In Mr. Wun’s case, the two periods of rehabilitation in a local hospital as well as the measures taken at home, i.e. architectural adaptations to home and property, use of the computer to maintain contact with friends and others in the community and to work doing translations, were unable to substantially compensate for the environmental inaccessibility Mr. Wun experienced in the community. Poor road and sidewalk conditions, physical barriers, wheelchair-inaccessible public transportation are some of the common external environmental factors that presented barriers for him. In fact, the issue of environmental accessibility in the community, although vital for Mr. Wun's community integration, was minimally addressed in the 17 months following his spinal cord injury (SCI). Addressing the issue of environmental accessibility in the community was beyond the scope of rehabilitation, and required public policy changes.
Public Policy That May Have Made a Difference for Mr. Wun
Even though national legislation that meets the mandates outlined in the United Nations Convention on the Rights for Persons with Disabilities (or “the Convention”){cs12-fn1} already existed in Thailand at the time this case study of Mr. Wun was conducted, accessing the world beyond his home was still largely out of reach. The legislation, the Persons with Disability Empowerment Act of 2007, was new at the time. Since then, several national action plans have been adopted, most recently the 4th National Plan on the Empowerment of Persons with Disabilities (2012-2016).{cs12-fn3}{cs12-fn4}{cs12-fn5},{cs12-fn6} Policy changes have also taken place; however translating these policies into concrete improvements seems to be “easier said than done”.{cs12-fn4}
""Policy changes have also taken place; however translating these policies into concrete improvements seems to be “easier said than done”""
The adoption of laws and policies to ensure “accessibility to physical, social, economic and cultural environments”{cs12-fn1} demonstrates Thailand’s political will in supporting the rights of persons with disability. While laws and policies offer an important starting point, effective strategies and the necessary resources for translation into improved accessibility for persons with SCI and other disabilities is still greatly needed. Considering existing guidelines and best practices is also essential. An example of existing guidelines for improving access is provided in box 3.
Box 3 | An Example of Guidelines for Improving Access – Walkways and Wheelchairs
A. Walkways{cs12-fn16}
The following guidelines are an example (in verbatim) of standards published by the European Conference of Ministers of Transport in 2006 to ensure pavements and pathways are accessible for pedestrians and wheelchair users.((BITTE DIE BULLETS ITALICS MACHEN))
- A minimum obstacle free footway at least 1500 mm wide - preferably 2 000 mm.
- Widths should be greater at bus stops (minimum 3000 mm) and in front of shops (3500 mm or more).
- If possible gradients should be not more than 5% (1 in 20) to cater for self-propelled wheelchairs: this should be used as a design limit in new development. The Swedish Association of Local Authorities 2 noted that a gradient of 2.5% (1 in 40) can be managed by the majority of people, but gradients steeper than this begin to cause difficulties for some manual wheelchair users.
- Where gradients are unavoidably steeper than this, level areas (preferably 1500 – 1800 mm long) should be incorporated at intervals of 10 m.
- Crossfalls, which are needed to make sure rain water drains away quickly, should be between 1.5 and 2.5% (1 in 40). Anything steeper than 2.5% makes it difficult for a wheelchair user to steer in a straight line.
- Where there is a drop or steep slope at the rear side of a footway (or both sides of a footpath) a 100 mm edging upstand should be provided as a safeguard for wheelchair users and as a tapping rail for long cane users.
- Surfaces should be non-slip, well maintained and any joints between paving slabs should be closed and flush to avoid catching the small wheels of a wheelchair.
- Covers and gratings should be non-slip and flush with the pavement surface.
- Nothing should overhang the footway (signs, tree branches, etc.) to a height of less than 2100 mm (preferably 2500 mm).
- Where it is not possible to avoid having obstacles in the pavement, such as lamp-posts, traffic signs, etc. they should have a contrasting band of colour 140 mm to 160 mm wide with the lower edge 1500 to 1700 mm above ground level. Trees in the footway should have a distinctive surface around them (for example grating or pebbled) to warn blind people.
- Seating should be provided at regular intervals of around 100 m.
- In parts of Europe, particularly in the north and Scandinavia, keeping footways clear of snow and ice is very important.
B. Wheelchairs{cs12-fn17}{cs12-fn18}
For most persons living with SCI, the wheelchair is an indispensable device for increasing mobility. A wheelchair can do much to increase accessibility, independence, participation and social integration. The Convention obligates countries who have ratified it to “take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities.”{cs12-fn1} In other words, persons with disabilities have the right to mobility aiding devices including wheelchairs. Wheelchairs must be appropriate, meaning they:
- Meet the user’s needs and environmental conditions
- Provide a proper fit and postural support
- Are safe and durable
- Are available
- Are affordable and can be maintained in the country
In many cases persons with disabilities in low-income countries cannot afford wheelchairs or the ideal type of wheelchair, and funding sources must be mobilised through government funding, donors and wheelchair funds. In addition, inaccessible environment, lack of training and rehabilitation, and poor choice of wheelchair pose a barrier to mobility. It is therefore important that policies for providing wheelchairs address issues of design, production, supply, service delivery, training and financing.
In summary, while rehabilitation can optimise the functioning of a person with SCI in terms of the body functions and structures, extend the range of activities the person can do, provide the person with assistive devices and corresponding training, or even adapt the person's home, if the efforts to improve the person's lived experience does not extend to also fostering environmental accessibility in the community, the person's full participation and integration in the community is compromised. Mr. Wun's case clearly illustrates this.
Mr. Wun's case also highlights the potential of the Convention{cs12-fn1} and international standards like the International Classification of Functioning, Disability and Health (ICF){cs12-fn15} for tackling the environmental accessibility challenges that are face by persons with SCI and other disabilities all over the world.