Kasey Edwards' painful encounter with a Florida alligator shredded his left arm almost to the shoulder, as the 300- to-400-pound reptile put him in a death roll, trying to drown him.

Although the summertime attack in a canal near Lake Okeechobee lasted less than a minute, Edwards said, "it felt like a lifetime." He thought he would die. But, with his remaining arm, he gouged the 11.5-foot alligator in the eye, and it finally released him.

Airlifted to Holmes Regional Medical Center, the 19-year-old remained in the Melbourne hospital for a week, before CBS producers heard about his plight and contacted him about getting a bionic replacement for his missing limb as part of a new network television show.

"They surprised me on air," he said of the decision to fit him with the iLimb, the first commercially available prosthetic hand with five fingers that allow grasping and holding objects, much as a normal hand would. "The more you wear it, the more natural it becomes," the Okeechobee resident said.

But Edwards is among the lucky few who had both the hand and his care donated.

Most of the nation's estimated 2 million amputees are unable to afford the $60,000 to $150,000 price tag for the iLimb, or any other technologically advanced replacement parts, advocacy groups say, and few insurers pay for these devices.

"Cheaper devices may go for as little as $5,000, but that's your great-great-grandmother's peg leg," said Kendra Calhoun, chief executive officer of the Amputee Coalition of America, an advocacy group based in Knoxville, Tenn.

"Arms and legs are not a luxury. If you're missing one, you want to be put back to as close as normal as possible."

While Medicare and the Department of Defense make sure returning Veterans get the best equipment available, Calhoun said, most insurers pay poorly, even though cost analyses in 11 states with "parity laws" suggests better coverage might add a 12- to 30-cent monthly increase to health-care premiums.

Parity laws call for equal coverage for prosthetics comparable to other essential medical care covered by health insurance. National legislation is now before the Congress.

"Yes, prosthetic care is expensive, but that's what you buy insurance for," Calhoun said. "Compare it to the cost of heart surgery or any other invasive procedure. We believe prosthetic devices should be covered in the same way."

Limitations on funding are the biggest issue, agreed Terri Bukacheski, a prosthetist at Orthopro Associates, a small specialty company in Miami. "How do you put a price on something that allows an individual to function in the most normal way possible?"

'Genuine need'

The insurance industry sees the cost issue, not the human one, from a different perspective, however.

"Everyone would agree we're talking about areas of genuine need," said Susan Pisano, vice president of communications for America's Health Insurance Plans, which represents more than 1,300 insurers providing health benefits to some 200 million Americans.

But employers, not insurers, make decisions about what health-care benefits to provide to their employees, she said, citing two criteria in general: evidence a service or device works well and the "ability or willingness of a purchaser" to pay for it.

"If employers wanted a greater level of coverage, Pisano said, "that would be something they could do."

And with many health insurers, consumers also have the option to purchase extra coverage, at an extra cost, she said, which might include better coverage for prosthetic devices, along with other competing medical services.

Experts say a majority of upper-extremity amputations occur because of traffic accidents and severe trauma or cancers, although more injuries of this type have come out of the wars in Afghanistan and Iraq, where even the best body armor leaves the arms more exposed.

Lower-limb amputations, on the other hand, result mostly from vascular diseases that affect circulation, especially diabetes, they said.

But no matter where such injuries take place, in any prostheses, "the most important part is the socket," the interface between the artificial limb and an amputee's residual muscles and tissues, said Alistair Gibson, a prosthetics expert and area practice manager for Hanger Prosthetics & Orthodics in Orlando.

"If not fitted correctly, it will not work," he said, comparing the fit to that for a pair of shoes.

And while computerization is the biggest change in the newer devices, Gibson said, only roughly one in five today are computerized, largely because of financial issues.

Power at fingertips

The computerized iLimb, created by Touch Bionics, offers subtle capabilities lacking in previous hand models, which simply opened and closed, providing a clumsy grip, according to Troy Farnsworth, an upper prosthetics expert with Hanger who fitted Edwards with his arm in Oklahoma City.

Hanger Prosthetics & Orthodics, a national prosthetics provider with headquarters in Maryland, donated Edwards's medical care, while Inner Wheel Foundation paid for the new limb.

"What's unique about the iLimb is it not only puts an individual power source in each finger," he said, "the thumb can rotate without even moving the wrist," as the device picks up electrical signals emitted by residual muscles on the surface of the skin.

It can read two muscle groups, the biceps and the triceps, he said, with the biceps rotating and closing the hand, while the triceps open it, giving Edwards and others with lost limbs an ability to "pick things up more easily, without exerting so much pressure."

Like his colleagues, Farnsworth cited fit as the most critical aspect of prosthesis.

"If it's not fitted well, it doesn't matter how sophisticated or advanced the design," he stressed.

Also, even though insurance coverage varies, "the most advanced component may not be appropriate for a particular lifestyle" for every amputee, he said, as there are "thousands of possible combinations of upper-extremity prostheses out there" and differing levels of activity need.

In Edward's case, given his youth, it seemed a natural choice, however. And he is so grateful, he said, he's done a number of public speaking engagements and even appeared on the "Today Show" twice, showing off his new part.

"If I keep positive, I hope to inspire others," he said, adding that it hasn't always been easy, adapting to an artificial appendage, that came about as the result of an attempt to replicate a high school stunt at about 2:30 a.m. one Sunday morning in June.

"You have to train yourself to use it, although now I can rotate the wrist and turn it 360-degrees," or full circle, Edwards said. "I get a kick out of doing it, but it really freaks some people out."

Contact Jenks at 242-3657 or sjenks@floridatoday.com.

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Artificial limbs advance
FLORIDA TODAY/Susan Jenks

From power knees to bionic legs and hands, computers have revolutionized the prosthetic industry, experts say.

"Computerization is a huge advance," said Kendra Calhoun, chief executive officer of the Amputee Coalition of America, an advocacy group based in Tennessee.

Using the same technology as cell phones, these devices contain transmitters and receivers that enable "talking back and forth" between residual muscles and artificial limbs.

The "power knee, for example, which utilizes the motion of the body, has sensors in the knee that tells it what to do, said Alistair Gibson, a prosthetics expert with Hanger Orthopedic Group, a leading prosthetic provider.

"It's a very groundbreaking piece of equipment," he said, although it does have drawbacks. "It has a very short battery life of about three hours, so patients have to turn the knee off to conserve power. And it's very heavy."

Such hurdles, along with high cost, still face the industry, Gibson and others said, with amputees returning from Iraq and Afghanistan focusing greater public attention on the need, however, and spurring additional research.

"There's always a spike in prosthetic development post-war," said Troy Farnswoth, another Hanger prosthetist who specializes in devices for missing upper limbs. "Things are changing very quickly in our field," with the Department of Defense pumping in "at least $58 million into prosthetics research."

Among the more dramatic initiatives: the idea that some day paralyzed individuals and amputees might be able to use the power of thought to move missing or immobile limbs.

Popularly known as "BrainGate," the research system is now in early human studies, under development by Cyberkinetics Neurotechnology Systems in Massachusetts.

The system involves the surgical implantation of a sensor smaller than a contact lens into the area of the brain responsible for movement control. It converts movement intent into a neural signal that is fed into a computer under the user's control.

"Our basic scientific question was how do you turn thoughts into action," said Dr. John Donoghue, the company's chief scientific officer on a three-minute video clip, explaining the system.

Contact Jenks at 242-3657 or sjenks@floridatoday.com