Interview Analysis Notes from the interviews were analyzed

Interview Analysis • Notes from the interviews were analyzed using inductive thematic analysis • common method for interpreting qualitative data • identify and describe themes represented by text • assignment of theme-based codes to text • analyze frequency of codes; co-occurrence or other relationships between coded text - quantification minimizes investigator bias • conducted separately by two investigators (Boyatzis, 1998) - additional check against investigator bias - discrepancies in interpretation resolved through discussion © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 1

Common Themes ENVIRONMENT DURABILITY/ UTILITY EDUCATION ADAPTATION COST © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 2

Common Themes • Farmers and prosthetists perceive that farmers’ prostheses deteriorate faster and fail more frequently than DURABILITY/ those of the general population UTILITY of persons with amputations • Farmers use their prostheses as tools to carry out farm work • Compared to having an intact limb, performance of many farm tasks is “Ifimpeded a manufacturer says or limited by use of a a component should last oneprosthesis year, for me it lasts about 3 months. ” — farmer • Prosthesis better than no prosthesis © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 3

Common Themes ENVIRONMENT • Farmers use prostheses under harsh environmental conditions • Weather, dirt, and rough terrain are hard on prostheses, leading them to break more frequently • Dust and dirt interferes with motion of movable parts • Wet and dirty conditions can be damaging to electricpowered devices • 6/17 farmers with upper limb amputations owned a myoelectric prosthesis but none used them for farm tasks © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 4

Common Themes • Choosing to use a prosthesis is an adaptation to address the challenges of farming with an amputation • Other adaptations are necessary to compensate for deficiencies in contemporary prosthetic technology: • routines ADAPTATION • farm equipment • prosthesis – self modifications • attitudes “First, you must have a good attitude, otherwise, you won’t use the device. "— farmer © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 5

Common Themes • Adaptations to farm equipment and routines are costly • Prostheses are expensive, high failure rate further increases costs • High costs lead to self-repairs, self-maintenance or going without a replacement prosthesis COST “An item that costs so much should last longer than it does. Everything is so expensive. ” — farmer © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 6

Common Themes • Adaptations to farm equipment and routines are costly • Prostheses are expensive, high failure rate further increases costs • Traveling long distances to see prosthetists with the expertise they need further increases out-of-pocket cost COST © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 7

Cost Insurance coverage status (N=30) • 15 (50%) - Private insurance • 6 (20%) - No insurance • 5 (17%) - Worker’s comp • 3 (10%) - Medicare/Medicaid • 1 (3%) - VA © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 8

Common Themes • Prosthetists are typically not educated about the specific needs of farmers with amputations • Can lead to inappropriate prosthetic designs (poor utility) • Many farmers reported that they felt prosthetists did not listen to their concerns and did not understand their daily routine EDUCATION • Farmers were not consistently educated and trained in the operation of their prostheses © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 9

Discussion • Good agreement in responses between farmers and prosthetists with regard to most themes Farmers considered modifying their own devices to be an indicator of ingenuity Prosthetists occasionally referred to these types of modifications as examples of misuse • Prosthetists need to work closely with farmers to specially configure their prostheses to minimize the probability of device failure © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 10

Publication © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 11

September 2012 News Coverage © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 12

Current Work • Expanded survey • Education materials • Device evaluation / design © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 13

Expanded Survey • A larger sample of subjects is needed to appropriately capture diversity and understand challenges of farming with an amputation • Increase representation of: • Types and levels of amputation • Types of farming • Specific prosthetic components used • Geographic regions • Ranchers © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 14

Expanded Survey © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 15

Agr. Ability Projects & Programs USDA-funded state projects Affiliate programs © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 16

Education • Webinar for experienced CPs and CPOs • Focus on “best practices” for farmer / rancher • Available through NUPOC and National Agr. Ability Project websites © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 17

Device Evaluation / Design Simplicity is preferred: • More complicated equipment is generally viewed as not durable • “parts that are too complicated fail” • Mechanical devices are preferred because they can be cleaned with soap and hot water • Most farmers interviewed do some of their own repairs or modifications • When parts need to be repaired “time is money” • can’t send prosthesis away because they don’t have a back-up © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 18

Design Criteria • durable materials and construction • socket design maintains health of limb • consistent performance within wide temperature range • resist exposure to corrosive or damaging liquids • resist exposure to airborne particulates • withstand cleansing of biological and chemical contaminants • maintainable by farmer or rancher • cosmetic © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 19

Device Evaluation laminated frame socket IPT Tomm Kristensen Champaign, IL Oslo, Norway Open. Socket CJ Socket Technologies Beverly, MA CJ Socket Tough. Ware Prosthetics Westminster, CO ITAL © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 20

Wider Application More durable and adaptable prosthetic components for farmers and ranchers may also benefit persons with amputations who work in other physically demanding occupations such as: construction forestry fishing mining © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 21

Acknowledgements • This research was funded by the National Institute on Disability and Rehabilitation Research (NIDRR) of the U. S. Department of Education under Grant No. H 133 E 080009. The opinions contained in this publication are those of the grantee and do not necessarily reflect those of the Department of Education. • The National Agr. Ability Project and Breaking New Ground Resource Center at Purdue University (supported under USDA Special Project 2008 -4159004796) for assistance with this study. • State and regional Agr. Ability Projects and Affiliated Programs for assistance in contacting farmers and ranchers. © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 22

References Boyatzis, R. (1998). Transforming Qualitative Information: Thematic Analysis and Code Development. Thousand Oaks: SAGE Publications. Brown, J. (2003). Amputations: A Continuing Workplace Hazard. http: //www. bls. gov/opub/cwc/sh 20030114 ar 01 p 1. htm. Access Date: 03/21/12. Bureau of Labor Statistics (2012). National Census of Fatal Occupational Injuries in 2011 (Preliminary Results). USDL-12 -1888. News Release, September 20, 2012. Kircher, R. (2003). Farming with an arm amputation. Oklahoma Agr. Ability Newsletter, 2(2), 1 -8. Office of Special Education and Rehabilitative Services (2008). National Institute on Disability and Rehabilitation Research—Disability and Rehabilitation Research Projects and Centers Program—Disability Rehabilitation Research Projects (DRRPs), Rehabilitation Research and Training Centers (RRTCs), and Rehabilitation Engineering Research Centers (RERCs). Federal Register, 73(22), 6132– 6146. Prosthetic Limbs Inadequate for Farmer, Rancher Use. O&P Business News, 21(10), 31 -32, Fall 2012. Waldera, K. , Heckathorne, C. , Parker, M. , Fatone, S (2012). Assessing the prosthetic needs of farmers and ranchers with amputations. Disability and Rehabilitation: Assistive Technology, Early Online. © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 23

Thank you? Questions circa 1918 © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 24

Contact Info Craig Heckathorne 680 North Lake Shore Dr. NUPOC, Suite 1100 Chicago, IL 60611 phone: 312 -503 -5723 email: c-heckathorne@northwestern. edu © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 25

High Fatal Work Injury Rates By Occupation – Preliminary 2011 Data source: U. S. Bureau of Labor Statistics © 2012 Northwestern University Prosthetics-Orthotics Center for Education and Research Agr. Ability NTW — 26