Description and Need:

A Left Ventricular Assist Device (LVAD) is a piece of portable medical equipment used as an option to treat advanced heart failure, and consists of the internal implanted motor, and an exterior driveline, a power pack with power cord, and two batteries. Because the needs of someone with an LVAD are different than those of someone without, it would be a natural assumption that the clothing needs are also different. There are many different approaches to adaptive clothing, and there are a variety of options currently available to meet the needs of different populations. Clothing designed for person's in wheelchairs, or for those with hemiparesis post stroke or TBI can be found with relative ease. However I have found that there are very few clothing options currently available that are designed for and meet the needs of the LVAD population, specifically taking into consideration equipment management, driveline safety, comfort, convenience, and design/fashion. The aim of this competence project product is to design, develop, and eventually distribute a line of clothing specifically designed for persons with an implanted portable LVAD.

Based on feedback received directly from those in the LVAD community, both LVAD recipients and their caregivers, the initial approach was to design something functional, with a base layer to house the LVAD equipment and a top "fashion" layer for purposes of concealment, comfort, and style. The LVAD community reported that most currently available clothing options are uncomfortable, unflattering, expensive, and offer very few option specifically for women. This feedback was taken into consideration throughout the initial design stages, when choosing material, and when producing the initial pieces in order to present to a small number of LVAD recipients for additional follow up feedback. This product is still in development, however the continued stages of development have brought significant improvement to the initial ideas and will continue to grow as the apparel line moves toward production and sales.

Theoretical Basis:

The Person Environment Occupation and Occupational Adaptation frames of reference were used as a theoretical basis for this product. The Person Environment Occupation frame of reference addresses the overlap of the three aspects of occupational engagement, and looks to create the optimal overlap while utilizing environmental and occupational modifications to meet the direct occupational needs of the person (Law et al., 1996). Optimizing the acute misalignment of the relationship between the LVAD patient, their environment, and their preferred occupation can be achieved through providing a more appropriate and comfortable garment that fits optimally for occupational engagement in any environment.

The Occupational Adaptation frame of reference emphasizes the relationship between the person and their environment, encouraging patient adaptation to optimize occupational engagement (Schkade & Schultz, 1992). Adapting typically designed clothing to fit the needs of someone with an implanted portable LVAD offers the opportunity for increased occupational engagement, allowing someone to feel more comfortable in their skin.

Literature Review:

Alterations in body image and unforeseen challenges while navigating life with an LVAD are suggested to cause difficulty with activities of daily living, especially dressing, as well as misunderstanding of equipment from those outside of the LVAD world (Marcuccilli & Casida, 2012; Sharp et al., 2018). While there is little in the way of large studies regarding the LVAD population and clothing or body image, there are multiple small sample and case studies that provide evidence to suggest a need for clothing designed specifically for this population. Based on feedback directly from those in the LVAD population gathered during preliminary research for the development of this product, finding clothing that is comfortable, durable, fashionable, and serves the functional needs of the LVAD equipment is extremely difficult. Not only are the options very limited, but they are also generally found to be expensive.

In one case study performed by Marcuccilli and Casida (2012), the subject found that after she became more independent with managing her LVAD equipment through her daily activities, she found it to be increasingly difficult to find clothing that met her needs. Having to manage equipment in public places brought challenges of differing concern. One patient found that being able to access LVAD equipment while in public places such as restaurants or grocery stores made layering for concealment complicated (Marcuccilli & Casida, 2012). Another subject reported concealment as being his most important factor in managing his LVAD equipment, as he had experienced multiple occasions in which his exposed equipment was mistaken for an explosive device (Sharp et al., 2018). This experience caused emotional and psychological stress in an already difficult situation, with the subject reporting that he limited life outside of his home in order to avoid similar situations to occur again (Sharp et al., 2018).

According to the AOTA (2020) maintaining or returning to functional independence in valued occupations is part of ones perceived quality of life. Tosto et al. (2019) found that a patients perceived return to functional independence post LVAD implant is a large determinant of device acceptance. Being able to independently and comfortably perform activities of daily living directly impacts quality of life, and having to manage LVAD equipment can cause distress and difficulty with task engagement. Having clothing options that are comfortable, durable, that manage LVAD equipment , and that are designed specifically with the LVAD recipient in mind has the potential to significantly increase independence and quality of life with every day activities.