Psychological Factors in Work-Related Amputation: Considerations for Rehabilitation Counselors

Abstract

Traumatic amputation is a catastrophic work injury and is often a major cause of disability. In the United States between 1992 and 1999, there were approximately 11,000 non-fatal workplace amputations each year (National Institute of Occupational Safety; [NIOSH], 2000). When compared to other workplace injuries, traumatic amputation is associated with among the highest work claim costs and days off work. This injury is most common in young to middle adult age males, and is most likely to occur within manufacturing industries. The workers at highest risk are industrial machine operators, fabricators, and labourers. Machinery is the major source of work-related amputation and the accidents typically involve being caught in, or compressed by equipment or objects. The vast majority (94%) of work-related amputation involve fingers (NIOSH, 2000) and are usually the result of crush or laceration injuries. Depending on the severity and level of amputation, work-related amputation often requires intensive acute medical care as well as arduous and sometimes protracted rehabilitation. In addition to treating life-threatening injuries, initial trauma management may attempt to surgically reattach the amputated limb. When that is not possible, efforts are turned to the repairing the tissue at the site of the amputation, often referred to as the residual limb, or stump. The initial postoperative phase focuses on wound treatment and early physical reactivation, and the use of prostheses or other artificial devices may be recommended. Rehabilitation ideally includes a multi-disciplinary approach of physical and rehabilitation medicine, psychology, prosthetic services, and vocational rehabilitation. Ongoing care of the residual limb, prosthetic readjustments, follow-up evaluations, and even surgical revisions are all part of the long-term management of work-related amputation. The process of adjusting to work-related amputation often involves ongoing cognitive, emotional, and behavioral adaptations. From the time of the accident, and through the acute and post acute rehabilitation phases, work-related amputation can evoke a complex range of psychological reactions. New psychological issues and coping challenges often emerge later, particularly as the worker attempts to adjust to the injury and its impact on daily life. This work injury can be associated with severe psychological sequelae including anxiety symptoms such as posttraumatic stress symptoms, depression, grief, body image disturbances, and chronic pain. Together, the physical and emotional effects of the injury can have devastating occupational, social, and interpersonal consequences. The purpose of our paper is to provide a review of the literature on the psychological factors associated with the adjustment and outcome of work-related amputation. Considerations for rehabilitation counselors in promoting psychosocial adjustment, return to work, and quality of life are also discussed. We also provide suggestions for how cognitive behavior therapy can be used by counselors to effectively address the complex range of psychological difficulties that can arise following this injury. Lastly, directions for future research are suggested. Psychological Factors in Work-Related Amputation Despite the personal and economic toll of this work injury, the empirical research on work-related amputation is relatively sparse. Vocational functioning in work-related amputation has received some empirical investigation (Dasgupta, McCluskie, Patel, & Robins, 5997; Millstein, Bain, & Hunter, 1985), and only a handful of studies have specifically examined the psychological aspects of this injury (Cheung, Alvaro, & Colotla, 2003; Grunert, et al., 1988b, 1990a; Henniger, Saunders, & Efanda, 2001). Research on accident-caused amputation, herein referred to as traumatic amputation, has generally found that psychological adjustment gradually occurs postinjury (Livneh, Antonak, & Gerhardt, 1999; Matsen, Malchow, & Matsen, 2000). …