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Accessibility of Lower Limb Prosthesis Transforms the Behaviour Trajectory of Amputees-A Scrutiny

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Accessibility of Lower Limb Prosthesis Transforms the Behaviour Trajectory of Amputees-A Scrutiny ACCESSIBILITY OF LOWER LIMB PROSTHESIS TRANSFORMS THE BEHAVIOUR TRAJECTORY OF AMPUTEES-A SCRUTINY Dr. Sarasvathi. V1, Dr. Visalakshi Rajeswari2 1Asst.prof, Dept of Resource Management, 2Professor and Head of the Department, Dept of Resource Management ABSTRACT Health and well – being have pervaded the minds and hearts of human beings as inextricable entities. Unfortunately the thrust on maintaining them remains backstage. A scan across the globe lays before one a big picture – burgeoning population with spotlights of those who are sick, aged and vulnerable. Amidst them is there a mounting category of those individuals remaining immobilized due to various circumstances. Cause of their plight is shouldered by the diseases they had fallen prey to or the accidents that had left them so. Either way the statistic on amputees’ sequel to those reasons keep surmounting day by day. India is an active participant in increasing the number. Curiosity to locate the truth behind led to some blinding facts. A micro level investigatory study was taken up by collecting data on amputees registered in four hospitals and three prosthetic centres in Coimbatore City chosen adopting convenience sampling. The number recorded for a period of one year from 2014 – 2015 (beginning), showed the presence of 928 amputees, among whom 88 per cent were men. This data projected another alarming statistic. From among the total amputees reported more than 72 per cent (669) were lower limb amputees, again displaying predominance of men. This indeed is a very big challenge for any country. Considering the minimal topographical area covered for this micro level study, the magnitude of the problem can never be compromised. These facts albeit necessitated finding out the profile (age of the amputee, cause of amputation, level of amputation) of the affected samples, especially those who had gone for an artificial limb – a prosthetic limb. Almost 50 (7%) had refused prosthetic limb during the initial stages itself – a finding which highlights on the poor awareness among the genre or the lack of accessibility to prosthesis in the early stages itself. Prosthesis can improve the results of rehabilitation of the person with a limb amputation. Successful design of prosthetic devices hinges upon a research and development process that intimately combines end-users with device developers. This process focuses on the usability of the product in what is sometimes called a “user centred” approach to design. Readjusting to life after amputation is likely to be challenging for most people. Difficulties in adjustment are typically associated with reports of depression, feelings of hopelessness, low self-esteem, fatigue, anxiety, and sometimes suicidal ideation. A multitude of related problems, including maladaptive coping behaviours (e.g., drug /alcohol consumption), greater disability, poorer social functioning, and loss of functional independence, may result from difficulties in psychological adjustment. The ultimate challenge to the family is to meet the rehabilitation-related needs and simultaneously to meet the needs of the family and its members of having a normal life. These factors also affect 358 | P a g e the Resource management potential of the affected individual. This study was focused on a behaviour trajectory, considering the user as a” consumer”. The benefits they acquire or what they lose is thought of as a discount, as their health is an essential resource, which can help them sustain, overcome their discomfort and lead a quality living. It is also envisaged that the outcomes of the study would make the device more “accessible” than being affordable and pave a positive way for realistic and fruitful use of the device (prosthesis), for its “designed use”. Keywords: Accessibility, Prosthesis, Trajectory, Amputee, Rehabilitation I. INTRODUCTION Health and disease are logical, complex and multi-factorial (Lloyd, 2014). The most common causes of impairment and disability include chronic diseases such as diabetes, cardiovascular disease and cancer; injuries such as those due to road traffic crashes, conflicts, falls, birth defects, malnutrition and other communicable diseases (NHRC 2005). Among these, diabetic foot ulcers cause elongated hospitalisations with high treatment costs and high rates of lower extremity amputations resulting in increased morbidity and decreased quality of life (Akcay, 2012). Injuries appear to be one of the major causes of disability accounting for at least 100,000 (23 percent) amputees. Amputations are performed to remove severely diseased, injured, or no longer functional extremities.Amputation leads to a permanent disability and brings a dramatic change in the life and function of the individual. This changed situation is experienced more by the lower limb amputees than by the upper limb amputees. Limitations in body structure and function due to the removal, affect the activity level, and thereby, the participation of the individual in the society (Ustun et al., 2003). Additionally, personal and environmental factors play an important role in determining outcomes after amputation and also their long term functioning. Psycho-social supports are considered as important determinants for adjustment to amputation (Desmond et al., 2008). Depression, anxiety and body image disturbances pose as determinants of standards in one‘s Quality of Living (QoL).Emotional status of lower limb amputee patients may be linked to perception of the body image (Akyol, 2013). Prosthesis is an artificial extension that replaces a missing body part such as an upper or lower body extremity. Prosthesis can improve the results of rehabilitation of the person with a limb amputation. If given the opportunity, most persons with an amputation will be able to use an artificial limb well. Successful design of prosthetic devices hinges upon a research and development process that intimately combines end-users with device developers (Biddiss, 2007). This process focuses on the usability of the product in what is sometimes called a ―user centred‖ approach to design. The concept of usability and the design and conduct of usability testing studies may be unfamiliar to many in prosthetics and rehabilitation because of the dearth of studies published in these areas. Successful rehabilitation of the amputee requires that the prosthesis be acceptable to him or her. Prosthesis acceptability depends on several factors including cosmesis, mass properties of the prosthesis, comfort, and function. Comfort and function are directly dependent on the quality of fit of the socket, the quality of suspension, the type of components used and the relative geometrical position of these components to each other. The position and orientation of these components, the major elements being the socket, joint(s), and terminator (e.g., foot), are defined as the alignment of the prosthesis. If an acceptable alignment of lower-limb prosthesis cannot be achieved, the limb may be rejected by the wearer. 359 | P a g e (http://www.rehab.research.va.gov/jour/86/23/2/pdf/zahedi.pdf). One of the single most determining factors of whether a person will use prosthesis is prosthetic socket design. Regardless of the cause, prosthesis abandonment is a serious problem that should be avoided whenever possible given the likelihood that repetitive stress syndrome may develop in individuals that rely heavily on one limb for daily tasks. The foundation for all prosthetic procedures is a well designed and considerate prosthetic socket (http://www.lakeprosthetics.com/published/The_Evolution_of_Upper_Limb_Prosthetic_Socket.5.pdf) Readjusting to life after amputation is likely to be challenging for most people. Difficulties in adjustment are typically associated with reports of depression, feelings of hopelessness, low self-esteem, fatigue, anxiety, and sometimes suicidal ideation. A multitude of related problems, including maladaptive coping behaviours (e.g., drug /alcohol consumption), greater disability, poorer social functioning, and loss of functional independence, may result from difficulties in psychological adjustment (Garafalo, 2000). Sequel of amputation has adopted an almost exclusive focus on the negative impact the event has on the persons' life and well-being. Recently, there has been an attempt to redress this imbalance by identifying factors that promote positive adjustment (Gallagher and MacLachlan, 2000). The ultimate challenge to the family is to meet the rehabilitation-related needs and simultaneously to meet the needs of the family and its members of having a normal life (Gonzalez et al., 1989 ). These factors also affect the Resource management potential of the affected individual. Amputees possess by definition a functional asymmetry. Lower leg amputation generally includes asymmetrical weight-bearing with more weight on the non-prosthetic leg (Duclos, et al. 2008). This can be detrimental to an amputee's long term quality of life. This suggests that successful rehabilitation of an acute or chronic impairment extends beyond the acquisition of endurance, strength, range of motion, or learning about a new strategy (Miller and Deathe, 2004) - factors contributing to one‘s well being and quality of life. Prosthetic technology is certainly advancing rapidly. For most people, these state-of-the-art devices are neither affordable nor well suited for day-to-day life. Yet it is found that amputees are apprehensive about access and adaptability of prostheses, which they depend on to regain gait and postural
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