Ace Leben

Betsy Natter
Design & Society
Literature Review for lower body amputees

Introduction
What struggles do lower body unilateral and bilateral amputees have working out? The
anguish for amputees is not only physiological but also psychological and, can have massive
effects on the amputees well being. The limitations of motion and stump complications make it
extremely difficult for amputees to exercise. The result is a damaging of Body Image which, is
amputee self perception based on physical look and projected character. The negative
relationship between an amputees well-being and their Body Image is supported by a study
done on 90 unilateral amputees which, uses Amputee Body Image Scale(ABIS) and Satisfaction
With Life Scale(SWLS) to state, As ABIS scores went up (less satisfied with body image), the
SWLS scores went down (less satisfied with life). The correlation coefficient of the transtibial
group was rs (58) = -.44, p<.0008 whereas the transfemoral group was rs (28) = -.76 p<.0001.
(Breakey, James W.). The main cause for concern is, what are we as nondisabled people doing
to help lower body amputees such as lower body veteran amputees?
Demographics
Veterans who have lost one or both legs are are the demographic group that the design
will be focused on. In 2012 an article from The World Post stated ...more than 1,500 Americans
have lost a leg or arm in combat in Iraq or Afghanistan, and hundreds have suffered the
amputation of multiple limbs, (Wood David). The target group is located nationally in the The
United States of America. Data on 1,288 veteran amputees from a Healthcare Inspection by The
Department of Veteran Affairs Office offer the age stats that were: unknown date of birth at
19.3%, 1821 years old 26.2%, 2225 years old 37.2%, 2629 years old 18.0%, 3034 years

old 10.7%, 35 or over years of age 8.0%, (Healthcare Inspection Prosthetic Limb Care in VA
Facilities). These stats show that the focus should be veteran amputees that are older than 18
years of age but no older than 35 years of age because 18 to 25 years of age are the highest in
percentage and, 35 or over constituted for the least percentage of veteran amputees. The report
also states that out of the 1,288 veterans 98.3% were male and 1.7% were female making it
necessary to maximize design aspects to focus more on males than females in the process.
Human factors and needs
Anthropometry, Biomechanics, Perception, and Awareness are the 4 factors to consider
for the human factors and needs in design for amputees. The design should be suited for a
workout environment so it most likely will be some sort of exercise tool. To meet the needs of
human physiology, as known as Anthropometry or Body Fit, designs must have changeable
features, versatile functionality, removable parts and safety valves. Changeable features should
allow for universal use of all body types and sizes since exercise will vary on the amputees
range of motion with affected limb, reach, height, weight and rehabilitation stage. Versatile
functionality will consist of allowing the amputee to choose a variety of lifts. Removable parts
should be a key cog in design to allow users to focus on their given needs. Including safety
valves such as a place to rest their arms during a workout should allow more fit for less
meticulous workers.
Biomechanics of the amputee should be considered to maximize comfort with adjustable
complexity, limiting amputation collisions, and include balance training. The changeable features
and versatile functionality should allow amputees to decrease or increase their workout
complexity and challenge which, suits their given rehabilitation process. Design should limit
collision with both a simple design and adjustable or removable parts. In adjusting or removing,
the part should preferably be taken out of collision range with respect to the amputees workout.
The care of a soft landing for stumps should also be considered due to stump pain. Effective
balance training should be incorporated to allow for the development of amputees center of

gravity(Gailey, Robert S., and Curtis R. Clark.) A study was done on 30 amputees, where 15
underwent Physaction training and the other 15 amputees underwent conventional balance
training, resulted in the group that did Physaction training having greater improvement in
balance performance than the controlled group. It concluded The present study showed the
effect of perturbation on balance control of unilateral lower limb amputees and thus gives
evidence that during early prosthetic training, balance training should be incorporated in the
rehabilitation program of amputees for their better participation in community life.(Sethy,
Damayanti, Eva S. Kujur, and Kaushik Sau). The major requirement in the area of Perception
and Awareness is that design needs to improve Body Image. Functionality should be simple and
directions informative to maximize Cognition or mental understanding of the design.
Existing solutions
One existing solution is the use of prosthetics. This can either supplement the design or
stand alone. The strengths of prosthetics are: prosthetics are custom fit or have universal
shape, removable in many cases, and have simple functionality. The largest weakness to
prosthetics is the training or rehabilitation to gain control of prosthetic use. This would be a
detriment to Body Fit as prosthetics dont have user friendly safety valves that impede danger
and allow the user to continue training. A design can be made to help pre-gait training which is
the training of the affected limb for prosthetics before implanted. Another weakness is that
prosthetics arent cheap and the most efficient prosthetics are very expensive. This is not a
factor mentioned previously but, is one to that affects amputees nonetheless.
Another solution is described in Knee and Hip Exercise Device and Method as An
exercise device particularly adapted for an isometric workout of lower body muscles includes a
seating plate. (Aruin, Alexander S., and John J. Nicholas.) To clarify what the machine is, it can
be related to a leg extension machine that has harnesses for the amputees limbs and thigh
workout options. The strength of this design is its simplicity and, affordability. The simplicity in
design and function makes it an ideal for maximum Cognition and ease of use so any amputee

can use without any misunderstandings. Affordability is a factor that is somewhat significant in
terms of veterans without strong financial support being able to access the product. The
weaknesses are: lack of functionality, non adjustable complexity and, stump danger. Lack of
functionality is caused by its simplicity where there is only a few workouts so, the amputee wont
be able to have maximum opportunity of training. Lack of adjustable complexity will also
significantly downgrade the potential effects of rehabilitation. Lastly, the main assumption of the
design is that stump healing is complete and doesnt account for the levels of rehabilitation
amputees might be in.
Design Approach
The design approach is basically adjustable parallel bars with cushion sides and a
trampoline type base which can be tightened for tension or removed. The bars will be able to
expand horizontally or vertically which will allow for the amputees to adjust to their fit and
workout. The trampoline will allow for balance training. The trampolines adjustable tension will
help amputees adjust difficulty in balance training.
Conclusion
In the beginning of this essay there was two questions considered that were, what were
the struggles of lower body amputees and what nondisabled persons were doing about it? The
simplified version that should be answered is, how can we as nondisabled persons help lower
body amputees in their endeavors to work out and rehabilitate? The existing designs
researched do not give the perfect design for all 4 factors discussed earlier so to confirm the
new design speculated has valid purpose. Is the current depth of research deep enough in
saying body image is a huge and fundamental concern, the design purpose is valid from the
analysis of two existing designs that dont meet criteria and that there is a population of young
male amputees to be helped, to conclude that the design will revolutionize the rehabilitation
process or that no rehabilitation equipment are working effectively to solve the problem?
Absolutely not, more research is needed to verify the state of the veteran amputee population in

terms of body image and the actual effect of existing solutions on the veteran amputee
population. This will in turn complete the analysis for the question and bring the answer in full
circle

Work cited

Aruin, Alexander S., and John J. Nicholas. Knee and Hip Exercise Device and Method. Aruin;
Alexander S., Nicholas; John J., assignee. Patent US6056675 A. 2 May 2000. Print.

Breakey, James W. "Body Image: The Lower-Limb Amputee." (n.d.): n. pag. American Academy
of Orthotists & Prosthetists. American Academy of Orthotists & Prosthetists. Web. 28 Jan. 2015.
<http://www.oandp.org/jpo/library/1997_02_058.asp>.

Gailey, Robert S., and Curtis R. Clark. "Physical Therapy Management of Adult Lower-Limb
Amputees." (n.d.): n. pag. Virtual Library Project. Digital Resource Foundation for the Orthotics
& Prosthetics Community, 2002. Web. 28 Jan. 2015. <http://www.oandplibrary.org/alp/chap2301.asp>.

Healthcare Inspection Prosthetic Limb Care in VA Facilities. Issue brief no. 11-02138-116.
Washington D.C: VA Office of Inspector General, 2012. U.S. Department of Veterans Affairs.
Web. 3 Feb. 2015. <http://www.va.gov/oig/pubs/VAOIG-11-02138-116.pdf>.

Moroz, Alex. "Leg Amputation Rehabilitation." The Merck Manual Professional Edition. The Merk
Manual, Sept. 2013. Web. 28 Jan. 2015.
<http://www.merckmanuals.com/professional/special_subjects/rehabilitation/leg_amputation_reh
abilitation.html>.

Sethy, Damayanti, Eva S. Kujur, and Kaushik Sau. "EFFECT OF BALANCE EXERCISE ON
BALANCE CONTROL IN UNILATERAL LOWER LIMB AMPUTEES." The Indian Journal of

Occupational Therapy 41.3 (2009): 63-68. Web. 28 Jan. 2015.

<http://medind.nic.in/iba/t09/i3/ibat09i3p63.pdf>.

"Standard of Care: Lower Extremity Amputation." (n.d.): n. pag. The Brigham and Womens
Hospital, Inc., Department of Rehabilitation Services. Web. 27 Jan. 2015.
<http://www.brighamandwomens.org/patients_visitors/pcs/rehabilitationservices/physical
%20therapy%20standards%20of%20care%20and%20protocols/general%20-%20le
%20amputation.pdf>

Wood, David. "U.S. Wounded In Iraq, Afghanistan Includes More Than 1,500 Amputees." The
World Post. The Huffington Post, 08 Nov. 2012. Web. 3 Feb. 2015.