What is amputation?
Amputation means the loss or absence of all or part of a limb. Causes of amputations include peripheral vascular disease (often associated with diabetes), trauma, tumors, and infections. In the United States, limb loss resulting from vascular conditions, referred to as dysvascular amputation, accounts for the majority of lower extremity amputations. Although the rates of limb differences due to congenital anomalies have remained consistent for several decades, dysvascular amputations have increased significantly. Upper extremity amputations are most often a result of an accident or trauma, with recent warfare increasing the rate of occurrence in the United States. In general, upper extremity amputations occur more often in younger age groups. In the wake of an amputation, a new amputee could have a myriad of post-operative medical concerns such as pain management, infection, and controlling the swelling and shaping of the residual limb. Additionally, there will likely be a period of significant rehabilitation, with a wide range of therapeutic goals that will vary for each individual. Amputees may experience a wide range of emotions in response to the loss of a limb, including anxiety, sadness, depression, anger, and grief.
How prevalent is amputation?
In the general population, there are almost 1.7 million people who live with having lost a limb. In the U.S., about one in every 200 people has had a limb amputated, the majority of which are due to vascular conditions and diabetes.48 Among all veterans from the OIF/OEF conflicts from 2001 to September 2010, there have been approximately 1,621 amputations. The majority of veterans having undergone an amputation are army service members from OIF, with 620 service members having lost a major limb.49 During World War I, over 4,000 service members underwent amputations, and amputations were performed on 15,000 service members during World War II. In the Korean, Vietnam, and Gulf Wars there were 1,000, 6,000, and 15 documented amputations on service members, respectively, not including body parts lost to frostbite and other cold injuries. Members of the army have also experienced traumatic amputations during peacetime, estimated at 20 per year.50 Importantly, such research and development has occurred post-9/11 in the area of prosthetics, and available prosthetics continue to improve, allowing veterans to regain most function in many cases.
What accommodations are suggested to support individuals who have lost a limb?
The Job Accommodation Network (JAN) has listed several accommodations for amputation. These include activities or actions around various topics such as:
Gross motor impairment
- Modify the work-site to make it accessible
- Provide parking close to the work-site
- Provide an accessible entrance
- Install automatic door openers
- Provide an accessible restroom and break room
- Provide an accessible route of travel to other work areas used by the employee
- Modify the workstation to make it accessible
- Adjust desk height if wheelchair or scooter is used
- Make sure materials and equipment are within reach range
- Move workstation close to other work areas, break rooms, and restrooms
Fine motor impairment
- Implement ergonomic workstation design
- Provide alternative computer and telephone access
- Provide sensitivity training to coworkers and supervisors
Upper extremity amputations (finger, hand, or arm)
- Keyboarding/data entry: One-handed keyboards, typing tutorials for one-hand or missing digits, speech recognition software, large-key keyboards, foot mouse, touch pads, trackballs, and/or head pointing systems
- Writing: Grip aids, writing cuffs, action arm orthotic devices, recoding devices for note taking, note-takers, and/or clipboards
- Using telephones: Speaker phones, telephones with programmable number storage, phone holders, and/or telephone headsets
- Gripping tools: Grasping cuffs, grasping orthoses, ergonomically designed tools, vibration dampening tool wraps and gloves, vises, positioners, foot controls, pistol grip attachments, and/or digital distance measuring devices
- Lifting items: Portable material lift equipment, tailgate lifts, hoists, lift tables, and/or compact lifting devices
- Carrying items: Lightweight carts, shoulder bags, scooters with carrying baskets, and/or other powered carts
- Filing papers: Lateral files, carousel rotary files, rulers as pry bars, and/or other reorganization (e.g., reduce the number of files per drawer)
- Housekeeping/cleaning: Lightweight vacuum cleaners, backpack vacs, long-handed cleaning aids, and/or grasping cuffs
- Driving: Steering knobs, power-assisted steering, grip gloves, steering wheel covers, remote engine starters, and/or other control modifications
Lower extremity amputations (toe, foot, or leg)
- Climbing: Stairlifts, wheelchair platform lifts, climbing wheelchairs, rolling safety ladders with handrails, work platforms, and/or hydraulic personnel lifts
- Standing: Stand supports, task stools, anti-fatigue matting, rest breaks, and/or sit/stand stools
- Lifting/carrying: Material handling lifts, cranes, hoists, powered carts/scooters, hydraulic lift carts, lift tables, tailgate lifts and/or lightweight carts with large wheels
- Driving: Hand controls, automatic clutching systems, left-foot gas pedals, automatic transmissions, and/or designated parking modifications
- Walking: Canes, crutches, rolling walkers with seats, wheelchairs, and/or powered wheelchairs/scooters
For more information about amputation and accommodations, please visit http://askjan.org/media/eaps/employmentampEAP.doc.