Help for Sleeping Legs

Help for Sleeping Legs

NEW HELP FOR SLEEPING LEGS:
SENSING DEVICE LETS DIABETICS 'FEEL' THEIR FEET AGAIN
by Don McLeod

FROM THE VOICE EDITOR: What follows is the first look at a new
treatment for diabetic neuropathy. Copyright 1998, "AARP Bulletin."
Reprinted with permission.
Virgil Pyatt strides confidently across the laboratory floor,
smiling at watching technicians and nimbly adjusting his gait for a ridge in
the carpeting. It looks like an ordinary stroll—but in fact it is far from
ordinary.
That's because for this bit of walking, Pyatt, one of an estimated
10 million Americans with diabetes whose feet have become numb and devoid of
feeling, is finally able to "feel" his feet again.
This is due to a miracle of modern electronics—he's wearing
ultrathin sensing devices inside his shoes. The sensors provide what in effect
are artificial nerve endings, to replace the natural ones that no longer work.
Diabetes is a disease in which abnormally high blood sugar levels
impair the body's ability to process energy. One outcome may be restricted circulation
in the feet and legs, leading to a loss of feeling.
Pyatt is a participant in a government-funded, high-tech research
experiment at Sabolich Research and Development, Inc., in Oklahoma City, one
of the nation's largest prosthetic research facilities. It's a for-profit company
that develops prosthetic and preventive technology for amputees or those in
danger of losing limbs to disease.
If the experiment lives up to the hope of its developers, it
may help diabetics with little or no feeling in their feet avoid an unwanted
fate that thousands must now endure—partial or full amputation of one or
both feet.
Without sensing devices, people like Pyatt are often unaware
of pressured area on the feet caused by improper walking habits, stones in their
shoes or even wrinkles in their socks, all of which can lead to sores and infections.
The average person would feel pain in these instances, explains Martin Mussman,
director of podiatric services for the Department of Veterans Affairs, but people
with numb feet cannot.
By the time Pyatt and others like him notice a sore on one of
their feet, Mussman says, infection often has had a long head start.
By then, the ailment sometimes is so advanced that part or all
of the foot must be amputated. The American Diabetes Association says that each
year 54,000 people, most of them over 65, lose a foot or leg to diabetes.
That's what happened last year to Claudio Torrez, 61, a technician
in Oklahoma City who had diabetes and no feeling in his feet. By the time he
discovered he had an ulcer in his heel, infection had already gotten into the
bone. Surgeons eventually had to amputate the leg below his knee.
The aim of the research in which Pyatt participates, conducted
with a grant from the National Institutes of Health (NIH), is to prevent many
of these amputations. "If this device can make corrections" for the
nerve loss in diabetics' feet," says Charles A. Wells, who is overseeing
the grant for NIH, "we can prevent a very, very costly problem with these
amputations." Wells is director of the Complications Research Program of
NIH's Institute of Diabetes and Digestive and Kidney Diseases.
The device works this way: Sensors inside the shoes are connected
to electrodes attached higher up on the person's body where he or she has feeling.
When a sensor "feels" a pebble inside the shoe, or "feels"
pressure when the foot hits the ground, it transmits a message to the electrode
site, which then tingles.
The brain gradually adapts and begins to substitute these artificial
sensations for those that were once felt in the now-numb foot. In time it feels
to the patient as if the sensation is actually occurring in the foot.
Thus, as the patient walks, he can "feel" his foot
rocking from heel to toe. He can "feel" a pebble in his shoe or a
wrinkle in his sock.
Other organizations are conducting research on devices to detect
the loss of nerve sensation. But so far as can be determine, this is the only
research project aimed at producing a device that would actually "replace"
lost nerve sensation.
So far, clinical observations of individuals such as Pyatt indicate
that the device is promising.
Pressure measurements taken with sophisticated computerized
equipment show that people wearing the device take shorter steps and apply less
pressure on the bottoms of their feet when they walk. Researchers hope the change
in walking style may help delay or possibly eliminate the need for amputation
in some patients.
Sabolich has just received a new grant from NIH to conduct the
second phase of the research-clinical trials that would track patients using
the device to see if improved walking techniques actually prevent the development
of foot ulcers.
Anticipated to begin this year, the research would last two
years. If it is completed without a hitch, John Sabolich—a prosthetist
and the president of the research facility—says he hopes that the device
will be on the market soon thereafter.
The cost for people with diabetes would be in the $3,000 range,
which would cover one device for each foot, Sabolich says. If the sensor prevented
amputation, that would be a major savings, as the average amputation costs $40,000.
Average lifetime expenses for prosthetic care for amputees range from $350,000
to $1 million. And, of course, people would obviously prefer to keep their flesh-and-blood
feet.
Other uses for this general technology are also on the horizon.
One is for amputees: Putting sensors inside the shoes worn by people with artificial
legs could make them more surefooted by letting them "feel" the unevenness
of the surface they're walking on.
Another application might be to help guard against sores and
ulcers on patients confined to wheelchairs or beds. Such sores "are highly
prevalent in nursing homes," says Sabolich, adding that treating people
with bedsores can be expensive.
Although this device may enable thousands of patients to avoid
foot amputations, "it is not going to be panacea" for everyone, he
cautions. Some patients may have such severe circulatory problems, he says,
that there is no medical alternative to amputation.