Posts tagged ‘disability’

Are you Comfort-Able on your toilet?

I have a strange habit of always going into the ADA stall in community bathrooms to do a quick visual check of the space, as I have yet to find one that does not have something ‘wrong’ :)

On this last occasion I was checking out a bathroom and noticing the typical errors—flush control not mounted on the wide side of the toilet area, door hook installed too high—and I noticed a woman near the sink area with an inquisitive look.  We engaged in conversation about the ADA stall and she proceeded to tell me that her husband was a remodeler and ‘everyone wants a comfort height toilet’ so he recommends them to all of his clients.  Hoping that I did not have a look of horror on my face, I politely let her know about my passion for space planning  and that not all people benefit from comfort height toilets. She quickly interrupted me and said, “now I am talking about comfort height toilets, not ADA height”.  I assured her that I knew the difference, and gave credit where credit was due regarding having the knowledge that there are different height toilets on the market, but continued our conversation with regard to feature-matching fixtures to meet the needs of the client.

A standard toilet measures 14 ½” above the finished floor to the top of the porcelain bowl.  This does not include the toilet seat, which can be different thicknesses and change the overall total height.  Federal law dictates that an ADA height toilet is to fall between 17”-19” above the finished floor.  This leaves the comfort height toilet.  A comfort height toilet is approximately 2” taller than a standard height toilet, measuring ~16.5” above the finished floor to the rim (not including toilet seat).  At 16.5” above the finished floor, this toilet height is not ADA-compliant as it is ½” lower (however, there are toilets on the market that are called ‘comfort height’ and do fall within the 17”-19” ADA height range).

I discussed that not all persons benefit from a comfort height toilet, as this is due to each person having different ergonomic needs based on their own body measurements.  It is also about the physiological position that one’s body must be in to maximize the ability to evacuate the bowels (yes, I am an Occupational Therapist by background, so I went there).  Look at the toilet systems of some other cultures; you will frequently find a bathroom stall with nothing else but a hole in the floor that requires one to squat to get the job done.  Obviously this scenario does not work for someone who has difficulty with sit-to-stand from a surface that puts their hips at a level below their knees, but these are the variables that need to be considered when choosing a toilet; especially since this is something that we as humans need to use multiple times a day.

I am 5’3” and have a longer torso and shorter legs; a comfort height toilet is currently too high for me.  At this time, a comfort height toilet is also too high for my husband, who happens to have a spinal C5-C6 incomplete spinal cord injury.  Most people would have a knee-jerk reaction and say, he should have an ADA height toilet, or at least a comfort height toilet, when in fact, that is too high……for him.  Will we benefit from a higher toilet in the future?  Perhaps, but it is not the right choice for us right now.

There are many variables when choosing a toilet, height being one of them.  Determining height also has many factors to consider including anthropometrics, transfer status (how one gets on/off the toilet), as well as how many different users will have access to this toilet.  A comfort height toilet is a great option; operative word here being ‘option’.  We have choices because we all have different needs.  Feature-matching fixtures to meet a person’s (or household’s) needs is key.

March 7, 2013 at 8:42 am 5 comments

My personal journey with Universal Design

My house is 10 years old.  Unlike the national statistic of the median age of homes in the United States being 36, our house is ten years old.  We built our house ten years ago, incorporating Universal Design features.  It is because my husband has a C5-C6 incomplete spinal cord injury and utilizes a manual and power wheelchair for his mobility that many people will say to me, ‘you built your house for your husband, right?’  My response is, we built the house for the both of us.

The fact that you can walk into my house and never know that a person with a disability lives there is testament that Universal Design can be invisible, beautiful, provide convenience, and be flexible and ready for you when you need it.  It is important to note that my husband is independent in our home; but, so am I, and so is anyone else when they come over to visit.  I was 30 years old when we moved into our new house, and I proudly turned 40 last month.  I am thankful that I have a pretty uneventful medical history, so far, but am more thankful that my house was built with Universal Design in mind, because these features have intermittently been important to me, personally, over the last ten years.

We are all temporarily able-bodied.  No one can predict if, when and where illness, injury or disability may strike.  At age 33 I was in a car accident on the highway.  I was lucky to only walk away with an abdominal contusion and a triangular fibrocartilage complex injury (think pinky finger side of your wrist) of my right (dominant) hand.  I had to wear a brace for 3 months, all day except for when bathing.  Not only was it bulky, I would have pain and difficulty with any task that would rotate or deviate my wrist as well as grip and some pinch.  Automatic can openers never made me so happy!  However, I was even more thankful to have loop/pull handles on cabinets and drawers and lever handles on my doors and even the faucets and shower mix valve!

At age 35, after having many issues with my contact lenses and glasses (which I had worn for over 20 years at that point) I decided to get Lasik surgery.  I was not a candidate for the standard ‘flap’ Lasik surgery, but rather Photo Refractive Keratectomy (PRK) Lasik.  There is a big difference in both procedure as well as recovery time.  Unlike the glamorous ability to see clearly and be ‘work-ready’ within 24-48 hours after traditional Lasik, PRK requires up to a one-week recovery process (no work recommended) and then vision is to full potential in about 6-8 weeks.  Sure, why not!  My initial healing process had me out of work that entire first week.  I was wearing extremely dark goggles throughout the day, due to extreme sensitivity to any light for the first half of the week.  By the end of the week, my vision was at its best 20/40 at times (which allowed me to drive), but would get worse as the day went on.  I found myself sitting at meetings or working with clients and they would be somewhat clear (that was the 20/40) then I would blink and they would be a big blur.  This roller coaster of vision lasted for about two months.  I am now happily 20/20.  However, during this time I was incredibly thankful for the color contrasting within my home to help me distinguish between objects within a space, especially in my kitchen.  I also benefited from the ability to adjust the lights lower when it bothered my eyes in the beginning, and increase the lighting later when I was not quite yet to 20/20.  I was also very thankful that we chose bull-nosed edging for our counter top as I bumped it frequently, without having good acuity and depth perception in the beginning, and was not hurt by any sharp edges.  This was a choice that was specifically originally made with multiple users of the space in mind: one being my husband, and the other was the forward thinking of possibly having children in the home (lifespan design) and looking at creating a safer environment by eliminating sharp edges.  Ironically, I also benefited.   Lastly, having front controls on the stove as well as the washer/dryer provided increased access and safety, as I found myself needing to get closer to locate them and to see the control/cycle.

Last year, I finally learned first hand what it feels like to be in so much back pain that you are literally stuck and can’t move.  We see this scenario in so many comedy sketches and movies, but never really ‘get it’ until it happens.  After having slept on a not so good hotel bed for two days, then a hospital couch for four days while my Mom was hospitalized, along with carrying heavy bags and helping move my Mom’s things, within a week I found myself up in the middle of the night in extreme pain and stuck, seated at the side of my bed.  My 39-year-old back had enough, and my husband, while seated in his wheelchair, had to help me off the bed.  After a doctor visit I was able to get the pain under control, but found that I had difficulty with most reach that was at or above shoulder level as well as below waist level.  This included any bending and reaching, even when I was using the best body mechanics to get the job done.  I was never so thankful for my pullout shelving!  This was truly an amazing benefit that was just a convenience for me, before this injury.  I was also very thankful for having placed many of my frequently used items at an easy level to reach, by using lowered cabinets or adjustable height shelving throughout the spaces within my home, where I did not have to rely on overhead reach or extreme bending for accessing storage.  My washer and dryer, being front loaders, created ease with completing laundry during this time.  Even my side-by-side refrigerator allowed me to access both the fridge and freezer without having to do overhead reach; I am on the shorter side at 5’3” :)    The pullout shelving within the fridge was the icing on the cake.  Even the design and organization of our pantry closet which places the dog and cat food bins at a higher level off the floor, allowing access for both myself and my husband without the need for bending, provided relief and gave me the ability to continue feeding my furry children.

My story is not unique.  In fact, it is pretty typical for the average person to have a temporarily disabling condition that impacts performance of everyday and meaningful activities.  The problem is, it is temporary.  We get back to our busy lives and forget what happened and how our environment made the condition even more disabling; until it happens again.

Frequently, when I talk about Universal Design I hear people say, “I don’t need that yet” or “It’s not for me, but it might help my grandmother”.  Universal Design is not ‘accessible design’.  It is not design just for someone who is ‘old’ or already has illness, injury or disability.     It is design for everyone.  I hope that my journey with Universal Design truly represents the level of convenience it has afforded me when I did not personally need it, but how it became invaluable, when I did.

Here’s to hoping this provides the proverbial A-ha!  moment :)

What is your Universal Design journey?

February 23, 2013 at 8:19 am Leave a comment

Imagine what it would be like to have your first mammogram…while seated in a wheelchair (2012 update)

Almost two years ago I wrote a blog regarding the Access Board planning to set standards for medical diagnostic equipment.  As of February 9, 2012, these proposed accessibility standards were published for comment in the Federal Register.

I am dedicating the re-posting of this blog in an effort to provoke thought about the importance of this issue.

From May 11, 2010:

For women around the world it is almost like a rite of passage: the baseline mammogram. It is advised to get it done prior to age 40 and I crossed that bridge this year. It is an interesting process that I felt more like a mannequin than a person, being positioned in such a way that the mammography machine can take the best picture. As I was standing there, being the compliant patient, I could not help but wonder, how would this process work if I were seated in a wheelchair? If I did not have control over my arms or my torso? Could the machine get a good picture???

In my case I actually needed to return as there was an inconclusive spot on one of my pictures. After a second round with the machine, it was determined that it was a positioning issue that folded the skin in such a way that obscured the picture. Now, if this can happen with an able-bodied person that can twist and contort in any way requested, how can one be sure an accurate picture can be taken for someone with a mobility impairment?

I frequently wonder how my husband manages, with a C5-C6 incomplete spinal cord injury, when he has a medical appointment.  I think about this as I sit in the dentist chair, as I am seated on the family doctor’s exam table, as I am getting up on the x-ray table sitting just so to get the best picture.  Currently, it may take him some extra time, but he is able to complete these functional transfers. What will happen five, ten or twenty years from now when he has less mobility? Less ability to complete functional transfers? How do others with mobility limitations manage this task when the equipment is built for use with able-bodied persons?

According to the Access Board, standards are to be set for medical diagnostic equipment under the new health care reform law. “The ‘Patient Protection and Affordable Care Act’ authorizes the Access Board to develop new access standards for medical diagnostic equipment including examination tables and chairs, weight scales, x-ray machines and other radiological equipment, and mammography equipment.” It is hard to believe that this is actually not addressed under the current ADA.

This is yet another area of accessibility that has been overlooked. I am thankful that there will be regulations for medical diagnostic equipment, but am realistic in knowing that seeing this actually take effect in the doctor offices may take a while.

What are your thoughts/experiences with this issue?

February 26, 2012 at 10:48 am Leave a comment

A bump may as well be a mountain to a wheelchair-user

It never ceases to amaze me how a “bump” can change your immediate plans.  This scenario happened on one “Sunday fun-day”, during the Summer 2010, but is just as relevant to our lives today.  It started with Bill and I wanting to use a sale coupon at the mall and then go out to dinner.  We hopped into his wheelchair accessible truck and off to the mall we went.

We parked in the van accessible designated space and started to deploy the lift.  It met Bill at the floor of the truck and he rolled onto the lift, no different from any other day.  As the lift gently places Bill onto the ground surface, it stops, leaving the “front gate” in the up position.  Bill is unable to roll off the lift.  We spend the next 30 minutes going through the motions to try to figure out why the “front gate” will not go down to let Bill roll out and off of the lift.  All of the features of the lift appear to be functioning except this last step in the process, and all of our efforts to remedy the situation prove to be unsuccessful.  The only thing left to do is to go back home.

In order to get Bill out of the truck, we have to bring his power wheelchair next to the lift, as it is deployed in the driveway.  He then transfers from the manual wheelchair to the power wheelchair to his freedom, while I lift his manual wheelchair over the “front gate” bump and back to accessible grounds.

Of course, it is a Sunday, and none of the adapted vehicle centers are open.  Bill waits until Monday to call and go over to the closest center (40 minutes from our house) to resolve the issue.  In order to get Bill back into the truck, we have to repeat the above process, with both his manual and power wheelchairs, to get him safely into the vehicle.  Luckily, Monday is Bill’s day off.  Unluckily, they are not able to see Bill and he has to go to the second service center which is another hour away, with no traffic.

Although this shop was busy, they were willing to accommodate Bill and service the lift.  They were able to help Bill get out of the truck, and put his service ticket in with the rest of the work they had to do for the day.  Three and a half hours later, the lift was fixed and Bill could drive the hour plus it takes to get back home.  Not the first choice of how to spend one’s day off, but a necessity to regain independence.

One small step for man, a giant leap for a wheelchair-user.

January 18, 2011 at 8:32 am Leave a comment

Participating in CPR training with a disability…..

This past weekend I did my annual health care professional ritual of completing my CPR re-certification.  Although, this time it was not so typical as I started to wonder, could Bill (my handsome husband, who happens to have a C5-C6 incomplete spinal cord injury) perform CPR on me in the event of an emergency?  What accommodations would the Red Cross and/or the American Heart Association make for those who want to be CPR certified and have a disability?

I spoke with a Red Cross representative from my area to get some clarification.  There are three main critical objectives that need to be met for CPR certification 1-to get on the floor, 2-To be able to give an effective breath (making the chest rise) and 3-to be able to give effective chest compressions.  If a participant is able to complete these three main critical objectives, as well as pass the written exam, they will receive the CPR certification card.

The representative reviewed that modifications can be made, as long as the three main critical objectives are still met.  For example, a woman with a congenital birth defect that had left her without forearms or hands recently took the course and completed the  certification.  The Red Cross representative reported that she was able to get on the floor, she was able to give effective breaths, but instead of using her hands to complete the chest compressions, she was able to effectively complete the chest compressions with her foot.

If, however, a person is unable to complete any of the three main critical objectives, a certification card cannot be issued.  Although certification would not be obtained, auditing the class to learn the information is still a viable option.  Learning this information would allow you to instruct others to help with CPR, in case of an emergency.

I thoroughly understand the need for these critical objectives to be met to provide effective CPR, but am delighted to know that modifications can be made.  If you are interested in learning more about what accommodations can be made for completing CPR with a disability, please contact the American Red Cross and/or the American Heart Association for details.

Save a life, learn CPR!

August 17, 2010 at 3:13 pm 2 comments

New Thinking for Effective Caregiving: A Conversation Between an Occupational Therapist and a Caregiver’s Coach (Part 1)

Family Wellness-

Debra:
We all are touched by injury, illness or disability. At EmpowerAbility, LLC, we know that for a client, everyone in their immediate circle plays a role in how well they heal. Whether I’m completing a home assessment, or working directly with the client in Occupational Therapy, it’s not just about the client, it’s about everyone around that person. It’s making sure that the environmental modifications I’m recommending in the home work for everyone.

The time we spend is frequently an almost equal split between time with the family and time with the client. In OT, we have to simultaneously be aware of everyone’s capabilities, limitations, and expectations. One example was with a caregiver whose father had Alzheimer’s. OT was a lifesaver. We were able to pull the daughter aside and help her sidestep burnout, by giving her strategies that helped her complete daily living activities while emphasizing the positive aspects of care. We gave her strategies for communicating with her father that let her get back in touch her values and social relationship that underlie her caregiving role. We also found her local resources that provided respite care (giving caregivers that much needed break,) and also caregivers groups where she could talk with others who fully relate to the caregiving role.

Everywhere along the spectrum, from acute care to outpatient and home health Occupational Therapy settings, the families are involved.

Holly:
So, Debra, you’re really talking about holistic wellness within the family system. Often the caregiver is the one left out of that picture because self-care can seem counter-intuitive from the caregiver’s perspective. Initially, there’s a sort of blindness caused by resisting what is happening, feeling they must “fix” the situation or their loved one.  “I’m trying to help my dad, to slow down his decline, and you’re suggesting that I focus on myself?!” That blindness prevents them from seeing their role in the bigger picture. Seeing caregiving with a broader view requires a new way of seeing for the caregiver. Once they ease up on their resistance and begin to accept that changes are normal and inevitable, they become freer to question, “What is My part in this?” And then they are more open to seeing the need for their own self-care.

So, caregiving is rife with unknowns and things that can’t be controlled. The one thing over which caregivers do have control is their own health and well-being. The family is a dynamic system—what one family member says, and how they are, effects the others. If I’m a caregiver experiencing a mood, it can infect others. If I’m letting myself get burned out, I’m not available to do the caregiving to which I’ve committed. So in order to do my best job, I am actually required to take care of myself, get the support I need, manage my emotions honestly and well. Selfcare is no longer a frill—it’s a necessity.

This topic of family dynamics is so rich, Debra. Are other ways in which you encounter and work with family dynamics? (to be continued)

—Holly Whiteside, caregiver’s coach & advocate, is author of “The Caregiver’s Compass: How to Navigate with Balance and Effectiveness Using Mindful Caregiving.” She invented Mindful Caregiving tools during her caregiving decade by applying to herself the life coaching principles that she had been teaching others. Find her book at Amazon.com, or learn more at www.CaregiversCompass.com. Holly can be reached at MindfulCaregiving@comcast.net.

July 21, 2010 at 7:55 am 1 comment

Imagine what it would be like to have your first mammogram…while seated in a wheelchair

For women around the world it is almost like a rite of passage: the baseline mammogram. It is advised to get it done prior to age 40 and I crossed that bridge this year. It is an interesting process that I felt more like a mannequin than a person, being positioned in such a way that the mammography machine can take the best picture. As I was standing there, being the compliant patient, I could not help but wonder, how would this process work if I were seated in a wheelchair? If I did not have control over my arms or my torso? Could the machine get a good picture???

In my case I actually needed to return as there was an inconclusive spot on one of my pictures. After a second round with the machine, it was determined that it was a positioning issue that folded the skin in such a way that obscured the picture. Now, if this can happen with an able-bodied person that can twist and contort in any way requested, how can one be sure an accurate picture can be taken for someone with a mobility impairment?

 I frequently wonder how my husband manages, with a C5-C6 incomplete spinal cord injury, when he has a medical appointment.  I think about this as I sit in the dentist chair, as I am seated on the family doctor’s exam table, as I am getting up on the x-ray table sitting just so to get the best picture.  Currently, it may take him some extra time, but he is able to complete these functional transfers. What will happen five, ten or twenty years from now when he has less mobility? Less ability to complete functional transfers? How do others with mobility limitations manage this task when the equipment is built for use with able-bodied persons?

 According to the Access Board, standards are to be set for medical diagnostic equipment under the new health care reform law. “The ‘Patient Protection and Affordable Care Act’ authorizes the Access Board to develop new access standards for medical diagnostic equipment including examination tables and chairs, weight scales, x-ray machines and other radiological equipment, and mammography equipment.” It is hard to believe that this is actually not addressed under the current ADA.

This is yet another area of accessibility that has been overlooked. I am thankful that there will be regulations for medical diagnostic equipment, but am realistic in knowing that seeing this actually take effect in the doctor offices may take a while.

What are your thoughts/experiences with this issue?

May 11, 2010 at 6:47 am Leave a comment

He’s got a ticket to ride

We have certainly been to our share of amusement parks, but every time it was definitely a challenge to assist Bill (who has an incomplete C5-C6 spinal cord injury) in and out of each of the rides.  

Our experience has been that there is a separate entrance for wheelchair users, to avoid the inaccessible line rails and turnstiles (with the exception of Disney).  This entrance puts you at the front of the line, which many times is to the dismay of those who are able-bodied and have stood in line for two hours, in the heat, to get on the ride.  The tricky part is assisting Bill during the transfer to and from his wheelchair into the ride itself.  After years of practice, we are like a well running pit-crew team, but this routine always draws plenty of spectators. Most of the time they do allow you to stay on the ride for two runs; consolation for all the trouble it takes to get in and out, I suppose.

I was excited to read an article about Morgans Wonderland in San Antonio, Texas.  It is dubbed “The World’s First Ultra Accessible Family Fun Park”.  It is specially designed for children and adults with special needs.  They have designed rides that have wheelchair accessible cars so the rider does not have to transfer—genius!  This begs the question, why has this not been done before?

Disney World's Rock'n' Roller Coaster (2004)

March 2, 2010 at 8:13 am 1 comment

Design for Disability….or just design for all?

 It is always fun for me to watch my friends walk through my front door, knowing that they are not thinking, “Hey, there are no steps to enter this house”. All of our exterior doors are stepless entryways to accommodate my husband’s wheelchair, but it is surely not immediately noticed by my guests. On more occasions than not, it has been a huge help to me as well; coming through the door with my wheeled work case, pushing my wheeled plant stands in/out of the house to change the soil, when leaving on vacation with my wheeled luggage and of course when we moved into the house it was priceless!

It is all of these great universally designed features that can be found in some of today’s products and buildings that benefit all people. So why, if these designs are virtually invisible, has the concept not caught on more?

An article in The Chronicle, feels that “Design for Disability Will Become the Norm”. In today’s world we are all touched by disability in some way; may it be a friend, family member or even ourselves. This is a constant that can and should be considered in all designs. Retrofitting is needed and does work, but can be costly and does not integrate the features into the overall aesthetics of the design, and potentially segregates the users.

The article notes, “When Thomas Edison filed his patent in 1877, among the uses he listed for it was ‘phonograph books, which will speak to blind people without effort on their part’.” Over 130 years later, we are seeing commercials for the recordable/talking books by Hallmark. If this was the mindset 130+ years ago, why are we not thinking this way for all new products/buildings now?

February 11, 2010 at 8:19 am Leave a comment


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