Sonia Sanghani

Stumps and Cranks

An Introduction to Amputee Cycling

Meyer & Meyer Sport (UK) Ltd.

Contents

Imprint

© 2016 by Meyer & Meyer Sport (UK) Ltd.

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Member of the World Sport Publishers’ Association (WSPA)

978-1-78255-419-6

verlag@m-m-sports.com

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ISBN 978-1-78255-419-6

Dedication

Dedicated to amputees, such as Paul Jesson New Zealand, as well as the many amputees featured in this book. Truly inspirational.

Opening

MADE OF BEAUTY

An excerpt from Heart on the Mountain by leg amputee Philip Sheridan, UK 2013.

Made of land
Of sky
Of sun, moon and stars.

Made of wind,
Of cloud
Of mist, rain and snow.

Made of trees,
Of flowers
Of all things green.

All things
Made beautiful.

WHEEL MEN 2001. WATERCOLOUR BY MARCY TATGE COAL CREEK CANYON, COLORADO.

Coal Creek Canyon is situated in the Rocky Mountain region of Colorado, USA. The Coal Creek Canyon Park has many natural resources and habitats for wildlife. Rare, protected species, such as the Preble’s meadow jumping mouse and small numbers of trout, can be found.

Reproduced with the kind permission of Steve Stevens, USA. Watercolour – courtesy of www.goldenoldy.org.

There is also habitat for elk, bobcat, deer, and mountain lions. Plants and vegetation close to a natural water source provides food and habitat for fish and wildlife of the park as well as protects the soil from water erosion. Visit jeffco.us (Coal Creek Canyon Park) for information on parks and trails of interest if cycling in the USA.

Introduction

Being an amputee does not necessarily mean you cannot ride a bicycle. There are various sorts of amputations (leg and arm) and lots of different bicycle solutions available so you, too, can enjoy the joy and freedom of cycling. After reading this book, you might decide to be a fair-weather leisure cyclist only. You might decide to alternate between using a car, bicycle, bus, or train on different days for different types of journeys. Or you could discover that you are far more adventurous than that, happy to go out in all kinds of weather, day or night, on a variety of different types of bicycles. Wherever your amputee cycling journey takes you, this book should, at least, help you to think about getting started.

Navigating the Book

This book is split into 14 chapters designed to focus on one specific area at a time, and you can read these in any order, depending on your needs. There is a practical section of activities at the end of each chapter for you to try. At each point, where necessary, the different aspects of each amputation (e.g., arm, leg, or combination) will be addressed so the book remains relevant to as many amputees as possible. Chapters will include information for children where applicable. We have tried to ensure a good balance between text, illustrations, and amputee experiences, and there will be plenty of suggestions as to further reading material.

Cartoon – courtesy of Marc Locatelli www.marclocatelli.ch

I am sitting here on a blustery, stormy, wet, and very windy day in the UK, reading about cycling. Why I am doing this? Just reading about it is difficult enough, let alone thinking about actually cycling for real! Especially in this weather and under these conditions – brrrrr!

The mere thought of it is bringing on a hot chocolate moment (or mulled wine for the alcohol drinkers among us) followed by a thawing out session in front of a burning log fire. Seriously, who does this type of activity on a day like this?

The answer to that is – a lot of people. Every day, in every city the world over, cyclists take to their bicycles. You can see young and old, men and women, city folk, and students wherever you look, going about their daily business on bicycles. The types of bicycles they use are as varied as they are – mountain bikes, road bikes, tandem bikes and fold-up bikes, bikes for commuting and bikes for fun.

As you look around, though, how often do you spot an amputee cycling? Not often, I expect!

There is no doubt that either becoming or being an amputee is not easy. Some amputees are born with limb problems that require amputation at a very early age while others acquire the status through medical surgery at later stages in their life. For all those who felt they were the only ones, read this and weep – at the last count, it was approximately 10 million and rising! Between 0.5 percent and 0.8 percent of global populations are amputees. The current annual rate of amputation is more than 1 million globally. That’s nearly one every 30 seconds! If those sets of numbers don’t make your eyes water, then a good dose of cycling in a brisk headwind may be the ideal challenge for you!

1/2 Map of Amputations across some areas of the World. Courtesy of www.clker.com

2/2 Map of Amputations across some areas of the World. Courtesy of www.clker.com

Photo of Abdul Qahir – courtesy of www.aabrar.org.af

I was born and live in Kabul. I am amputated below the knee on both the legs. I was 7 years old when I stepped on a mine while fetching food for my family. This incident washed all my dreams and took me to a silent side away from the community and active involvement. It not only gave me bodily injury, but my sentiments, my passion, and my zeal were also severely disrupted. I was in a desperate situation as no hope remained in my life. I had two legs, and both were taken from me. I became deprived of a very necessary and important component of my body. I was maligned and stigmatized by the behaviour of my community toward me. I felt myself in isolation and couldn’t forecast what needed to be done to eradicate my problems and restart a normal life in this community.

People started to think of me as a useless and ineffective part of this society and, to speak frankly, as a burden on the community. Since my amputation, I wasn’t able to attend school due to my immobility. I wasn’t able to commute freely to and from school, but I attended some literacy and numeracy courses organized by Afghan Amputee Bicyclists for Rehabilitation and Recreation (AABRAR). I have a full-time job now where I work as a watchman with some foreigners inside Kabul, Afghanistan. I am able to work freely and earn a reasonable livelihood for my family. I am a permanent member of Afghanistan Paralympic Committee (APC). I am a cyclist for APC and have participated in many national and international games in Athens, Greece, as well as Cycling for Peace in Frankfurt, Germany. I have always participated as a cyclist in the Bicycle and Wheelchair race organized on 3 December (International Day of People with Disability) each year by AABRAR. In the sixth year of this event, I won!

FUNNY THINGS HAPPEN ON BIKES!

I was in a race, and I was trying something new on my bike leg. My coach says never try anything new on race day, but I ignored it that one time. I came off the bike into transition, and my foot fell off (ha, ha). I was hopping andwobbling around with my bike, trying to make it to my running legs. It was so funny for me, but everyone around was freaking out.

Rajesh Durbal, USA

Armin Köhli, a double below-knee amputee, formalized his racing career by qualifying for the Sydney Olympics in 2000 where he competed against some of the cyclists mentioned in this book. His speciality is long-distance and ultra-distance touring.

Photo of Armin Köhli – courtesy of www.tourdarmin.ch

Between 2001 and 2003, he cycled hundreds of kilometers in races against able-bodied cyclists. His passion for cycling, active campaigning against landmines, editing, and journalism led him to undertake further fundraising and awareness-raising tours.

In 2004, he raced the Tour d’Afrique, which involved cycling 11,720 kilometers in 99 days. He came third in that tour against able-bodied cyclists. Then came three successive landmine awareness-raising tours: Geneva-Zagreb, 2005; Tour de Suisse, 2006 and Geneva-Dead Sea, 2007, followed by Pacemakers Ride Against Nuclear Weapons in 2008. Along the way, he connected with many cyclists (both able-bodied and disabled), and reports in the media of his tours have made headline news in countries affected by landmine issues. Armin has devoted tremendous zeal and enthusiasm into developing this book.

He hopes it brings as much joy and fun to those reading it as he has when he is cycling. He would highly recommend a good bike ride for any amputee to help them deal with their situation. Once you have read this book, no doubt you will agree!

FUNNY THINGS HAPPEN ON BIKES!

Preparing for training, I changed the prosthetics (one pair is almost without cosmetics). I put them on, fixed the sleeve, but it didn’t feel as comfortable as usual. Something was hurting in one leg. I removed the sleeve and that leg – and discovered a dead mouse inside. Poor thing! Found its way into the leg, but no chance to get out. Too steep and no grip.

Armin Köhli, Switzerland

WHY CYCLE IF YOU ARE AN AMPUTEE?

Aside from trauma and war, the majority of amputations are the result of poor blood circulation (vascular disease), diabetes, smoking, and infectious diseases. Amputation can occur at any age, in any country, and, in many cases, is the result of an unpredicted event. The disabling impact of amputation is of grave concern to amputees. Typically, there is a reduced ability to enjoy an adequate quality of life in work-related activities, hobbies, and family life. Losing a limb is often associated with negative grief-like feelings, such as depression, anxiety, anger, or hopelessness. Depression occurs in 21 to 35 percent of amputees as compared to 10 to 15 percent in the general population. Social exclusion associated with disability increases the risk of depression, alcoholism, and other self-harming behaviors. Negative feelings can be counteracted by gentle, low-impact exercises such as cycling. As you focus your energy on rotating the wheels of a bicycle, mood-elevating chemicals (endorphins) such as serotonin are released into your blood stream. Serotonin release is considered to be soothing on your mind and spirit, a natural form of stress relief. Life-changing events such as amputation require you to have a positive, clear frame of mind while working out how to do activities you used to do automatically and without thinking before you became an amputee.

Cycling is often described by those who do it regularly as an exercise that gives you high levels of personal, positive energy. As you ride your bike, your heart learns to work more efficiently to improve your circulation and breathing. The sense of well-being and happiness you get from cycling helps to tackle feelings of depression. There are many different forms – mountain biking, road racing, BMX/cyclocross, and handcycling, to name just a few. For some, it will take the danger, skills, thrills, and spills of mountain biking to meet their expectations of exhilaration. Others may get the same enhancement of mood when they test themselves against the clock and leave the competition behind in a super quick race. Your mood and general energy levels will be affected to differing degrees, depending on the type of cycling you do and the goals you set yourself to achieve while cycling.

Every amputee (of any age) is an individual; some require big challenges and others small challenges. Some are adventurers and innovators, others are not. Testing the limits of possibility has long been the driving force of adventurers and explorers. These elements are visible among many of the examples of real amputees portrayed throughout this book.

Just because you may have lost a limb (or three) does not mean you are not allowed to cycle, can’t cycle, or dare not cycle. On the contrary, losing a limb gives you more reason than ever to cycle. The need to develop balance, coordination, and flexibility that cycling facilitates is the same (if not slightly greater) for amputees following limb loss as for the general population.

Cycling in all its forms and disciplines is a highly subjective, personal experience. It is inevitably a social activity that encourages and facilitates the development of strong, close friendships. If you do not like the thought of cycling alone, consider joining a cycling group or club. You might meet lots of different people, and many cycling possibilities become available to you. You could decide to share those enjoyable cycling moments with family, friends, or as a couple. Just using a bicycle for the daily commute in a big, anonymous city will introduce you to other cyclists by default. Eventually, you may like to try pedaling along alone in search of those guilty moments of pleasurable solitude.

When I was contacted about contributing to this book, I at first balked at the notion. Life had again changed so much for me that I really did not feel I had much to contribute. The author posed the question of where were all the people today that set so many goals just a few years back. I had to think about that and realized that she was really asking a deeper question about the nature and progression of the stages of change surrounding amputation.

While still unproven, I have a theory that when amputation or other major trauma occurs, the body undergoes a biochemical change. One can liken the change to a prolonged fight or flight response within the body. This could be a reason why one sees so many rising up again and not only return to everyday life after amputation but, as was my case, taking a physical activity to the extreme. To say that an individual is simply overcompensating just does not answer the question.

I was a happy fat little furniture maker going about my life, and the next thing I know I am an amputee, solo riding across the American deserts in July and loving it. I likenmy story to the character, Forest Gump. After a great loss, he would run back and forth across a continent for years until one day he just stopped. He was done. As odd and uninformative as it is, that really is about it. Perhaps this biochemical switch turns off, I don’t know, but one day you are simply finished with endurance cycling, and you move on. But in the meantime, it can be a time filled with grand adventures, so enjoy it.

I believe it is this fundamental shift in attitude and awareness that has led to the success of so many barriers being broken by those in the sport of amputee cycling. In 2003, I was told on many occasions that what I was trying to do I could not because of my disability. They were right. As long as I accepted my limitation, then I could not do so. My cycling was a way for me to understand my limitation was of my own making and that of the social norm. I, however, decided to go beyond the accepted boundaries and feel whole again. It was a very important part of my life and a great personal achievement at the time. One has lots of time to reflect while cycling, and my time led me to the understanding that once I no longer viewed myself as disabled, I somehow moved beyond the label of being an amputee.

I once held great pride in my being an amputee and achieving all I had done. Today, a decade later, I rarely think of myself in those terms. Perhaps I have achieved the Seven Stages of Grief (according to Elizabeth Kübler-Ross) in terms of my limb loss. Whatever the reason, much of the world of a professional endurance cyclist is behind me. Today, I am pleased with having returned to school and to teach at a local college. I care for rare and endangered carnivorous plants. I commute 12 miles to work each day by bike and, yes, my right leg never grew back. But in its place is a richness I don’t think I would trade for its return. Cycling brought me full circle, and while I am not the same as when I started, I am pretty happy with the results!

An article featuring Dan Sheret and his work can be found at www.starnewsonline.com.

WHY CYCLE IF YOU ARE AN AMPUTEE?

Not everyone cycles because it is cheap, quick, easy, helps the environment or keeps them physically healthy. Fundamentally, a lot of cyclists say they cycle simply because they enjoy it. They enjoy the freedom, the exhilaration, the tests of courage and endurance, and, most of all, the feeling of well-being and pride that a good bike ride provides. Such pleasurable feelings enhance the cycling experience considerably, making it easier to integrate it as an activity into your existing lifestyle.

Mobility and transportation issues take on greater significance if you are an amputee (especially lower limb). For all the reasons you know or have been told about why you shouldn’t cycle, when you ask other amputee cyclists why they ride their bikes, they will cite as many reasons why you should. A bicycle (or its many variations) enables better mobility so you can go outdoors, come into close contact with nature and simply relish the feeling of being alive. Spectacular scenery, fresh air and enchanting wildlife are always an added bonus to every journey of discovery you undertake on a bicycle or its many variations, even in, or close to, a busy city!

If you are not a cyclist (or have never been a cyclist), it can all seem rather perplexing and difficult to understand. To top it all, being a fairly new amputee may make you inclined to put cycling rather low down on your priorities of dealing with the profound psychological effects of undergoing limb amputation. Immersing yourself in the broader elements of cycling, such as experiencing its history and development from a museum visit, attending a display of cycling art or getting involved in festivals or sports events organized by cycling communities, can help you catch that all-important, if as yet elusive, cycling bug! For some it may even require a holiday to a cycle-friendly town or city in countries such as Denmark or Japan to work out how to join in the fun of it all. You will soon discover that leisure cycling is a form of exercise that doesn’t involve a high level of skill. It doesn’t have to be expensive to do, and it may help you come to terms with your amputation, lose excess weight, and simply feel better.

For children with amputations, cycling should be an integral daily activity as it enables them to be more independent and confident as individuals. Being able to find their way safely to and from school (either with their friends or on their own) encourages children to think and learn about the place they live in for themselves. Involving children with amputation in general childhood activities with other non-amputee children allows them to learn to enjoy each other’s company as equals. It is important for your child’s social development not to isolate them from others because of your concerns about their disability. The world can cope with it, and so can you!

Different forms of cycling are worth trying as an amputee, and you may interchange between them to various degrees as you progress. The more you cycle, the easier it becomes. Muscles in your body adapt as you become fitter and stronger. You will start to feel better and be able to do more on an everyday basis. This will increase your levels of happiness and satisfaction with your situation, and you will want to keep cycling on a more regular basis.

The wheels of the bike whirl at a dizzying pace. The blur that is Dory Selinger hurtling toward another medal beguiles the crystal-clear memory of what got him there in the first place. It was a typical morning ride with his teammates in 1993 when a car from nowhere slammed into them all, killing his friend, mangling his leg, and placing him in a coma for seven days. Life changed in an instant, but not just in the physical sense, for Selinger. Through the grief and heartache of a lost teammate, through the pain and struggle of an agonizing rehabilitation, one constant, singular focus helped Selinger persevere: the bike.

Photo of Dory Selinger – courtesy of www.doryselinger.com

It was a love for cycling that rescued him from despair, inspired him to regain his strength, and drove him to become something even greater than himself. Selinger is one of America’s best-known Paralympic cyclists. He has claimed repeated national titles in track and road racing and time trial competitions in the Disabled Division at the U.S. Cycling Championships. He has won victories at the 1998 and 2002 World Championships and 1999 and 2001 European Championships. He started this off with winning the gold at the 1996 Paralympic Games in Atlanta, Georgia. He holds two world records as well as every U.S. velodrome record for cyclists in his classification.

Re-produced with kind permission by Dory Selinger:

FUNNY THINGS HAPPEN ON BIKES

My friend and I went out on a trail near Cwmavon, and time was flying. It had been a bit of a hot day, so we thought we would go out later in the afternoon. When we started, it was a lot later than we thought it was, and we actually came back in darkness. The last half hour of the trail was pitch black – thank god myfriend had a head flashlight so we could find our way back, but we totally mistimed that one altogether! What you tend to find is that when you are in forestry trails, once the sun goes down, everything goes dark very quickly due to the density of the trees and shrubbery, so, yes, that was a bit of an experience as well coming out of there in the dark with just one head light between us!

Jon Pini, UK

WHY CYCLE IF YOU ARE AN AMPUTEE?

The best people to explain in words and actions are the amputees of all ages who cycle on lots of different forms of bicycles on a regular basis. In their own words, throughout this book, they will be explaining to you why it is they cycle, how they started and learned, what they find helps them, and lots more. Some of the amputees featured here you may have heard of through their competitive cycling achievements at national or international level, and some may be new to you. They are all, in fact, extraordinary, everyday individuals with immense passion, commitment, and vision. Enjoy reading, and, most of all, enjoy this miniature glimpse into the world of amputee cycling. It really is full of the most amazing and inspiring people you could ever hope to meet!

If you have never cycled before (or not considered it before), reading this book may just be the motivation you need to try it out for yourself. You might catch yourself wondering what it would be like to be one of those hyper-cool urban messengers whizzing around the city. Or a high-level racer setting a personal and world best record for others to aspire to, perhaps? Or even find yourself dreaming about cycling around the world on a penny farthing or handcycle. The possibilities are truly endless and achievable with the right attitude and support in place.

As this book seeks to encompass as many possibilities that cycling can bring you either directly or indirectly, here is an article that shows the achievements which many would consider impossible are, in fact, possible. It highlights how innovative and experimental cycling is as a flexible method of transportation. In the 1980s, sports cyclist, Yvon Le Caer, proved it was possible to cycle across the English Channel. No one has attempted to break that record to date, and no amputee has admitted to have tried it out yet, but there is always the future. Enjoy being totally amazed at what you are about to read!

Yvon Le Caer was a world-class competition cyclist before he embarked on his ocean-going exploits. His speed records for human powered watercraft still stand more than twenty years later. An innovative watercraft which would merge bicycle and marine technologies: that was the ambition of champion racing cyclist Yvon le Caer. His “AquaCycle” was years in development, and he had already crossed the Gulf Stream between the Bahamas and Florida on a prototype when he decided to test his latest model on the difficult waters between France and England. This was a second attempt – his first, in 1983, ended in disaster when his own escort vessel sliced 4 feet off the front of his craft, all in the middle of the night of his 22nd wedding anniversary! Wiser and better equipped, and, on the eve of his 50th birthday, Yvon was determined and motivated like never before.

In May 1985, Yvon had just tested a brand new propulsion system, with frame and rudder apparatus, finally achieving the right level of sea craft efficiency. The totally independent gear-driven propeller system (with “pushing” and “pulling” mode options), complete with crank arms and pedals, could be replaced at sea with very little loss of time. For crossing the Channel in 1985, Yvon opted for the “pulling” mode – propeller upstream of the flow on the forward side of the “outdrive.”

“Operation English Channel” would take Yvon from Cherbourg to Poole in September 1985. Although swimmers stroke across the 21-mile-wide Strait of Dover, Yvon Le Caer’s chosen route lies 180 miles west of the Strait.

The 75-mile-wide body of water lying between Cherbourg at the tip of the Peninsula of Normandy and Poole on the Dorset coast of England features strong currents, busy shipping lanes, unpredictable weather and turbulent, cold, and foggy waters. Extreme tidal ranges also create constantly shifting high velocity tidal currents.

His earlier career in competitive cycling was an essential part of his preparation. In the early 80s, he was still riding an average of 15,000 miles a year, and during the few months preceding the 1985 crossing, it was not unusual for him to ride 60 to 70 miles on the road in the morning, then AquaCycle for 2 or 3 hours in the afternoon.

Finally, on September 9, 1985, despite hostile conditions, Yvon left Cherbourg at dusk, with his escort vessel, support personnel and a French TV crew onboard. He “pedalled” all night, across shipping lanes and through a sharp broadside chop. Due to tidal currents, it was a rather long 92-mile meandering path with constant course adjustments. After a moonless and cold night (48 ˚Fahrenheit), the morning brought dense fog, hampering navigation during the final hours. Adverse tidal currents when approaching the Solent meant he lost some time. Still Yvon never gave up, he reached Poole harbour entrance by late morning, 10 September, 16 hours, 42 minutes after leaving Cherbourg. In resolutely confronting the elements, he had, against all odds, gained the last word.

“It required a great deal of effort, coordination and planning,” says Yvon. “In such adverse conditions, it is essential to have a good escort vessel. In this regard, my wife Andrea, and all navigators and technicians onboard as well, did a fine job; so did the French Marine Nationale (Cross-Jobourg) and the British Coast Guard who kept a vigilant watch all along, alerting continuously all passing ships of our position and movement at sea.”

“I read once that: ‘Doing what you want is achievable, if you set realistic goals and follow through,’ a saying so true, in my case. I came out of the starting gate like a bullet (sort of), leaving Cherbourg for Poole at dusk. The rest is history. At last, I made it through, in a time that will be most likely broken someday, but still stands for now, more than two decades later.”

I have a transtibial distal amputation that occurred 11 years ago. I didn’t cycle before the amputation. There’s not a specific route for cyclists to ride or practice. In some cases, the roads have separate space for cycling. In the roads where there are no separate spaces, we train with vehicular traffic. It’s difficult to cycle in traffic in Colombia due to the high incidents of cycling accidents, but it’s just a minor issue compared to the passion that we feel for this sport. I remember a time in Denmark when I was training on the highway. The culture is one where they are very respectful to cyclists on the road, and a lot of people admire this sport. It felt very peaceful, even when it was a cold day. It was very comfortable and pleasant on my bike. I had the feeling that the environment had less pollution. You don’t feel insecure on the streets, in traffic, or with the people.

Photo of Esneider Muñoz Marín – courtesy of www.arcangeles.org

FUNNY THINGS HAPPEN ON BIKES!

We had a fun time once when we were on Subachoque-Cundimarca, and we had a friendwho has cerebral palsy training with us. We were descending at great speed, and there was a closed turn in which my friend lost control and fell from his bike. When the paramedics arrived, one was very concerned. She said my friend was convulsing without knowing that his movements were exaggerated due to his condition.

Esneider Muñoz Marín, Colombia

This made us laugh, because she really wanted him to “get better” without knowing what else to do. Finally we told her the reason of his unintentional movements. It was very funny to see how she was calmed after that scary moment!

Still not sure you’d like to try cycling to see if it helps you deal with your amputation and daily living activities? Then consider this Zen proverb:

A Zen teacher saw five of his students returning from the market, riding their bicycles. When they arrived at the monastery and had dismounted, the teacher asked the students, “Why are you riding your bicycles?”

There are many ways to interpret proverbs, and you will devise your own interpretation as you read it. In its simplest form, the reasons to ride a bicycle are:

Have you ever considered why it is exactly that you don’t cycle? Is there just one reason in your particular case or is it a combination of reasons? Are these reasons not to cycle new and recently developed or long standing, possibly even outdated ones? Are they still sufficiently valid to hold on to or is it now time to leave them behind and become a part of the amazing revolution embracing amputee cycling around the world today?

The Transtheoretical Model of Behavioural Change developed by Prochaska and DiClemente is worth considering if you want some help in working out those reasons. There are six different stages: pre-contemplation, contemplation, preparation, action, maintenance, and termination. Take a look at it and see if you find it useful for working out why cycling is beneficial if you are an amputee.

Further Reading

Things to Try for Yourself

Did you know?

I’m a bilateralamputee. I was injured in Iraq on July 5, 2005, when my patrol walked into an improvised explosive device (IED) that was buried in the ground. I cycled as a kid but stopped as I got older. I was active in soccer during middle and high school; most places I grew up were within walking distance.

Photo of Joe Beimfohr – courtesy of www.darrellparks.com

I started handcycling in 2008. My very first race was the 2008 New York City (NYC) Marathon. For new amputees, attend either an adaptive sports camp or clinic and try different types of bikes. Your level of injury will determine what bike you can ride, but the bikes are so advanced these days that no one model is faster than another. It still all comes down to the rider!

Prosthetic device is the term used to describe arm or leg replacements that enable amputees to remain functionally independent throughout their lives. Globally, there is huge demand for these devices. The World Health Organization estimates that in Latin America, Africa, and Asia combined over 30 million people require prosthetic limbs, braces, or other devices. Future services are predicted to exceed $3 billion for amputee patients in the USA alone. Children may require new limbs every 6 to 12 months to accommodate their growth rate, whereas adult limbs generally last 3 to 5 years. Over a young amputee’s lifetime, up to 20 sets of limbs may be required.

The human leg is made up of bones, joints, muscles, nerves, and blood vessels. These allow the leg to be used for walking, running, jumping, swimming, kneeling, and other general activities. The human arm is made up of bones, joints, muscles, nerves, and blood vessels. These allow the arm and hand to be used for grasping, holding, carrying, writing, washing, cleaning, throwing, swimming, and other activities of daily life.

The most difficult forms of amputation are shoulder and hip. These areas have many vital joints and bones that support the body during movement. Damage to these areas causes significant immobility and loss of function. The higher up the amputation, the more artificial components are needed which increases the financial cost of the limb. Each element of joint, bone, muscle, or other tissue removed and replaced by an artificial limb results in more loss of function, impairment, and increased energy requirements during limb use. If there is a lack of muscle, the stump becomes bony. This increases the amount of friction experienced during prosthesis use.

Healing of the wound without complications of the scar area is the ultimate aim of the immediate post-amputation phase. Good levels of blood flow to the remaining limb area are vital for wound healing to occur. Appropriate wound dressing improves the chances of good wound healing without infection.

Prosthetic limbs are normally fitted between one to six months following amputation. Waiting longer reduces the chance of it being accepted and used for daily activities. Amputated skin has to be mobilized and desensitized to keep the stump pliable and accustomed to the friction of wearing prosthesis. Scar tissue must be completely healed before mobilization or desensitization is undertaken. These techniques involve deep massaging the bony areas of the stump and moving different texture fabrics over the skin. This must be done gradually without irritating, breaking, or infecting the stump skin.

I have been an amputee for almost 21 years. I used to be an official employee in our district before my amputation. One day I was on my way to the office when suddenly I heard an explosion. It was a roadside bomb. After the explosion, I was unconscious for almost 24 hours. When I opened my eyes, I was in the hospital, and later on, I was told I had lost my right leg. It was 1992. I did not cycle before my amputation; I used to walk to work. But since I have been an amputee, I have been cycling. I always ride a bike which has two wheels and is made in China. I don’t have any adaptations on the bike.

Photo of Habib Jan – courtesy of www.aabrar.org.af

FUNNY THINGS HAPPEN ON BIKES

One day, I had my two sons and daughter with me on my bike. I wanted to take them to a picnic very far from my home. On the way, I saw some wonderful sights, such aspeople on the roadside busy in their fields; the safe, calm route; the interesting and romantic sounds of the birds in the trees; and the soft and clean water we had in a spring along the way. We really enjoyed that journey. It is worth mentioning that my spouse was very angry with me because we arrived back so late that night!

Habib Jan, Afghanistan

I was born and grew up in the west of Dông Hói, Vietnam. After graduating high school, I got a job at a small sugar mill. I had a work accident and lost my left arm. I was only 19, full of the dreams and hopes of a teenager. I lived in suffering and despair.

Photo of Hoang Thi Lan – courtesy of www.aepd-vn.org

Many times I planned to commit suicide, but all the care and love from my family and the people in my community helped me to rise up and overcome the trauma and complex feelings. I realized that I had to take care of myself and find a job that was suitable for my situation. There weren’t many jobs suitable for people with a disability; therefore, I decided to start a small vegetable business at a local market.

As you know, vegetables wither easily. With the long distance to the market, they would not stay fresh if I carried them and walked to the market. Therefore, I decided I need to learn to ride a bicycle.

I had experienced cycling before I had the accident, but since then, I possessed the fear that I couldn’t handle something difficult like that. I tried to remember how to ride a bicycle, the feeling of balancing the bicycle, and how the feet work on the pedals. I remembered it all, and my family supported me by sharing their feelings about a cycle ride. The day that I rode the bicycle again, I didn’t have as much difficulty as I imagined. The emotion was different from before as I still could handle everything. I was so happy that I overcame my fear.

And since I could ride a bicycle, I could carry 45 to 110 pounds (20-50 kg) of fresh vegetables to the local market so much faster than walking. I want to send a message toother people with disability: What I can do, you can do better. Be confident, my friends.

FUNNY THINGS HAPPEN ON BIKES

My friend, Geoff, had a habit of leaving his parking brake on when he started a race. One time he rode 6 miles before he realized it was on. So now, whether he’s at a race or not, before we start racing, I always say out loud to everyone, “Take off your parking brake Geoff!”

Joe Beimfohr, USA

ABOUT PROSTHETICS

Once a device has been measured and fitted, the amputee is shown how to put it on and take it off. Prosthesis users are shown how to clean the socket area of the device daily and undertake basic maintenance checks, such as looking for defects, scratches, loose screws, or weak rivets. This should be done on a weekly basis. The device should be kept free of dirt, sand, and other debris.

Initially a treatment plan is drawn up for an intermittent wearing schedule to prevent skin breakdown. Prosthesis use is gradually increased until worn on a regular basis. Many amputees aim to wear their limbs all day, every day, with as much functionality as possible. The more complex the requirements, the more technology goes into manufacture, resulting in an expensive limb.

Rust inside the prosthetics following the Tour d’Afrique! Photo of prosthetic limbs – courtesy of www.tourdarmin.ch.

During the first year or so, if the amputee uses the prosthesis regularly, there will be a reduction in stump volume and a change in the overall shape of the stump. This will affect the closeness of fit. New sockets or adaptations have to be made at this stage. It may take some years for a stable stump size to be reached. Any change in body weight (increase or decrease) may also affect the fit and ease of use of the limb. Components usually come with a manufacturer’s warranty from 12 months to 3 years. Most amputees will choose to keep specific components that they are satisfied with longer than the official warranty period. However, the older the component, the higher the risk of mechanical failure, so it is worthwhile to change parts regularly.

Prosthetics Parts

There are common and specific parts to a prosthesis, depending on individual need. There are lots of user-specific components which are not covered in this section. Further reading suggestions are provided at the end of the chapter.

The common parts are referred to as:

Specific components include:

COMMON PROSTHETIC PARTS

A. Sockets protect the stump area where the most force is felt by the user. The better the fit, the better the control, and the less irritation or damage to the stump skin or tissues.

Photo of female amputee with bike – courtesy of www.muktiindia.org

Photo of Mono limb – courtesy of www.muktiindia.org

B. Liners are made of flexible, cushioning material, such as silicone, polyurethane or coplymer. In developing countries, rubber from tires has been used. They require the amputee to wear a thick sock next to the skin. The aim is to protect the stump skin from chaffing and movement while wearing the prosthetic. Silicone liners are used with the lock and pin prosthesis. Polyurethane liners are used for bony, scarred tissue and work best on vacuum or suction prosthesis. Copolymer can be used in both types of prostheses. The liners are anatomically shaped, and some have antibacterial additives or soothing gels, such as Aloe Vera, incorporated into them.

Photo of different types of liners – courtesy of www.willowwoodco.com, www.ottobock.co.uk and www.ossur.co.uk

Heat causes amputated skin to sweat and break down, leading to infection. Efficient regulation of heat and sweat may enable higher activity levels. Increased sweating during cycling also loosens the fit of the limb to the stump and can result in it falling off. Using a liner that has exposed silicone on it causes it to stick to the sleeve. This increased grip reduces the risk of the limb falling off due to sweating.

Photo of Glide Wear Patch – courtesy of www.amputeesupplies.com

The pushing and pulling effect that results from prosthetics use causes shear forces to break down skin in vulnerable areas, such as the knees and ends of the stump. The GlideWear patch is a new development to absorb the motion that would normally be transferred to the skin. Another option under development is the socket-cooling sleeve. It uses a water bottle sized canister of liquid carbon dioxide (CO2) to keep the skin cool during exercise.

I don’t use a pin at the bottom, so the liner is not connected to the shaft. I fix it just through the sleeve. Indeed, I had two races where one leg fell off; so we had to think about fixing it better, and we ended up with the sleeves and the liners partially without fabric.

That’s the crucial bit. These are taken on and off in the same way as normal liners, and it’s almost 100 percent safe. You couldn’t tear it away!

Photo of liner – courtesy of www.tourdarmin.ch

The liners and their sleeves are produced by Wagner Polymertechnik in Germany:

Formerly, the government health system offered me the prosthesis in order to improve my well-being, but it was not suitable for cycling.

Photo of Esneider Muñoz Marín www.arcangeles.org

Nowadays, the International Olympic and Paralympic Committee and Coldeportes have given me suitable prosthesis to cycle and perform.