Given that accessibility plays a major role in the lives and quality of life of people with SCI and those with other disabilities, it importance has been reflected in the United Nations Convention on the Rights of Persons with Disabilities (See Box 1).6 Article 9 of the convention seeks “to enable persons with disabilities to live independently and participate fully in all aspects of life, State Parties shall take appropriate measures to ensure to persons with disabilities access, on an equal basis with others, to the physical environment…” (Article 9 excerpt, UN Convention on the Rights of Persons with Disabilities; see the full text in Box 2).

Read more: SCI and Environmental Accessibility

Mr. Wun

Falling asleep while driving without a safey belt, Mr. Wun was involved in a serious motor vehicle accident that resulted in a fracture of his C6 vertebra. At the time he was 22 years old. Following an emergency surgery to stabilize his spine, the injury left him with an ASIA A, C6 tetraplegia. He remained in an intensive care unit (ICU) for four months, where interventions focused on healing his bodily structures and improving his bodily functions. To assist him with respiration after the surgery, a temporary tube was placed through his neck into his trachea (called a “tracheostomy tube”). Unfortunately, this caused difficulties in swallowing (“dysphagia”) and a second tube (known as a “percutaneuous endoscopic gastrostomy tube” or “PEG tube”) was placed for feeding directly to the stomach, minimizing his need to swallow.

Read more: Mr. Wun's Story

A range of interventions proceeded for each of the Cycle Goals. For example, to improve mobility, muscle endurance training and exercises to increase muscle power and joint mobility were undertaken. Furthermore, wound care was performed to try and heal the tracheostomy incision – a contributing factor to Mr. Wun’s swallowing difficulties.

Read more: Assignment and Intervention

At the end of the Rehab Cycle, Mr. Wun’s gains were only modest. Some interventions resulted in slight improvements, while others only maintained Mr. Wun’s conditions without worsening them. The problem of the impaired healing of the tracheostomy incision, for example, remained and consequently impacted his related bodily functions; a follow-up surgery would be required. Urination and defecation functions remained completely impaired, but intervention targets were still achieved because no further complications arose (e.g. urinary tract infections, bowel impactions, etc.).

Mr. Wun left the Cycle with better self-care skills.
Read more: Evaluation

Accessibility is a broad term encompassing many elements and may include physical, socio-cultural and technological aspects. This case study highlighted issues of environmental accessibility. The degree of environmental accessibility that a person with SCI has is a function of both the physical accessibility of the private and public environments and the degree of functioning and mobility of the individual with and without assistive devices. Under ideal circumstances, there is a collective coordination and optimization of these elements in a patient’s life and community. Some of these are:

Read more: Discussion

SCI and Environmental Accessibility - An Experience from Thailand

For persons living with spinal cord injuries (SCI) or other types of physical disabilities, accessibility is key for successful reintegration into communities and is vitally important for overall life satisfaction. Accessibility is defined as “a possibility for all people including disabled and elderly persons to approach, enter, pass and make use of the built environment and its facilities without assistance.” 1 More broadly, accessibility extends from being able to access physical and environmental space to the socio-cultural domain, as in the case of communications and relationships, including the use of facilitating technologies. This broad definition of access and accessibility is impacted directly by both a person’s degree of mobility as well as the use of assistive devices. In addition, beyond the individual there is an entire range of environmental factors, both facilitators and barriers.

Read more: General Introduction