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Journal | Vol | Issue | 2017
BASSIERE FOR RHEUMATOID ARTHRITIS PATIENTS Pooja.K; Priya.J, Masters in Design Space; National institute of Fashion Technology, New Delhi
Abstract Arthritis is a condition involving damage to the joints of the body. Arthritis is the most prevalent chronic condition for middle-aged and older people. The RA women have special needs in brassiere design that must be met to enable them to don and doff the brassier easily. To don and doff bra, the considerable amount of coordination, sensation, dexterity, balance, range of motion and muscular strength is required. Donning and doffing are considered to be a great problem in clothing (Newton, 1976). Having the ability to dress and undress oneself creates a sense of independence and confidence (Rice, 1971). The objective of this study was to identifying dressing needs of the brassiere in particular of the individual suffering from Rheumatoid Arthritis. Evaluation of the cause and extent to which, bra discomfort becomes a barrier in hand movements was done and major problems related to hand movements were studied. The main problems due to restricted hand and joint movements of RA females that emerged out were fastening/unfastening of fasteners/strings, buttoning, zipping, tying, wearing strap of the bra, chain pulling, and holding. Functioning of the bra was also studied with factors of fit: conformation to the body, comfort: physical (fabric texture), psychological (disability, femininity, and need of wearing the bra or not), social. Keywords: Rheumatoid Arthritis; Brassiere; Donning and doffing; Hand movement I. INTRODUCTION Rheumatoid Arthritis is an autoimmune disease in which body’s immune system protects its health by attacking foreign substances like bacteria and viruses which mistakenly attacks tissues near joints and sometimes it also attack body organs such as liver, lungs, heart, pericardium, pleura, sclera, nodular lesions, etc., which caused inflammation and swelling in the damaged area. Rheumatoid Arthritis which is also known by the name RA commonly affects the joints of the hands, feet, wrists, elbows, knees, ankles and Shoulders. Rheumatoid Arthritis usually affects joints symmetrically, if it affecting left hand then it will also affect right hand. Effect of Rheumatoid Arthritis is equal on both sides. Over time, there is a loss of cartilage, and the joint spacing between bones can become smaller. It results in swelling and pain in and around the joints.
Rheumatoid Arthritis generally affects females 40 and above years according to Census of India 2011. In most cases, joint deformity also occurs and joint damage done by RA cannot be reversed it can only stop by medication. II. OBJECTIVE OF THE STUDY The objective of the research was to systematically study the problems faced by RA female patient in terms of donning and doffing of bra. Hand and joint dexterity and their movement being emphasised upon and its relationship with respect to donning and doffing of brassier. The focus was laid on the basic bra structure in terms of fabric, yarn, finish, closure mechanisms, trims, and size in relation to hand movements of RA patients. Also, socio-psychological factors were taken into considerations in the context of wearing
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the bra, questioning the need of wearing the bra. Already existing functional clothing were studied and their acceptance in the society. III. BACKGROUND OF THE STUDY According to a survey, conducted by Census of India in 2011, on the disabled population by sex and residence of India were 26,810,557 which were 2.21% of the population of India which is 1.221 billion in 2011, in which population of male and female were 14,986,202 and 11,824,355 respectively. The population of male and female in the urban area was 4,578,034 and 3,600,602 which was 2.34% and 1.98% of the disabled population in the urban area. The population of the person with movement disability was highest which was 5,436,604 which were 20.3% of total population of disabled persons, in which population of male and female was 3,370,374 and 2,066,230 respectively which was 22.5% of the total disabled male population and 17.5% of the total disabled female population. The population of the female with disability in Delhi in 2011 was 173,484 in which population of female with movement disability was 67,383 (State UT wise Persons with Disability, 2011). The number of female population with movement disability was higher from other disability so, research is focused on women with movement disability. In movement disability also there are many types of disability which are Limited hand dexterity, Arthritis, Multiple sclerosis, Fibromyalgia, Torn rotator cuff, Limited upper arm mobility, Paralytic persons, etc. According to the survey conducted by Census of India in 2011, total population of Delhi was 16,787,941 of which male and female was 8,987,326 and 7,800,615 respectively, and in India, per 100,000 there is 7535 Rheumatoid arthritis female patient above 40 yrs. So, the number of female Rheumatoid Arthritis patients in Delhi over the age of 40 years comes out to be 135,630 (approx). Rheumatoid Arthritis is the leading condition for women of middle (45-64) age and older (65-74, 75+) ages. It stands out very prominently for women, with prevalence rates 20-25 percent higher than their second ranked condition, high blood pressure Work disability is a major consequence of Rheu-
matoid Arthritis. Although Rheumatoid Arthritis is cumulative over time, 20% to 30% of patients become permanently work disabled in the first 2 to 3 years of the disease (Sokka). Physical disability in Rheumatoid Arthritis affects the types of clothing that can be worn. The extent of the effect depends on the type of disability, the degree of physical limitation, and the body part(s) affecting the disability. Due to the numerous variation of physical disability that exists, identifying the framework within which clothing issue might be clearly defined and organised in a complex but necessary process (Bevan, 29 Nov 2013). Mobility is also a significant issue for clothing product development. A certain amount of ease in clothing is necessary for donning and doffing, manipulating fasteners adjust clothing once it is on the body, and comfortable movement, so that the individual does not have to work against their clothing (Watkins). If clothing impedes the normal range of body movement, physical and mental fatigue can result (Watkins). Rheumatoid Arthritis patients have less power in hand, hence have mobility issues and face problem in donning and doffing of clothes. Thick seams, rough fabric or bulky trims if placed in pressure areas, under the arm, and against the back can amplify their hand movements and related problems. With these criteria in mind, focus on clothing related problems were studied. PROBLEM FACED BY DONNING AND DOFFING IN RHEUMATOID ARTHRITIS RA affects different joints of finger, thumb, wrist, elbow, which are involved in donning and doffing of bra and also hamper the activities which are involved in doffing and doffing of the bra - fastening/unfastening of fasteners/strings, buttoning, zipping, tying, wearing strap of bra, chain pulling and holding. These were mainly because of spasticity in their limbs because of that they were not able to raise their limbs. Poor muscular movements of fingers created problems while fastening/unfastening of front back opening ( N. Pruthi, P. Seetharaman, and Chanchal, 2003 ). Different body parts have different types of body movement which are responsible for different types of activities which are as follows: Joints of finger perform flexion and extension movement which are
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responsible for activities like buttoning, zipping, tying and chain pulling. Joints of thumb and wrist have circumduction, abduction, adduction and retropulsion movement which perform activities of buttoning, zipping, tying and chain pulling and holding. Elbow joints have flexion and extension movement which helps in wearing strap of the bra. Due to restriction in hand mobility of the upper limb body in Rheumatoid Arthritis, one has to depend on others for daily life activities, wearing clothes, here brassier being focused upon. Their clothing requirements are different from an average normal group with respect to mobility constraints due to joint deformations. These physical limitations also have the psychological impact on the wearer. Functional cum comfortable clothes do influence both physical and emotional well-being (Smith, 1975). Some clothing producers make special designs for disabled people. Many disabled people feel that these special garments still emphasize their disability, and they prefer to take the trouble to buy the clothing in normal shops with a much larger choice and adapt to their needs. The functional clothing should beautify body shape and enhance self-confidence. Also, disabled clothing is not available in standard size, and are alterations of existing clothes and the tailor-made brassiere is expensive for the RA patient and requires special tailoring skills. ‘Clothing is also one of the rehabilitating tools for the handicapped as it facilitates and encourages independent dressing and undressing and boost up their self-esteem which also needs special attention.’ – P. Seetharaman (2008) According to Friends et al (1973) Disabled need clothing that fit their body which is not of standard size or shape. Few of them need garments with packets which can be reached easily with manipulated fasteners that can be operated with limited arm movements while others need reinforcements in specific areas. Inappropriate clothing that put pressure on the body, thick seams, rough fabrics and even bulky trims placed underarm or against the back causes formation of pressure sores.
STUDIES DONE ON CLOTHES DESIGNED FOR PEOPLE WITH RESTRICTION IN HAND DEXTERITY Clothing that is designed to promote self-dressing improves a person’s ability to maintain physical activity and allows the person to be self-sufficient. It may also enhance the person’s self-esteem. Hence, it is essential to furnish some of the reviews available regarding this aspect. ‘Design and construct kurta with self-help features for female orthopedic patients.‘ Khanna (1989) – It suggested that designs of clothing for handicapped persons should be guided by special attributes and needs of such individuals. It directs how accessories (self-help features) like zippers, velcro, large button holes help in decreasing problems in dressing and undressing. ‘Suitable garments according to specific needs of orthopedically handicapped school going children.’ Kaur(1997) - It outlined the major factors for dissatisfaction with existing clothing with respect to orthopedically handicapped children. It suggested reinforcements at the armpits, knee, and seat with provision for alteration in length and circumference of trousers as an aid to the handicapped children. ‘Design functional garments for paralytic adult man.’ Aggarwal et al. (1998) - The study emphasized upon the functional, aesthetic and comfortable aspects of a garment to overcome the dressing problems of the person having the paralytic effect on the right side. It majorly focused upon camouflaging the disability and improving the personality of a paralytic adult. ‘Comfort of clothing’ Sawbridge(1989) - It ponders over the assessment of clothing comfort by the consumer. Interrelation of fabric types with respect to body type, and its closeness to the body. Discomfort sensation that is likely to be experienced in wear. With fabric type, the importance of the yarn and finish of the garment. The stimulus of vision, hair, touches and feel, odor or smell that contribute to an overall judgment of clothing comfort.
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IV. METHODOLOGY
References
Different disabilities are highly individualized with respect to the problems faced by the individual. A few commonly shared clothing requirements are appearance, safety, comfort, independence, durability, and availability of clothing. The information revealed that most of the special needs of one group varied from those of other in physical limitations and clothing needs. Therefore, the focus was made on Rheumatoid Arthritis, to analyze the movement related problems with donning and doffing of the brassiere.
1. Anand, N. (201). Designing Adaptive clothig for the Rheumatoid Arthritis. New Delhi.
DATA COLLECTION Studying the existing literature about RA and difficulties faced by RA patients regarding donning and doffing of brassieres. Also, other studies on specially abled as well as regular individuals with respect to restrictions in hand dexterity were taken into considerations. Also, existing functional clothing was studied to see their impact on the patients. Elements of the clothing’s like, types of fasteners, trims, fabric, seams, sizes were taken into consideration to analyze the relationship between hand movements and these elements. Studies on sociopsychological factors for brassieres were looked upon. V. CONCLUSION Bra discomfort with respect to hand movements becomes a key problem for RA patients. RA patients have limited and restricted joint functions. This physical limitation impacts the ability of women to self-dress. Socio-psychological factors also effect wearing brassiere which forces us to question on ‘why do we need to wear Brassieres’. RA patient faces most of the problems like restricted arm movement for donning on and doffing off the brassiere, limited grip to manipulate fasteners and closures, the stiffness of joints for maneuvering and locating trims and brassiere’s features. The solution can be done keeping the above things in mind.
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