In a world where the power of perception often shapes our understanding of others as well as ourselves, it’s crucial to embark on an exploration of wheelchair safety in solidarity with promoting inclusive mobility that values integrity and wellness beyond physical needs. Debunking prevailing social myths surrounding the cognitive capabilities of individual mobility device users, we hope to illuminate a path to break free from the cycle of biases that has constrained those individuals’ self-perceptions and driving potentials.
Emphasizing the functional strengths of individual mobility devices users, we will delve into how various factors – exposures to and interactions with mobility devices and societal attitudes – can profoundly influence the safe use of mobility devices, whether for the better or worse. In doing so, we hope to shift the focus away from individuals’ diagnoses and/or functional limitations to pay more attention to their current capabilities and the accessibility, or lack thereof, of society.
In our previous blogs, we explored surprising technological factors such as seating, programming and configurations, and drive controls: 3 Reasons for Accidents with Wheelchairs that Might Surprise You (Technological Factors) as well as key environmental barriers from accessibility, weather to traffic: Safeguarding Wheelchair Users: Unveiling 3 Key Environmental Barriers that Impact the Safe Use of Wheelchairs that all contributed to the safety around wheelchairs. With this third blog breaking down the significance of exposure and societal attitudes in interaction with individual wheelchair users, we invite everyone to perceive the safe use of mobility devices as an opportunity for assistance rather than a problem demanding solutions.
1. Exposure
1.1 Mobility Training Communications
It is essential to shift the conversation surrounding the training for individuals with disabilities from a focus solely on what they cannot do to a recognition and emphasis on what they still can, as this perspective encourages a more positively balanced view on their mobility potentials, especially with proper uses of mobility devices and adaptive technology. To elaborate, when individuals are learning about overall functionality of their bodies which is essential to their safety on mobility devices, they should have also received questions such as “which body part(s) do you find you use the most and are most helpful?” rather than only questions like “which part of your body do you struggle with the most in your everyday life and routine when you try to use mobility devices?”.
These two seemingly similar questions actually carry contrasting implications that can strengthen or weaken individual mentalities over time. One question emphasizes heavily on the individuals’ needs for the solutions proposed based on their reported limitations. This passive focus, in another word, implies that the individuals must depend on factors outside of their control to make their decisions for them. The other question, on the contrary, leaves the decision-making power within the hands of the individuals by simply highlighting all the functional capabilities they still have which lead them to understand and recognize the available solutions in a much more dignified manner. The latter one is often more difficult to achieve because it requires not just telling, but also educating the individuals more in depth about their circumstances in order to arrive at the right decisions on their own.
1.2 Self Awareness of Mobility Capacity
To build the self awareness needed to fully take control of one’s safety as well as realize one’s mobility potential in the long run, one should familiarize oneself with the diverse spectrum of functional abilities that impact one’s mobility:
Cognitive Ability
Cognitive Ability is the way we think. It is all about our ability to focus, memorize, multi-task, and make decisions. It impacts our attention and interpretation of the world around us. If an individual has impacted cognitive ability, it is likely they will need more training and repetition of tasks involving their mobility device in their home and outdoor settings, to ensure they have the ability to safely make decisions about when to go faster, slower, change direction, and/or stop their wheelchair. Additionally, if decision making is impacted due to cognitive impairment, it is best to steer clear of doing multiple tasks at once while driving the mobility device, as the individual cannot use all their attention to their safety if they are distracted.
Fine Motor Ability
Fine motor ability is the way we move and use our fingers, hands, feet, and toes to complete tasks. Individuals with impacted fine motor skills may need more therapeutic intervention to maintain or enhance their level of functioning to better use their fingers and hands. In this case, training in alternative drive controls such as sip-n-puff, chin/tongue switch, and head array would be helpful – anything that can be used in place of a joystick that requires finger and hand movement.
Gross Motor Ability
Gross motor ability is the way we move and use our head, neck, shoulders, arms, trunk, hip, and legs to complete tasks and navigate the world around us. Individuals with impacted gross motor skills may be receiving ongoing rehabilitation to maintain or enhance their current functioning and might be able to move their body to a certain degree while using their mobility device.
Visual Ability
Visual ability is the way we see the world around us. It is how clearly we see, how far we can see, how much depth we can recognize, what colors we see, and what textures we can recognize. Spatial ability is how we use all of this information to help us navigate in relation to our environment. Together, these are termed visual-spatial ability. Therapeutic interventions involving eye movements, hand-eye-coordination, and depth perception could help with rehabilitation. Training on adaptive technology and assistive devices that may help to “see” the world around them, past the point of their real visual field, could help in operating mobility devices safely.
1.2 Experience with Mobility Devices
More time spent using a mobility device provides more experiential learning opportunities for individuals to become more aware of their bodies in relation to their surroundings, leading to safer use of mobility devices. Overtime, more experienced individuals learn to understand how to navigate various terrains in various weather conditions. They learn what areas in their homes are harder to navigate and which public spaces are accessible to mobility devices. They also have a better idea of how they can balance, go faster, go slower, or stop entirely while navigating known terrains ( the environment blog in this safety series discusses this in more details). All in all, individuals who have more experience with their mobility devices can better advocate for improvements that will make their community more accessible and inclusive.
Individuals can learn to use their assistive devices and adaptive devices better, through use of these alongside their mobility device. Additionally, their ability to solve problems and later, build confidence in mobility device use increases as well. For example, the individual is not only aware of their own strengths, but the features of their assistive and adaptive technology, and the combination of both helps the individuals learn to be a safer mobility device user. Our technology blog in this safety series explores this further. Overall, their quality of life and self efficacy increase through experience of terrain and learning of technology.
Solution:
It is important to provide training on cognition, fine motor skills, gross motor skills, and visual-spatial skills to clinicians, vendors, families, and anyone else who works with individuals who use mobility devices. This knowledge would help stakeholders understand the goals and strengths of individuals who use mobility devices, so recommendations and opportunities can be made to fit well with these individuals. They can also learn more about the strengths-based approach and person- and family-centered care. This would help view needs as goals and view functioning as strengths. Experience working with mobility devices over time will assist with understanding accessibility more as well.
2. Societal Attitude
It is important to understand what societal attitudes, perceptions, and acceptance is when it comes to mobility devices and individuals who use them. Although accessibility and disability may seem like universal concepts, the level of acceptance society displays varies.
Can societal attitudes of independence have an impact on how society views users of mobility devices and ultimately, how users of mobility devices view themselves? Can cultures where independence is highly valued view disability as more devastating perhaps, when compared to cultures where interdependence is supported? Is it possible that individuals who use mobility devices from independence-valuing cultures view themselves as being more in need of accessibility than individuals who use mobility devices from interdependence-valuing cultures?
A journal article published in the Scandinavian Journal of Occupational Therapy suggests that societal attitudes of disability impact whether individuals who use power mobility devices either feel included or excluded in society. The issue is not just societal attitudes, it is deeper. The way society feels about individuals who use mobility devices impacts the way that individuals who use mobility devices view themselves.
We have to be mindful to make sure that our attitudes of disability, mobility devices, and accessibility are equitable and fair so we can create a more inclusive society for everyone. Explicitly, this may look like individuals saying insensitive things about disabilities. Implicitly, this negative bias may play out in the way that spaces are designed, policies are created, and health related evidence-based practices are researched. Some individuals may not be familiar with the challenges faced by wheelchair users and may lack awareness or understanding of their needs. This can result in barriers that make it harder for wheelchair users to move around comfortably and safely.
Solution:
Providing more advocacy related campaigns, social media posts, and education can help people understand whether society is being inclusive of individuals who use mobility devices or if there is more work that needs to be done to enhance accessibility of society by changing attitudes towards disability and accessibility.
3. Interaction
Individuals using a mobility device have either used these as a child or they come into contact with using a mobility device in their adult life. Skills like navigation, learning a skill, using our senses, identifying problems, and using creativity to solve these problems develop not just through our training in mobility devices and the experience we have with mobility devices. Rather, it goes beyond that – the training and experience works through the element of interaction. Interaction is when the individual can make changes to their mobility device, environment, and/or themselves in response to their experience with the mobility device and associated technology, their own goals and strengths, and their environment.
For example, when an individual uses their mobility device and their adaptive devices and technology in their daily routine, they may realize they need to alter their mobility device (such as adjust their seating), their routine (perhaps to low-traffic times), the devices and technology on the mobility device (perhaps adding cameras or blind spot sensors), and/or their own training (perhaps needing more information or training on certain aspects). Check out our blog on The Prevention of Wheelchair Collisions to understand more about the value of experience, training, and your role in how to use mobility devices safely.
Solution:
The three blogs in the safety series highlight the importance of the technological, environmental, and individual aspects of safe mobility. We must understand the individual and their needs not in isolation, but view the goals and strengths of the individual in relation to their current mobility device, environment, training, experience, technology, and support available through relevant stakeholders (such as clinicians, vendors, and family).
In summary, the goal of this entire blog series was to shed light on the factors beyond the individual’s diagnosis and functioning, and to increase opportunities for independent mobility. The purpose of this blog series therefore, is to take the strengths-based approach to improving quality of life. Just as one must not just speak of health in the presence of illness, one must not speak of accessibility only in the presence of disability, otherwise we will only work to make this society more accessible if and when there is a disability.
References
Mortenson, W. B., Miller, W. C., & Hardy, T. (2009). Ready to roll? Wheelchair use in residential care. . Disability Health Research network: UBC Okanagan. http://www.dhrn.ca/page.php?pageID=181
Widehammar, C., Lidström Holmqvist, K., Pettersson, I., & Hermansson, L. N. (2020). Attitudes is the most important environmental factor for use of powered mobility devices – users’ perspectives. Scandinavian journal of occupational therapy, 27(4), 298–308. https://doi.org/10.1080/11038128.2019.1573918
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In this blog, you will learn how wheelchairs can enrich quality of life as you discover the three most common yet impactful environmental obstacles as well as ways to overcome them. From accessibility options, weather conditions, to population density, we break these factors down thoroughly in relation to mobility safety. Our goal of the Wheelchair Safety Series is to introduce a holistic perspective on how environments influence safety on wheels. This second article in the blog series sheds light on how the following environmental factors may interfere with the safe use of wheelchairs:
- Accessibility
- Weather
- Traffic
Raising awareness about environmental hazards to wheelchair safety helps increase not just the safety of wheelchair users, but also the chance for the public to get involved. We hope that everyone can be a part of a more accessible and mindful shared environment.
Accessibility
The presence of accessibility-related environmental hazards can limit a wheelchair user’s ability to navigate their surroundings safely and independently, hindering their mobility and quality of life. Accessibility of public and private spaces is one major issue. Individual wheelchair users frequent public spaces such as parks, libraries, malls, theaters, healthcare facilities, and grocery stores. If a building has no ramps, elevators, appropriate clearance and size of doorways, and/or visible signs, it prevents wheelchair users from entering as well as impairs their ability to maneuver safely once inside.
Commonly seen challenges of navigating public spaces include and are not limited to maneuvering narrow aisles, backing up and into spaces with lots of traffic and/or fragile items, elevation changes between flooring, and having belongings (such as backpacks, oxygen tanks, or wiring from your adaptive and assistive technological devices) getting caught while maneuvering.
Lack of Awareness Leads to Lack of Accessibility
Additionally, cracked or uneven paths, gravel surfaces, and rugged terrains can easily get the wheels stuck, leading to wheelchair accidents. At times, especially in busy cities, we constantly see parked cars or groups of people blocking sidewalk entrances and exits, forcing wheelchair users to take alternative routes that are potentially dangerous. Navigating on the sidewalk is especially a safety concern when curbs are involved. A common fear of wheelchair users is accidentally going over a curb and into oncoming traffic, as this could lead to catastrophic injuries.
On the other side of the curbs, there are additional factors of risk such as changes in elevation and surface type (e.g., grass, mud, gravel). Tipping or falling into grassy patches can lead to the wheels getting stuck. An injury prevention journal presented a study highlighting wheelchair-related injuries by age. It suggested that over 100,000 injuries lead to ER visits one year. In which 65–80% of injuries related to tips and falls. As you can see, barriers above all deter wheelchair users from accessing and enjoying outdoor spaces, negatively impacting their safety, independence, confidence in their ability to maneuver a wheelchair, and quality of life.
Solutions:
- Downloading apps that show accessibility rates of a particular location.
- Additions to wheelchairs mentioned by Sunrise Medical, such as encoders, can help with safe steering of the wheelchair to ensure it stays on the path and direction it was intended to be on, regardless of the environmental hazards that come in the way.
- If going to a new public place and you need more information about its accessibility, perhaps calling ahead or visiting their ‘contact us’ and/or ‘about us’ section on their website might help plan ahead for your visit. Look for signage that might prepare you about the accessibility of a place ahead of time, for example, parking lots.
Weather
In most regions where seasons changing is a yearly ritual, not many are aware of the various challenges that come with each of the four seasons. From summer, fall, winter, to spring, wheelchair users face plenty of seasonal challenges within their indoor and outdoor environments that demand more awareness and attention from the community.
To name a few, there are unclean pathways covered by fall leaves and/or snow. There may cracked terrain with water piled up inside. There are leaves, snow, and water that can hinder the driver’s view and/or depth perception, making it difficult to predict what they are driving themselves into and increasing the likelihood of a bad accident. During winter times, wheelchair users can bump into snow banks. They can easily scrape parts of their wheelchair, and even tip and fall, crashing into snow banks.
Weather changes may impact accessibility of public transportation for individuals using wheelchairs. Uncleared sidewalks near bus stops prevent wheelchair users from boarding the buses. This adds unnecessary cost and stress to wheelchair users just to get around. In places where weather conditions change often, timely maintenance of pathways is a challenge. Failure to do so forces wheelchair users to allocate more funds for alternative transportation such as uber and taxis just to avoid social isolation and carry out routine errands (read more on this topic at inaccessibility of public transportation).
Solutions:
- Having access to cost-effective accessible taxi services such as Uber and Lyft. Torontonians can check out our blog on what to look out for when trying to book a ride on Accessible Transit in Toronto.
- Looking for visible signage (‘an icy slope’ or ‘road curves ahead’ or ‘bridge ices over in winter’) to prepare you for safe navigation of your wheelchair can be helpful.
- Keep up-to-date with wheelchair maintenance. Make sure you complete maintenance of all your assistive devices and your wheelchair ahead of weather changes. This way, your wheelchair, technology, and you, are all ready for safe wheelchair navigation and maneuverability.
Traffic
Using a wheelchair in a busy environment with lots of cars and people can get hazardous for wheelchair users. Public spaces are generally louder during high traffic hours such as the beginning and end of the day. During those times especially, there are a lot of larger vehicles that tend to reduce visibility and accessibility for everyone, not just individuals who use wheelchairs. Examples include large transportation trucks, large school buses, large public transport buses, and emergency vehicles.
Awareness of surrounding areas is important not just for individuals who use wheelchairs, but the general public as well. Wheelchair users are more vulnerable to accidents in high traffic areas. Automobile drivers may not be paying attention to the road, especially in high traffic areas. This may lead to collisions with wheelchairs.
Let’s talk about what is beyond the typical traffic.
When we say traffic, we often think of cars, buses, and bikes. What we don’t realize is that traffic on the road is not the only concern. Foot traffic on sidewalks can be of concern as well. When there are a lot of people accessing public walkways, maneuvering a wheelchair gets challenging as the user has lot more things they must try to avoid bumping into. To add to that, others sharing public sidewalks need to be mindful of how much space they leave to wheelchair users when using devices such as scooters, strollers, and walkers.
On top of everything mentioned above, the less talked about concept of “sensory traffic” needs to addressed. Intensive vehicular and pedestrian traffic often come with overwhelming sounds and lights as well. Not only must wheelchair users navigate through weather and accessibility related environment factors, they must also do all this under the constant influences of surrounding sensory stimulations and distractions. A sudden sensory input can lead the individual to act abruptly braking out of panic or accelerating in a rush. The individual has to divide their attention between all three traffic types then, vehicular, pedestrian, and sensory: this attention required for long periods of time and to make decisions, makes it even more difficult for individuals using wheelchairs to be socially active.
Solutions:
- You can increase your visibility to others by wearing bright colours, adding LEDs to your wheelchair and parts, hanging bright bags on your wheelchair if you use bags. Check out our blog on Wheelchair Safety Tips for more ideas.
- Adding sensors, cameras, and mirrors to your wheelchair could warn you when there is a change in your immediate environment. For example, a sensor could notify you if someone drives, runs, or walks past you suddenly. Check out our blog on the Pros and Cons of Visual Aids.
- Using a white cane could help improve depth perception during changes in elevation so you can prepare ahead of time when maneuvering your wheelchair.
At the end of this blog, we invite you to envision the potential opportunities out there for us to create a more inclusive and supportive environment! Do check out our previous blog in this Safety Series that talks about the 3 technology-related factors impacting the safe use of wheelchairs: seating, programming and configurations, and drive controls.
References/Citations:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563507/https://brazemobility.com/3-reasons-for-accidents-with-wheelchairs-that-might-surprise-you/https://brazemobility.com/life-is-a-journey-not-a-destination/https://brazemobility.com/wheelchair-safety-tips-for-driving-on-roads/https://brazemobility.com/visual-aids-for-people-who-use-wheelchairs/https://brazemobility.com/accessible-transit-the-what-where-how-of-wheel-trans/https://www.sunrisemedical.ca/education-in-motion/clinical-corner/december-2016/steer-correction-for-power-mobility Mortenson, W. B., Miller, W. C., & Hardy, T. (2009). Ready to roll? Wheelchair use in residential care. . Disability Health Research network: UBC Okanagan. http://www.dhrn.ca/page.php?pageID=181 Xiang, H., Chany, A. M., & Smith, G. A. (2006). Wheelchair related injuries treated in US emergency departments. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 12(1), 8–11. Retrieved from https://doi.org/10.1136/ip.2005.010033
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