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Accessibility Assistant

Accessibility Assistant

Dexterity and Mobility Impairment Fact Sheet

In the following section, physical disabilities are listed sequentially, one-by-one, and the associated functional limitations are briefly reviewed. But, it should be noted that in actuality, most disabilities result in more that one limitation. For example, some people with severe cerebral palsy have dexterity, mobility, cognitive, and language limitations. As we mentioned earlier, aging often leads to reductions in vision and hearing. Remember that for any disability, the function that the person can employ will be unique to that individual and will probably be different from someone else with the same disability.

Due to the complexity of variation, it may be useful to think about dexterity and mobility challenges in terms of how physical functioning is affected. For example, dexterity limitations may reduce the person's ability to lift, reach, or carry objects. Dexterity limitations affect the person's ability to manipulate objects and/or use arms, hands, or fingers.

On the other hand, mobility limitations may affect the person's balance, coordination, sensation, and movement of head, hands, body, legs, and/or feet. People with mobility limitations have reduced ability or control in turning, bending, or balance; slowness when walking; difficulty in kneeling, sitting down, rising, standing, walking, and /or climbing stairs or ladders. Disability can occur suddenly, due to accidents of birth such as Cerebral Palsy (CP), or as the result of acute disease. Or disabilities may develop slowly, as in aging or chronic disease. Some disabilities are progressive, that is, they become more severe over time. Keep in mind that people having temporary or minor conditions such as flu or a broken arm, as well as those who experience the effects of aging, may also experience these same functional limitations.

Cultural and Social Contexts

Independent Living and the Independent Living Movement. Independent living is a major goal for most people with physical disabilities. People With Disabilities (PWDs) have worked together "cross-disability" to form the "Independent Living" movement. This movement of PWDs helping themselves has contributed to the removal of policies that institutionalized people and barred them from community living. As a result of self-advocacy and civil rights, people with physical disabilities are more in control of their lives, are beginning to obtain gainful employment (although these statistics are still quite grim), are establishing families, contributing to their communities, and exercising political power. There are several "cross-disability" organizations that are engaged in nonprofit research, development of public policy and advocacy for civil rights, independent living, and social inclusion of people with disabilities. For more information, follow the links to the History & Philosophy of the Independent Living Movement (http://www.ilru.org/html/publications/training_manuals/IL201.txt), National Organization on Disability (http://www.nod.org), and the World Institute on Disability (http://www.wid.org).

Home health care and personal assistant services and supports enable elders and PWDs to maintain their independence, live in their own homes, and be involved in their communities. "Personal assistants" provide services and supports that assist elders and people with disabilities with Activities for Daily Living (ADL) such as eating, toileting, grooming, dressing, bathing, and transfers, and Instrumental Activities for Daily Living (IADL) such as planning and preparing meals, managing finances, shopping, performing household chores, phoning, and participating in the community. Without personal assistant services and supports many elders and people with disabilities would not be able to live in their communities and homes, but would be institutionalized in nursing homes and other care facilities. For more information on the importance of personal assistant services and supports, follow the link to American Disabled for Attendant Programs Today (ADAPT) (http://www.adapt.org/casaintr.htm).

There remains much to do to make houses, apartments, and other community living spaces accessible to elders and people with physical disabilities. Wider doorways, ramps, lowered kitchen cabinets, adjustable height countertops, higher bathroom commodes, roll-in showers, open vanities, and grab bars are just a few of the environmental modifications that elders and people with physical disabilities use to live independently. Organizations and agencies are working to influence construction standards and public policy to make inclusive design and environmental access to living spaces a reality. For more information on inclusive design in living spaces follow the link to the Center for Inclusive Design and Environmental Access (http://www.ap.buffalo.edu/idea/Home/index.asp).

Assistive Technology

Low Tech Devices and Activities of Daily Living (ADL). There is a range of low-tech devices that assist people with dexterity limitations to adapt their environment. Low-tech aids are useful, fairly low-cost, and easy to construct or purchase. Examples include a larger grip on a spoon or fork for easy gripping, or Dycem matting to prevent a plate or bowl from moving while dining. Other low-tech aids are available for dressing and grooming, such as larger grips on combs and brushes. Reachers are perhaps the most used and best-known low-tech aid for ADL. Recreational aids include automatic card shufflers and cardholders, special grips for fishing rods, and mounting equipment for hands-free camera operation from a wheelchair.

High Tech Devices. The personal computer is perhaps one of the most important technological advances for people with disabilities. The personal computer has been called the great equalizer between people with varying abilities and strength. Just as others do, people with disabilities use personal computers for many things, including augmentative communication, correspondence, calculating, searching, sorting and storing information, purchasing goods and services, creating music, art and multimedia, and controlling environments (lights, HVAC, entertainment systems, doors, windows and curtains, answering phones, etc.) through "smart-home" technology.

People with dexterity limitations and severe physical disabilities use many devices to adapt computers to their needs. Input adjustment utilities such as sticky keys, slow keys and mouse keys allow users to adjust input parameters to accommodate individual preferences. Alternative input devices such as on-screen keyboard, voice recognition software, mouth stick, various types of switches, and radio frequency and infrared head pointing devices can be used by people with limited dexterity to operate computers. Various types of specialized keyboards, mice, and monitors are available to fit the individual's needs and preferences. These adaptations are not "worry-free." Compatibility issues occur due to changes in hardware, software, operating systems, and networks, primarily due to a lack of standards for software interfaces. Some adaptations require programming. Very few are "out-of-the-box" ready to use. Some require considerable end-user training and support. People with disabilities expect that these assistive technology devices will operate seamlessly with electronic and information technology, but this is often not the case.

With computer access and training in computer software, PWDs have access to environments, to goods and services, to work, and to other people. Workplace trends indicate that most new jobs created today require knowledge and skills in the use of personal computers and productivity software. It has also been noted that the workforce is aging. With age, function declines. Older workers are experiencing problems with repetitive stress. These trends require more and better ergonomic adaptations to help people maintain function and reduce injury.

Think about your own functional abilities. Do you ever have difficulty seeing data on your laptop screen? Do your hands, fingers, and wrists hurt after typing at your keyboard all day? Maybe you should consider some ergonomic and assistive technology for your personal computer.

Communication and Telecommunication Devices. To communicate, people with speech limitations may use amplifiers, artificial larynxes, speech clarifiers, and/or computers called Augmentative and Alternative Communication (AAC) devices. Advances in computer technology, particularly in the area of speech synthesis, have changed and continue to change how these individuals communicate. With an AAC device, the user can input a message or select a pre-set message, and the AAC device converts the message to speech or print. Most AAC devices allow the user to select the voice qualities of the speech synthesis. Some AAC devices are only used for speech production, while others are capable of a variety of computer-related tasks. Some are small enough to be worn on the user's wrist. Multifunctional AAC devices require specialized mounting for wheelchair users. Others require programming and periodic maintenance. AAC users expect their devices to interact seamlessly with computers and other electronic and information technology. Often, this AT-IT (Assistive Technology-Information Technology) interoperability is non-existent or illusive.

Speakerphones are often very helpful to people with dexterity limitations, especially big button phones with adjustable volume controls. This commonly available device makes telephone conversations comfortable for elders and individuals who do not have the strength or mobility to hold a telephone receiver but who can otherwise communicate on the telephone. The speakerphone is a good example of how mainstream consumer electronics can be acquired off-the-shelf to address the needs of elders and people with disabilities.

Mobility. The benefits of mobility aids are obvious. People with mobility limitations have a wide variety of mobility products they can choose from, including canes, walkers, scooters, and wheelchairs. Motorized or power wheelchairs come with computer electronics for navigation that can be programmed to control computers, AAC devices, and environments. The electronics on the powerchair can be programmed along with special switches to permit persons with only partial head or neck control or finger or foot control to move about independently. Other types of powerchairs stand the user up or lay the user back to reduce sitting time. Some powerchairs are specially designed to climb stairs.

For those with upper body strength, a variety of manual wheelchairs are available including lightweight sport chairs and wilderness chairs, and, for the competitive wheelchair athlete, basketball, tennis, rugby, and racing chairs are available. Today, a hybrid exists between the power wheelchair and the manual wheelchair. It is called the power assist wheelchair. The power assist wheelchair preserves the independence of users with limited upper body strength without giving up the convenience of the lightweight manual chair.

In addition to mobility aids, specially designed transportation aids are available. Full sized vans, mini vans, pickup trucks, SUVs, and automobiles can be equipped with driving controls, ramps, and scooter and wheelchair lifts. Several manufacturers of recreational vehicles and boats offer adaptable designs that can be customized to the needs of elders and PWDs.

For amputees, artificial limbs with bionic functions are available. Myoelectric (or bionic) limbs made from special materials contain sensors that pick up electric signals transmitted from the individual's brain through the limb. These signals are received by an electronic microprocessor and translated into bionic movements, controlled by the user.

People with dexterity and mobility limitations frequently use service animals for assistance. Specially trained dogs can pull a wheelchair user, pick up items, open doors, push elevator buttons, turn lights on and off, and pick up a telephone receiver. Robots also hold promise for assisting elders and people with disabilities. In the future, home robots may assist with communication, cooking, cleaning, and other activities for daily living.

Prevalence of People with Dexterity, Mobility and Cognitive Limitations

When using an E&IT product, functions such as strength, stamina, range of motion, and accuracy of movement determine if a person will experience barriers. Unfortunately there has been no definitive research to report on these factors, only medical diagnoses. Therefore the prevalence data that follows reflect a medical orientation for disability statistics that focuses on the diagnosis rather than the impact of the disability on these essential factors.

The disabilities that follow are grouped by numbers of persons with each diagnosis, beginning with the greatest number to the smallest. Note: These statistics are from many different organizations and it is likely they have different data collection methods. It is believed that U.S. Census figures may under report some types of disabilities and use more conservative sets of data because people do not "self identify" as having a disability, especially elders who experience compromised vision, hearing, dexterity and mobility, but do not label this experience as "disability."

Disability Number of Persons
Arthritis 30 Million (Arthritis Foundation)
Polio 8 Million (Polio & Post-Polio International)
Traumatic Brain Injury 5.3 Million (National Center for Injury Prevention and Control)
Stroke 4.7 Million (American Stroke Association)
Alzheimer's Disease 4.5 Million (Alzheimer's Association)
Amputee 1.3 Million (Amputee Coalition of America)
Muscular Dystrophy 1 Million (Muscular Dystrophy Association)
Cerebral Palsy 764,000 (United Cerebral Palsy Association)
Epilepsy 600,000 (Epilepsy Foundation)
Multiple Sclerosis 400,000 (National Multiple Sclerosis Society)
Spinal Cord Injuries 200,000 (National Center for Injury Prevention and Control)
Dexterity limitations of hand(s) 15.2 Million, limited use of hands (U.S. Census)
Difficulty with IADLs 13 Million (U.S. Census)
Need personal assistance 10 Million (U.S. Census)
Difficulty with ADLs 8.7 Million (U.S. Census)
Use mobility device(s) 6.4 Million use a cane, crutches or a walker; 2.2 Million use a wheelchair (U.S. Census)
Cognitive/language limitations 2.3 Million, speech is difficult to understand (U.S. Census)
Total All Disabilities 52.6 Million or 19.7% of the 1997 U.S. population (non-institutionalized) (U.S. Census)
Total Elders, age 65+ 31 Million, 1997 U.S. population (non-institutionalized) (U.S. Census)

Arthritis is a term used to describe painful inflammation of the joint or joints. Arthritis is a disability with many causes. There are over 100 types of arthritis. Inflammation causes a reduction in tactile sensation and range of movement with a corresponding loss of dexterity and mobility. Research seems to indicate that some forms of arthritis have genetic links, but the causes of many forms are not well understood. Medication, diet, and exercise are just some of the suggestions for dealing with the pain and loss of function that characterizes this disability. Some people may have joint replacement, while others may have surgery in an effort to reduce pain and restore function. Because arthritis affects each person differently, there are many types of standard and alternative therapies. Depending on the severity of the disability, the person may benefit from all types of assistive technology devices including communication aids, aids for Activities of Daily Living and Instrumental Activities of Daily Living (ADL/IADL), computer access devices, mobility devices, recreational aids, transportation adaptations, and modifications to home and work environments. For more information follow the link to the Arthritis Foundation (http://www.arthritis.org).

Polio or poliomyelitis results from a viral infection that attacks the nerve cells in the spinal cord. With proper vaccination, polio can be easily prevented, but because polio is no longer a common disease in the United States, many parents do not vaccinate their children. Internationally, polio is still one of the most common causes of disabilities in children. The effects of the infection show up many years later. Many children acquired the disability during the epidemics of the 1930's, 1940's and 1950's. Today, many of these adults suffer from post-polio syndrome. The disability results in deep fatigue, decreased muscle functioning, and increased pain in muscles and joints. Polio doesn't affect intelligence. The effects of the disability include mild to severe paralysis; shortening of the muscles and tendons limiting limb movement; weak joints; and deformities such as sway back or dislocated joints. Loss of upper body muscle tone also contributes to upper respiratory infections. Franklin D. Roosevelt is probably one of the most famous people with this disability. For more information on polio, follow the link to The World Health Organization's Polio Eradication Project (http://www.polioeradication.org).

Commonly called TBI, traumatic brain injury is the result of trauma to the head. TBI often results in physical and cognitive impairments. Depending on how the brain is injured, the person may lose some vision, hearing, speech, mobility, dexterity, and thinking abilities. It may take many years to relearn simple tasks. TBI is the number one killer of people under the age of 34; most die from injuries received in motor vehicle accidents. People with brain injury experience loss of functions in many areas and thus benefit from adaptations and accommodations to living and working spaces. They may benefit from many types of assistive devices for communication, assisted listening, activities of daily living, computer access, environmental controls, seating and mobility, transportation, recreation, and employment. For more information on TBI, follow the link to The Brain Injury Association of America (http://www.biausa.org)

A stroke (Cerebral Vascular Accident, CVA) is a cardiovascular incident that leads to disability. A stroke occurs when a clot bursts, usually as a result of blockage in a blood vessel that is carrying oxygen and other nutrients to the brain. When any part of the brain doesn't get the oxygen it needs, it begins to die. When the part of the brain that's affected dies, the part of the body it controls is affected. Strokes cause paralysis and affect memory, speech, and vision. For example, if a stroke occurs in the right side of the brain, it is possible that the person will experience paralysis on the left side (hemiplegia) of the body, along with vision problems and memory loss. If a stroke occurs on the left side of the brain, it is possible that the person will experience paralysis on the right side of the body, speech and language problems, and memory loss. In most cases, stroke survivors need rehabilitation. Rehabilitation is focused on helping the person return to independent living. Many survivors must relearn self-care, mobility, communication, memory, and social skills. They rely on assistive technology devices to assist them in these activities. For example, a person with left-brain involvement that has affected the speech center in the brain may use communication aids. Whereas, the person with right-brain involvement that affects vision may need assistive devices including magnifiers, text-to-speech reading aids, computer screen readers, and products that provide auditory feedback, etc. Both will benefit from aids for ADL and IADL, mobility devices, adapted recreation and transportation devices, and modifications to living and work environments. Stroke is a leading cause of serious, long-term disability. For more information on stroke, follow the link to the American Stroke Association (http://www.strokeassociation.org).

Alzheimer's disease is the leading cause of dementia among elders. It is a disorder that destroys cells in the brain. This loss of brain cells contributes to gradual memory loss, decline in the physical and mental ability to perform routine tasks, disorientation, difficulty in learning and remembering, loss of language, impaired judgment, and personality changes. As the disease progresses, people with Alzheimer's become unable to care for themselves. The loss of brain cells contributes to the failure of other systems in the body. Alzheimer's disease arises from a complex combination of genetic and non-genetic factors rather than from any single cause. Although scientific research is progressing, no treatments are currently available that slow the progression of Alzheimer's, or prevent the disease. For more information on Alzheimer's disease, follow the link to the Alzheimer's Association (http://www.alz.org).

The term "amputee" is used to refer to a person who has sustained limb and/or digit (finger/toe) loss or has limb and/or digit differences. Limb loss refers to the absence of any part of an arm or leg due to surgical or traumatic amputation, while the term "limb difference" usually describes the absence of a limb or its malformation. Limb loss is the result of, rather than the cause of other health problems. The most common causes of limb loss include trauma, infection, diabetes, vascular disease, cancer and other diseases. The causes of limb differences are usually unknown. Many amputees use prosthetic limbs. Fitting prosthetic limbs requires several visits to a prosthetist. Physical and occupational therapy and/or gait training may be needed to facilitate the use of prostheses and other assistive technology devices to regain independence. People who cannot or choose not to use prosthetics may require more assistance with mobility, but most amputees use mobility devices (crutches, canes, walkers, wheelchairs, and/or scooters), transportation adaptation, and aids for ADL/IADLs. Persons with digit loss or digit malformation often use aids for ADL/IADLs and devices for computer access. Both groups benefit from modified recreational devices and modifications to living and working spaces. For more information follow the link to Amputee Coalition of America (ACA) (http://www.amputee-coalition.org).

Muscular dystrophy (MD) is used to describe a group of neuromuscular diseases in which the muscles progressively weaken. The muscle cells degenerate and are replaced by fat and fibrous cells. The cause of muscular dystrophy is unknown, but it appears to affect mainly males with onset between the ages of 30 and 60 years of age. Common types of muscular dystrophy include Duchenne's and ALS (Amyotrophic Lateral Sclerosis), commonly known as Lou Gehrig's disease. MD usually results in severe limitations to mobility. In the case of ALS, it involves a progressive paralysis of the major voluntary muscle groups resulting in paralysis and speech difficulties. People with Duchenne's and ALS eventually need to use wheelchairs and other mobility devices. If speech is affected, augmentative and alternative communication devices are used. A number of aids for ADL are used to assist with activities of daily living (ADL) due to muscle weakness. For more information on this disability, follow the link to The Muscular Dystrophy Association (http://www.mdausa.org).

Cerebral palsy (CP) is used to describe the inability to fully control movement or motor function. The major cause of CP is anoxia, or lack of oxygen to the brain, usually from accidents of birth or during the first three years. CP is not a disease. It is not progressive, nor is it infectious. Once acquired, it cannot be cured. Other disabilities sometimes accompany CP, such as seizures, abnormal sensation and perception, visual and hearing impairments, and speech impairments. Although cognitive impairment is present in some people with CP, the majority function with normal or above normal intelligence.

CP is usually described in three types. "Spastic CP" describes movements that are stiff or rigid, "athetoid" describes involuntary uncontrollable movements, and "ataxic" describes movements such as walking that are disrupted by problems with balance and depth perception. In some individuals, ataxic is used to describe low (floppy) muscle tone. The disability may affect only one limb (monoplegia); upper and lower limbs on the same side of the body (hemiplegia); lower limbs only (paraplegia); three limbs, usually both lower and one upper (triplegia); and all four limbs (quadriplegia).

Many people with CP have difficulty communicating; the disability makes it difficult to control the muscles that are used to produce speech. Additionally, the person may have difficulty eating and may have facial contortions and problems with drooling. Many people with CP use Augmentative and Alternative Communication (AAC) tools, such as language boards, computers, and speech synthesizers. If mobility is affected, the person may use braces, crutches, scooter or wheelchair to get around. Many people with CP use a variety of aids for activities of daily living (ADL) and instrumental activities of daily living (IADL), and many use environmental control systems to control devices around the home, including lights, doors, audio/TV equipment, etc. See the section that follows for more detail about assistive technology used for ADLs/IADLs. For more information on CP, follow the link to The United Cerebral Palsy Association (http://www.ucpa.org).

Epilepsy is a chronic neurological disability, often caused by injury, which results in a seizure disorder. A seizure is a brief disturbance in the normal electrical functions of the brain. The rapid firing of synapse in one area of the brain triggers the same behavior in other areas. This activity moves across the brain and spreads like a storm. The person's brain works normally except when this seizure activity is triggered. Seizures vary from momentary loss of attention to grand mal seizures that result in severe loss of motor control and awareness. Epilepsy is not contagious. Epilepsy is generally not the kind of condition that gets worse with time. Most adults who have it can expect to live a normal life span. Rapidly flashing lights can trigger seizures, particularly in the 10 to 25 Hz range. For more information on epilepsy, follow the link to the Epilepsy Foundation (http://www.epilepsyfoundation.org).

Multiple sclerosis (MS) is a neuromuscular disease in which the myelin covering of nerve fibers in the brain and spinal column deteriorates. Once the myelin is damaged, it is replaced with scar tissue that blocks and distorts messages from the brain. The cause of MS is not known. There is no cure. It is not contagious. The most common theory is that a virus seems to trigger an autoimmune reaction in the body that causes the autoimmune system to begin attacking its own healthy myelin. MS affects people very differently. The symptoms sometimes come and go. People with this disability experience muscle weakness, loss of coordination, tremors, paralysis, spasticity, vision impairment, and fatigue. Intelligence is not affected. Mobility and dexterity are affected. People with MS often use assistive devices for mobility and dexterity. For more information on MS, follow the link to The National Multiple Sclerosis Society (http://www.nmss.org).

Most spinal cord injuries (SCI) are the result of direct damage to the spine, such as fractures or dislocations or both. Some are caused by swelling and inflammation (interruptions of blood circulation) that damage cells within the spinal column. The most common causes of SCI are motor vehicle accidents, falls and jumps, gunshot wounds, and diving accidents. There is no cure for SCI. Researchers are working on lab conditions that allow central nervous system cells to regenerate, and experiments are being conducted with fetal cells to foster nerve growth and repair. The disability usually affects lower limbs (paraplegia) or all four limbs (quadriplegia). Moving up the spinal column, the higher the level of injury, the greater the involvement of paralysis. In most cases, people with SCI need rehabilitation. Rehabilitation is focused on helping the person return to independent living. Many people with SCI must relearn self-care and mobility skills. Most people with SCI use wheelchairs and transportation aids for mobility and a variety of aids for ADL and IADL, computer access devices, environmental controls, adapted recreational equipment, and modifications to living and work spaces. Quadriplegics at the C-4 level often experience partial or full paralysis of the diaphragm, sometimes necessitating the use of ventilator for assistance in breathing. Christopher Reeves is probably one of the most famous people with this disability. For more information on SCI, follow the link to The Spinal Injury Information Network (http://www.spinalcord.uab.edu).