a lot smoother to walk on than the others... Everything will be different. Every day-to-day life activity will be easier, I think.

"I've been waiting for his day."

Early test

About four months ago, Edman arranged for a representative of iWalk -- the company that makes BiOM -- to try the ankle on Halvorsen and Moyer in Grand Forks.

"It was the least amount of work I've ever done walking on a prosthesis," said Halvorsen, a prosthetics-orthotics technician at Altru.

His experience was "unbelievable," he said. "It's like nothing was there. It was more like the feeling of having my foot back than I've had since I lost my leg."

In comparison, his old prosthetic "was like walking on a 2-by-4."

He and Moyer didn't want to give the device back.

'Exceptional candidates'

These men are "exceptional candidates" for the technology, said Edman. "They are young, physically fit and have a reasonable BMI (body mass index).

"Both are 'crazy-active' -- they are rough. They'll find out what it's made of," feedback the company will welcome, he said. "They can tell me if something's not working in language I can understand."

Also "they can actually program this from a smart-phone."

Frasure agreed that being active is a plus, as well as the fact that "they vary their walking speeds and walk on uneven terrain a lot.

"They would each benefit from increased range of motion and increased energy return" the device will give them, Frasure said.

With traditional prostheses, amputees "feel like they're walking on a stick and dragging it along -- almost like an anchor," Edman said.

An amputee expends about 25 percent more energy in walking than if he or she had the use of both legs, he said. "Imagine your workday being 25 percent longer than it is -- how tired (you'd be) at the end of the day."

He said BiOM ankle inventor, MIT's Dr. Hugh Herr , himself a double-amputee, succeeded in making the sensors "small enough and light enough and the motor strong enough to propel a couple-100-pound person.

"The technology caught up to the dream."

Because the number of amputee patients is "so small," Edman said, "everything's kind of slow coming to prosthetics. It's good to see these guys are getting the attention they deserve."

Halvorsen and Moyer "should get payback in (more) energy and (less) wear-and-tear on the other (normal) leg," Edman said. "When you lose a leg, the other leg takes a beating. There's significant impact on the remaining limb. The last thing you want is total knee or total hip (replacement).

"It's more than just how well you walk. It's an investment in overall health."

First recipients

On May 29, Moyer and Halvorsen became the first in the region to be fitted with the BiOM ankle, according to Altru. The region includes North Dakota, Montana, Minnesota, South Dakota and Wisconsin.

Each will use the tablet, provided with the BiOM ankle, to adjust their personal settings themselves, depending on the speed they're walking and surface conditions. They each received three batteries to power the device -- each is good for about 2,000 prosthetic steps (or 4,000 regular steps) and will signal the user when a few hundred steps remain.

The average American takes 6,000 to 6,500 steps a day, Frasure said.

On uneven terrain, amputees feel unstable and unbalanced, he noted. "It's a true risk factor."

So far, iWalk has worked primarily with Department of Defense and Veterans Affairs clients, Frasure said. It is in the process of acquiring an "L" code, which Medicare uses to assign reimbursement value to prosthetic technology.

Future demand for the device "will depend on the reimbursement side of it," he said. "It's always a question of: How will health care reform affect this?"

The suggested retail price for the BiOM Ankle System is $70,000, Frasure said. But as the technology ages and the number of users increases, the device will become more affordable.

Coverage "through independent or private insurance companies is more of a challenge," Frasure said.

"A lot of insurance companies don't have policies on it yet; it's too new," Edman said.

"If you're only using a prosthetic for transferring from bed to chair, or other limited use, it probably won't be covered," he said.

"Insurance companies are reviewing it and Medicare is looking at it" to determine who would qualify for coverage, he said. "Obviously, it's expensive. That's a tough thing."

Prospective recipients will have to fall into a "functional level" that's high enough to qualify for coverage or to justify the cost, he said.

Frasure expects more people will have access to the technology in the future.

"As long as (the device) is enhancing performance," he said, and it proves effective in reducing the costs of osteoarthritis, hip and knee joint replacement and pain management, it will make more sense for insurance companies to cover its use.

Excited to use it

Halvorsen is anxious to try his new ankle on his next pheasant-hunting trip this fall, he said.

Moyer is also excited too, he said.

"I can't wait to try this out elk-hunting, on horseback, in Montana. That's where I'll be in October."

This will be his first elk-hunting trip since he lost his leg, he said.

Halvorsen is looking forward to the benefits that he hopes to see daily.

"I'm going to be a lot less tired at the end of the day."

He hopes to try jogging again, he said, and is looking forward to more fun with his children, Holden, 3, and Corbyn, 9 months.

"I know I'll be able to keep up with them better."