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level, those whose jobs or hobbies and general independence are badly affected by the loss of a limb will have more difficulty coping than those who can adapt more easily. Men often fear impotence or sterility with the loss of a limb.

    Clients usually dream of themselves as possessing all their limbs. Getting out of bed at night, those who have lost a lower limb quite often forget their loss, and fall over.
    I’d been told of the circumstances of Owen’s accident. It was no wonder that he was shut down, closed off. He had other issues. But it’s my job to concentrate on occupational therapy: emotional or psychological therapy is between the client and counsellor. The boundaries that are in place have to be respected, otherwise things get confused and none of us are able to do our particular jobs properly. That doesn’t mean that if Owen had started talking I wouldn’t have listened. I would have. That’s part of my job as well. But he didn’t. He never said a word about the accident.
    I understand Owen declined to continue seeing the counsellor after their third or fourth session.
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    Each prosthetic device is bespoke, made for the individual client. There are two types of artificial upper limb, or terminal device: the hand and the hook, either of which is secured to a plastic socket that encases the residium.
    Most clients are keen to replace their lost hand with a replica, of which there are two sorts: a passive, fixed hand or an active hand with a grasping mechanism that moves the index and middle fingers, and the thumb, towards each other, while the fourth and fifth fingers remain fixed.
    An active hand is commonly operated myoelectrically: the prosthetic socket has two electrodes which connect with flexor and extensor muscles in the residium. When the wearer consciously contracts the appropriate muscle, the electrode transmits the microvoltage generated by the muscle to a small motor that enables the hand mechanism to open or close the fingers. Sensors in the fingers stop them grasping objects too tightly.

    Hands are laminates made from glass-reinforced plastic and acrylic resin. They are covered with a flexible ‘glove’ that matches the hair colour and skin tone of the client’s other, real hand. A cheap PVC glove may cost as little as £80, while a high-definition, ultrarealistic one made of silicon can cost £3,000 – 5,000 for a whole leg or an arm.
    People often wear rings, wristwatches or other jewellery on their artificial hand. One of my clients has found it so difficult to come to terms with his amputation that he sleeps with his artificial arm on.
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    It was at first impossible to determine what kind of prosthesis Owen wanted. As I’ve said, he showed no interest in his future. But then things changed. He came to his fourth meeting with me – he was now out of hospital, back at home – and brightly asked me to show him the hooks again.
    Hooks are lighter than other types of device; they’re tougher and more durable. Most amputees, however, care very much what other people think. They resent and are upset by people noticing and staring at their artificial limb, their disability. A very few clients don’t give a damn, and care only about the functionality of their prosthesis. I knew I should be wary of Owen’s leap from depressive lack of interest to a gung-ho attitude: if this was evidence merely of denial then it would not bode well for recovery. My reservations, however, were overcome as Owen spoke of his determination to resume as active a life as possible. He worked as a self-employed gardener, and together we looked into the array of gardening tools modified for disabled people; he spoke of his young son and his wish to do everything with and for him that any father could. The only thing he didn’t want to consider was motor vehicle adaptation
for disability: Owen said he had no wish ever to drive a car again.
    Hooks