Wheelchair accessibility of public buildings: a review of the literature

Navigating new normals: the influence of COVID-19 policies on community access and well-being of people with mobility disabilities in everyday life

Context

This study explores the influence of COVID-19 public health mandates on people with mobility disabilities in the United States in their everyday lives. It highlights the intersection of disability with social determinants of health, emphasizing the need for a comprehensive policy response.

Methods

Qualitative data were collected through 76 semi-structured interviews with people with mobility disabilities. Interviews focused on experiences with COVID-19 mandates and community access, analyzed using thematic analysis and coded for emergent subthemes.

Results

The relationship between community participation and COVID-19 compliance was complex for people with disabilities. Inaccessible environments and inflexible policies made it difficult for people with disabilities to practice good safety measures, while widespread noncompliance by community members limited their community participation. The findings revealed additional mixed lived experiences of COVID-19 policies on community participation, accessibility, and access to resources and support. While technology facilitated some aspects of community participation, issues with accessibility, public transportation, and personal assistance services were exacerbated.

Conclusion

COVID-19 policies have complex implications for people with mobility disabilities. Findings suggest a need for inclusive policymaking, improved disability awareness, and continued support for accessible technology and services. Future research should further explore these dynamics to inform policy and practice.

The struggle for access - a qualitative document study of how people using wheeled mobility devices experience exclusion and discrimination

PURPOSE

The overall aim of this study was to describe experiences of discrimination due to inaccessibility among people using mobility devices.

MATERIAL AND METHODS

We conducted a thematic qualitative analysis of 88 complaints about wheeled mobility device use, inaccessibility, and discrimination submitted to the Swedish Equality Ombudsman (DO) during 2015 and 2016.

RESULTS

The analysis resulted in three themes: instigating change by invoking laws and regulations and highlighting lack of compliance; demanding to be recognised, understood, and listened to; and struggling for equal access and social participation. Regulations and treaties were invoked as the basis for complaints by people using mobility devices regarding their lack of access to physical environments and impediments to their enjoyment of their full right to participate in and contribute to society. The complaints described feelings of discrimination, the disadvantages and exclusion due to physical inaccessibility, and experiences of being prevented from living one's life as others do.

CONCLUSIONS

Complaints filed by people using mobility devices showed that they were denied access to a wide range of contexts, including offices, theatres, restaurants, schools, and public transportation, though they desired to live an active and social life outside their homes. Filing a complaint was a way to take action, highlight present inaccessibility, and express a hope for change.IMPLICATIONS FOR REHABILITATIONDifficulties experienced by people using wheeled mobility devices can reveal knowledge important for revising existing design and renovation standards for housing and public buildings.Documenting facilitators and barriers in different environments is important for giving voice to the needs of wheeled mobility device users and revealing standards that need to be strongly enforced or revised.People using wheeled mobility devices should be supported in finding solutions in inaccessible environments, both to fulfil their wishes and to enable their participation in society.

Disabled-by-design: effects of inaccessible urban public spaces on users of mobility assistive devices - a systematic review

PURPOSE

Despite the increase of users of Mobility Assistive Devices (MobAD), there has been a lack of accessibility in urban environments in many parts of the world. We present a systematic review of how the inaccessible design of public spaces affects quality-of-life - including aspects of health and safety, independence, and social participation - of MobAD users.

MATERIALS AND METHODS

We conducted a literature search in three databases (i.e., Scopus, Web of Science, and PubMed) and initially discovered 3980 publications. We analysed 48 peer-reviewed journal articles published in English from 2005 to 2021 and assessed their quality of evidence via the Mixed Methods Appraisal Tool.

RESULTS

Findings indicated a substantial number of inaccessible elements for MobAD users in public spaces. Pathway characteristics, boarding ramps, entrance features, confined spaces, and service surfaces were deemed to be the least accessible elements. These barriers had multifaceted effects on MobAD users' quality of life with aspects of physical health, mobility, and use of public transport being most affected.

CONCLUSIONS

Notwithstanding that the reviewed studies mostly ocused on wheelchair users residing in high-income countries, this review outlines the critical role of the design of the built environment as a factor of disablement for MobAD users. We conclude by highlighting a few recommendations for future research and practice, especially inclusive approaches and adaptive techniques to assist MobAD users with performing tasks in public spaces independently.Implications for RehabilitationUsers of Mobility Assistive Devices experience a lack of accessibility provisions in public open spaces and buildings internationally.Physical barriers in public spaces substantially diminish the health and safety, autonomy, and social participation of users of Mobility Assistive Devices.There is a definite need for the adoption of inclusive strategies and adaptive techniques in placemaking processes so that users of Mobility Assistive Devices can have equitable access to public spaces.

Manual wheelchair biomechanics while overcoming various environmental barriers: A systematic review

During manual wheelchair (MWC) locomotion, the user's upper limbs are subject to heavy stresses and fatigue because the upper body is permanently engaged to propel the MWC. These stresses and fatigue vary according to the environmental barriers encountered outdoors along a given path. This study aimed at conducting a systematic review of the literature assessing the biomechanics of MWC users crossing various situations, which represent physical environmental barriers. Through a systematic search on PubMed, 34 articles were selected and classified according to the investigated environmental barriers: slope; cross-slope; curb; and ground type. For each barrier, biomechanical parameters were divided into four categories: spatiotemporal parameters; kinematics; kinetics; and muscle activity. All results from the different studies were gathered, including numerical data, and assessed with respect to the methodology used in each study. This review sheds light on the fact that certain situations (cross-slopes and curbs) or parameters (kinematics) have scarcely been studied, and that a wider set of situations should be studied. Five recommendations were made at the end of this review process to standardize the procedure when reporting materials, methods, and results for the study of biomechanics of any environmental barrier encountered in MWC locomotion: (i) effectively reporting barriers' lengths, grades, or heights; (ii) striving for standardization or a report of the approach conditions of the barrier, such as velocity, especially on curbs; (iii) reporting the configuration of the used MWC, and if it was fitted to the subject's morphology; (iv) reporting rotation sequences for the expression of moments and kinematics, and when used, the definition of the musculoskeletal model; lastly (v) when possible, reporting measurement uncertainties and model reconstruction errors.

Meta-analysis of studies on the impact of mobility disability simulation programs on attitudes toward people with disabilities and environmental in/accessibility

The reported equivocal evidence of the effectiveness of disability simulation programs in reducing ableist attitudes toward people with disabilities has led to a persistent debate about the suggested discontinuation of such simulation programs to avoid further reinforcement of ableism. The present research conducted a meta-analysis on 12 empirical studies evaluating the impact of mobility disability simulation programs on attitudes toward people with disabilities and environmental accessibility to better inform future research and practice. A citation search using keywords related to "disability" and "simulation" in the title and/or abstract in 11 major online databases (i.e., Cochrane, EBSCOhost, EMBASE, Google Scholar, IEEE Xplore, JSTOR, LearnTechLib, ProQuest, PsycINFO, Scopus, and Web of Science) was conducted to retrieve relevant empirical articles that are published within the earliest dates of each database and June 2021 for the meta-analysis. Meta-analysis using a random effects model revealed that participation in the simulation programs resulted in large effect sizes in increasing fear and anxiety [Cohen's d = -1.51, 95% CI (-2.98, -.05), n = 2] but small effect sizes in improving conceptions of social inclusion at postsimulation [Cohen's d = .24, 95% CI (.01, .47), n = 5] while reducing stereotypes toward people with disabilities at follow-up [Cohen's d = .57, 95% CI (.10, 1.03), n = 3]. Inconclusive changes in the behavioral tendency of inclusion-promoting actions and stereotypes at postsimulation were found. The three exploratory moderators (i.e., the program duration, the presence of facilitators with disabilities, and the debriefing arrangement) were not statistically significantly associated with between-subgroup differences in the program's effectiveness in reducing stereotypes toward people with disabilities. The findings informed a series of recommended reforms in the program message framing, formats of the simulation, scope and referents of outcome measures, incorporation of environmental perspectives and behavioral measures, and methodological quality of the program evaluation study.

Inclusiveness assessment tool for disabled persons in higher education facilities

Purpose

Globally, there is a growing proportion of disabled people as a result of different circumstances. This growth generates attention and leads to ways to integrate the affected population into society. Addressing such disability and integration is particularly important at buildings level, enabling and expanding the scope of activities for people with disabilities (PWDs). The rising number of PWDs and the need to integrate them into society create a need for action to improve their living condition and integration into society. This study aims to examine the issue of accessibility for PWDs in higher education facilities in Qatar.

Design/methodology/approach

Addressing accessibility at buildings level is particularly important in higher education because it enables inclusion in training and education and increases the potential for productive engagement in society. The study aims to develop an objective tool to assess and measure accessibility in educational institutions. Five selected buildings were examined and evaluated at Qatar University based on proximity, multi-use, vertical and horizontal circulation availability. The survey respondents were randomly selected. An existing assessment method was used in surveying respondents, including those with and without disabilities.

Findings

A comparative study was conducted to explore the discrepancy between facility users with and without disability, indicating the gap in existing tools.

Originality/value

The developed tool generates the same outcome when conducted by different assessors, indicating the level of compliance and percentage met as a benefit, not a focus. It allows professionals and non-professionals with minimal experience to conduct the assessment.

A scoping review of public building accessibility

BACKGROUND

The built environment needs to be designed so that all people can participate in the activities they want and need to do. Yet, accessibility is difficult to put into practice, and accessibility issues tend to be overlooked in the building and planning processes.

OBJECTIVES

The aim of this scoping review was to summarize the research front in the area of accessibility to public buildings. Specific aims were to identify knowledge gaps, to identify access activities in relation to environmental features and to link to predominant activities in terms of the International Classification of Functioning, Disability and Health (ICF).

METHODS

A literature search was performed in PubMed, PsycINFO, Inspec, Embase and Cochrane databases. Articles in English based on original empirical studies investigating accessibility of public buildings for adults aged ≥18 years with functional limitations were considered.

RESULTS

Of the 40 articles included, ten involved study participants, while 30 only examined buildings using instruments to assess accessibility. In addition, the psychometric properties were only tested for a few of them. All articles concerned mobility and several visual limitations, while few addressed cognitive or hearing limitations. Ten main access activities were identified, from using parking/drop-off area to exiting building.

CONCLUSIONS

By using the ICF and theoretically relating the accessibility problems to activities, the results revealed that there are large knowledge gaps about accessibility to public buildings for older people and people with functional limitations and that there is a need for more methodological considerations in this area of research.

Patient and caregiver factors in ambulatory incident reports: a mixed-methods analysis

OBJECTIVES

Patients and caregivers are the primary stakeholders in ambulatory safety, given they perform daily chronic disease self-management, medication administration and outpatient follow-up. However, little attention has been given to their role in adverse events. We identified themes related to patient and caregiver factors and challenges in ambulatory safety incident reports from a Patient Safety Organization.

METHODS

We conducted a mixed-methods analysis of ambulatory incident reports submitted to the Collaborative Healthcare Patient Safety Organization, including 450 hospitals or clinic members in 13 US states. We included events that had patient and/or caregiver behavioural, socioeconomic and clinical factors that may have contributed to the event. Two members of the team independently coded patient/caregiver factors, with dual coding of 20% of events. We then conducted a 'frequent item set' analysis to identify which factors most frequently co-occurred. We applied inductive analysis to the most frequent sets to interpret themes. Our team included a diverse stakeholder advisory council of patients, caregivers and healthcare staff.

RESULTS

We analysed 522 incident reports and excluded 73 for a final sample of 449 events. Our co-occurrence analysis found the following three themes: (1) clinical advice may conflict with patient priorities; (2) breakdowns in communication and patient education cause medication adverse events and (3) patients with disabilities are vulnerable to the external environment.

CONCLUSIONS

Ambulatory safety reports capture both structural and behavioural factors contributing to adverse events. Actionable takeaways include the following: improving clinician counselling of patients to convey medical advice to elicit priorities, enhanced education regarding medication adverse events and expanding safety precautions for patients with disabilities at home. Ambulatory safety reporting must include patients in reporting and event review for better mitigation of future harm.

Rehabilitation: mobility, exercise & sports; a critical position stand on current and future research perspectives

BACKGROUND

Human movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of "RehabMove" congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration.

METHODS

This position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress.

RESULTS

The take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate "human and technology asset management" at both individual and organization levels and over the lifespan.

CONCLUSIONS

With this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention.IMPLICATIONS FOR REHABILITATIONContinued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences.Notions from "human and technology asset management and ergonomics" are fundamental to rehabilitation practice and research.The rehabilitation concept will further merge into general health care and the quality there-off.

Living with spinal cord injury in Mongolia: A qualitative study on perceived environmental barriers

Context: Environmental factors play a key role in the lives of individuals with a spinal cord injury (SCI). This study identifies environmental barriers and their impacts on daily lives as perceived by individuals living with SCI in Mongolia. Design: A qualitative study with semi-structured interviews was conducted. A topic guide for the interviews was structured around the components of the International Classification of Functioning, Disability, and Health. Setting: Urban and rural areas of Mongolia. Participants: A purposive sample of 16 persons with traumatic SCI. Interventions: Not applicable. Outcome Measures: Not applicable. Results: Seven categories of environmental barriers were mentioned, such as poor access to the physical environment, absence of wheelchair-friendly transportation, negative societal attitudes, inadequate health and rehabilitation services, lack of access to assistive devices and medicines, limited financial resources for healthcare, and inaccurate categorization of disabilities in laws. These barriers were claimed to have an impact on physical and psychological health, limit activities, and restrict participation in almost all areas of life. Conclusion: This study contributes to the identification of targets for interventions aimed at improving the lived experience of persons with SCI in a low-resource context. The findings reveal that while the Mongolian government already has laws and policies in place to improve access to the physical environment, transportation, assistive devices and employment, much more has to be done in terms of enforcement. Specialized SCI care and rehabilitation services are highly demanded in Mongolia.

Wheelchair accessibility of mosques in Riyadh

BACKGROUND

Engagement in religious and spiritual activities and expression are important to many people. Praying in a mosque is a major component of basic worship for Muslims. Riyadh has a population of more than six million people and more than 17 thousand mosques.

OBJECTIVE

The purpose of this study was to explore wheelchair accessibility of mosques in Riyadh from the perspective of wheelchair users and their caregivers.

METHODS

A survey was conducted to explore the opinions of wheelchair users and their caregivers regarding wheelchair accessibility of frequently used mosques.

RESULTS

Forty-eight wheelchair users and 12 caregivers participated in the study. The main reason for being confined to a wheelchair was a motor vehicle accident (77%). The majority of the participants (84%) indicated that they needed assistance to propel their wheelchairs. Overall, 86% of wheelchair users and 84% of caregivers expressed dissatisfaction with the mosques' accessibility for wheelchair users.

CONCLUSION

Mosques were found not to be accessible for wheelchair users. The current situation forces wheelchair users to pray in isolation in their houses, preventing them from participating in an important part of their faith. Though acts mandating the accessibility of public places for wheelchair users have been promulgated in the Kingdom of Saudi Arabia (KSA), the acts are not implemented in ways which can contribute to a meaningful, tolerable and independent life for wheelchair users.

Exploring accessibility issues of a public building for the mobility impaired. Case study: interstate bus terminal (ISBT), Vijayawada, India. Disabil Rehabil Assist Technol 2017;13:271-279. [PMID: 28475421 DOI: 10.1080/17483107.2017.1312573]

Right to access in the built environment creates equal and nondiscriminatory opportunities to a person with disabilities in order to move freely around and interact positively without hindrance and barriers. The objective of the study is to understand the existing accessibility related issues and implementation of guidelines and standards for public buildings. The technical verification using onsite and offsite access audit format for current provision of facilities in the internal and external environment has been carried out with the format prepared in reference to Central Public Works Department (CPWD) accessibility guidelines for mobility impaired and elderly and American Disability Act (ADA) guidelines. The access audit format included parameters like accessibility, safety, security, comfort and convenience and it addresses the barriers faced by wheel chair users, people with crutches, prosthetics and with non-assistive devices. The study addressed accessibility compliance in three zones of the building with initiation from parking area zone, inside the building, and area outside the building premises. The findings highlight the environmental barriers encountered by mobility impaired people and represented graphically in the layout plan and physical effort required to overcome the challenges in the built environment. The overall accessibility compliance is 42% in the interstate bus terminal. Implications for rehabilitation The study identifies the environmental limitations, human and technologically facilitators with the help of Central Public Works Department (CPWD) and American Disability Act (ADA) guidelines (1990). It highlights barriers for mobility-impaired users, by demonstrating in a spatial layout and the means to facilitate easy access with minimal frustration, stress and with less physical effort. It demonstrates the need for preparation of separate guidelines for making the existing types of buildings to be access and disabled-friendly. New accessibility guidelines shall be prepared by incorporating concepts like such as relative accessibility into new bus terminal buildings. Guidelines help the disabled in the process of rehabilitation and develop inclusiveness not rather than alienation.

The Cybathlon promotes the development of assistive technology for people with physical disabilities

Background

The Cybathlon is a new kind of championship, where people with physical disabilities compete against each other at tasks of daily life, with the aid of advanced assistive devices including robotic technologies. The first championship will take place at the Swiss Arena Kloten, Zurich, on 8 October 2016.

The idea

Six disciplines are part of the competition comprising races with powered leg prostheses, powered arm prostheses, functional electrical stimulation driven bikes, powered wheelchairs, powered exoskeletons and brain-computer interfaces. This commentary describes the six disciplines and explains the current technological deficiencies that have to be addressed by the competing teams. These deficiencies at present often lead to disappointment or even rejection of some of the related technologies in daily applications.

Conclusion

The Cybathlon aims to promote the development of useful technologies that facilitate the lives of people with disabilities. In the long run, the developed devices should become affordable and functional for all relevant activities in daily life.

Determinants of Psychosocial Difficulties Experienced by Persons with Brain Disorders: Towards a 'Horizontal Epidemiology' Approach

BACKGROUND

Persons with brain disorders experience significant psychosocial difficulties (PSD) in daily life, e.g. problems with managing daily routine or emotional lability, and the level of the PSD depends on social, physical and political environments, and psychologic-personal determinants. Our objective is to determine a brief set of environmental and psychologic-personal factors that are shared determinants of PSD among persons with different brain disorders.

METHODS

Cross-sectional study, convenience sample of persons with either dementia, stroke, multiple sclerosis, epilepsy, migraine, depression, schizophrenia, substance dependence or Parkinson's disease. Random forest regression and classical linear regression were used in the analyses.

RESULTS

722 subjects were interviewed in four European countries. The brief set of determinants encompasses presence of comorbidities, health status appraisal, stressful life events, personality changes, adaptation, self-esteem, self-worth, built environment, weather, and health problems in the family.

CONCLUSIONS

The identified brief set of common determinants of PSD can be used to support the implementation of cross-cutting interventions, social actions and policy tools to lower PSD experienced by persons with brain disorders. This set complements a recently proposed reliable and valid direct metric of PSD for brain disorders called PARADISE24.

Exploration des cadres de construction des rampes d'accessibilité

Accessibility to buildings promotes social participation through the application of inclusive design. However, architectural frameworks for constructing accessibility ramps are based on scant scientific evidence. This article presents a statement of established standards for construction criteria for accessibility ramps and makes recommendations from the perspective of inclusive design. A literature review was performed using the databases Medline, OTseeker, PsycINFO, and CINAHL (2000 to 2013), combining keywords referring to: universal accessibility, inclusive design, accessibility ramps, biomechanics, obesity, and disabilities. Non-scientific literature was also explored (e.g. building codes). The fifty-eight articles selected were grouped under five themes: 1) ramps and users; 2) materials and climate; 3) visual reference; 4) "wayfinding"; 5) durability, aesthetics and culture. Recommendations encouraging interdisciplinary practice, pegged to inclusive design, are exhibited (e.g. tracking, tilt, contrast).

Differentiating ability in users of the ReWalk(TM) powered exoskeleton: an analysis of walking kinematics

The ReWalk(TM) powered exoskeleton assists thoracic level motor complete spinal cord injury patients who are paralyzed to walk again with an independent, functional, upright, reciprocating gait. We completed an evaluation of twelve such individuals with promising results. All subjects met basic criteria to be able to use the ReWalk(TM)--including items such as sufficient bone mineral density, leg passive range of motion, strength, body size and weight limits. All subjects received approximately the same number of training sessions. However there was a wide distribution in walking ability. Walking velocities ranged from under 0.1m/s to approximately 0.5m/s. This variability was not completely explained by injury level The remaining sources of that variability are not clear at present. This paper reports our preliminary analysis into how the walking kinematics differed across the subjects--as a first step to understand the possible contribution to the velocity range and determine if the subjects who did not walk as well could be taught to improve by mimicking the better walkers.

The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury

OBJECTIVE

The aim of this study was to assess the safety and performance of ReWalk in enabling people with paraplegia due to spinal cord injury to carry out routine ambulatory functions.

DESIGN

This was an open, noncomparative, nonrandomized study of the safety and performance of the ReWalk powered exoskeleton. All 12 subjects have completed the active intervention; three remain in long-term follow-up.

RESULTS

After training, all subjects were able to independently transfer and walk, without human assistance while using the ReWalk, for at least 50 to 100 m continuously, for a period of at least 5 to 10 mins continuously and with velocities ranging from 0.03 to 0.45 m/sec (mean, 0.25 m/sec). Excluding two subjects with considerably reduced walking abilities, average distances and velocities improved significantly. Some subjects reported improvements in pain, bowel and bladder function, and spasticity during the trial. All subjects had strong positive comments regarding the emotional/psychosocial benefits of the use of ReWalk.

CONCLUSIONS

ReWalk holds considerable potential as a safe ambulatory powered orthosis for motor-complete thoracic-level spinal cord injury patients. Most subjects achieved a level of walking proficiency close to that needed for limited community ambulation. A high degree of performance variability was observed across individuals. Some of this variability was explained by level of injury, but other factors have not been completely identified. Further development and application of this rehabilitation tool to other diagnoses are expected in the future.