Hand or foot?

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Photo via Dr. Joe Kiff

If you could only keep one, which would you choose: Hand or foot? Eyesight or hearing? Arm or leg? Choices like this luckily come to most of us in the form of morbid games of imagination we play with our friends. But for an unfortunate population, the choice is made for them at work.

In an article by Elsie Cheung and colleagues (2003), they drew on an observation of many clinicians: employees who experience severe injuries or amputations to their upper-extremity (i.e., fingers, hands, arms) at work seem to be particularly vulnerable to psychological maladjustment. While anecdotes may serve their purpose, Cheung and co. wanted to test whether those who experienced upper-extremity injuries were in fact psychologically worse-off than others who experienced severe injuries and amputations elsewhere. This clearly had implications for treatment and rehabilitation.

Diving into the library at the Workers Compensation Board of British Columbia, Cheung and colleagues pulled out files for individuals who 1) experienced upper extremity amputations or lower extremity amputations, 2) who were assessed by a clinical psychologist at the outpatient rehabilitation center, and 3) were psychologically healthy prior to the injury.

Statistical comparisons of the two groups revealed some interesting results in line with the observations of clinicians.  Workers who had injuries to their upper extremities had substantially more symptoms of posttraumatic stress disorder (e.g., distressing flashbacks, emotional numbness) and slightly elevated signs of depression. When considering pain, however, both groups experienced similar levels.

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So, what is the take away? Why do severe injuries and amputations to our fingers, hands, and arms leave us more vulnerable to psychological maladjustment? Cheung and co. align with Grunert and colleagues (1988), who made the argument that it comes down to functional loss, self-image, and social acceptance. So much of what we do on a day-to-day basis depends on using our hands (like typing this very sentence). What we do is important in shaping who we are, and who we are is who people have come to accept. All of this comes crashing down when that choice is made for the unfortunate few.

References

Cheung, E., Alvaro, R., & Colotla, V. A. (2003). Psychological distress in workers with traumatic upper or lower limb amputations following industrial injuries. Rehabilitation Psychology, 48(2), 109-112.  

Grunert, B. K., Smith, C. J., Devine, C. A., Fehring, B. A., Matloub, H. S., Sanger, J. R., & Yousif, N. J. (1988). Early psychological aspects of severe hand injury. Journal of Hand Surgery, 13B, 177–180.

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