Enabling America Assessing the Role of Rehabilitation Science and Engineering (1997) / Chapter Skim
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6 DISABILITY AND THE ENVIRONMENT
6 DISABILITY AND THE ENVIRONMENT
Pages 147-169
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From page 147... ...
The overall message of this chapter is that the amount of disability is not determined by levels of pathologies, impairments, or functional limitations, but instead is a function of the kind of services provided to people with disabling conditions and the extent to which the physical, built environment is accommodating or not accommodating to the particular disabling condition. Because societies differ in their willingness to provide the available technology and, indeed, their willingness to provide the research funds to improve that technology, disability ulti 147
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From page 148... ...
When functional limitations exist, social participation is possible only when environmental support is present. If there is no environmental support, the distance between what the person can do and what the environment affords creates a barrier that limits social participation.
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From page 149... ...
Table 6-1 presents some examples of enabling and disabling factors in the natural environment. The Natural Environment The natural environment may have a major impact on whether a limitation is disabling.
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From page 150... ...
. ~ wnetner acquired commercially ott-tne-snelt, mocll~lecl, or customlzecl, that is used to increase, maintain, or improve the functional capabilities of an individual with a disability." Thus, assistive technology affects the level to which a functional limitation is disabling.
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From page 151... ...
The report states that, in spite of states' technology-related assistance programs carried out under the Tech Act, there remains "a need to support systems change and advocacy activities to assist States to develop and implement consumer-responsive, comprehensive state-wide programs of technology-related assistance for individuals with disabilities of all ages." Even with these limitations, more individuals than ever before are using assistive technology to compensate for their disabling conditions and enhance the environment in which they live and work. Universal Design It is frequently the case that the built environment can be modified permanently so that functional limitations become less disabling and personal or temporary assistive technologies are not needed.
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From page 152... ...
However, decisions about the use of technology or built environments are social decisions. The next major section considers the effects of the social and psychological environments on the extent to which a particular functional limitation will be disabling or not.
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From page 153... ...
DISABILITY AND THE ENVIRONMENT TABLE 6-2 Examples of Environmental Modification 153 Environmental Modification Can Occur Through the Use of: Such as: Mobility aids Communication aids Accessible structural elements Accessible features Job accommodations Differential use of personnel Hand orthosis Mouth stick Prosthetic limb Wheelchair (manual and/or motorized) Canes Crutches Braces Telephone amplifier or TDD Voice-activated computer Closed or real-time captioning Computer-assisted notetaker Print enlarger Reading machines Books on tape Sign language or oral interpreters Braille writer Cochlear implant Communication boards FM, audio-induction loop, or infrared systems Ramps Elevators Wide doors Safety bars Nonskid floors Sound-reflective building materials Enhanced lighting Electrical sockets that meet appropriate reach ranges Hardwired flashing alerting systems Increased textural contrast Built up handles Voice-activated computer Automobile hand controls Simplification of task Flexible work hours Rest breaks Splitting job into parts Relegate nonessential functions to others Personal care assistants Notetakers Secretaries Editors Sign language interpreters
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From page 154... ...
However, this section focuses primarily on the role of nonmaterial culture in that process. Cultures have an impact on the types of pathologies that will occur as well as on their recognition as pathologies.
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From page 155... ...
technology aSSDI, Social Security Disability Income. Pathway from Pathology to Impairment to Functional Limitation Culture can affect the likelihood of the transition from pathology to impairment.
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From page 156... ...
For example, hearing losses were not equivalent to functional limitations in Martha's Vineyard, because "everyone there knew sign language" (Groce, 1985~. Or, if everyone has a backache, it is not defined by the culture as limiting (Koos, 1954~.
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From page 157... ...
Each of these societal institutions also affects the degree to which functional limitations will be experienced by individuals as disabling. All of the ways in which intrapsychic processes or societal institutions affect the enabling-disabling process cannot be considered here.
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From page 158... ...
Research on employment among persons with disabilities indicates, for example, that such persons in communities undergoing rapid economic expansion will be much more likely to secure jobs than those in communities with depressed or contracting labor markets. Similarly, wealthy communities are more able to provide environmental supports such as accessible public transportation and public buildings or support payments for personal assistance benefits.
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From page 159... ...
For example, access to employment among people with disabling conditions is determined by a combination of the national and regional labor markets, but the impact of differences across small neighborhoods is unlikely to be very great. In contrast, the economic status of a neighborhood will play a larger role in determining whether there are physical accommodations in the built environment that would facilitate mobility for people with impairments or functional limitations, or both.
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From page 160... ...
The extent to which people with impairments and functional limitations will participate in the labor force is a function of the funds spent in training programs, in the way that health care is financed, and in the ways that job accommodations are mandated and paid for. Similarly, for those with severe disabling conditions, access to personal assistance services may be required for participation in almost all activities, and such access is dependent on the availability of funding for such services through either direct payment or tax credits.
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From page 161... ...
The findings from several studies provide evidence of improved behavioral and functional outcomes under efficacious conditions for individuals with and without disabling conditions (Maddux, 1996~. How do self-efficacy beliefs affect disability?
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From page 162... ...
Under conditions of perceived lack of control, people with disabling conditions are not likely to engage in behaviors (e.g., attend therapy or advocate for civil rights) to reduce disabling conditions and improve functional outcomes.
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From page 163... ...
Under conditions in which individuals with disabling conditions use active and problem-solving coping strategies to manage their life circumstances, there will be better functional outcomes across several dimensions (e.g., activities of daily living, and employment) than when passive coping strategies are used.
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From page 164... ...
These psychological constructs are interrelated and are influenced to a large extent by the external social and physical environments. The reason for the inclusion of the psychological environment in this report is to assert that just as the physical and social environments can be changed to support people with disabling conditions, so can the psychological environment.
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From page 165... ...
Others fatalistically accept functional limitations and conditions that are amenable to change with a supportive environment. In both of these situations, the person with the potentially disabling condition is not allowed to develop to his or her fullest potential.
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From page 166... ...
, 130 were identified as including some focus on "disability." These abstracts were subsequently reviewed further for their focus on the environment as a causal factor, that is, as an independent variable in a study that evaluated disability in some manner. It was often difficult to assess the particular relevance of the environment in the individual studies.
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From page 167... ...
Despite the growing recognition of the importance of the environment in determining the prevalence of disability, the committee could find relatively little research that explicitly focuses on the impact of the environment on disability. Even though environmental variables do appear in the research, they are seldom the independent variable.
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From page 168... ...
affect how limitations and disability are experienced Economic factors affect the extent to which disability is experienced Political factors Public policy affects the objective and subjective experience of disability them more accepting of functional limitations? What values and beliefs of subcultures in the United States affect how disability is perceived and ultimately experienced?
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From page 169... ...
DISABILITY AND THE ENVIRONMENT 169 · identify criticalfactors in work,family, and community environments that enable people withfunctional limitations. Recommendation 6.2 The composition of study sections at NIH and other agencies that have relevance to disability issues should be broadened to include the expertise and awareness that is reflected in the model of disability that is described in this report.
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