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VA fits amputee with advanced mechanical arm

Former U.S. Army Sgt. Hilario Bermanis II, a triple amputee, takes a break alongside his scuba diving instructor during the National Disabled Veterans Winter Sports Clinic in Snowmass, Colo., April 2, 2007.

WILLIAM D. MOSS/DOD

By WILLIAM COLE | The Honolulu Star-Advertiser | Published: February 20, 2015

HONOLULU (Tribune News Service) — Just two days after getting a new high-tech prosthetic left hand and forearm, Iraq War triple amputee Hilario Bermanis II can pick up an M&M between thumb and forefinger, and he's pretty happy with that.

The 32-year-old Army veteran wraps his hand around another with just the right amount of pressure for a handshake. His newly mobile mechanical fingers can operate a pump water spray bottle.

Flash the shaka? He can do that.

"I went today to an ATM machine, right?" Bermanis said Thursday, mimicking the movements with his black-clad hand. "So I punch in the numbers, and I grab my money and put it in my pocket and press the numbers again."

Asked whether he could do that with his last prosthetic hand, Bermanis said, "No way. But this one — you can."

He demonstrated the new hand at the VA's outpatient therapy program on the grounds of Tripler Army Medical Center.

The former 82nd Airborne paratrooper doesn't want to talk about the 2003 rocket-propelled grenade attack that claimed his arm and both legs and killed a fellow soldier, but he doesn't mind talking about his new $45,000 i-limb ultra revolution.

Its maker, Touch Bionics, says it "offers more dexterity and moves more like a natural hand than any other powered prosthetic hand."

To an amputee "it's like heaven," said Bermanis, who's from Pohnpei in the Federated States of Micronesia.

It's the first such prosthetic hand and arm provided by the Department of Veterans Affairs in the state, and a sign of the VA's ongoing commitment to provide the latest technology for veterans like Bermanis, officials said.

The VA Pacific Islands Health Care System said it brought prosthetist Herb Nie­huus to Hono­lulu in January 2014, and he and others have traveled to neighbor islands and Guam to provide specialized prosthetic care.

Niehuus, who works for the VA on the Tripler grounds, estimates there are about 500 amputee veterans under VA care in the Pacific. Most of those he sees are combat vets, he said.

"Right now we're seeing mostly VA veterans," but the VA prosthetics program is expanding to include active-duty service members, Nie­huus said.

"We just got our first consult for an active-duty (serv­ice member)," he said. "So we're making that transition. We're building the program up to accommodate active duty as well as our veterans."

Niehuus designs, measures, casts, fits and adjusts prosthetics — right down to the green-and-black design on Bermanis' manufactured forearm with his last name running down the side.

In the first six or seven months, the new effort saved the VA about $700,000 compared with the former cost of outsourcing prosthetics, Niehuus said.

"I'm trying to bring in the highest technology for these veterans if it can help them get a better quality of life," Niehuus said, adding that "the technology is really advancing. It's constantly getting better and better."

The i-limb ultra revolution has five different motors in each finger, while past prosthetic hands might have had a simpler thumb-and-fingers pinching ability, Niehuus said. Each finger bends at the natural joints.

"The hand functions on a lot of different levels, so like shaking someone's hand would kick in a feature called ‘vari-grip' where the fingers will actually roll around whatever object is in front of it," Niehuus said.

The way the "myoelectric" prosthetic works is through muscle movements in the residual part of the arm that translate into signals to the artificial hand, which functions according to how the user is using it, Niehuus said.

"So if they send a strong signal, the hand is going to give a strong response," he said. "If they send a softer signal, a controlled signal, it's going to send a softer controlled response."

The i-limb also has 24 grip patterns that can be accessed through a phone app, and 16 custom grip patterns, Niehuus said.

According to a 2014 American Academy of Orthopaedic Surgeons report, nearly 2,000 Iraq and Af­ghani­stan veterans required amputations. The president's 2016 VA budget request includes $2.8 billion for prosthetics.

Despite the i-limb's capabilities and ongoing research, the American Academy report said a truly functioning bionic hand "is still a work in progress."

In Bermanis' case his new arm replaces an outdated one with much more limited capability.

The new forearm is made from a lava rock material that is like carbon fiber, Niehuus said. A rubberized glove covers the mechanical fingers.

Bermanis flew in Monday, got the i-limb Tuesday and had made significant progress by Thursday before an expected flight back to Pohnpei on Friday.

Niehuus said Bermanis was exceptional in how quickly he picked up use of the i-limb.

"What he has done is unheard of as far as the advancements that he's already achieved," Niehuus said.

The VA prosthetics group plans to team up with the Navy hospital on Guam to be part of its medical staff so it can start seeing active-duty personnel there, Niehuus said.

"The main thing is, the focus is, the care," Niehuus said, "making sure that these guys get what they want, and make sure it functions correctly (so they're) not just throwing it in the closet."

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