611 W. Union Street
Benson, AZ 85602
(520) 586-0800

Health Choice Integrated Care crisis Line

AzCH Nurse Assist Line


611 W. Union Street
Benson, AZ 85602
(520) 586-0800

AzCH Nurse Assist Line


powered by centersite dot net

Getting Started
Here are some forms to get started. These can be printed and brought with you so that you can pre-fill out some known info ahead of time. More...

Medical Disorders
Basic InformationLookupsLatest News
Runaway Immune System May Play Role in Chronic Fatigue SyndromeMigraine's 'Silver Lining': Lowered Risk for Diabetes?Health Tip: Use Medical Devices SafelyFast Facts for Men (and Women) About High CholesterolDon't Let Holiday Season Stress Worsen Your Allergies, AsthmaSave Your Skin From the Ravages of Cold WeatherA Family Tragedy Highlights Carbon Monoxide DangerAHA: Thyroid Problems Linked to Worsening Heart FailurePhysical Therapy Can Help You Avoid Opioids When Joint Pain StrikesHealth Tip: Understanding Blood ClotsCould You Have Silent Gallstones?New Disease-Bearing Tick Set to Spread Throughout United StatesObesity to Blame for Almost 1 in 25 Cancers WorldwideEczema Can Drive People to Thoughts of Suicide: StudyHispanics Bear Brunt of Exposure to Workplace Hazards: Study'Experience to Share': Facebook Page Helps Families Hit by Polio-Like IllnessHospitalizations Rising Among the HomelessAnimal, Bug Bites a Billion-Dollar BurdenHidden Dangers in DustCould You Be Short on Vitamin D?AHA: New Report Emphasizes Safety of StatinsKidney Disease More Deadly for MenMore Illnesses From Tainted Romaine Lettuce ReportedMillions of Americans Still Breathing Secondhand Smoke: ReportKidney Disease Claiming More LivesHealth Tip: What to Do If You Suspect a ConcussionMany Americans Unaware of Promise of Targeted, 'Personalized' Medicine: PollAn App, Your Fingernail -- and Anemia Screening Is DoneAHA: Hearts From Unusual Donors Could Help Meet Growing Transplant DemandGene Therapy for Sickle Cell Takes Another Step ForwardFew Americans Have Optimal 'Metabolic Health'Most Americans Lie to Their Doctors1 in 10 Will Develop Eczema in Their LifetimeMany Cases of Polio-Like Illness in Kids May Be MisdiagnosedHealth Tip: Limit Exposure to BPAFirdapse Approved for Rare Autoimmune DisorderSecondhand Pot Smoke Can Harm an Asthmatic ChildAsian Longhorned Tick Is Invading United StatesNew Surgery Gets Amputee Moving Again -- Without the 'Phantom Limb' EffectClimate Change Ups Heat Deaths, Especially Among Elderly: ReportAHA: Infections May Be a Trigger for Heart Attack, StrokeWhat Couch Potatoes Don't Know Can Hurt ThemParkinson's Gene Therapy Wires New Brain CircuitsWhat's Best for Babies With Recurring Ear InfectionsNext for Disabling Back Pain? New Discs From Patients' Own CellsFreeze-Dried Vaccine May Help Rid World of PolioJust a Little Weightlifting Can Help Your HeartNerve Zap Might Ease Pain of Herniated DiskA 'Hypoallergenic' Dog? You May Be Barking Up the Wrong TreeAfter a Spouse's Death, Sleep Woes Up Health Risks
Questions and AnswersLinksBook Reviews
Related Topics

Men's Health
Women's Health

New Surgery Gets Amputee Moving Again -- Without the 'Phantom Limb' Effect

HealthDay News
by By Dennis Thompson
HealthDay Reporter
Updated: Nov 29th 2018

new article illustration

THURSDAY, Nov. 29, 2018 (HealthDay News) -- Climbing enthusiast Jim Ewing lost his left foot in the aftermath of a 50-foot fall off a Cayman Islands cliff.

But Ewing is scaling rock walls again with the aid of a robotic ankle and foot he works as well as his former flesh-and-blood version, thanks to a groundbreaking amputation procedure that eliminates the "phantom limb" effect. That's a disorienting side effect that makes it hard for patients to work their prosthetic limbs properly.

This August -- a little more than two years after his amputation -- Ewing successfully tackled the Lotus Flower Tower, a renowned 8,430-foot peak located in the Northwest Territories of Canada.

"When I'm connected to the robotic ankle, I can use it as if it's my very own," said Ewing, 54, of Falmouth, Maine. "It's a very natural transition going from no foot to all of a sudden having my foot back. I don't have to retrain my brain or retrain my muscles to do anything. It's pretty much a one-for-one replacement."

Losing a limb causes many disconcerting effects, as the brain tries to interpret signals from an arm or leg that's no longer there.

One of the oddest might be the fact that not only do people feel as though they have a phantom limb, but that limb's position in their mind often doesn't match the location of their prosthetic replacement.

"They can perceive a foot that is somewhere in space, but oftentimes is disembodied," said lead researcher Dr. Matthew Carty, director of the Lower Extremity Transplant Program at Brigham and Women's Hospital in Boston. "It doesn't map geographically to where their prosthetic foot is. It's kind of floating to the side, or they may feel it's encased in a hard block and they can't move it."

These misleading signals can make it difficult for amputees to learn how to work a prosthetic limb properly.

New surgery erases disconnect with prosthetic limb

In July 2016, Ewing became the first person to undergo an amputation procedure designed to eliminate this disconnect.

Named after him, the Ewing Amputation recreates the normal tug-and-stretch relationship of muscles that occurs during normal movement of legs or arms.

When you move a limb, muscles on one side contract while muscles on the other side stretch, Carty explained. For example, when you lift a foot off the ground and move your ankle around, you'll feel muscles on both sides of your leg moving back and forth.

Researchers have learned that as they work, the muscles are sending constant signals to the brain's proprioceptive sensory system. Proprioception is your ability to know the exact position of your limbs at all times, allowing you to precisely coordinate their movements.

"It transmits information back to our brain where the limb is in space without us having to look at it," Carty said.

Traditional amputation screws up these signals by decoupling the muscles, Carty said. The lack of push-and-pull muscle feedback confuses the brain, creating misleading perceptions of a disembodied phantom limb.

A Ewing Amputation recreates the push/pull dynamic by surgically connecting muscles that normally operate in pairs, forcing one muscle to stretch in response to the other muscle contracting.

Fed the normal muscle signals, the brain is better able to make a person's perception of their lost limb line up with their new prosthetic, Carty said.

"The phantom limb the patient perceives maps geographically over their prosthetic device," Carty said. "When they think about moving their phantom limb, their brain superimposes that phantom limb over the prosthetic limb."

Amputees also often feel sensations of itching or pain associated with their phantom limb, as the brain struggles to make sense of discordant signals. The Ewing Amputation appears to prevent those sensations, the researchers added.

Success with procedure grows

Since Ewing, doctors have performed this amputation procedure on 11 more patients, Carty said. Ten lost their leg below the knee, and one lost their leg above the knee.

"At this point, we have enough data to say we think we've figured out a better way to do amputations, and we're in the process of testing that in a variety of different clinical scenarios," Carty said.

The research team has received funding to develop the procedure for arm amputation as well, Carty added.

Ewing had his climbing accident in December 2014, and at first, the damage to his left ankle was the least of his worries. He had life-threatening injuries throughout his body that required emergency treatment.

However, the ankle failed to heal properly during two years of recovery, remaining painful and swollen, Ewing said. A CT scan revealed that most of the bone in the ankle had died.

"It was not going to heal and recover," Ewing said. "It was not likely I would ever regain use of the foot, so I opted to have it amputated."

Carty had been working with a team at MIT to create a robotic limb that would work in conjunction with the new transplant procedure his team had dreamed up. It just so happened that a friend of Ewing is a lead researcher at MIT, who put him in contact with Carty.

But special surgery not for every amputee

This sequence of events points out one drawback to the new procedure, said Dr. Ageliki Vouyouka, an associate professor of surgery and radiology at the Icahn School of Medicine at Mount Sinai in New York City.

The procedure uses tissue harvested from the amputated limb to create the new connections between muscle groups, Vouyouka noted. Given this, people who lose limbs damaged by gangrene, poor blood flow or other diseases that kill off tissue would likely not be good candidates for the Ewing Amputation.

But the new procedure is a "very interesting development" that is likely to become a new standard for amputation if further testing bears it out, said Vouyouka, who was not involved with the research.

"Mostly I can see that happening for limbs lost to war trauma or civilian trauma," she said.

The new amputation procedure has provided other benefits on top of easier adaptation to his prosthetic foot, Ewing said.

"The muscle definition is much stronger. There's much more tissue there. My leg hasn't atrophied away to skin and bones, which happens quite a lot with amputations," Ewing said.

"The thinking is the residual limb is healthier because there's all this active muscle tissue there. You have improved circulation, more muscle tissue for padding and all of that," he said.

The study on Ewing's case was published recently in the online journal PRS Global Open.

More information

The Mayo Clinic has more about phantom pain.