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From Disability to Hyper-Ability?
By Brady Delander Rapidly advancing technology blurs the line of equality in competition.
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South Africa's Oscar Pistorius (left) competes next to Italy's Marco Moraglio in a mens 400m race. Pistorius has magnified the debate about whether or not technological advances in prosthetics have provided disabled athletes an unfair advantage over whole-bodied athletes. ALBERTO PIZZOLI/AFP/Getty Images. |
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Months after his leg was literally torn away from his body, Brian Bartlett took his first steps with a new prosthesis. Though he still had open wounds and was connected to a morphine drip, Bartlett wanted to get back on his feet and pressured his prosthetist to get him into a socket as quickly as possible. About 20 feet into his planned walk around the block, blood was dripping down the prosthesis, and Bartlett thought he might pass out.
"I was in so much pain," says Bartlett, who in 1998 was struck by a car and pinned against another, an accident that took his leg. "I'll never forget that. It was horrible, and to go from my own leg into this prosthesis was such a letdown."
Bartlett, inventor of the Bartlett Tendon after the accident and a professional freeskier before it, put himself through the excruciating process in an effort to get back to his aggressively active lifestyle and some sense of normalcy.
(Editor's Note: See sidebar "
The Bartlett Tendon
")
In the year following his accident, Bartlett was flying down the slopes at 70 mph, catching 150 feet of air, and skiing off 40-foot drops into the powder below. Impressive, for sure, but Bartlett was doing all of this on one leg, with one ski and a set of poles. "Yeah, but the able-body guys were going about 80 mph," Bartlett says nonchalantly.
No Advantage
Necessity dictated Bartlett design his own prosthesis. There was nothing on the market that could withstand the rigors of his jaw-dropping, high-flying, hard-impact aerial stunts, whether on snow or the rock and dirt tracks carved out for downhill mountain bike racing. However, even as the eighth prototype of his namesake tendon allows him to compete against and beat some of the top whole-bodied downhill racers in the world, he says it is certainly no advantage.
A top-notch athlete before the accident and after, Bartlett takes umbrage at the theory that today's rapidly advancing prostheses provide an edge for disabled athletes competing in the whole-bodied arena. "It takes so much physical strength and balance just to walk with a prosthesis; that supersedes any benefit," Bartlett says. "For people to say you have an advantage, I just don't buy it."
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Brian Bartlett takes a break from downhill riding to show off the Bartlett Tendon. Photo by Timmy Corkery. |
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Bartlett's friend and fellow athlete Jason Lalla, CP, Next Step Orthotics & Prosthetics Inc., Manchester, New Hampshire, offers a proposal to anyone who believes in the growing debate about sophisticated prostheses turning athletes from disabled into too-abled.
"My initial sarcastic comment to this notion of someone being too-abled was, if anyone wants to sign up for an amputation to test the theory, here's my card," says Lalla, a transfemoral amputee like Bartlett. "I just don't see any legitimacy to it yet."
Yet
might be the key word. The debate about "techno-doping," which South African sprinter Oscar Pistorius recently brought to the spotlight, could be heating up now in order to avoid a meltdown in the near future. The International Association of Athletics Federation (IAAF) is in the process of testing Pistorius' Cheetah® Flex-Foot® running legs to determine if he can compete against whole-bodied athletes at the 2008 Olympics in Beijing, China.
It should be noted that the IAAF is not obligated to examine the Pistorius matter.
Science vs. Emotion
Pistorius, a sprinter who owns three world records for disabled athletes, is the poster boy for the "trans-human" debate. The IAAF said his prostheses might provide an unfair advantage over sprinters with natural limbs, pointing to lesser wind resistance as one possible factor. The federation is currently testing Pistorious' legs and will soon decide if he will be allowed to compete. Public opinion seems to favor Pistorius, as 68 percent of respondents to a recent WashingtonPost.com poll said he should be permitted to compete against whole-bodied athletes. But science is not a party to emotion, and therein lies the rub.
"Where do you draw the line?" asks Randy Alley, BSc, CP, FAAOP, CFT, president of biodesigns inc., Thousand Oaks, California. "Common sense says that people with a below-the-knee amputation will actually be able to, at some point in the future, surpass the world records of able-bodied athletes. With energy storage and lighter limbs, it seems more than possible."
As for now, however, most of the O&P professionals who were asked agreed that the technology isn't there. "As much as we would like to think that our systems are superior to what we are born with, we simply are not there yet," says Kevin Carroll, MS, CP, FAAOP, vice president of prosthetics for Hanger Orthopedic Group Inc., Bethesda, Maryland. "The modern prosthetic system of today has the ability to store and release energy, but it's not like your natural leg."
Not even close, according to athletes and as described by an expert in the field. In Pistorius' case, he can't push out of the blocks like a whole-bodied sprinter would. Instead, he uses his hip muscles to pull himself forward. The Flex-Foot provides an 80 percent to 85 percent return of energy. The natural human leg offers an energy return as high as 250 percent; however, these numbers have been disputed by some scientists (
scienceofsport.blogspot.com/2007/07/oscar-pistorius-science-and-engineering.html
).
Expending Extra Energy
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Mark Eberhart, a transfemoral amputee, rides the rapids in his kayak, one of many extreme sports in which he competes. |
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Those who actually use a prosthesis in competition tend to agree that an artificial limb—even a lightweight, highly advanced carbon fiber model—doesn't propel a runner forward or reduce the amount of energy expended, as some have contended.
"Did you know that it takes more energy for an amputee to do a race? We use 40 percent more energy and twice the oxygen," says Sarah Reinertsen, a transfemoral amputee who competes in Ironman events and other competitions. "My doing the Ironman in Kona, [Hawaii], in 2005, it took more energy than an able-bodied athlete—it was as though I did it twice. How can anyone have an advantage when they are missing a leg?"
Rather than looking at a technologically advanced prosthesis as an advantage over whole-bodied athletes, Reinertsen and others said prostheses merely give amputees and those with limb loss a chance to compete on a nearly level playing field. There is no added benefit when the amputee athlete's starting point is taken into account.
"You literally have to learn to walk again," Lalla says. "You have to retrain muscles that have been bisected. You have to learn how to fire those muscles in a different manner. Depending on the situation, there is other trauma to deal with, like skin grafting or calcium overgrowth."
Pushing Harder
The Bartlett Tendon
Simon Lawton first met Brian Bartlett, fittingly enough, on a mountain bike trail. Lawton, a professional downhill rider, quickly realized that Bartlett couldn't stand up on his bicycle. A transfemoral amputee, Bartlett's prosthesis limited him to the saddle-not an ideal situation in the daring and dangerous sport.
"If you can't stand up, you are really at the mercy of the bicycle," Lawton says. "You can't stand and climb hills; you can't absorb bumps. It's a huge problem."
Bartlett, who continued his extremely active lifestyle after his leg was amputated in 1998, couldn't find a prosthetic leg that allowed him to do the things he wanted, which included skiing off the side of mountains.
"There aren't any prostheses out there than can take a 40-foot drop," Bartlett says. "Except for mine.... When I first started looking, people just told me that I was crazy and to give it up, to go without a prosthesis. There simply weren't any prostheses that could take these kinds of hits. So I built my own."
The prosthetic market was loaded with quality "bone frames," but Bartlett needed some muscle and tendons. Enter the Bartlett Tendon. Bartlett built what amounted to an MCL and ACL out of different durometers of rubber and attached them to his artificial leg. Now on his eighth design, the Bartlett Tendon allows the prosthesis to recover from a bent-leg position. It is so sturdy, Bartlett plans to test it out on base jumps, essentially cliff-diving with a parachute. His creation also stands up to the dirt and mud that goes with downhill mountain bike racing.
Bartlett, who has absorbed the cost of his invention from the first day, has started lending out his design to other active amputees, including prosthetist Jason Lalla, CP.
"We are the only guys in the world who can stand and sprint [on a bicycle] without a knee," Bartlett says. "This design allows you to do that."
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Add to that list the development of core strength, balance, and a comfortable fit in the socket. Also consider that the amputee athletes competing at the highest levels are just that—athletes. Pistorius must possess the same fast-twitch muscles that all world-class sprinters have. The major difference between the whole-bodied athletes and those who use prostheses could be something that isn't visible.
"As an amputee, pushing yourself above and beyond is second nature," Lalla says. "There is a lot of work ethic involved—that heart and desire and drive behind it. Once you get that smell of blood, when you start pushing the people with no disability, that's motivation."
Unseen desire is perhaps the greatest equalizer. But rapidly advancing technology cannot be ignored, nor can the human urge to be the best. Online blogs have proposed that a prosthetic "arms race" could take place, with athletes pushing for artificial limbs that will put them atop the winner's stand no matter what the cost. Even if that means amputating perfectly healthy limbs in order to do it, though that notion seems far-fetched.
"I think it would be the one-in-a-million eccentric person who might do it. They could head off to a Third World country for an amputation and come back and say they got hit by a train or something to get the stuff," says Mark Eberhart, another
athlete and transfemoral amputee who has tested out the Bartlett Tendon. "As for an advantage with a prosthesis, it all comes down to materials technology. For a high-level amputee athlete, it comes down to materials combined with sheer determination. If Brian had both legs and the same level of desire, he might beat every rider out there."
Engineers will always look for ways to improve their designs. Just as in auto or bicycle racing, equipment improves, advances are made, and those trailing the leader are forced to play catch-up. If there is an advantage to be had when it comes to equipment, someone will pursue it.
"Look at Lance Armstrong," the seven-time winner of the Tour de France, says Randy Schmitke, CPA, MBA, CFO of O&P Digital Technologies, Gainesville, Florida. "He is meticulous in building his bikes. The way he approaches it is just amazing, and I'm sure he shaves off a few seconds just by the design of his bike.
"Engineering drives the competition in sport. With disabled athletes, the equipment is at one with the body. My feeling is that there is some advantage there just because of the technology involved."
Going Downhill Fast
As for Bartlett, who competes for Fluidride and Iron Horse at the top amateur level in downhill mountain biking, he can't seem to slow down now that his prosthesis can keep up. He earned a spot on one of the best downhill teams, and he competes against some of the best, and whole-bodied, racers in the world. Bartlett understands competition as a whole-bodied and a disabled athlete, and, like Reinertsen, he says his prosthesis offers no advantage when he is zipping down the track; it merely allows him the opportunity to do it. "As an amputee, I was searching for that human feel. I knew the feeling I was searching for; it was just a matter of finding it," Bartlett says. "With that feeling in place now with the latest design, I know I can compete against anyone."
Bartlett hasn't experienced the level of scrutiny in the downhill racing world that Pistorius has in track and field. If anything, whole-bodied competitors are more in awe of Bartlett than anything else, though they would never admit as much.
"There is a lot of attention drawn to him just because of the nature of his situation," says Simon Lawton, who is a professional downhill racer and the owner of Fluidride. "But once the other riders see how competitive Brian and Jason [Lalla] are, their focus turns to trying to beat those guys. People are blown away&. We would love to get to the point where people accuse Brian of cheating. That's a sure sign of success."
Brady Delander can be reached at brady@opedge.com
The Sources
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Randy Alley, BSc, CP, FAAOP, CFT
Alley is the president of biodesigns inc., Thousand Oaks, California. He is the designer of the widely used Anatomically Contoured and Controlled Interface (ACCI) and XFrame prosthetic interface systems and was instrumental in preparing Department of Defense (DoD) personnel with addressing the prosthetic needs of wounded soldiers returning from the Afghanistan and Iraq conflicts.
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Jason Lalla, CP
Lalla is a prosthetist for Next Step Orthotics & Prosthetics Inc., Manchester, New Hampshire, and transfemoral amputee. Also an athlete, Lalla is known for his speed in downhill mountain bike races.
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Brian Bartlett
Bartlett invented the Bartlett Tendon out of necessity after he was unable to find a prosthesis that could withstand his extreme sporting lifestyle. He is one of the top amateur downhill mountain bike racers, disabled or not.
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Sarah Reinertsen
A transfemoral amputee, Reinertsen competes in Ironman competitions. More information can be found at her website:
www.AlwaysTri.net
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Kevin Carroll, MS, CP, FAAOP
A researcher, educator, international speaker, and clinician, Carroll is the vice president of prosthetics for Hanger Orthopedic Group. A lower-extremity expert, Carroll sees up to 100 patients across the country every week.
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Randy Schmitke, CPA, MBA
Schmitke is the CFO of O&P Digital Technologies, Gainesville, Florida, and an avid bicyclist.
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Mark Eberhart
Eberhart is a transfemoral amputee who volunteers his time at the Walter Reed Army Medical Center in Washington DC. A snowboarder, mountain biker, and runner, he also works with Team River Runner, an organization established by kayakers that helps amputees rehabilitate with aquatic therapy.
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Simon Lawton
Lawton, the owner of Fluidride, a retail bicycle shop and competitive racing team, is a professional downhill mountain bike rider and considered an expert on human movement.
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Table Of Contents - October 2007
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