Farming with Upper Extremity Limitation/Amputation

Amputations are all too common, accounting for 11% of all agricultural related injuries. On the farm, injuries resulting in an amputation are typically caused by entanglement, entrapment, crushing injuries, or infection from a traumatic injury. Upper extremity amputations can include finger amputations, hand amputations, and arm amputations either below-elbow or above-elbow. Other limitations due to traumatic injury to the upper extremities include decreased strength, reduced range of motion or limited function due to tendon, muscle, nerve, or joint damage. An upper extremity injury presents a higher risk for secondary injuries to occur because decreased padding or scar tissue around the injury site may not tolerate usual bumping or minor impacts with objects such as farm machinery or tools. Overcompensating with one extremity because of limited use of the injured extremity can cause secondary injuries such as sprain/strains to muscles or damage to the joints. Individuals are more susceptible to frostbite because of nerve damage or decreased circulation to the injured extremity.

Extent of Recovery

The extent of your recovery depends largely on your physical condition prior to amputation. Many amputees who are in good physical condition continue to work and do most of the other activities their peers do. Extent and speed of recovery depends mostly on these factors:

1. Your age and the length of the healing process. People heal more slowly as they get older. The more complex the amputation and its wound, the slower healing is likely to be.
2. The extent of other medical problems associated with the amputation such as burns or diseases causing general debilitation such as diabetes or not enough blood supply to the limb (vascular insufficiency) all of which tend to lengthen the recovery process.
3. Learning to use a prosthesis is hard work, so your overall physical condition and health will play an important role in how quickly you can progress.
4. How closely you follow the instructions of your physiotherapist. This is especially true of how much you do. It is easier to prevent problems than to cure them, so don't overdo!
5. How much you want to recover and learn to use a prosthesis. Determination has no substitute.
6. Psychological factors can speed up or slow down your recovery. Support from family and friends, and various social and economic factors can play an important role in either speeding up or virtually stopping your recovery.

Working With an Amputation

You can do almost anything you want to regardless of the type of amputation. Individuals with an amputation will have to learn a new way to perform simple tasks by utilizing other body parts. With some prostheses, it takes slightly more energy to complete simple tasks than with normal limbs. This increased energy expenditure, along with pain and irritation, can limit how much you can do. This is especially true of the amount of activity you can do without causing problems in the residual limb. A real limit is how much irritation your skin can take from the pressure, sweat, and twisting of the socket.

Tips for Farming With Upper Extremity Limitations Include:

1. For finger and hand injuries with decreased tissue or padding around bony prominence, wear a custom-made padded glove to prevent skin from breaking and potential infection from bumping into objects.
2. Pocket hand warmers can be used for finger and hand injuries that have decreased circulation to prevent possible frostbite.
3. Although nails can be started using one hand, it increases the risk of smashing a finger or receiving a blood-blister. One-handed nail starters might be considered.
4. When climbing with a prosthetic device, it is important not to rely on the terminal device when grasping an overhead rung on a ladder. It may be safer to wrap the forearm of the prosthesis around the outside of the ladder.
5. When working around livestock, prevent being caught onto chains, collars, ropes, halters, or other materials attached to livestock. If using a prehensile hand, grip the end of a cow's chain so that you can let go more easily.
6. A quick-release chest harness might be useful for those situations in which a prosthetic device may get caught onto something. A chest harness allows releases with a pull of a Velcro strap to release the prosthesis quickly from the stump. A chest harness may not be appropriate for everyone. A prosthetist should be consulted.
7. When using an upper-extremity prosthetic device with an internal elbow lock, try to avoid lifting and carrying objects that exceed the strength of the elbow lock. Consult with a prosthetist on appropriate weight that could be carried. An external elbow lock made out of durable material such as stainless steel might be considered for heavier lifting and carrying. Keep in mind that a heavy-duty external elbow lock will add more weight to the prosthesis.
8. Do not touch electric fences with the terminal device of prosthesis. The electrical current may travel the terminal device through the metal cable and you will experience a shock to the back or shoulder.
9. To prevent frostbite to the stump of a below-elbow amputation, the following are some tips that might help:

• Add additional stump socks to provide more insulation.
• Obtain 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 so that you can warm up the stump. A heater or electric hair dryer may be useful in the farm shop to warm the stump in emergencies. Caution should be taken to ensure that not too much heat is applied due to the potential of burns resulting from decreased sensation in the stump. A muff might also be used to keep the stump warm while performing tasks in which the arm is not needed.

10. Be careful to compensate for lost gripping ability when performing tasks with your non-affected hand. Jigs, fixtures, clamps, and vice grips should be used to compensate for the loss of strength or ability.
11. Use one-handed tools and other labor-saving devices to help prevent additional injuries to the affected limb as well as potential injuries to your other hand or arm.
12. For bilateral arm amputations additional steps made out of non-slip material, wider steps, and handholds could be added to farm machinery to make mounting and dismounting safer due to decreased balance and grasping ability.
13. Special caution should be taken when performing tasks that could result in your prosthesis getting caught. These tasks include throwing bales of hay, climbing, catching livestock, and working around power machinery.
14. Any adaptations or modifications specifically intended for use by an individual with a disability should be used by that individual only. Use of a modification or adaptation by another individual could result in an injury.

Acknowledgments

This fact sheet was reviewed by Karen Mancl, PhD, Professor, Food, Agricultural and Biological Engineering, The Ohio State University; and Pat Luchkowsky, Director of Public Affairs, Easter Seals of Ohio.

References

Reed, D. & Kidd, P. (2009). AgDARE- Agricultural Disability Awareness and Risk Education. University of Kentucky.
nasdonline.org/209/amp8/d000153/agdare-agricultural-disability-awareness-and-risk-education.html

The Easter Seal Society. (n.d.). Safety Tips for Farming with Upper Extremity (Arm) Limitations. Iowa State University Cooperative Extension.
nasdonline.org/254/d000053/safety-tips-for-farming-with-upper-extremity-arm.html

About AgrAbility Based Fact Sheets

These fact sheets were developed to promote success in agriculture for Ohio's farmers and farm families coping with a disability or long-term health condition. AgrAbility offers information and referral materials such as this fact sheet, along with on-site assessment, technical assistance, and awareness in preventing secondary injuries. Fact sheets were developed with funding from NIFA, project number OHON0006.