12 | SCI and Environmental Accessibility

SCI and Environmental Accessibility - An Experience from Thailand

General Introduction

For persons living with a spinal cord injury (SCI) or other types of physical disabilities, accessibility is key to successful community reintegration and vitally important for overall life satisfaction.

According to article 9 of the United Nations Convention on the Rights for Persons with Disabilities (or “the Convention” from now on), accessibility is defined as enabling “persons with disabilities to live independently and participate fully in all aspects of life...”. In its Preamble, the Convention even describes accessibility as more than just being able to access physical and environmental space; it extends to the socio-cultural domain: “recognizing the importance of accessibility to the physical, social, economic and cultural environment, to health and education and to information and communication, in enabling persons with disabilities to fully enjoy all human rights and fundamental freedoms.”{cs12-fn1} See box 1.

...accessibility is defined as enabling ‘persons with disabilities to live independently and participate fully in all aspects of life’...more than just being able to access physical and environmental space; it extends to the socio-cultural domain...

This broad definition of access and accessibility is impacted directly by a person’s degree of mobility, the use of assistive devices, as well as a range of environmental factors that can pose as facilitators and/or as barriers.

Box 1 | The Convention

In 1987, a global meeting of experts recommended that the United Nations (UN) General Assembly drafts an international convention for eliminating discrimination of persons with disabilities. The Convention was adopted in 2006, establishing a critical human rights instrument with an “explicit social development dimension.” It regards persons with disabilities as having the right to freely make decisions about their own lives as members of society. It lays out the basic rights of persons with disabilities around the world, emphasising autonomy and self-determination.{cs12-fn1}

As of January 2016, the Convention has been signed by 160 countries and ratified by 161.{cs12-fn2} In signing the Convention countries confirm that they intend to become parties to the Convention; however, they are not obliged to take further action. Countries that ratify the Convention have a legal obligation to enact specific legislation that ensures persons with disabilities the rights outlined in the Convention.

There is also an optional protocol to the Convention that recognises the Committee on the Rights of Persons with Disabilities to hear individual complaints. This optional protocol was adopted in May 2008.{cs12-fn2}

Although accessibility is a central theme throughout the Convention, article 9 of the Convention outlines specific measures regarding accessibility that would guarantee the rights of persons with disabilities.

Box 2 | Article 9: Accessibility

To fully appreciate the spirit of article 9 on accessibility, the complete text is provided in verbatim below:{cs12-fn1}


1. To enable persons with disabilities to live independently and participate fully in all aspects of life, States Parties shall take appropriate measures to ensure to persons with disabilities access, on an equal basis with others, to the physical environment, to transportation, to information and communications, including information and communications technologies and systems, and to other facilities and services open or provided to the public, both in urban and in rural areas. These measures, which shall include the identification and elimination of obstacles and barriers to accessibility, shall apply to, inter alia:

  1. Buildings, roads, transportation and other indoor and outdoor facilities, including schools, housing, medical facilities and workplaces;
  2. Information, communications and other services, including electronic services and emergency services

2. States Parties shall also take appropriate measures to:

  1. Develop, promulgate and monitor the implementation of minimum standards and guidelines for the accessibility of facilities and services open or provided to the public;
  2. Ensure that private entities that offer facilities and services which are open or provided to the public take into account all aspects of accessibility for persons with disabilities;
  3. Provide training for stakeholders on accessibility issues facing persons with disabilities;
  4. Provide in buildings and other facilities open to the public signage in Braille and in easy to read and understand forms;
  5. Provide forms of live assistance and intermediaries, including guides, readers and professional sign language interpreters, to facilitate accessibility to buildings and other facilities open to the public;
  6. Promote other appropriate forms of assistance and support to persons with disabilities to ensure their access to information;
  7. Promote access for persons with disabilities to new information and communications technologies and systems, including the Internet,
  8. Promote the design, development, production and distribution of accessible information and communications technologies and systems at an early stage, so that these technologies and systems become accessible at minimum cost.

In addition to article 9, the Convention highlights accessibility in other ways. Article 21 for example mentions accessible multimedia, information and communication technology, article 27 addresses accessibility as related to work and employment, article 29 and 30 touches upon the role of accessibility in ensuring the right of persons with disabilities to participate in public life (e.g. voting) and in cultural life, recreation and sports (e.g. theatre, tourism, etc.).

The Convention and Thailand

The Convention was signed by Thailand in March 2007 and ratified in July 2008, establishing an important legal framework with the potential of positively impacting the lives of the approx. 1.9 million Thais living with disabilities.{cs12-fn3}Consequently, the Thai government has undertaken numerous efforts to develop disability policies that aim to improve the quality of life of persons with disabilities, promote anti-discrimination and increase access to social welfare, services and assistive devices. Even before Thailand ratified the Convention, it adopted the Persons with Disabilities Empowerment Act of 2007; it modified existing disability legislation to satisfy the objectives of the Convention.{cs12-fn3}{cs12-fn4}{cs12-fn5}

In this legislation empowerment is defined as, among other things, “support for full and efficient social participation under accessible and barrier-free environment for persons with disabilities”.{cs12-fn5} This has been elaborated in the several national action plans following the enactment of the legislation. In the 4th National Plan on the Empowerment of Persons with Disabilities (2012-2016) the government, including local authorities, is obligated “to create and provide accessible and usable environments, buildings, places and transportations...usable products, equipment, assistive devices and technologies for daily living of persons with disabilities”.{cs12-fn6}

What Does Accessibility Mean for Persons with SCI?

The degree of accessibility a person with SCI has impacts on his or her participation in daily life and overall ability to reintegrate into the community.{cs12-fn7}{cs12-fn8}{cs12-fn9} This is especially true for developing countries. For example, a study that examined the accessibility needs of persons with disabilities in developing countries encountered reports from persons with physical disabilities being denied access to public transportation due to structural barriers such as steps and stairs, seating in buses or trains that were ill-suited for persons with physical disabilities, turnstiles and high ticket booths. In addition, unpaved or poorly maintained sidewalks and road surfaces sometimes prevented wheelchair users from leaving their home except for essential trips.{cs12-fn10}{cs12-fn11}

Accessibility has also shown to be strongly related to life satisfaction.{cs12-fn12}{cs12-fn13} In a large-scale study using data from the United States National Spinal Cord Injury Database (NSCID), Whiteneck et al. found that environmental factors are a major predictor of life satisfaction in persons with SCI, and that barriers in the natural environment (i.e. physical and structural surroundings) and transportation are among the top 5 most problematic environmental factors faced.{cs12-fn13} Moreover, the 2013 report International Perspectives on Spinal Cord Injury published by the World Health Organization (WHO) concludes that “barriers to services and environments restrict participation and undermine quality of life”.{cs12-fn9}

While tremendous efforts have been made to improved accessibility in the past decades, as clearly seen in the example of Thailand,{cs12-fn5}{cs12-fn6} there are still many communities in countries all over the world where the physical environment remains inaccessible for persons with SCI.{cs12-fn9}{cs12-fn14} This also applies to Thailand, especially in the rural areas.{cs12-fn4}

This case study of Mr. Wun, a young man living with SCI, will illustrate the importance of environmental accessibility for full participation of a person with SCI in Thailand. The case study will describe the rehabilitation of Mr. Wun using the framework of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF){cs12-fn15} and the Rehab-Cycle® approach.

See section “Rehab-Cycle® and corresponding ICF-based documentation tool” on page 6.