Staff Sgt. James Sides, who lost his arm in Afghanistan, is the first person to receive an implantable myoelectric sensor that allows him to operate his prosthetic arm with the remaining muscles in his arm. (Mike Morones/Staff)
A year after an improvised explosive device pulled him from the front lines of the battlefield, a Marine staff sergeant stood on the front line of medical science, becoming the first patient to receive an implant that allows him to operate his prosthetic arm with his upper arm muscles.
Staff Sgt. James Sides, 31, an explosive ordnance disposal technician with five deployments under his belt, was wounded in Afghanistan on July 15, 2012, when an IED detonated underneath him. Despite the blast, which cost him part of his right arm and the sight in his left eye, Sides never lost his optimism and courage, qualities that made him a perfect candidate for a prosthetic technology that has been in development since the war began.
Called the implantable myoelectric sensor (IMES), the system uses sensors the size of rice grains to communicate with the muscles in an amputee’s upper arm. Once these sensors are surgically implanted, they allow the muscles to manipulate a prosthetic, giving the patient greater ease of movement and much wider range of motion than conventional prosthetics.
The IEDs deployed against coalition troops in Iraq and Afghanistan resulted in a sharp increase in upper-body amputations, with about 20 percent of all American war zone amputees losing an upper limb, said Dr. Paul Pasquina, the principle investigator and chairman of the Department of Physical Medicine and Rehabilitation at the Uniformed Services University of Health Sciences in Bethesda, Md. This new need highlighted some of the problems with the technology available to help patients with these kinds of injuries: The external myoelectric prosthetic, which picks up signals from the skin, can be unreliable and constricting, and doctors see a high abandonment rate among users.
“Obviously, our commitment is to improve independence but also to help support the highest quality of life,” he said.
Pasquina, a retired Army colonel, joined forces with the Alfred Mann Foundation, a research organization that had filed a patent for the technology behind the IMES system in 2001. After getting a series of approvals, they approached the staff sergeant with the opportunity to receive the new system.
Sides, who started wearing prosthetics only months after his injury, jumped at the chance to be part of the study, and they scheduled the operation for June 2013 at Walter Reed National Military Medical Center in Bethesda. Because the doctors needed to make sure the implants were functioning properly, he had to stay awake for the two-hour procedure.
“The surgery room looked like a concert, everyone was there,” Sides said. “I had to watch it; it was pretty gnarly. Sometimes it was like, ‘Oh, this is cool, I’m watching a TV show.’ Then I remembered it was me.”
But everything went well, and he was enjoying pizza and beer later that night. He received his new prosthetic two weeks later.
The system allows Sides to use three ranges of motion in his prosthetic arm and hand simultaneously: open and close, rotate and thumb movement. His old myoelectric prosthetic would stop responding when his skin got damp or when he reached too far, and could only handle one range of motion at a time.
“Waiting in line at the grocery store and at the ATM, I felt like I was being rushed before,” he said. “I can do things faster now. It’s just a quality of life thing.”
The most exciting developments may be yet to come. The IMES system means medical advancement for amputees have outpaced the prosthetic technology available, Pasquina said. Sides has eight implants offering three ranges of motion; in theory, a more advanced prosthetic could offer him a fourth range of motion. In the future, doctors may also be able to implant the myoelectric sensors in the limbs of amputees during initial surgery after their injury, minimizing invasive procedures and the time needed to adapt to a prosthetic. Implantation of the devices could also become a clinical outpatient procedure.
A Defense Department grant is pending to develop an IMES system for lower-limb prosthetics, he said.
“What we see on the horizon is a system that has better capabilities than the current system has ... better degrees of freedom, more rapid sampling rates,” said David Hankin, chief executive officer of the Alfred Mann Foundation. “We’re working on that right now.”
Meanwhile, Sides will remain in the study examining the effects of the new system for two years, returning to Walter Reed for tests at six-month intervals. The second patient to receive the IMES system, also a service member, is expected to undergo the procedure later this month.
So far, the news is all good: Sides has more than doubled his performance on motor skills tests, such as sorting small blocks into boxes, since receiving his new prosthetic.
“The real test of any technology is how useful this is, day in and day out, moving on with his life,” Pasquina said. “(Sides will) send us little video clips of himself barbecuing or hanging out with his fiancee.”
Sides will get out of the Marine Corps on March 30 to pursue a degree in geology. He said he urges encouraged the wounded troops who may come after him to embrace opportunities and find ways to stay active.
Pasquina said Sides’ willingness to be the first to try out a prosthetic system that could help future amputees shows the qualities that made him a hero in the Marines.
“When you talk about somebody with courage, and somebody that wants to help his team, he’s the guy that signed up with the Marine Corps to go and deactivate bombs. You can’t get more courageous than that,” he said. “He’s going out and putting himself at obviously some risk to better the lives of others. This is obviously in character with the type of person that he is.”■