Learning to walk again


Craig Gambacini, of Naugatuck, demonstrates how he can kneel using a motorized prosthetic leg at New England Orthotics and Prosthetics in Middlebury Nov. 6. Looking on is Ian Duggan and Brad Scott, with Ossur. –RA ARCHIVE
Craig Gambacini, of Naugatuck, demonstrates how he can kneel using a motorized prosthetic leg at New England Orthotics and Prosthetics in Middlebury Nov. 6. Looking on is Ian Duggan and Brad Scott, with Ossur. –RA ARCHIVE

As Craig Gambacini bent to sit down, he lost his balance a little and plopped down into the chair.

Not good enough, he decided, and stood up again, his robotic knee emitting a high-pitched hum as it helped to lift him up.

Almost 25 years after he lost his left leg in a motorcycle accident, Gambacini, 62, of Naugatuck, has been fitted with a cutting-edge, computer-driven prosthetic knee and leg that uses the tiniest shifts in body movement to anticipate where and how Gambacini wants to move, and helps him do it.

“I’m really trying to retrain myself,” he said, rising, then sitting again in this medical office in Middlebury before adding he’s doing “pretty good” at it.

He’s actually doing much better than that, said John Burger, a certified prosthetist orthotist (CPO) at New England Orthotic and Prosthetic Systems (NEOPS). For someone who had favored his right side for the past two and a half decades, learning to walk normally again has been progressing quickly for Gambacini, Burger said.

Motorized prosthetic devices are not new. In fact, Gambacini for years has worn one in which an internal computer helped provide him a more natural gait.

The difference in this new, $48,000 robotic limb was described by an expert as the difference between a bicycle and a motorcycle.

This new device, a sleek and metallic piston-looking instrument, automatically adjusts its motion based on microscopic movements of Gambacini’s hip. His previous device’s computer had to be adjusted manually in the NEOPS office.

This is important because older prosthetic legs move in a pendulum fashion; Gambacini needed to step hard on his right leg in order to activate the “swing” in the old prosthetic knee joint. This new one swings pretty much on its own.

Second, it’s the first such device to provide lift. When Gambacini moves to stand up, the robotic knee responds and helps push him up, just like a real leg would.

“It’s really just an extension of his body,” NEOPS COO Mac Hanger said. “It’s not wired into his brain. It’s responsive to the forces of the muscles above it in the socket.”

In fact, it’s so much like a real leg that Gambacini’s challenge isn’t so much getting used to a new prosthetic as it is learning to walk the way he used to before he lost his leg.

“It’s not really hard to learn … but after 20 years of the old one, I keep going back to the old way,” Gambacini said.

The robotic knee was developed by an Icelandic company called Ossur, and is being pioneered in Connecticut by NEOPS. In fact, Gambacini is only the second amputee in the state to have one, Hanger said.

But Hanger — whose great grandfather pioneered prosthetic limbs after losing his own leg in the Civil War — said he sees the robotic limb as being beneficial to many amputees.

Most amputees, Hanger said, are older than Gambacini and lost their legs due to circulatory problems and diseases like diabetes.

Their age and missing limb affect their balance, he said.

“One of the biggest problems an amputee faces is falls,” he said, adding it’s cheaper and more productive to spend close to $50,000 on a robotic knee than to spend more than twice that repairing a broken hip after a fall.

The challenge, he said, is to get insurance companies to see it that way.

“Most insurance companies will consider paying for it, given the right medical documentation, the right clinical outline,” he said. “If a person can benefit from it, most insurance companies, including Medicare, will pay for it.”

Gambacini is a veteran, so his medical expenses were covered by the VA.

The robotic knee isn’t the only newfangled prosthetic NEOPS is introducing to the state.

Through a partnership with the Massachusetts Institute of Technology, it has introduced an innovative arm brace that restores movement for people who have lost mobility, such as stroke victims.

Worn on the arm like an exoskeleton, it works similar to Gambacini’s new knee in that it uses tiny movements of the back and shoulder to anticipate where the patient wants to move the arm.

Hanger said that for some stroke victims it can restore the ability to feed themselves, carry grocery bags or, again, just retain their balance and center of gravity.

The other benefit to the knee device and arm brace is more emotional, but just as tangible. Studies show, Hanger said, that the more a prosthetic provides a return to a more natural, normal life, the emotional lift it gives people has a positive effect on their health. It makes them less prone to strokes, heart attacks and depression, he said.

“When people become independent and functional and mobile again, we get to witness a complete change in their personality,” he said.

Hanger added, “They come in to our office depressed with a low energy level just beaten down by life, by the trauma they faced or the disease they faced. As they get up on a prosthesis, particularly these new ones with more responsive technology, you can see hope return to their eyes.”