Oklahoma AgrAbility Newsletter
March/April 2003 • Volume 2 • Issue 2
Farming with an Arm Amputation
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NOTE: Mention or display of a trademark, proprietary product or firm in text or figures does not constitute an endorsement by the U.S. Department of Agriculture, Oklahoma State University, Langston University or the National AgrAbility Project and does not imply approval to the exclusion of other suitable products or firms.
In This Issue
Farming with an Arm Amputation
Support of the Disablement Model
Easier Living
The Oklahoma AgrAbility Project is here to help you complete your daily tasks a little easier. This issue of the newsletter covers both Assistive Technology devices and helps explain our support for the Disablement Model. I hope you gain a better understanding of what AgrAbility is about and how we can better serve you.
Please note that the assistive technology devices are a small sampling of what is available. Also, many devices may not be labeled as assistive, but they will help prevent secondary injuries.
All Best Wishes,
Rachael Kircher, AgrAbility Project Coordinator
Farming with an Arm Amputation
The "farmer’s hook" has become an all too frequent sight in rural America. According to the National Safety Council, farming ranks among the four most deadly industries in the United States. One out of every 10 of these workers will suffer an amputation while on the job. The National Center for Health Statistics reports that a higher proportion of farmers are missing fingers or toes due to amputations than the non-farm population. Farmers are at a much greater risk of an amputation simply by the type of equipment and machinery used in agriculture production. Upper extremity amputations have historically been a serious problem for agricultural workers with a majority of the injuries occurring to the fingers, hand, and wrist.
Traditionally, the most frequently prescribed terminal device for farmers has been the "Standard" or "Dorrance Hook". Many refer to it as the "farmers hook" due to its frequency of use in the agricultural community. The Dorrance Hook operates on the principle that the hand remains closed when the muscles are relaxed and open when making use of the muscles.
The "Prehensile Hand", relies on the wearer’s muscle use for its gripping strength – thus open when the muscles are relaxed and then closed when the muscles and mind coordination cause it to close.
A certified Prosthetist, a specialist or maker of artificial limbs, should always be consulted when persons consider using an artificial limb. The first objective of the prosthetist is to provide basic information and education to the amputee concerning their condition. They provide insight concerning the available prosthetic options and how they could help address the specific challenges of the amputee. The primary concern in prosthetics is to understand the abilities and desires of the amputee. Each amputee is an individual with unique characteristics that must be accommodated. Because of the unique demands of farming, accommodating amputees can take considerable time and trial of products to find the optimum prosthesis.
The most common problems farmers experience when obtaining their prosthesis are learning how to use it to perform various farm tasks, and servicing the device. The lack of comprehensive rehabilitation services in rural areas can present a major problem. As a result, many farmers have relied on local craftsmen and their own ingenuity to make necessary repairs and modifications.
Some common problems and possible solutions for farmers:
- Cable Breakage: Cable breakage is the most frequent problem with a Dorrance Hook or the Prehensile Hand. One solution for below-the-elbow amputations is to replace the cable with nylon rope, which slides through metal loops riveted to the socket and tricep cuff.
- Harness Comfort: Farmers have stated that the harness caused irritation, particularly under the arm. They also expressed reaching limitations and the need for a quick-release harness, for when the terminal device (the hook or hand) became caught on something and the wearer needed to let go. One farmer, with the help of his wife and a local saddle maker, constructed a harness out of machine washable Dacron webbing, sheep-skin material for underarm comfort, velcro, and part of a bib overall buckle for front attachment and quick release.
- Exposure to Cold: Since amputees usually experience a decreased blood flow and decreased sensation in their stump, there is a greater danger of frostbite occurring in the stump without them noticing it. The need for a heated or insulated socket has been indicated by most farmers with below-elbow amputations working in cold weather. Farmers have experimented with various items including nylon hose to reduce perspiration, tube socks pulled over the top of the prosthesis, and even electric hunting socks. Various methods can be tried, for what will not meet one farmer’s need may serve another’s need very well. Work done by Eickman and Mathesen at the University of North Dakota found that the bulk of the heat loss from the prosthesis occurred around the upper-socket region. One of their recommendations was the use of an insulated band around the top of the prosthesis to limit heat loss around the outer polyester cover.
- Device Limitations: Limitations include such things as: difficulty gripping door knobs or other smooth objects with terminal devices, a knife holder on some standard hooks that has been found to catch on clothing, strength and quality of terminal devices, using a hammer and nail, tightening and loosening bolts and using many hand tools has its limitations. Various modifications were made by the farmers to address these limitations, each one a little different, according to their own needs and challenges.
As you can see, farmers experiencing amputation and a future with prosthetics might have some challenges. Many, if not all, of the challenges can be overcome. Often we just need to concentrate on how something can be changed or modified so that a task can be completed. A thought of one farmer who has experienced an amputation was that a positive attitude can greatly help someone adjust to an amputation. His suggestion is "not to focus on your limitations but look for ways to function normally in spite of them."
Secondary Injury Risks
Farmers with upper-extremity amputations are at risk of secondary injuries because they may (a) have decreased padding or scar tissue around a stump that may make it vulnerable to damage from bumping or brushing against farm machinery or buildings, (b) wear a prosthesis that may get entangled in farm machinery, materials, crops, livestock, or equipment, (c) use the non-effected arm or hand to break a fall or perform a hazardous task, and (d) be susceptible to frostbite in areas with nerve damage or decreased circulation. According to the National Agriculture Safety Database and The Easter Seals Society, farmers throughout the United States who have experienced upper-extremity amputations provided the following information below that may help others avoid secondary injuries.
- A custom-made, padded glove can prevent skin breakage and reduce the potential for infections in an injured finger and hand that has decreased tissue or padding around the bony prominence.
- Pocket hand-warmers can be used to prevent injured fingers and hands that have decreased circulation from becoming frostbitten.
- Although nails can be started using one hand, doing so may result in a smashed finger or a blood-blister. One-handed nail starters could be a good alternative. These starters include the Ted Hammer, the Auto Hammer, or a hammer that has been adapted with magnets attached to the inside of the claw that holds the nail in place while it is being started. One farmer who uses a Dorrance Hook found a simple solution–he grasped a comb in the jaws of the terminal device and placed nails between the teeth of the comb. The comb held several nails in place so he was able to start them all very quickly.
- Climbing a ladder with a prosthetic device can be dangerous. It is important not to rely on the terminal device when grasping an overhead rung on a ladder. A safer solution can be to wrap the forearm of the prosthesis around the outside of the ladder.
- Care should be taken when working around livestock. The terminal device can easily catch on chains, collars, ropes, halters, or to the mane or hair of livestock and, as one farmer put it, "you can get an awful ride". If a Prehensile hand is used, the far-most grip on the terminal device should be used when grasping a cow’s chain to enable easier release of the animal.
- A quick-release chest harness can be useful in a situation where a prosthetic device catches on something like a tree branch, a bale of hay, or a chain around a cow’s neck. Using a chest harness with a quick release Velcro strap could be a good remedy. Pulling on the Velcro strap can quickly release the prosthesis from the stump in an emergency situation. A chest harness may not be appropriate for everyone; therefore, a prosthetist should be consulted.
- When using an upper-extremity prosthetic device with an internal elbow lock, caution should be taken in lifting and carrying objects that exceed the strength of the elbow lock. A prosthetist should be consulted on appropriate weight limits for carrying objects. An external elbow lock made out of durable material, such as stainless steel, might be considered for someone who does heavy lifting and carrying. Remember: a heavy-duty external elbow lock will add more weight to the prosthesis.
- Care should be taken to not touch electric fences with the terminal device of the prosthesis. The electrical current may travel up the terminal device through the metal cable resulting in a shock to the back or shoulder.
- During winter months in colder climates, the stump can be susceptible to frostbite. An additional stump sock could be added to provide more insulation. Use stump socks that lift perspiration away from the skin. Tube socks can be added to the outside of the socket to provide more insulation. Frequent work breaks should be considered to make sure the stump stays warm. A heater, with proper ventilation, or electric hair dryer may be useful in the farm shop to warm the stump in emergencies. Due to decreased sensation in the stump, caution should be taken to avoid applying excessive heat that may result in burns. A muff might also be used to keep the stump warm when the prosthesis is not being worn.
- The non-effected hand or arm is at risk of a repetitive stress injury due to overuse in compensating for the loss of the opposite hand or arm. Jigs, fixtures, clamps, and vice grips could be used to compensate for the loss of strength or ability. The Quick Grip and Robo Grip are just two tools that benefit individuals who only have the use of one hand.
- Tools designed for one-handed use and other laborsaving devices can assist in preventing secondary injuries to both the affected limb and the non-affected limb.
- Several farmers with bilateral arm amputations have reported a loss of balance when walking or climbing. Additional steps made out of non-slip material, wider steps, and handholds could be added to farm machinery to make mounting and dismounting the machinery safer for those who have decreased balance and grasping ability.
- Special caution should be taken when performing tasks that could result in the prosthesis getting entangled in any way. These tasks include throwing bales of hay, climbing ladders, handling livestock, and working around power machinery.
No one, especially farmers, should feel that they are plowing new ground alone following a limb amputation. There are excellent resources and competent professionals who can help make the transition back to independence and work easier.
One amputee farmer’s advice to new amputees: "Don’t be afraid to try things. Many things can be figured out on your own through trial and error when living with an amputation. If you can overcome the fear of failure you will make plenty of accomplishments."
The following are a few sources that should be helpful:
National Amputation Foundation
40 Church Street
Malverne, NY 11565
(516) 887-3600
5929 N. May, Suite 511
Oklahoma City, OK 73112
(888) 235-5452
The Amputee Coalition of America
900 E. Hill Ave, Suite 285
Knoxville, TN 37915
(888) 267-5669
American Amputee Foundation
Box 250218, Hillcrest Station
Little Rock, AR 72225
(501) 666-2523
The information shared is based on data gathered by the Easter Seals Farm Family Rehabilitation Management (FaRM) Program through financial support from the Injury Prevention Research Center at the University of Iowa, Grant #R49\CCR703640-02 funded by the Center for Disease Control. No scientific research has been conducted to determine if the above tips or suggestions are safe or effective. The information is simply ideas shared by farmers affected by disabilities and the experience of the staff at the FaRM Program. For more information or clarifications of information shared, please contact the FaRM Program at (515) 289-1933 or submit comments or questions to P.O. Box 4002, Des Moines, Iowa, 50333. This document has been edited by the National AgrAbility Project staff at the University of Wisconsin-Cooperative Extension, Biological Systems Engineering Department and Easter Seals.
Source: Breaking New Ground, Prosthetic and Worksite Modifications for Farmers With Upper Extremity Amputations; Natlional Ag Safety Database(nasd); USDA The National AgrAbility Project/The Easter Seal Society.
One-Handed Assistive Devices
There are many assistive devices available for individuals with only the use of one hand. These are just a few examples of the multitude available. Contact your local county extension office or the AgrAbility project for more information.
N-Abler III, Wrist/Hand Orthotic Brace, Texas Assistive devices: www.n-abler.org
This device can assist individuals who suffer from: Nerve or Muscle Damage, Birth Defects, Stroke, Spinal Cord Injury, Injurious Repetitive Tasks, and Carpal Tunnel Syndrome.
One-Handed Clamp & Spreader: www.leevalley.com
This bar clamp has a removable head and stop pins that can be converted into a spreader clamp, a movable tailpiece to allow for shorter clamping capacity, wide clamping jaws, and a narrow-profile handle. The spring-loaded handle has an advance-feed mechanism with the release clutch at thumb position for easy one-handed operation.
Tri-Pin Steering Device: www.handicaids.com
Spinner Steering Devices are free-spinning handles that fit on the steering wheel. The Tri-Pin device is designed for drivers with impaired gripping abilities. A Spinner Ring (not shown) is a steel loop that spins freely and can be gripped with a prosthetic hand.
One-Handed Envelope Opener: www.sammonspreston.com
This small, portable device enables individuals with decreased function of one arm or hand to independently open envelopes. Individuals must have good control of the arm they are using and good eye-hand coordination. Guarded razor cuts envelopes while suction cup base attaches firmly to most flat surfaces, including countertops, wheelchair trays, and office desks.
One-Handed Button Hook: www.sammonspreston.com
For big buttons, you need a big button hook. For smaller buttons, a smaller button hook will do. Anyone lacking motor coordination will be glad to have this double-duty button hook. Just slip the wire hook through the button hole, grab the button with the wire and pull it back through the hole.
One-Handed Nailing Hammer: www.leevalleytools.com
Nails are held in the groove securely by an integral rare-earth magnet. The advantage of this style is that it lets you hold material with one hand as you use the other hand to start and drive the nail.
Fishing Rod Devices: Access To Recreation: www.accesstorecreation.com
Holds all four styles of rods: bait, spin, spincasting, and fly. The body frame is strong molded plastic. The under side is padded with a soft foam rubber padding for added comfort. The suspender-like harness is strong webbing with an easy on/off buckle. The adjustable insert grips to the rod so you can play the fish with one hand.
This clamp-on fishing pole holder keeps a good grip on the pole and makes the reel available for one hand operation. A rigid, heavy-walled PVC plastic tube 1.6" inside diameter x 6" long, holds the fishing rod handle while a slot in the side supports the reel and keeps it from moving while your fish is reeled in.
The pole is easily removed from the holder. A clamp with a screw and large wing nut make it adaptable to any tubular wheelchair bar 7/8" to 1-1/8" diameter. The holder is also a perfect fit for use on lawn chairs, beach chairs and sports wheelchairs.
Support of the Disablement Model
The Oklahoma AgrAbility project seeks to support farmers and ranchers who have sustained injuries that result in disabilities through a variety of means. The focus of the AgrAbility project is to provide support through education, and technological assessment in an effort to facilitate a quality of life that maximizes human function for Oklahoma farmers/ranchers and their families.
The Oklahoma AgrAbility Project endorses the maximizing human function through the application of the Disablement Model adopted by the National Center for Medical Rehabilitation Research Classification (NCMRRC). The NCMRRC Disablement Model is a variation of the World Health Organization—International Classification of Impairments, Disabilities, and Handicaps (ICIDH). In 1980 the World Health Organization adopted the Disablement Model:
Disease: Intrinsic pathology or disorder
Impairment: Loss or abnormality of psychological, physiological, or anatomical structure or function at the organ level
Disability: Restriction or lack of ability to perform an activity in a normal manner
Handicap: Disadvantage due to impairments or disability that limits or prevents fulfillment of normal role—depending on age, sex, sociocultural factors for the person
It is the belief of advocates for the disabled that a handicap results when society imposes restrictions. With the advent of the American with Disabilities Act, and with increased public awareness of the rights of individuals with disabilities, the use of the term handicap has been dropped from the Disablement Model proposed by the National Center for Medical Rehabilitation Research Classification.
Pathophysiology: Interruption of normal physiologic developmental processes or structures
Impairment: Loss or abnormality of cognitive, emotional, physiological, or anatomical structure or function
Functional Limitation: Restriction or lack of ability to perform an action in the manner or range consistent with the purpose of an organ or organs
Disability: Limitation or inability to perform tasks, activities, and roles to levels expected within the physical and social contexts
Societal: Restriction attributable to social policy or barriers that limit the fulfillment of roles
The Oklahoma AgrAbility Project seeks to work within the Disablement Model to maximize human function by reducing the barriers to living and working the agricultural life for individuals and families with known pathology, impairments, functional limitations, and disabilities.
This newsletter was supported in part by USDA-CSREES grant award number 2002-41590-01370.