While visiting family home in Lismore, I have had the opportunity to record a series of insightful interviews with local amputees and the dedicated professionals who work alongside them.
Among these conversations was a deeply engaging discussion with prosthetist Peter Farrand and physiotherapist Peter Davis, who together offer decades of combined experience in amputee care.
Their shared insights trace the remarkable transformation of prosthetics from an era of traditional, high-risk handcrafting to modern, high-tech multidisciplinary rehabilitation, highlighting how structural shifts and technological leaps continue to reshape outcomes for amputees in regional communities.
The audio from this interview will feature in a forthcoming episode of The Limb Shift.
Reflecting on his entry into the industry over forty years ago, Peter Farrand recalls entering a trade dominated by post-war veterans:
“My dad was a World War Two digger, and he knew somebody that was running a limb centre down at North Sydney. Back in those days, a lot of the World War Two diggers made the limbs when they came back from war. They were called limb maker and fitters, not prosthetists.”
In those early years, crafting limbs required intensive manual labour and involved considerable physical danger:
“Back then it was all exoskeletal… they were hand carved wooden sockets. The exo style leg was basically the old wooden full limb and we used to put a fibreglass skin over it. There was no adjustment once you’d made the leg… you pretty much had to saw the leg in half and stick a whole new chunk of wood in there and do it again.”
Fabricating these early devices demanded absolute precision with high-speed machinery:
Suspension systems were similarly cumbersome. Below-knee prostheses relied heavily on leather fittings:
“They used a leather corset and a lace and you know that were quite cumbersome.”
Alternatively:
“They used leather cuffs over the top of the knee cap… or you’d modify the socket heavy over the condyles and it would just stay on with the shape of somebody’s leg.”
Above-knee prostheses required a distinct setup:
“A pelvic belt, which was just a big old school leather belt… connected to that was a thing called a shoulder strap… that went over the opposite shoulder and you could tighten it.”
The introduction of modular components completely revolutionized fabrication and alignment.
Foot designs underwent an equally dramatic evolution. Prosthetics shifted from solid wood feet to the Seattle foot with a nylon keel, and eventually to carbon fibre options:
Modern dynamic response feet utilize advanced materials. Today, advanced options incorporate microprocessor-controlled joints:
The structural delivery of prosthetic care also underwent massive changes when federally funded Repatriation Artificial Limb and Appliance Centres (RALAC) were privatized in the early 1990s:
“There was (one) in every city… funded by the Department of Veteran Affairs. In the early nineties… they decided to shut the them down and we all got the golden handshake… the whole industry privatised then, and they gave the funding to each state to look after their own schemes.”
This structural shift allowed clinicians to establish localized regional services. Farrand moved to Northern New South Wales, eventually building his practice from a small workshop into a dedicated regional facility:
“I actually started working for a company as a contractor. I eventually wanted to start making my own limbs again, so I basically set up my own workshop under the house… then I need a bigger space… found a five acre property… which had a big old cow shed on it and that got slowly converted into a pretty amazing prosthetic facility.”
The arrival of the National Disability Insurance Scheme (NDIS) further reformed client access to specialized equipment:
“The NDIS is an absolute game changer. It’s not just back in the day where it was all about supplying somebody with a prosthetic leg and a pretty basic leg… now if it’s reasonable and necessary… we can use the componentry and the technology that’s available now to change that person’s life.”
From a physical therapy perspective, physiotherapist Peter Davis emphasizes that achieving great outcomes depends on targeted pre-prosthetic care and systematic gait retraining. Initial therapy focuses on maintaining joint mobility and building compensatory strength:
“A lot of it will be around practicing with safe transfers, practicing getting in and out of wheelchairs. But then as well, looking at making sure they’re maintaining their muscle length, especially in the hamstring muscles and the muscles at the front of their hips… if they’ve got tight muscles in those areas, it can really then impact how they walk later on.”
Because lower-limb loss changes a person’s movement mechanics, targeted strength work is non-negotiable:
“They have to compensate with their hip muscles, their knee muscles to be even stronger, to be able to let them get back doing it.”
Rehabilitation programs balance clinical gym work with functional, real-world requirements:
“You can simulate things in a gym environment… but once you get to a certain point, it is those real world challenges.”
For regional patients, home visits allow therapy to adapt to unique lifestyle demands:
“Some of those farmers that you go out to see… you had to see them and work out how they’re going to get through a fence or climb onto their tractor.”
Ultimately, long-term success relies on trust and strong communication across the clinical team. Farrand highlights that patience during early recovery is key:
“Slow and steady wins the race… it’s a good twelve month journey… your body’s not used to taking half your body weight, so it’s going to take some time to desensitize.”
Davis echoes this sentiment, emphasizing that active patient participation drives true rehabilitation:
“It’s communicating to your physio that you know what you want to work on… you’re the one driving the rehab.”
