1. Pilot Survey Results Regarding Upper Extremity Prosthesis Use and Issues Among Wisconsin AgrAbility Clients. Presented by: Richard J. Straub, PhD Project Leader University of Wisconsin-Madison, Biological Systems Engineering Department. AgrAbility of Wisconsin.

2. Contributors University of Wisconsin – Madison Occupational Therapy Program, Department of Kinesiology Joshua J. Hedrich, MSOT Dorothy F. Edwards, PhD Medstar Health Systems – National Rehabilitation Hospital, Washington, D.C. Rahsaan J. Holley, MS, OTR Alexander W. Dromerick, MD University of Wisconsin-Madison, Biological Systems Engineering Department/AgrAbility of Wisconsin Robert H. Meyer, MS Richard J. Straub, PhD

3. Background AgrAbility of Wisconsin was approached in the Fall of 2009 to assist with a survey related to upper extremity amputation and prosthetic training. The investigators were interested in any differences between rural and urban populations.

4. Project purpose and participants To explore the effects of:  upper extremity prosthesis use, and  prosthetic training on the functional ability of individuals with an upper extremity amputation 74 clients (past and current) of the AgrAbility of Wisconsin program.

5. Survey Basics Self-report mail based survey:  Characteristics of participants Location and etiology of amputation, prosthesis type, use and frequency  Self-efficacy in prosthesis use and common activities.  Training involved in learning to use prosthesis  DASH (Disabilities of the Arm, Shoulder and Hand) Standardized, valid survey instrument (30 items)  Demographic and employment questions

6. Methods Survey packets were provided to AgrAbility of Wisconsin.  Survey, introduction letter and reply postage paid envelope (returned directly to UW Survey Center)  AgrAbility of Wisconsin inserted a personalized letter describing the purpose and informing the clients of their rights under our UW-Extension IRB guidelines.  No follow up procedures or incentives were used. Participants were informed in the AAW letter that this was a one-time survey mailing.

7. Results Total number of surveys mailed out: 74 Completed surveys returned: 20 (1 was returned incomplete) Response rate 27%

8. Demographics 19 male, 1 female Mean age 54 (S.D. 11.7) Range 34 – 82 Amputation level  Partial hand - 7  Wrist disarticulation - 3  Below elbow - 4  At elbow - 1  Below shoulder - 3  At shoulder - 3

9. Etiology of Amputations 19 civilian related trauma (9 specifically listed farm accident as cause) 1 birth related defect Timeframe: 2000 - 2009 - 5 amputations 1990 - 1999 - 7 amputations

10. Prosthetic Use 12 individuals indicated current or prior use of a device:  Cosmetic - 4  Body powered - 9  Externally powered - 2  Hybrid - 1 Number of days used in last month:  0 days - 2  1 - 10 days - 2  At least 28 days - 7  Did not indicate - 1 Length of time per day used in previous week:  0 - 3 hours - 1 individual  7 to 9 hours - 3 individuals  10 + hours - 4 individuals  Did not indicate - 4 individuals *note some clients reported use of more than 1 type of device.

11. Ability to use prosthesis in certain activities: ActivityAble to useNot able (want to) Write110 (4) Turn a key38 (3) Prepare a meal74 (1) Place an object on a shelf, overhead 56 (3) Heavy household chores 65 (1) Make a bed83 (1) Carry a shopping bag101 (1) Carry a heavy object83 (3)

12. Ability to perform tasks, continued… Change lightbulb overhead 110 (4) Wash/blowdry hair56 (2) Put on pullover sweater65 (1) Use knife to cut food47 (3) Recreation low effort (cards, knit) 73 (2) Recreation some arm force (golf, hammer) 56 (5) Recreation with free arm movement (frisbee) 37 (4)

13. Client Responses 1. Holding objects during activity, including holding nails to hammer, holding string to tie knot or shoes, holding book or papers 2. Meal preparation activities, includes using a knife, peeling vegetables 3. Carrying objects 4. Operating vehicle/farm equipment/power tools 5. Using manual labor tools, including shovels, forks, scrapers

14. Discussion Participants reported some degree of success with prostheses Some areas from the previous table indicate a desire to perform a task  Writing, overhead tasks, recreation Small sample size limits conclusions, this is informational, pilot data only.

15. Discussion, Cont. Why did those individuals who said they received training score higher on the disability level?  Possibly the extent of the amputation -- those with the greatest amputation were offered more training.  Participants may not be aware of potential increase in ability with use of prostheses

16. Conclusions Improved focus on specific needs based training. Lifetime, follow-up training Research to improve training techniques.

17. Questions? Applications? How can we apply this information to the work that we do with clients using prostheses? What training is available now for farmers who experience amputation?  Any farm specific occupational training? Are we looking at all aspects of life when we work with clients?  Recreation, activities of daily living, etc.