It is important to recognize a distinction between accessibility in the private sphere (which can often be modified or changed by indiviuduals or rehabilitative approaches for improved access) and in the public sphere, where alterations to improve access to public services or spaces present greater challenges. Within the public sphere, government policies and laws as well as city planning and building codes have a significant impact upon how accessible public areas are to those with disabilities. This realm is largely out of the control of individual patients and rehabilitation teams (although lobbying for improvements may produce results over the long-term).
A person’s degree of accessibility impacts in turn his or her participation and overall ability to reintegrate into communities. Physical barriers such as unpaved or poorly maintained sidewalks, small public transportation buses and heavy traffic 2 are just a few examples of the many environmental challenges that can translate into decreased access and hindered reintegration, resulting in lower life satisfaction.
Needless to say, spinal cord injury (SCI) patients’ access to both physical environments and socio-cultural relationships may be highly compromised. One study has demonstrated that those with SCI and greater “access to the environment” are more satisfied with life. 3 While physical accessibility in many communities has improved dramatically in the past 20 years, people with disabilities continue to face major challenges in communities where the physical environment remains inaccessible. A study of mobility and access needs in South Africa, India, Malawi and Mozambique identified “structural barriers to access” as one of three main barriers4 for those with disabilities (the other two being social and psychological).2 Another survey of over 2000 persons with SCI in the United States pinpointed the natural environment and transportation as the two most common environmental barriers.4