Prostheses in Physically Demanding Work

Although the American workplace continues to shift away from physically challenging civilian occupations dependent on strength and endurance, there are still occupations, such as those involving agriculture, where physical challenges are an integral part of the work. During the past several years, the Northwestern University Prosthetics-Orthotics Center, Chicago, Illinois, has been interviewing and surveying farmers and ranchers with limb amputations about their use of, or decision not to use, prostheses in their work. While the majority choose to use prostheses, it is clear from their statements that contemporary prostheses are often not up to the performance standards needed for farmers and ranchers to work as effectively as their able-bodied peers. Of the 40 farmers interviewed during the first phase of the project, 17 had upper-limb amputations and 23 had lower-limb amputations. Among those with upper-limb amputations, 11 had amputations distal to the elbow, and all of them used prostheses in their farm work. Only one of the six farmers with an amputation proximal to the elbow used a prosthesis in his work. The five who did not use prostheses did not find transhumeral or shoulder disarticulation prostheses useful enough to offset problems with comfort, weight, maintenance, or the attention needed to incorporate the prosthesis into a task. In contrast to the farmers with upper-limb amputations, all of the interviewed farmers with lower-limb amputations used prostheses, including eight with amputations through or proximal to the knee. Falls while using lower-limb prostheses were common and were generally due to difficulty reacting to stepping on an object, tripping, or slipping on a wet or icy surface, rather than to a mechanical or suspension failure. One farmer offered that the most useful thing he learned during training to use his prosthesis was how to fall to minimize injury. Twenty-six prosthetists who provided service to farmers and ranchers with amputations also participated in our interviews. Consistent with our findings, they indicated that most farmers and ranchers use mechanical prostheses in their work. Although the individuals used heavy-duty components and devices with reinforced construction, they still typically experienced more frequent repairs than the general population of prosthesis users. Some farmers and ranchers use prostheses with electric-powered components; however, they generally don't consider these components durable enough for full-time use and don't want the cost and inconvenience of frequent repairs. Having an electric-powered prosthesis that is not sealed against moisture also means having to be more careful about damage from inclement weather, liquefied chemicals, water for crops and animals, and solutions used to clean the prosthesis when soiled or contaminated. Paying for prostheses was a major concern for survery participants. Although half of the individuals who answered the question had private insurance, many had high deductibles, and one-fifth of respondents had no insurance. Cost was also a factor when discussing repairs, including the cost of lost productivity during repairs and the inability to afford a back-up prosthesis. We are continuing to collect survey data from farmers and ranchers about prosthesis use and problems encountered. Our data could lead to improvements in prosthetic components for farmers and ranchers, and benefit those who are employed in other physically demanding careers. Author's note: To access the survey, visit www.nupoc.northwestern.edu/nupoc-research/other/px_agworkers Craig Heckathorne, MS, is a research engineer with the Northwestern University Prosthetics-Orthotics Center. Reference Waldera, K. E., C. W. Heckathorne, M. Parker, and S. Fatone. 2012. Assessing the prosthetic needs of farmers and ranchers with amputations. Disability and Rehabilitation: Assistive Technology 8 (3):204-12.

Prostheses in Physically Demanding Work

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