Five Questions With: Linda Resnik

LINDA RESNIK is a research career scientist with the Providence VA Medical Center and a professor of health services, policy and practice at Brown University’s School of Public Health. /COURTESY BROWN UNIVERSITY
LINDA RESNIK is a research career scientist with the Providence VA Medical Center and a professor of health services, policy and practice at Brown University’s School of Public Health. /COURTESY BROWN UNIVERSITY

Linda Resnik, a research career scientist with the Providence VA Medical Center and a professor of health services, policy and practice at Brown University’s School of Public Health, was recognized by the VA with the Paul B. Magnuson Award for her work with veterans affected by upper-limb amputations. Resnik talked with Providence Business News about the VA’s new prosthetic for veterans who have experienced upper-limb loss.

PBN: Tell us more about the Life Under Kinetic Evolution Arm for veterans with upper-limb amputation?

RESNIK: The LUKE Arm, also known as the DEKA Arm, was developed through funding from the Defense Advanced Research Projects Agency, known as DARPA [the independent research branch of the U.S. Department of Defense]. It is the first computer-driven prosthetic arm capable of multiple, simultaneous movements.

PBN: How and when was it created and what was your role in developing this new prosthetic?

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RESNIK: In 2008, DARPA and the VA signed a memorandum of understanding to collaborate on clinical trials of the device. I led the multisite VA study to optimize the DEKA Arm. One of the main purposes of this study was to provide feedback from end users – persons with amputation and the clinicians who care for them – so the developer could optimize the design to best meet the users’ needs.

The study also collected data on outcomes of the DEKA Arm. These data were provided to DEKA and used in support of the application for approval from the U.S. Food and Drug Administration of the device, which was received in 2014. I also led a multisite take-home study of the DEKA Arm.

The LUKE Arm has recently become commercially available and will soon be available to veterans and active duty service members. Some of the lessons learned during the take-home study are being directly translated into clinical protocols for prescribing, fitting and training patients to use this device.

PBN: Who are good candidates for receiving this prosthetic – individuals with a partial or full arm amputation – and what will it do for them?

RESNIK: Individuals who have a single or bilateral upper-limb amputation(s) – below the elbow, above the elbow or at the shoulder level – who are able to commit to the fitting and training requirements of the LUKE Arm, which are quite rigorous. Fitting and training with the LUKE Arm requires a significant commitment on the part of the individual, which, for the veteran, involves travel to a VA Upper Limb Amputation Specialty Center and multiple sessions of therapy for training on how to use the device.

One of the primary methods of controlling the LUKE Arm is through inertial measurement units worn on the feet; therefore, good candidates must have the ability to control their feet and ankles.

The LUKE Arm is modular and is available for different levels of upper-limb amputation, including transradial (below the elbow), transhumeral (above the elbow), and shoulder disarticulation (the entire arm).  All levels have six pre-programmed grips, powered wrist rotation and flexion/extension. The shoulder level has 10 different powered types of motion and is capable of multiple simultaneous powered movements.

PBN: Is the VA using this new technology now? How widespread is the veteran community’s need for it?

RESNIK: Although we have been using this technology in research for the past nine years, this is the first year that the VA will begin evaluating and fitting appropriate candidates for the LUKE Arm. Of the more than 90,000 veterans with some level of limb amputation seen at the VA in fiscal year 2016, more than 23,000 had some level of upper-limb amputation, the majority of whom have amputations of the fingers or partial hand. There are about 4,000 veterans who have an amputation at a level appropriate for the LUKE Arm; that said, not all of these veterans will be able to use this advanced device. Further, many persons with upper-limb amputation are dissatisfied with their existing prostheses and many have abandoned using devices altogether.

PBN: Do you envision this prosthetic having commercial application in a patient population beyond that of the veteran population?

RESNIK: Absolutely, the advanced technology available in the LUKE Arm may benefit nonveterans with upper extremity amputations who meet the criteria for use.

Nancy Kirsch is a PBN contributing writer.