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Running head: Assistive Technology: Prego Peri Pack

Assistive Technology: Prego Peri Pack Casey Walker

Touro University Nevada

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Assistive Technology: Prego Peri Pack Assistive technology is a term that is used to “refer to a broad range of devices, services, strategies, and practices that are conceived and applied to ameliorate the problems faced by individuals who have disabilities” (Cook & Polgar, 2008, p. 4). It is based off the idea that there is an individual with specific abilities trying to complete an activity within a particular context. The goal of the assistive technology is to enable the individual to achieve success in their efforts to participate in the activity despite their disabilities. In other words, the assistive technology system process emphasizes “use of available function (human component) to accomplish what is desired (activity) in a given context (place, environment, people)” (Cook & Polgar, 2008, p. 35) without focus of remediation of or rehabilitation of the body to a higher level of functioning, but instead, accommodating the disability with compensatory strategies and devices to assist in this goal (Cook & Polgar, 2008, p.35). It is evident that the primary focus of all assistive technology is the client. In order to fully understand the purpose, function, and usability of a particular device, it is first important to have a good understanding of the client or population of individuals that it is aimed at helping. In addition, a good grasp of the difficulties, impairments, abilities, disabilities and concerns are essential in the understanding of the purpose of the assistive device. Therefore, before explaining what the Prego Peri Pack is, it is important to understand the client factors of the specific population that it is aimed to benefit: pregnant women. Pregnancy and Occupational Challenges Throughout a woman’s pregnancy there are many biological changes that occur both psychologically and physically. These rapid changes can cause disruptions in the abilities of


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these women to fully engage in the occupations that they did prior to pregnancy. Furthermore, the occupational performance is typically diminished. There are a plethora of changes that occur; however, there are two main areas that are not often spoken of. This includes the maintenance of the perineal area and the effect this has on the sexuality of the woman. Pregnancy causes major changes in hormonal levels of the pregnant woman and sequentially, there is an increase sweat output and increased amount of vaginal discharge. This makes them more vulnerable to infection and it is suggested that personal hygiene be a priority, especially of the genital region. Soap and water should be used to clean the area often (Antenatal Care Module Section 14.3). This can be particularly challenging as the abdominal region of the body grows. Hemorrhoids are another common occurrence during pregnancy. In a 2007 article by Vazquez, it was reported that the prevalence of hemorrhoids presenting with symptoms are more common in pregnant woman than those that are not pregnant. The exact prevalence is not known; however, one study in Montenegro reported hemorrhoids presented during pregnancy in 85% of the women. (Vazquez, 2007). Hemorrhoids are “swollen veins at or near the anus, which are usually asymptomatic” but “can become symptomatic if they prolapse (the forward or downward displacement of a part of the rectal mucosae) through the anus” (Vazquez, 2007). There are four different stages of severity of hemorrhoids and the stages are diagnosed by a physician. Inspections for severity, inflammation, and bleeding are done by the doctor and specific treatment guidelines are given as necessary; however, it is suggested that for mild pain, burning, and itching that occur, topical anaesthetic agents should be applied unless there are specific contraindications (Vazquez, 2007).


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Self-care and grooming of the hair in the pubic area is a topic that, although it isn’t talked about much, it important to many pregnant women. Often times this is overlooked because there are no medical risks for not shaving the genital region during pregnancy. A study published in 2006 by Tanner, Woodings, and Monacster found insufficient evidence for hair removal on the rate of surgical site infections. Hair removal in the genital area is personal preference and is associated with a culture of individuals that find it to be cleaner and more attractive. This is more typical in younger generations and a blog on sexeducationnow.com report that “pubic hair is considered dirty, and having it off is considered sexy and clean.” For women that agree with this, shaving is a meaningful occupation that not only falls into their ADLs as a grooming and self-care activity but also falls under maintaining their sexuality. Polomeno published information about sex during pregnancy that included an abundance of information about the impact that the various pregnancy side effects can have on sexuality and the importance of maintaining intimacy during pregnancy for the strength of the couple, among other benefits (2000). It is believed that “the intimacy dimension of the couple’s relationship is the most affected dimension in the transition to parenthood;” therefore, “information that helps couples use mutual pleasuring to cement the passion in their relationship during the changes of pregnancy can make pregnancy an exciting time, rather than one of discord” (Polomeno, 2000). Sadly, information about sex and pregnancy is hard to find for many couples (Polomeno, 2000). As occupational therapists, it is important to be a resource and advocate for clients that have concerns about sexuality and “pregnant women and their partners especially want and need information about sexuality” (Allen & Fountain, 2007). Using the PLISSIT model to approach the topic is suggested to initiate conversation. PLISSIT is an acronym for Permission, Limited Information, Specific Suggestions, and Intensive Therapy and is the most common model used to


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address sexual functioning (Allen & Fountain, 2007). Using this model as a guide for giving clients enough information regarding sexuality and pregnancy and how to maintain self-care, the Prego Peri Pack was created to assist in the education, occupational participation, and occupational performance of expecting women. Prego Peri Pack The Prego Peri Pack is a set of items that are intended to address some of the perineal care challenges that arise during pregnancy. There are four items that comprise the kit. Adjustable Mirror Attached to an adjustable high stand and goose-neck there is a mirror that can be used to increase the vision of the pubic area below the protruding belly of a pregnant woman. This can be placed on the floor and adjusted to the appropriate height and angle for optimal view for the woman who is pregnant. This is significant in increasing the awareness of this part of the body and safety while participating in the self-care and hygiene tasks that are recommended during antenatal care. This is the primary piece of equipment to increase the safety of the hygiene tasks. It allows for the woman to see what she is doing while performing the cleansing and shaving, self-examine for any changes to the area, and do so while standing up with a safe and wide base of support and no bending at the hips or back. Hemorrhoid Cream Applicator There is a long handled bristle brush that has a raised sponge and washcloth on the opposite side of the bristle brush that allows for cleansing of the rectum and easy application of hemorrhoid cream. This is important for pregnant women to be able to care for themselves,


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bring themselves relief from the pain and discomfort of the hemorrhoids, and maintain modesty and independence. At this time, many women have to seek the assistance of a caregiver or significant other to help them with this which is an unpleasant and embarrassing experience that decreases their self-esteem and confidence, especially as a sexual being. It is important to maintain sexuality, especially during pregnancy, as there are many challenges that the couple is faced with during this time (Polomeno, 2000). Vaginal Cleanser and Shaving Cream Applicator There is a long handled bristle brush that has soft bristles for easy cleaning the genitalia area and there is a natural sea sponge on the opposite side. This is to be used for shaving cream application to the pubic area. Frequent and thorough cleaning of the genitalia is important during pregnancy to prevent infection secondary to increase sweat and vaginal secretions. Furthermore, the ability to adequately apply and lather shaving cream to the area is important in the skin care management during shaving. Shaving is a meaningful occupation to many women and by increasing the ability and safety to do so, increases the occupational performance. Pregnancy-Friendly Razor This pregnancy-friendly razor is comprised of a long, curved handle attached onto a Venus razor. This fabricated handle is specially designed to promote occupational participation in self-grooming of the pubic area. It is made from scrap splinting material, Aquaplast. It increases function by having a curved handle that adds length to the arm and the razor for easy reaching. In addition, the curved handle allows for easier reach and an optimal angle when shaving the genital area. As mentioned previously, this is a part of some cultures and play an integral part in maintaining sexuality in some women; making this a significant activity of daily


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living (ADL) for this population. By utilizing this razor, the independence and safety in this occupational activity is greatly increased. Further safety considerations were made in the fabrication of this device. There is an additional lay of Plasti Dip, a multi-purpose rubber coating, which increases the grip of the handle. This is important because when the splinting material gets wet during the grooming activity it may become slick and slippery. Since the individual is using the device to manipulate a sharp object, optimal grip and control is essential. Purpose and Function The primary purpose of the Prego Peri Pack is to increase the occupational participation, performance, independence, and safety for expecting women when engaging in the meaningful activities of self-grooming and maintaining sexuality. Users Although the kit was created for the population of women that are childbearing, it is not limited to only them. It can be utilized by the obese population with the same purpose and function. Since there is an obesity epidemic, there is a growing population that would benefit from this device, in addition to the individuals that it was intended for. Current Approaches After interviewing some peers during their pregnancy and searching online through blogs, it was made apparent that there are no current products on the market that are similar to this. Most individuals reported feeling with one hand and bending to try to see around the belly to achieve shaving. Others reported utilizing their significant others to groom for them;


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however, most were not happy about this and were seeking other methods. Some women turned to spa services to have a professional wax but often complained of the significant amount of pain and cost associated. The lack of other options makes this a very unique prototype. There are no other kits on the market that assist pregnant women with perineal care, genital shaving, and hemorrhoid cream application. Usability Assessment After fabricating all of the parts of the Prego Peri Pack, the opinion of a colleague that is nine months pregnant was obtained. After manipulating and maneuvering the devices for less than a minute, her face light up and she reported that it would be great for her to have and to have had for months now. Not only would her perineal care be made easier, but shaving her lower legs and washing her feet would be made simpler and safer. She reported less back strain while completing her grooming and bathing activities than she typically does in her current methods. In conclusion, there is great usability to the Prego Peri Pack. Technical Assessment This device is considered a method of assistive technology that is ‘low-tech.’ There is little complication or complexity to the device and using the device takes no training or efforts to learn. It is something that someone can start using immediately, making it even more userfriendly.


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Cost Analysis

Item

Cost/ Unit

Amount Used

Final Cost

Mirror

$0.99

1

$0.99

Razor

$5.97

1

$5.97

Long-Handled Brushes Natural Sea Sponge Washcloth

$0.99

2

$1.98

$0.99

1

$0.99

$0.99

1

$0.99

Hairdryer Stand

$1.00

1

$1.00

Krazy Glue

$6.93

0.5

$3.47

$9.88/ 4 Feet

2 Inches

$0.49

Scrap Splinting $110/ 24”x36” 3”x12” Material Total Cost For Fabrication of Prego Peri Pack

$4.58

2” Velcro

$19.47

Conclusion In the final analysis, it is evident that the Prego Peri Pack is a unique, inexpensive, and adaptive solution for compensatory strategies in occupations that pregnant women engage in. In addition, it has great usability and benefit to increase their independence and safety during this participation.


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References Advantage Medical Supplies: http://www.advantagemedical.com/products/infinity-1/8-thicksplinting-sheets-24-x-36/ Cook, A.M. & Polgar, J.M. (2008). Cook & Hussey’s Assistive technologies: Principles and practice. (3rd ed.). St. Louis, MO: Elsevier/Mosby. Ethiopian Health Extension Programme. Antenatal Care Module 14, Section 3. Retrieved from: http://labspace.open.ac.uk/mod/oucontent/view.php?id=450497&section=1.5 Polomeno, V. (2000). Sex and pregnancy: a perinatal educator's guide. Journal of Perinatal Education, 9(4), 15-27. Sexual Cleanliness & Pubic Hair Removing Tips for a Sexy You! Retrieved from: http://sexeducationnow.com/sexual-cleanliness-pubic-hair-removing-tips.html Tanner J, Woodings D, Moncaster K. Preoperative hair removal to reduce surgical site infection. The Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004122. DOI: 10.1002/14651858.CD004122.pub2. Vazquez, J.C. Constipation, haemorrhoids, and heartburn in pregnancy. Clinical Evidence (Online): 2008: 1411. Sub-article 21.


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Appendix A Figures 1 & 2: Use of the long-handled razor, adjustable mirror, and long-handled sponge for shaving cream application and genital cleansing promote increased function, safety, base of support and control during perineal care in an individual that is nine-months pregnant.

Figures 3 & 4: Demonstrate the previous methods of shaving the legs. Note: poor body mechanics that put the individual at a great risk for falling, back strain, and low back pain.

Figures 5 & 6: Demonstrate the increased base of support, stability, safe body mechanics, decreased energy output, efficiency, and overall usability and benefit to the pregnancy-friendly razor. Note: The significant decrease in fall risk, back strain, and low back pain.


649- AT Device