Psychosocial and behavioral consequences of a change in lower extremity orthosis



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This study investigated the psychological, social, and behavioral effects of making a physical disability less visible. With cosmetic features emphasized, a corrugated polypropylene orthosis was developed to replace the conventional metal leg brace. The new brace was designed to be less cumbersome, heavy, and less apparent. Specifically, this study is an attempt to assess changes in self-perception, social reaction, and daily activities as a consequence of changing from the conventional to the polypropylene orthosis. Changes in self-perception were assessed by an inventory which was constructed to measure various aspects of interpersonal and physical self-perception. Behavioral changes were recorded by a daily activities diary. The SelfPerception Inventory (SPI) and Daily Activities Diary (DAD: consisting of seven daily record sheets) were administered on a pre-, post-test basis to ten physically disabled outpatients who normally wear lower extremity orthotic equipment. These patients wore the conventional brace and were anticipating changing to the polypropylene brace. One week before being fitted with the new brace, they were given the SPI and DAD. About two months later, they were again given the SPI and DAD. SPI results showed there was a near significant tendency for patients to feel less physically impaired when wearing the polypropylene brace. This was due to: 1) feeling more mobile and less restricted, and 2) experiencing the impaired leg as more unified with the rest of the body. Contrary to expectation, patients felt significantly more uncertain about their futures and preferred more physical distance between themselves and others in the new brace. Item analysis revealed that patients felt significantly more socially active and satisfied at the post-testing. They also saw themselves as having more sex appeal when in the new brace. Furthermore, patients felt less self-conscious and more interpersonally comfortable in the polypropylene brace. Individual changes in self-perception were also reported for each patient. Some patients clearly benefited from the new brace, while others made negative changes or no changes. The data suggest that personality factors and other variables played a decisive role in whether patients made positive changes in self-perception. DAD results showed patients spent significantly fewer hours per day alone, and more hours each day outside the home when wearing the polypropylene orthosis. There was also a near significant trend for patients to watch less television and enter more varied behavioral settings per week. In short, patients significantly broadened their physical and interpersonal experiences. It is suggested that these changes were primarily due to wearing the polypropylene orthosis. The social effects study involved a video-tape presentation of eight physically handicapped Ss: 1) walking with the conventional brace, and 2) walking with the polypropylene brace. Forty-one college students rated the Ss on a Perceived Disability Rating Scale, which measures physical condition, personable qualities, and social acceptance. Young and middle-aged disabled Ss were judged as significantly less handicapped in the polypropylene brace. Middle-aged Ss were seen as significantly more socially effective and attractive in the new brace. Older Ss were considered significantly less handicapped, more attractive, and more acceptable, in the conventional brace. Regardless of age or type of brace, Ss were socially acceptable to others. Replacing the conventional with the polypropylene orthosis elicits a more desirable social reaction when the disabled person is female and under forty years of age. In conclusion, it is possible to beneficially alter self-perception, behavior, and social reaction, by 'simply' making a disability less visible.



Orthopedic apparatus--Psychological aspects