Prosthetic Limbs Inadequate for Farmer, Rancher Use

Farmers and ranchers require more durable, affordable and adaptable
prostheses to facilitate them in their work. This study was published recently
in Disability and Rehabilitation: Assistive Technology.

“Farming continues to be a very physically demanding
occupation,” Craig Heckathorne, MS, research engineer at
Northwestern University Prosthetics-Orthotics Center (NUPOC), told O&P
Business News.
“They’re in and out of their vehicles all day,
climbing fences and ladders in their barns and storage facilities and because
they’re working outdoors the terrain changes. There needs to be a
concerted effort to educate prosthetists about farming activities and the
farmer about what devices can offer.”

Concerns related to prostheses

From November 2008 to March 2011, Heckathorne and Kathryn Waldera,
past NUPOC research engineer and project director, interviewed 40
farmers with upper- or lower-limb amputations and 26 prosthetists with
experience in providing services to farmers and ranchers with amputations. They
explored issues such as current and past prostheses used, prosthetic failures
and ability to complete farm tasks using a prosthesis.

Craig Heckathorne

Craig Heckathorne


Durability/utility, environment, adaptation, cost and education of
farmers and prosthetists were concerns related to prostheses. When compared
with an intact limb, a prosthesis limited the performance of many farm tasks
because farmers are more demanding of their prostheses, using them as tools to
carry out work on the farm. This demanding wear affected the durability of the
prostheses, making them deteriorate faster and fail more frequently compared
with those of the general population of individuals with amputations. Weather
and rough terrain can cause the prostheses to break more easily, cause them to
get stuck in mud or caught in weeds and interfere with the motion of any
movable prosthetic part such as joints, locking mechanisms or control cables.

“Durability really came to the forefront, not only from the farmers
who we interviewed, but also from the prosthetists who were serving them,”
Heckathorne said. “Across the board, the number one issue is that devices
are generally not meeting manufacturer’s suggested time frames before
failure for this population. They’re often not even close to meeting what
farmers need in terms of durability.”

Injuries and insurance

Farmers experienced fractures due to falls related to their prostheses.
They also reported back pain, which was caused by the weight of their
prostheses or because they could not kneel with a lower-limb prosthesis and
must bend at the waist to compensate. Farmers reported other secondary injuries
as well. Adaptations to farm equipment and prostheses can also cause safety
issues, affect durability and result in expensive repairs. Some farmers either
do not have or have inadequate medical insurance and most do not receive
worker’s compensation because they are small business owners, which lead
to out-of-pocket purchase of their prostheses. The high failure rate of some
prosthetic components resulted in additional increased costs to farmers.

Finally, prosthetics components and constructions are often
inappropriately implemented due to prosthetists’ lack of education about
the specific needs of farmers with amputations. According to farmers, some
prosthetists did not understand a farmer’s daily routine and did not
adequately address their concerns. Farmers also reported that they were not
consistently educated and trained in the operation of their prostheses from
rehabilitation professionals. However, prosthetists reported that farmers were
often unrealistic in their expectations of what prostheses could do for them.


Prosthetic Limbs Inadequate for Farmer, Rancher Use


“One take-home message for clinicians is to be sensitive. Farmers
view self-sufficiency and do-it-yourself repairs as a positive reflection of
their personalities and work ethic,” Heckathorne said. “Don’t
lecture them about being too hard on their device. It’s not going to get
you anywhere because they’re not going to change their work attitude. They
have to get the job done.”

The next step

In collaboration with the National AgrAbility Project, Heckathorne and
colleagues are part way through a 5-year project funded by the National
Institute on Disability and Rehabilitation Research (NIDRR) that explores the
experiences of farmers and ranchers with prosthetic devices.

“We learned that there was very little written about the
circumstances that farmers with prostheses experience as a group. There are a
lot of anecdotal stories and some documentation of individual situations, but
there are no collective surveys that have been done to try to identify some of
the component problems and failure modes, which is why we undertook the first
interview survey. However, that’s only the initial stage of the
project,” Heckathorne said.

In the next stage the researchers will look at a broader sample of
farmers through an online and print survey. They will also be pursuing
engineering design projects and evaluating products that are targeted for
farmers and ranchers. Specifically, they are searching for individuals who may
be designing prosthetics for developing countries. According to Heckathorne,
developing countries can be used as a model for rural agricultural communities
within a developed country because of their agricultural demands, as well as
cost and distribution constraints.

“There is a lot of emphasis in the United States on developing
computer-controlled electronic and motorized devices, but that is probably not
yet where we want to go in terms of solutions for farmers, commercial
fishermen, construction workers who are outdoors, or individuals in the timber
industry and maybe even soldiers who are thinking of going back into active
duty,” Heckathorne said. “There is still a lot of room to be looking
at other kinds of solutions that are not fully electronic or not electronic in
any way.” — by Casey Murphy

For more information:

Waldera KE, Heckathorne CW, Parker M, Fatone S. Assessing the prosthetic
needs of farmers and ranchers with amputations. Disabil Rehabil Assist
July 10, 2012. [Epub ahead of print]

Disclosure: Heckathorne has no relevant financial disclosures.

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