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For Wounded Soldiers, Prosthetic Help At Home

Advances in military medicine mean that more soldiers are surviving on the battlefieled, but many are coming home with missing limbs. When they come home, those soldiers turn to Colonel Paul Pasquina, medical director of the amputee program at Walter Reed Army Medical Center for the latest in in prosthetics.

15:44

Other segments from the episode on November 10, 2009

Fresh Air with Terry Gross, November 10, 2009: Interview with Jonathan Kuniholm; Interview with Paul Paquina; Interview with Woody Harrelson; Review of James Hand's album "Shadow on the Ground."

Transcript

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An Open-Source Approach To Better Prosthetics

DAVE DAVIES, host:

This is FRESH AIR. I’m Dave Davies, senior writer for the Philadelphia Daily
News, filling in for Terry Gross.

Jonathan Kuniholm was a graduate student in biomedical engineering at Duke
before his Marine Reserve unit was deployed to Iraq. In January 2005, he lost
his right arm below the elbow in a blast from an improvised explosive device.

He now works in the Revolutionizing Prosthetics Project, an effort funded by
the Defense Advanced Research Projects Agency, or DARPA. The government has
stepped up their research because of the number of vets returning from Iraq and
Afghanistan needing limbs. The researchers are working with advance
technologies to create a prosthesis that works almost as well as a real arm and
hand. But most of their research hasn’t yet made it out of the lab.

When Kuniholm came back from Iraq, he was given a myoelectric arm and a more
traditional device. He chose to use the older model that uses metal pinchers
operated by cables attached to his shoulder rather than the newer myoelectric
arm with joints powered by electric motors.

Mr. JONATHAN KUNIHOLM (Co-Founder, Open Prosthetics Project): These prosthesis,
these advancements are used by, you know, maybe less than 5 percent of the
overall patient population missing arms. Only about half of arm amputees even
wear a prosthesis at all. And of the ones who do, most end up wearing these
body-powered prosthesis.

And so the effort in the rehab community was to try to get greater use of these
advanced ones, and see, you know, that it’s not clear whether the reason that
people don’t wear them is because of how well they work or how much they cost.
Insurance often doesn’t reimburse for them. It’s viewed by the insurance
industry as a cosmetic device and not a functional one. And I wasn’t satisfied
with those myoelectric devices. I find them to be heavy, slow, a hassle to keep
recharged. The way that they attached to your body is uncomfortable and
restricts your range of motion. And as you say, I ended up wearing, you know,
with some advancements in materials, essentially what people got returning from
World War II.

DAVIES: So let’s talk about the differences here a little bit. I mean, the
prosthetic that people have been wearing for years and years, people would
recognize that it has essentially a hook on the end, right?

Mr. KUNIHOLM: That’s right. David Dorrance patented this device first in 1912.
And if you look at that 1912 patent, I got some pictures on our Web site, you
would recognize it as the ancestor very much of the device that I wear today,
although minus titanium. And it has some very interesting features. I mean,
it’s been criticized by others in the media as being nothing more than a rubber
band on a stick. And, you know, and the fact is that there is a lot of thought
and evolution in designs that has gone into that. You know, I will say that it
remains an inadequate solution to replace a hand. But my belief, which is not
shared by everyone, that it’s the most functional device available.

So what it is is a couple of curved pieces of metal that we call fingers and
then another piece of metal sticking out at an angle that we call a thumb that
has a cable on it. And by either extending your forearm or by shrugging your
opposite shoulder to which this cable is attached, you can pull the hook open
and the rubber bands pull it shut. So, in this way, you could hold a cup with
it.

And one of the interesting features that might not be immediately obvious
looking at it is the fingers have a little bit of a curve to them. So, for
example, the curve finger would reach around the back of a cup and keep it from
slipping out when it’s enclosing a cup. And there’s a little feature in the
rubber, in the fingers that’s been there since just after World War II that
they then called a cigarette notch and is, I think, now a pen notch.

You would think – one of the funny things about this is you would think,
looking at old films, “Best Years of Our Lives” where an amputee from World War
II won an Academy Award, an amateur, not an actor. And there are, I think,
maybe three times in the movie he’s shown lighting a cigarette with book of
paper matches with his pair of hooks. He’s a bilateral amputee, missing both
arms. And this and many other things might give you the impression that
returning veterans to smoking was one of the major rehab goals…

(Soundbite of laughter)

Mr. KUNIHOLM: …after World War II.

DAVIES: Right. One of the challenges here is that, when you think about it, we
move our arms and hands and wrists, and one trick is to get all of the
different movements that would approximate what we do now. But we don’t just
move our things, we actually apply force. We lift objects. We twist doorknobs
and jars. And if you’re going to make an arm that actually does that, it has
not just - you need not just to make it move. You need to give it power. So I
wanted to talk about some of the technical challenges in creating a more
realistic arm. Where does the power come from? Electric motors?

Mr. KUNIHOLM: The project that I’m involved in - and, in fact, both DARPA
projects ended up focusing on electric motor-powered prosthesis. But along the
way, the four-year program consider a whole bunch of other ones, including a
peroxide-based one from Vanderbilt that they’d called the rocket arm. Their
hydraulic arms were considered.

One of the two tracks in the four-year program involved a device called a
cobot(ph) that was developed by a company called Kinnya(ph) in Chicago. It was
a really incredible device, a central spinning shaft with 15 balls being
rotated by the shaft and steering motors on each one. So you get the single
motor able to apply continuously variable force on 15 different tendons pulling
in the hand - I mean, truly incredible things. But really, the best thing that
we have going in terms of compact application of power in robotics is the
electric motor. And so that’s where everybody ended up focusing.

DAVIES: So, yeah…

Mr. KUNIHOLM: Let me first say really quickly that I think your question sort
of indicates a bias both in the rehab industry and the general populace. You
mentioned the effort to create a realistic arm. And this is a bias I think of
the two-handed in a lot of ways, because if you ask most amputees, what they
really want is to restore functionality and not how realistic the hand might
look. And there are a lot of sacrifices that end up being made in trying to
make something look like a hand. And so, you know, a lot of times people look
at these hooks and their first reaction is, gosh, I wouldn’t want to walk
around with that thing attached to me. You know, it ought to look like a hand.
But the reason a lot of us have voted with our feet for these hooks is because
they’re the best thing to restore function right now.

DAVIES: In developing a more advanced prosthesis, in addition to having an arm
which has these batteries and electric motors so that it can make the
prosthesis perform a lot of functions and exert force, you have to figure out
how the wearer communicates its wishes and commands to all that machinery. How
do you do that?

Mr. KUNIHOLM: There really are several challenges associated with this. The
overall goal of the four-year project is direct neural integration and thought-
controlled prosthetic hand control. I personally, while that interests me as a
user, I’m much more focused on what I might actually be able to have now. And
there is…

DAVIES: Just to clarify, Jonathan, when you said neural control, are you
talking about having the prosthesis, in effect, wired into your brain?

Mr. KUNIHOLM: Yes. That’s exactly right. And obviously that – when you think
about the ideal, that’s what we would all like. But at the same time, as a
user, you know, that's a clinical study that I'm not interested in signing up
for. I don’t need anything plugged into my brain right now.

And the other part of this is that we have available to us, some technology
that's been around for more than 20 years that is actually quite effective at
determining user intent for a large number of patients and nothing has been
done with that technology. That technology is myoelectric pattern recognition.

So these little censors, when you put them on the surface of the skin, can
detect the little electrical impulses that are made by your muscles under the
skin. And all of the output of those censors together, is then compared to
intended movements, and you train it much like you would voice recognition
software. So you go through a series of movements just like a voice user might
read the Gettysburg Address and then you know which words the user was trying
to say.

DAVIES: Jonathan Kuniholm works on the Revolutionizing Prosthetics Project.

Well talk more after a break.

This is FRESH AIR.

(Soundbite of music)

DAVIES: Our guest is Jonathan Kuniholm. He's a biomedical engineer who lost
part of his arm in action in Iraq. He now works on a Defense Department-funded
project to develop better prosthetics.

Well, Jonathan Kuniholm, you’re working in a Defense Department-funded effort
at the Applied Physics Laboratory at Johns Hopkins. It's called the
Revolutionizing Prosthetics Project and you work with a team of engineers. I
assume that you are different from them and you’re the only one who actually is
missing part of a limb. When they’ve developed a, you know, a prototype
prosthesis, do they have you strap it on and try it?

Mr. KUNIHOM: We’ve done some of that, although I have not been able to take
anything home that we’ve been working on the project. It's all been things that
I used in the lab environment for relatively brief periods of time. I mean one
of the things that a lot of people probably don’t realize about R and D
programs is that prototypes very often require a team of engineers hovering
around something, just keeping it working.

And so there will be, you know, a demonstration or a photo opportunity or
something like that, and the impression could be given that much more has
already been accomplished than actually has. You know, one of my impressions
about all this, having been involved in a bunch of media coverage of all these
various things, is that we absolutely have an incredible bias in the media. And
that bias is not a political one, like most of my friends on either end of the
political spectrum might say that it is.

It’s, in fact, a bias towards entertainment - and that entertainment can be a
really good story or a really bad story and anything that's more complicated in
between, usually is just hard for people to understand and people in the media
aren't interested in covering that.

DAVIES: So what they want is a miraculous arm that works or a story that this
is all a waste of money?

Mr. KUNIHOM: Exactly. Or that, you know, or that it's just a travesty, you
know. And then on the other end of the spectrum, a lot of stories that I've
involved in about amputees have sought to talk about this incredible technical
achievements that we're making. And what I think a lot of those stories ignore,
is the challenges that remain in getting the stuff to market and you know, even
tested out on significant numbers of patients.

The reimbursement structure, for example, remains a huge challenge. You know,
an example is a, you know, a year or two ago I got a call from a kid who's 17
years old, blew his hand off with a homemade firecracker. He has, and this is
typical in a lot of the insurance industry, a $1500 lifetime cap on prosthetic
services.

That's not going to buy him even a third of the arm that I'm wearing that we’ve
just talked about as being a really low tech, essentially World War II
technology. And I get emails, nearly daily, from people who can't get a
prosthesis at all. And so the really advanced ones that I was talking about,
which I have just said I felt were, sort of, even themselves, inadequate and
not a great solution, costs - for somebody of my level of amputation - $35,000.

And the really highly articulated ones from these research projects that we're
talking about will likely cost hundreds of thousands of dollars for a single
copy. You know? So there's going to need to be insurance reimbursement of this
or it will not succeed. I mean we will have made something that nobody can
afford to buy.

DAVIES: Because there has to be a market if anybody's going to manufacture it,
right?

Mr. KUNIHOM: Yeah, I mean...

DAVIES: Right.

Mr. KUNIHOM: ...you know, the Defense Department and the VA have come out very
strongly to support those of us who've lost arms in conflict in any way that
they can. And I have absolute confidence that those agencies would absolutely
buy these things for us as soon as they're available. I mean that's the reason
that these entities are doing research to try to create the things that they
wish that they could buy for us now that they can't

What a lot of people don’t realize though, despite the amount of attention that
we’ve gotten in the media is that as of February, only a 186 of us had lost
parts of arms in both of these conflicts combined since 2003. And, you know,
that makes us only a very small fraction of the, you know, on the order of
70,000 people in the United States who are missing arms.

DAVIES: You know, you’ve written how some of the companies that are involved in
making prosthetic devices have used proprietary and encrypted stuff to, you
know, not share what they're doing because they, I guess they want to make
money from it.

And I'm just wondering if these companies are going to be benefiting from this
government funded research, is there a way to make them share their technical
information so that others can, you know, develop devices which work with them
and attach to them?

Mr. KUNIHOM: I would really love for that to be the case, because, you know,
the government has been the only game in town in R and D in this area for some
time. I mean all of the advances that we talked about following World War II
were, in fact, government funded. And for a period of time following World War
II, all of the prosthetic patents associated with this research were assigned
to the secretary of the Army.

I mean I personally believe that we ought to do something similar. Although, at
the same time, there are legitimate arguments for trying to get stuff, that
last mile through some commercial incentive. And so the argument has been made
on the other side, that unless somebody has some sort of competitive advantage
that they can exploit, they won't follow this through and take things to
production.

Although, I think an argument to counter that is that, in a lot of areas, there
has not been even a dime of private money spent on a lot of the stuff, even to
take it through clinical trials. And, you know, that being the case, it sort of
makes you wonder why do we really need to give somebody a monopoly for some
extended period of time, you know, if we could just turn around and make it
sustainable simply to make these things.

But what I do know is that we’ve done a, you know, hundred year experiment in
doing things the traditional way that's been an utter failure and so, you know,
I have some ideas that some might think are fairly radical but, you know, it
may be time for some radical thinking.

DAVIES: Jonathan Kuniholm...

Mr. KUNIHOM: Yeah.

DAVIES: ...thanks so much for speaking with us.

Mr. KUNIHOM: Thank you very much for having me. I appreciate it.

DAVIES: Jonathan Kuniholm is a biomedical engineer who was wounded in Iraq and
now works on the Revolutionizing Prosthetics Project funded by the Defense
Advanced Research Projects Agency. His work is featured in a book by Michael
Belfiore about DARPA's research called "The Department of Mad Scientists: How
DARPA Is Remaking Our World, from the Internet to Artificial Limbs." You can
read an excerpt on our Web site, FRESH AIR.npr.org.
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For Wounded Soldiers, Prosthetic Help At Home

DAVE DAVIES, host:

When injured vets return to the U.S., their first stop is the Walter Reed Army
Medical Center. Today's improvements in tanks, body armor and medical care have
led to more soldiers surviving their injuries than in previous wars.

My next guest, Colonel Paul Pasquina, is the medical director of the amputee
program and chairman of the Department of Physical Medicine and Rehabilitation
at Walter Reed.

As Jonathan Kuniholm discussed in the first part of our show, the Defense
Advanced Research Projects Agency has many projects underway that are making it
possible for Dr. Pasquina to give his patients more advance artificial limbs so
they can lead more normal lives.

This past weekend, Dr. Pasquina was given a Lifetime Achievement Award by
Country United, a joint effort of the Henry M. Jackson Foundation for the
Advancement of Military Medicine and the Tug McGraw Foundation.

Well, Colonel Paul Pasquina, welcome to FRESH AIR. Let me ask you first, do the
advances in battlefield medicine mean that you have more seriously injured
soldiers coming into Walter Reed and people with more amputations?

Colonel PAUL PASQUINA (Medical director of the amputee program at Walter Reed
Army Medical Center): Well, I think there have been dramatic improvements in
the survival rates of injured combat service members that have been recognized
in operations in Iraq and Afghanistan. Primarily, we have the most highly
skilled medics that are in the field providing first aid lifesaving treatment
as well as expert field surgeons, anesthesiologists, nurses providing combat
casualty care.

So the survival rates of this conflict have been unmatched in history, but as a
result of that, we do see a number of injured service members that are
surviving wounds that would not have been survivable in prior conflicts which
has created significant challenges obviously, for our medical professionals,
but more importantly, challenges for those service members and their families
for recovery.

DAVIES: Have you seen noticeable improvements in prosthetics just since the
beginning of Iraq war in 2003?

Col. PASQUINA: There's no question there's been a significant improvement in
the technology that exists for care for individuals with limb loss. There had
already been a significant movement in terms of development of lower limb
prosthetics, in terms of materials, in terms of energy-storing capabilities and
socket design to make a more comfortable and functional lower limb prosthesis.

There had not been as much advancement in the upper limb. And with the
challenges that we were seeing for our injured service members with upper limb
loss, we felt it very important that the Department of Defense and the
Department of Veterans Affairs invest a significant amount of money towards
research for upper limb prosthetic development.

DAVIES: You know, I've read that there's something called a C-leg. That's not
S-E-A, that's the capitol letter C, which is I guess includes some battery-
powered joints. Can you tell us about what that is?

Col. PASQUINA: Sure. There are several microprocessor knees that are on the
market, produced by various prosthetic companies. And what a microprocessor
knee does it has a computer chip that controls the resistance of that knee to
either flexion or extension, so that it actually can adjust the resistance
based on your cadence or your speed of walking - so that when you’re walking
faster it will provide less resistance; when you’re walking slower, it will
provide more resistance. So it works by the knee adjusting to the speed of an
individual's ambulation.

DAVIES: And it can tell when you’re going uphill or going downhill too, I
guess.

Col. PASQUINA: Well, there are various components that can help with, yes, the
adjustment up or downhill.

DAVIES: Colonel Paul Pasquina is medical director of the amputee program at
Walter Reed Army Medical Center. He'll be back in the second half of the show.

I'm Dave Davies and this is FRESH AIR.

(Soundbite of music)

DAVIES: Coming up, returning amputees to the highest level of function. More
with Colonel Paul Pasquina, medical director of the amputee program at Walter
Reed.

Also Woody Harrelson tells us about his new film "The Messenger" in which he
plays a soldier delivering the news to families that their loved one has died
in combat.

And Ken Tucker reviews the new album by Texas country singer James Hand.

(Soundbite of music)

DAVIES: This is FRESH AIR. I’m Dave Davies sitting in for Terry Gross.

Back with Colonel Paul Pasquina, medical director of the amputee program at the
Walter Reed Army Medical Center. He talked about some of the challenges
researchers face in developing artificial limbs that function more like real
arms and legs.

Col. PASQUINA: What we see as the next great movement towards improvement or
technology development in lower-limb prostheses is development of power. You
have to realize that all lower-limb prostheses that are available today, or at
least the majority, are passive devices, meaning that they don’t replace the
muscles that are lost with an amputation so that you have to actually support
the entire leg and swing that forward or backwards. The introduction of motors
into a prostheses will actually help propel an individual either out of a
chair, up a flight of steps or, you know, forward during ambulation.

So we see the future of prosthetics incorporating more motors to replace some
of that muscle loss. There are two powered knee devices, one that has been on
the market, one that is now coming to market, that does offer some great
advantages to that that still need to be evaluated and still need to be
developed, but we see that as a potential great advancement in lower-limb
prostheses.

DAVIES: Tell us about artificial arms. What’s the tougher of artificial arms,
wrists or hand devices that you can put on and what sorts of functionality do
they provide?

Col. PASQUINA: So, for the individuals that we see with upper-limb loss, we
typically start them on what’s called a myoelectric prosthesis - so a motorized
prosthesis that works on sensors over the muscles that will pick up on muscle
activity and then cause an elbow to flex or extend, or a hand to open and
close.

DAVIES: And that’s a muscle in the - at the end of the residual limb?

Col. PASQUINA: That’s correct.

DAVIES: Okay.

Col. PASQUINA: And our approach to that is because we believe it’s very
important to get an individual using a prosthesis as early as possible to help
with their rehabilitation and recovery, and because we believe that bimanual
activities will help preserve the intact limb over the length of an
individual’s life. So, that if you just resort to using one hand all the time,
then you’ll have an increased risk of developing arthritis or overused injuries
of that remaining wrist, elbow or shoulder. So, we believe that’s very
important. And the reason for our choice of a myoelectric prosthesis often is
because of the extent of injuries that we do see with combat injuries. There is
often time significant soft-tissue injury or skin injury that prohibit the use
of a cable-powered system that would put more pressure or more strain on that
limb.

DAVIES: So, the myoelectric prosthesis is one which has batteries and which
attaches to the vestigial limb, the stump if you will, and it has electronic
sensors, which detect muscle movements and convert that into digital signals
and actually make the, what, the fingers move, the wrist turn?

Col. PASQUINA: That’s correct. It makes the hand open or close on demand, elbow
flex or extend. And then the wrists rotate if a wrist rotator is added. And
what that allows us to do is actually train an individual with limb loss before
their residual limb is even able to withstand a socket. So, before a limb is
even closed, you can put these electrodes on their muscle, get them to start
driving prosthetic devices and exercise those muscles before their limb is even
ready for a fitting for a prosthesis.

DAVIES: And then what’s the next step?

Col. PASQUINA: So then as they learn how to use that prosthesis, then we also
introduce a more traditional body powered prosthesis which is controlled by
movements of either the shoulder or upper limb to pull a cable system to either
open or close a hand device or a terminal device or an elbow, which is the more
traditional type of prosthesis. And we are fortunate in the Department of
Defense to provide both a myoelectric prosthesis as well as a body powered
prosthesis to all of our individuals, and so that they can decide which one is
more functional for them. So, when they’re going through the rehabilitation
process, oftentimes it’s not clear what their long-term goals will be. So,
while they may prefer a body powered or a myoelectric prosthesis now as they
move forward with their - either returning to active-duty military service or
returning to the community, they may end up using one prosthesis more than
another prosthesis, depending on what profession they go into.

DAVIES: So, then they walk away with two in the end, yeah.

Col. PASQUINA: That’s correct. And we also do - also provide activity-specific
prosthetic components to allow them to get back to the activities of their
choice - again, whether that be weightlifting, whether that be…

DAVIES: Can you describe…

Col. PASQUINA: …basketball.

DAVIES: Can you describe one or two of these activity-specific components?

Col. PASQUINA: Sure. So for an upper-limb amputee, there are various terminal
devices that will fit whatever that activity may be. So if that activity is
hunting or shooting, then a different terminal device will be used than perhaps
would be used for rowing a boat or scaling a wall during rock climbing.

DAVIES: My understanding is that historically GIs who have suffered amputations
have generally left the military. That is changing I gather. Is that right?

Col. PASQUINA: That’s correct. We have seen about 20 percent of our injured
service members with limb loss that have gone through the medical board process
that have decided to and have achieved going back to active-duty military
service. So, there has been, kind of, a cultural shift in terms of opening the
door for our injured service members to return to active-duty service. We have
to be careful in our approach to that. Obviously our goal is to help our
injured service members return to their highest level of function and return to
the goals that they set. But many enter military service wanting a military
career and we’re very, very happy to be able to provide that opportunity for
them.

DAVIES: Do you get to know the patients under the (unintelligible) yourself?

Col. PASQUINA: I get to know many of the patients. I wish I could get to know
all of them, but I do get to know quite a few, yes.

DAVIES: Is there an example of one who came in, maybe in the depths of despair,
with an amputation that you can recall changing when they were fitted with a
prosthesis and were able to restore some of their body functions?

Col. PASQUINA: Well, there’s no question that we see a significant amount of
tragedy in the work that we do. But I think the tragedy we see is far
outweighed by the inspiration that we all feel seeing our service members, and
again, their resilience and courage that they demonstrate.

Watching somebody get up for the first time out of bed after they’ve been on
prolonged bed rest for multiple injuries is always an uplifting experience, as
well as watching individuals that have come through a long rehabilitation
process that have now moved on with their lives and their career, have gone
off, gotten married, had children, either return to the military service or
return to education and then come back to Walter Reed or Bethesda and talk to
some of our newly injured service members, because their telling of their story
and the path that they’ve carved, I think, opens up doors for future veterans.

DAVIES: Well, Colonel Paul Pasquina, thanks so much for speaking with us.

Col. PASQUINA: Oh, thank you.

DAVIES: Colonel Paul Pasquina is medical director of the amputee program and
chairman of the Department of Physical Medicine and Rehabilitation at Walter
Reed Army Medical Center.

Coming up, actor Woody Harrelson on his new film, “The Messenger,” in which he
plays a soldier who notifies family members when a loved one has died in
combat. This is FRESH AIR.
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Woody Harrelson Goes To War In “The Messenger”

DAVE DAVIES, host:

In a new film by first-time director Oren Moverman, Woody Harrelson and Ben
Foster, co-star as Army casualty notification officers, those assigned to visit
family members and tell them their loved ones has died in combat. The film is
called, “The Messenger.”

I spoke to Harrelson yesterday about the role. Woody Harrelson first became
known for his role in the long-running TV series, “Cheers.” He’s also appeared
in “Natural Born Killers,” “The People vs. Larry Flynt,” and “No Country for
Old Men,” and he’s currently in the movie “Zombieland.”

In this clip from “The Messenger,” Harrelson is Captain Tony Stone, a veteran
of casualty notification. He’s instructing Foster’s character, Staff Sergeant
Will Montgomery, who’s new to the assignment, on what is and isn’t done when
delivering the tragic news of a death in combat.

(Soundbite of movie, “The Messenger”)

Mr. WOODY HARRELSON (Actor): (As Captain Tony Stone) You do not speak with
anybody other than the next of kin - no friend, no neighbor, no co-worker or
mistress. Hours of operation are 0600 to 2200 hours and we don’t want to wake
anybody up in the middle of the night. If you ask me, hitting them with the
news at the crack of dawn is not exactly a great way to start their day -
breakfast-wise.

Mr. BEN FOSTER (Actor): (As Staff Sergeant Will Montgomery) What do we do if
the next of kin isn’t around?

Mr. HARRELSON: (As Captain Tony Stone) We leave. We don’t wait. We don’t lurk.
We come back later. This is a zero-defect mission, a pure hit-and-get
operation.

MR. FOSTER: (As Staff Sergeant Will Montgomery) Is that it, sir?

Mr. HARRELSON: (As Captain Tony Stone) One more thing: You do not touch the
N.O.K. Avoid physical contact with the next of kin, unless it’s a medical
emergency, like if they’re having a heart attack or something. You are
representing the secretary of the Army, not Will Montgomery. So in case you
feel like offering a hug or something - don’t. It will only get you in trouble.

DAVIES: Woody Harrelson, welcome to FRESH AIR. This new film is about casualty
notification officers, those who bring the tragic news of the loss of a service
member to the members of their family. What did you do to get to know that
world and the people who have that job?

Mr. HARRELSON: Well, fortunately, we got an opportunity. One of our first road
trips was to go to Walter Reed Hospital. And we spent some time with the men
and women there and – although, it’s one of those ironic things because you
think going there, you’re going to see a lot of people who are - obviously have
been injured, lost legs, have been burned or blinded and you think, you know,
you’re going to be really depressed. But I’ve got to say, it was one of the
more uplifting experiences I ever had with some men and women who just blew my
mind. They were just amazing people. So…

DAVIES: You know, I don’t remember you playing a soldier a lot in the past.
Talk a little about getting into that character of Captain Tony Stone - I mean,
the physical transformation, the way you carry yourself as an Army captain.

Mr. HARRELSON: A lot of it has to do with Oren Moverman, the director. He
really helped me because – for one thing, he was in the Israeli military for a
while and he has a familiarity with the military. And honestly, as I told
Oren, there’s really two particular occupations I thought I could never play:
one, being a soldier and the other being a policeman, just because I just don’t
feel like – I don’t know what it is, maybe it’s something to do with authority
or something, but – so this one I was really nervous about and I was working on
a movie called “Bunraku,” in Bucharest, and I was, you know, hardcore working
on that. And then had to leave and come to do this. And I only had a few days
prep. Part of what helped me was Oren sent, you know, some backstory to the
character because, you know, otherwise I didn’t feel like I had enough time to
just use my imagination to try to figure it out. So, luckily he sent me some
pages of backstory to help me think in terms of Tony Stone. He sent me with my
class As and my fatigues, so I’m marching around Bucharest in my boots and, you
know, probably and odd sight, but…

DAVIES: And you shaved your head for this role, right?

Mr. HARRELSON: And yeah, he asked me to shave my head. So, yeah, I did that.
And, I mean, just did – the most - in reading a book, Tim O’Brien’s “The Things
They Carry,” really helped. And, you know, there were a lot of things, but
nothing really helped as much as just spending time with the soldiers. I felt
like that really helped me humanize them in such a way that I felt like, oh,
you know, they’re not that much different from me, you know. So…

DAVIES: And this character of yours is also carrying some personal baggage.
He’s a, what, a reformed alcoholic, kind of hiding from the pain in his life
and maybe that which he is bringing to these loved ones.

Mr. HARRELSON: Yeah, I think that’s true. He’s got a lot of pain and rage
inside of him and, you know, kind of keeps it all under wraps when he goes and
does his notifications. But during the course of the film, we get to know him a
little better through Ben Foster’s character, Will Montgomery. And - who’s also
kind of a stoic guy who, it takes a lot to get underneath his emotions. And
that’s one of the beauties of the way this movie was made because you really
come to know both of these characters in a slow, but very effective way. And
they really come to love each other. It’s an unlikely friendship that develops.

DAVIES: Right. And there’s sort of a hard-bitten exterior that they both put
on. And then they have to go into some of the most emotionally wrenching
circumstances any of us will ever have to in notifying these loved ones of the
death of a serviceman. And as I thought about this, it occurred to me that all
of us know what it’s like to have a phone call that we dread, you know, to
break up with a boyfriend or girlfriend or deliver uncomfortable news to
somebody we know. These people who do this job have to walk up and deliver this
life-shattering news to a total stranger. And I’m wondering as you played that,
when you get out of the car with Ben Foster and you’re walking up to these
people, are you thinking about how you steel yourself for that kind of an
experience?

Mr. HARRELSON: Yeah. Everything on the set was kind of perfectly laid out to
make it the best or the realest possible experience, you know. It was shot with
one camera, one take. We didn’t meet the people ahead of time who we were doing
the scene with. We didn’t arrange it or block it or rehearse it. So, we did all
have the, you know, the dialogue, but inside of that, there was still a lot of
unpredictable things. And emotionally, it was very charged and even if
sometimes I didn’t feel connected emotionally, Ben Foster would show me, you
know, pictures of some of the young men and women who had served and been
killed in the action and it would just - immediately the emotion of it would
come flooding back.

And so, it really felt that I would generally - you know, being Captain Tony
Stone and supposed to be stone-like and not really, you know, too emotional,
you know, I tried to stick by that. But as soon as they would say cut – they’d
say cut, I’d started crying because I was – I felt so in it, you know. And the
actors we were with were phenomenal. So, they really made it an emotional
experience.

DAVIES: So these - if I understand this correctly, there was no rehearsal. You
were going up to people you had literally never seen before as if you were
carrying this news and then you encounter their reactions.

Mr. HARRELSON: Yeah. I mean, there were six notifications. Two of them were
Samantha Morton and Steve Buscemi. So, we had seen them before, but we didn’t
see them before doing this and we didn’t – I’d never met Samantha Morton. So,
yeah, I think it was a good way to do it, but it was, you know, intense.

DAVIES: Actor Woody Harrelson. His new film is “The Messenger.” I also spoke to
Harrelson about some of his other film roles. You can hear that part of our
interview soon on FRESH AIR.
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Strong And Simple As A “Shadow On The Ground”

DAVE DAVIES, host:

James Hand is a 57-year-old Texas country singer, who’s just released his third
album called, “Shadow On The Ground.” It was co-produced by Ray Benson, long-
time leader of the band Asleep at the Wheel, and Lloyd Maines, who played in
Joe Ely’s band and produced some of the Flatlanders’ albums.

Rock critic Ken Tucker says James Hand’s Texas-based music doesn’t sound like
the country coming out of Nashville these days.

(Soundbite of song, “Don’t Depend On Me”)

Mr. JAMES HAND (Singer): (Singing) You had to know the day you met me, the kind
of man I am, one to always rain, seldom face and never gives a damn. You put
too much trust in what you must have surely been able to see, you knew from the
start, it’s her, not you in my heart, so don’t depend on me…

KEN TUCKER: Middle-aged and without patience for the niceties of image or
excuses, James Hand cuts to the chase on most of the songs on “Shadow On The
Ground.” That song, “Don’t Depend On Me,” is a simple declaration of facts.
It’s sung simply, but the message, as written by Hand himself, is devastatingly
blunt. You knew from the start, he sings to a woman he’s involved with, it’s
her not you in my heart. So don’t depend on me for anything that true love was
meant to give. Wow, what a charmer, huh?

(Soundbite of song, “Mona Lisa”)

Mr. HAND: (Singing) Mona Lisa, Mona Lisa, men have named you, for that Mona
Lisa strangeness in your smile. Is it only ‘cause you’re lonely they have
blamed you? Or for that Mona Lisa sadness in your smile? Is you smile to tempt
a lover…

TUCKER: The thing is James Hand is charming. Take that version of the Nat King
Cole hit “Mona Lisa.” It partakes of the Mexican country rhythms the singer
grew up with in Central Texas, and the arrangement, combined with Hand’s fluid
phrasing, can at least for a little while, make you forget Nat King Cole’s
indelible version, which is no small achievement. This is the kind of pop-music
cover that no one else with a country-music record contract is making these
days. It’s out of time, out of hand.

(Soundbite of song, “Don’t Want Me Too”)

Mr. HAND: (Singing) You didn’t want me when you had me or you never would have
left, and I still don’t know why you did, now all I can do is make a big fool
of myself, acting like a love-drunk oh love you done me bad and the part that
made me sad, is that I’m still in love with you. Oh, I shake my head and I
wonder why, why, why? I want someone that don’t want me too…

TUCKER: That’s a very typical and very good example of the sort of honky-tonk
music James Hand has spent decades playing in small-to-medium dancehalls
throughout the Southwest and beyond. His phrasing on that one is pure Hank
Williams, so is the sentiment in the lyric — his lover doesn’t want him, and
more fundamentally, he doesn’t want himself in the shape he’s in. On another
song, “Floor to Crawl,” Hand demonstrates a shift into a slightly higher
register and a hitch in his inflections. He’s a pro at making small adjustments
depending on his material. And that material is very good in this case, a song
Hand wrote that allows for the maximum, howling dissolution and poignancy.

(Soundbite of song, “Floor to Crawl”)

Mr. HAND: (Singing) There ain’t a problem I’ve got that the world don’t know
about. And when I get high in notch, they’ll all want to (unintelligible) me
out. But every now and then, I kick one on my kin, and at times like these, I
guess there ain’t nobody to see, I need a floor to crawl and a wall to climb,
but when (unintelligible) and the door I can hide behind. Deep holes when I
fall, who knows what I might find, I need a floor to crawl and a wall to climb.

TUCKER: The steel guitar that provides the slippery floor for James Hand’s
voice to crawl across in that song is typical of how tightly constructed this
loose-limbed album is, with help from producers Ray Benson, and Lloyd Maines.
He’s made his hometown outpost in Texas the center of a stark universe you’re
invited to visit, or not. It’s up to you, because James Hand isn’t changing his
style for you or anyone else.

DAVIES: Ken Tucker is editor at large for Entertainment Weekly. He reviewed
“Shadow On The Ground” by James Hand. You can download podcasts of our show at
freshair.npr.org and you can follow us on Twitter at nprfreshair.
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Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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