University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Thanks to the Americans with Disabilities Act (ADA) (o, en Español, "La Ley para Personas con Discapacidades"), a majority of facilities and services that are available to the general public - including government and office buildings, businesses, entertainment locales (like movie theatres and concert halls), and schools - have features that make them accessible to people with disabilities. Some examples of these accommodations include ramps, widened aisles, large bathroom stalls with grab bars, and cuts in the curb at street corners that are easier to maneuver in a wheelchair or with crutches.

While accessibility features like this give many people more opportunities for getting around, it's not a guarantee that there will be no barriers left for people who have impaired mobility. The ADA does allow reasonable exceptions, such as for small businesses where making changes would be too expensive, so sometimes creative solutions need to be found. Your friends, family or care attendant might be able to help you in a public place that has not been designed for people with disabilities. Sometimes employees of a company or even customers might also be willing to assist you if you want to ask them, such as opening an alternate entrance that is wider than the main door or reaching for items on a high shelf in a store. Better still, if you go to a particular store or other public place often, let the managers or owners know that, as a customer, you would appreciate it if they made their environment more accessible. Let them know there are free guides available online that show how to make their facilities accessible, including one at the ADA website. If you have a printer, you can even print out the brochure for yourself or for your doctor. You can also inform them that a recent study has shown that the cost of making an office or workplace accessible for people with disabilities is relatively inexpensive, usually much less expensive than people think it will be 1. Share with them that if they make some changes that will make it easier for you to access their place of business, you will encourage all your other friends who have disabilities to become customers as well, so that the modifications will pay off. (If they ignore you or don't offer to make even a small change, you might consider taking your business elsewhere.) Speaking up for yourself like this is called self-advocacy, and it might lead to some positive changes in your community!

A surprising, and frustrating, barrier to accessibility is when a health care facility is not truly accessible for people with disabilities. For example, studies reported that the examination table in many doctors' offices is too high for a person with spinal cord injury to get up on, and few offices have proper equipment to make a safe transfer possible 2 3. One study found that clinics with sloped parking lots that were extremely tiring to go up, even from the disabled parking spaces 2. This is again a case where self-advocacy is very important; in fact, research has shown that even one meeting or talk (about 1-hour long) to an individual or a group about disabilities can be enough to increase their knowledge and improve their attitudes toward people with disabilities 1. Let your doctor or therapist know that their office or office equipment is not accessible. Tell them that if they get more accessible furnishings, you will come back as a patient, and you will recommend them to other people with disabilities you know. Showing a health care provider that paying for new equipment to accommodate people with disabilities will be worthwhile financially could be a strong motivation! You may wish to tell them about the online brochures, including the one from the ADA website, and one on the website of the North Carolina Office on Disability and Health, which is specifically for health care providers. And, just like any other business, if they don't take action on your requests as a "customer" and you don't feel comfortable that this health care provider is paying attention to your needs, take your "business" to someone else who is more considerate of your needs.

While there are many ways to gain access to a home or business, even if it hasn't been designed with people who use wheelchairs in mind, it certainly helps save energy and avoid problems when an environment is made "accessible." You might want to consider altering the place you spend the most time - namely, your home - that will make it more "user-friendly" for you, or moving into a home that is already made with accessibility in mind. Alley, for example, moved into a housing complex that was made for independently-living people with disabilities, and Dave lived in a house designed to have accessibility features, like a large bedroom suite and an elevator. Knowing how you like to do your daily tasks will probably give you some ideas of changes that could make things easier and more efficient. Both Alma and Judy, for example, redesigned their living spaces themselves based on their own preferences.

There are also medical professionals, such as occupational therapists, who are trained to recognize ways to improve accessibility. They can recommend or make changes that not only allow more accessibility, but also improve the ergonomics (that is, the efficiency of the layout) that will reduce physical stress and give you biomechanical advantage (that is, moving in the most effective and powerful way possible, based on how your body works). You might be able to get assistance with expenses to redesign your home from insurance, foundations, public funds or other money sources; professionals like your physician, a lawyer, a social worker or an occupational therapist might be able to refer you to potential resources. Remember that some simple redesigns can greatly improve accessibility for very little cost! 1 (For more ideas and resources for redesigning your home, check out the section in this publication called "Environment".)

If you would like to learn more about the ADA, you can go to the U.S. Department of Justice's website on the ADA, which includes links to news, publications and other government agencies that are responsible for enforcing or obeying the ADA. información sobre La Ley para Personas con Discapacidades en Español está en este portal. The Spinal Cord Injury Model System, maintained by the University of Alabama at Birmingham, has a page about Home Modification, with links to resources on topics including accessible homes and mobility.

A website that can act as a starting place for exploration of many issues related to making home modifications to improve accessibility is the "National Resource Center on Supportive Housing and Home Modification," or more simply, Based at the University of Southern California, is a non-profit organization that promotes independent living for persons of all ages and abilities. For more about how occupational therapists can help you redesign your home for greater accessibility or help you find accessible features or places in your community, go to the American Occupational Therapy Association website.

1 Hunt, C. S., & Hunt, B. (2004). Changing attitudes toward people with disabilities: Experimenting with an educational intervention. Journal of Managerial Issues, 16, (2), 266-280.

2 Neri, M. T., & Kroll, T. (2003). Understanding the consequences of access barriers to health care: Experiences of adults with disabilities. Disability and Rehabilitation, 25, (2), 85-96.

3 Putnam, M., Geenen, S., Powers, L., Saxton, M., Finney, S., & Dautel, P. (2003). Health and wellness: People with disabilities discuss barriers and facilitators to well being. Journal of Rehabilitation, 69, (1), 37-45.