For more than 25 years, assistive technology has enabled hundreds of thousands of agricultural producers to continue farming. Unfortunately, there is little research on how the assistive technology used might contribute to acquiring secondary injuries while working on the farm. This paper discusses the experiences of 20 farmers who acquired an injury or experienced a “close call” while using a wheelchair or prosthetic device to perform a farm task. In addition, these farmers share their ideas for improvements in designs of new wheelchairs or prosthetic devices, as well as recommendations for farmers with disabilities who might use this equipment while farming.
Farming, wheelchair, prosthesis, secondary injuries, assistive technology
More than 13 million individuals in rural America are affected by disabilities. Nationwide, approximately 288,000 agricultural workers between the ages of 15 and 79 have a disability that affects their ability to perform one or more essential tasks (4). For many individuals, disability jeopardizes their rural and agricultural futures. In a study conducted by the BNG Resource Center at Purdue University, farmers who experience severe disability, such as spinal cord injuries or amputations, continued to perform tasks that have been considered hazardous(2) by agricultural producers. Although farming may be hazardous to agricultural producers with or without a disability, many people within the agricultural/farm community believe that farm hazards and injuries are a part of the inherent uncertainties often associated with farming (5). Furthermore, “the freedom of and, indeed, the willingness and necessity of accepting risk are a fundamental value associated with the settling and advancement of this country” (5 ).
The Rural Research and Training Center at the University of Montana states that the average person with a disability reports 14 secondary conditions or injuries. More than 400,000 people who use manual wheelchairs experience serious secondary injuries to their shoulders, wrists, backs, and other parts of their bodies (7). Furthermore, Anson and Shepherd (3) state that individuals who are six or more years post-injury have a higher incidence of secondary complications than those who have been injured fewer than five years. Three years of data (2001-2004) from the National AgrAbility project of farmers who have received services show that 120 AgrAbility clients reported a lower limb amputation as their primary disability (1). Farmers who have an upper or lower extremity amputation are at risk of acquiring secondary injuries due to slips, falls, prosthetic entanglements, overuse injury of the opposite limb, and an injury to the residual limb (the stump).
For more than 25 years, assistive technology has enabled hundreds of thousands of agricultural producers to continue farming. Unfortunately, there is little research related to additional injuries when farming using assistive technology. The purpose of this paper is to provide examples of how secondary injuries have or might occur while performing a farm task by farmers who use a wheelchair or a prosthetic device and to share feedback, ideas and recommendations made by farmers to reduce potential injuries.
20 farmers who use either a wheelchair or a prosthetic device were interviewed to learn about their experiences with secondary injuries or “close calls” when performing a farm task. The data collected during these interviews and focus groups were codes and sorted into the following categories: (1) wheelchair related risks described by farmers, (2) prosthetic related risks described by farmers; (3) issues and recommendations made by farmers for improvement in wheelchairs used on the farm; and (4) issues and recommendations made by farmers for improvements in prosthetic devices used on the farm
Falls from the wheelchair when performing a farm related task was the most frequent wheelchair related mishap reported. Falls to either side occurred when trying to pick up objects from the ground. Sideway falls also occurred when one of the front casters hit a rock or a hole in the terrain, causing a shift in the center of gravity. Hilly terrain also resulted in falls when navigating the side of a slope. Forward falls occurred when the wheelchair engaged a small object or a threshold entrance into a machine shed or a shop; when going downhill and hitting a small hole in the grass that couldn’t be seen; and when reaching forward to pick up a small object. Backward falls occurred during wheelies while attempting to get over an obstacle or when throwing heavy objects such as firewood into the truck.
Transferring to and from a wheelchair from a tractor lift has also resulted in various falls due to transfer height difference and uneven transfers.
Getting stuck around the farm was the second most frequently reported mishap occurrence. Getting stuck in the mud, snow, gravel, or grass and being unable to call for help has resulted in farmers having to get out of their chairs and drag themselves to a safer area.
Other reported isolated situations involving wheelchair use were injuries related to carrying heavy objects on one’s lap in the shop or getting burned from carrying hot welded objects in the shop on one’s lap, thinking that it had already cooled down. Additionally, wheelchair entanglements with chains and ropes that could easily get wrapped around or caught onto the wheelchair were reported.
All farmers who used a manual wheelchair reported an increase in shoulder pain due to pushing the wheelchair over hilly, rocky and uneven rough terrain.
Farmers who experienced a leg amputation reported falls and injures due to walking across uneven ground, on an incline or icy surface, mounting and dismounting from a tractor and landing incorrectly, or when changing clothes in the mudroom that required balancing on one leg. In addition to falls, all farmers reported sores or blisters to their stumps. These occurred primarily in the summer time when the prosthesis rubbed repeatedly against other objects or after operating farm machinery for extended periods. In the winter months, the prosthetic devices also irritated the stump due to lack of insulation in the socket of the prosthesis. Other complaints reported about the prosthesis itself included: losing springs, pin breakage, device or socket breaks repeatedly and the need to frequently clean out the knee joint.
Prosthetic entanglement was also reported causing the prosthetic device to be pulled off or resulting in a fall when climbing a ladder, climbing over a gate, or getting the prosthetic foot caught in weeds.
Injuries to opposite limbs as well as hands, wrists and shoulders were reported when falls did occur. More over use injury of the opposite leg and back pain was reported by all farmers who experienced a leg amputation.
Farmers who experienced an arm amputation reported several incidents that occurred with their prosthesis, such as electrical shock traveling into the back when touching an electric fence with the prosthetic device; getting the “farmer’s hook” caught onto livestock and being dragged; breaking the wrist unit on the prosthesis when hitting a pig; getting caught on the twine of a bale of hay and getting pulled down; falling which resulted in the prosthesis breaking; cable fray wrist unit breaking, cable pulling out of the eyelet, plastic socket breakage. All farmers using an upper extremity prosthetic device reported issues with sores developing on their stump in the summer and sensitivity to the cold in the winter; overuse injuries of the opposite limb and upper back pain was also reported.
The most frequently breaking parts of the prosthetic device during farming were the cable, the wrist unit and the elbow lock.
Several farmers reported concern about long term use of a manual wheelchair around the farm with resulting hand, wrist, and shoulder pain from negotiating difficult terrain. One farmer suggested educating the rehabilitation community about the importance of power chairs, power-assisted wheels, and electric scooters for farmers who are currently using a manual chair. He stated “you hear that old mentality ‘Oh, you are a para and you need a manual chair…’, and that is the doctrine that is preached. Let’s start practicing and teaching “proper tools for a proper job”.
Making front casters bigger: 8-10 inches or 10-12 inches for getting through gravel; hard mud flaps that don’t crack or break; using wheels with more camber to prevent side tipping and falls; eliminating front casters and putting a duplicate set of drive wheels and motors on the front ( essentially to make the chair working like a skid loader); making a four-wheel drive chair that would get the user where he/she wanted to go, then having the ability to use the stand up feature and do what needs to be done; shock absorbers; a chair that elevates in order to complete some farm tasks.
All farmers reported the importance of a communication system on the wheelchair such as a cell phone, two way radios, horn, or a loud whistle to call for help when the chair gets stuck or when falling from the chair.
Titanium wrist and elbow units that don’t break; cable that won’t fray; provide extra screws and nuts; titanium pins; design a wrist unit that moves; a lower extremity prosthesis that will function better when walking through a field (e.g. soybeans) or on an incline surface; quick release harness; design a foot that bends when it gets caught in weeds; test sockets that are a little more durable for doing farm chores; a better socket solution for providing adequate ventilation, moisture control and protection during cold or hot weather; and a prosthetic leg that allows a farmer to kneel.
Farming will continue to be a labor intensive occupation requiring the worker to perform tasks that a wheelchair or prosthetic device was not designed to do. Farmers, outdoor enthusiasts, and others who use this equipment can benefit from new designs and new materials that are more durable. Unfortunately, insurance companies view this equipment as medically necessary durable medical equipment and not work related equipment. Therefore, funding reimbursement through traditional health insurance will be challenging. Suggesting that these improvements will ultimately save money in reduced secondary injuries on the farm will require significant documentation and research.
Therese Willkomm
17 Layton Drive
Canterbury, NH 03224
603-491-6555
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