Mobility is frequently described in terms of individual body function and structures however contemporary views of disability also recognise the role of environment in creating disability. Aim. To identify consumer perspectives regarding barriers and facilitators to optimal mobility for a heterogeneous population of impaired Victorians who use assistive technology in their daily lives. Method. An accessible survey investigated the impact of supports or facilitators upon actual and desired life outcomes and health-related quality of life, from 100？AT users in Victoria, Australia. This paper reports upon data pertaining to community mobility. Results. A range of barriers and enablers to community mobility were identified including access to AT devices, environmental interventions, public transport, and inclusive community environs. Substantial levels of unmet need result in limited personal mobility and community participation. Outcomes fall short of many principles enshrined in current policy and human rights frameworks. Conclusion. AT devices as well as accessible and inclusive home and community environs are essential to maximizing mobility for many. Given the impact of the environment upon the capacity of individuals to realise community mobility, this raises the question as to whether rehabilitation practitioners, as well as prescribing AT devices, should work to build accessible communities via systemic advocacy. 1. Introduction Getting around at the home and in the community is a core activity, central to much human participation and therefore of key interest to rehabilitation practitioners. Identifying the constraints and supports which consumers perceive as impacting their current and desired life outcomes will both inform the work of rehabilitation practitioners and identify any barriers usually beyond the gaze of rehabilitation practice [1]. 1.1. Mobility Mobility, defined by the Oxford Dictionary of English [2] as the capacity to move, is a core element of human capacity. Independent mobility, preferably without the need for assistive technology (AT), is viewed as a key outcome measure, alongside communication and self-care, in the rehabilitation literature [3]. Health-related quality-of-life measures also regard the capacity to independently mobilize as a key indicator for quality of life [4, 5]. The extent of mobility will depend upon both the capacity of the person and the nature of the environments in which the person operates. A tension exists in considering the relationship between the person and the environment in which mobility takes
References
[1]
B. J. Lutz and B. J. Bowers, “Disability in everyday life,” Qualitative Health Research, vol. 15, no. 8, pp. 1037–1054, 2005.
[2]
Oxford Dictionary of English, Oxford University Press, New York, NY, USA, 2nd edition, 2008.
[3]
K. L. Rust and R. O. Smith, “Assistive technology in the measurement of rehabilitation and health outcomes: a review and analysis of instruments,” American Journal of Physical Medicine and Rehabilitation, vol. 84, no. 10, pp. 780–793, 2005.
[4]
N. B. Oldridge, “Outcomes measurement: health-related quality of life,” Assistive Technology, vol. 8, no. 2, pp. 82–93, 1996.
[5]
G. Hawthorne, J. Richardson, and R. Osborne, “The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life,” Quality of Life Research, vol. 8, no. 3, pp. 209–224, 1999.
[6]
M. H. Rioux, “Disability: the place of judgement in a world of fact,” Journal of Intellectual Disability Research, vol. 41, no. 2, pp. 102–111, 1997.
[7]
J. Swain, S. French, C. Barnes, and C. Thomas, Eds., Disabling Barriers—Enabling Environments, Sage, London, Uk, 2004.
[8]
C. Barnes and G. Mercer, Eds., Implementing the Social Model of Disability: Theory and Research Leeds, The Disability Press, 2004.
[9]
T. Shakespeare, Disability Rights and Wrongs, Routledge, New York, NY, USA, 2006.
[10]
T. Shakespeare, “Disability: suffering, social oppression, or complex predicament,” in The Contingent Nature of Life: Bioethics and Limits of Human Existence, C. Rehmann-Sutter and D. Mieth, Eds., pp. 235–246, Springer, Amsterdam, The Netherlands, 2008.
[11]
C. Thomas, Sociologies of Disability and Illness: Contested Ideas in Disability Studies and Medical Sociology, Palgrave Macmillan, Basingstoke, UK, 2007.
[12]
World Health Organisation, International Classification of Functioning, Disability and Health, World Health Organisation, Geneva, Switzerland, 2001.
[13]
G. G. Whiteneck, C. L. Harrison-Felix, D. C. Mellick, C. A. Brooks, S. B. Charlifue, and K. A. Gerhart, “Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers,” Archives of Physical Medicine and Rehabilitation, vol. 85, no. 8, pp. 1324–1335, 2004.
[14]
Commonwealth of Australia, National Disability Strategy 2010–2020, 2011.
[15]
State Government of Victoria, Victorian State Disability Plan, Disability Service Division, Victorian Government Department of Human Services, Melbourne, Australia, 2002.
[16]
United Nations, Convention on the Rights of Persons with Disabilities and Optional Protocol, United Nations, Geneva, Switzerland, 2006.
[17]
R. O. Smith, IMPACT 2 MODEL, 2009, http://www.r2d2.uwm.edu/archive/impact2model.html, 2002.
[18]
A. Cook and S. Hussey, Eds., Assistive Technologies: Principles and Practice, vol. 3, Mosby Elsevier, St. Louis, Mo, USA, 2008.
[19]
N. Layton and E. Wilson, “Re-conceptualizing disability and assistive technology: Australian consumers driving policy change,” Technology and Disability, vol. 21, no. 4, pp. 135–141, 2010.
A. Molenda, “Equipped for living literature review: identify the monetary benefit to individuals and government of assistive technology,” Journal of Independent Living Centres Australia, vol. 22, pp. 21–23, 2006.
[22]
AAATE, “AAATE position paper: a 2003 view on technology and disability,” in Proceedings of the Association for the Advancement of Assistive Technology in Europe (AAATE '03), 2003.
[23]
F. Heywood and L. Turner, Better Outcomes, Lower Costs: Implications for Health and Social Care Budgets of Investment in Housing Adaptations, Improvements and Equipment: a Review of the Evidence, University of Bristol Office for Disability Issues, Bristol, UK, 2007.
[24]
N. Layton, E. Wilson, S. Colgan, M. Moodie, and R. Carter, The Equipping Inclusion Studies: Assistive Technology Use and Outcomes in Victoria, Deakin University, Melbourne, Australia, 2010.
[25]
A. T. Collaboration, 2009, Assistive Technology-Economics Collaboration, http://www.at.org.au.
[26]
AEAA, Aids and Equipment Action Alliance, Melbourne, Australia, 2006.
[27]
E. Wilson, “Defining and measuring the outcomes of inclusive community for people with disability, their families and the communities with whom they engage,” in From Ideology to Reality: Current Issues in Implementation of Intellectual Disability Policy: Proceedings of the Roundtable on Intellectual Disability Policy, C. Bigby, C. Fyffe, and J. Mansell, Eds., pp. 24–33, LaTrobe University, Bundoora, Australia, 2006.
[28]
D. Gottliebson, N. Layton, and E. Wilson, “Comparative effectiveness report: online survey tools,” Disability and Rehabilitation: Assistive Technology, vol. 5, no. 6, pp. 401–410, 2010.
[29]
ISO 9999, Assistive Products for Persons with Disability—Classification and Terminology, ISO, 2007.
[30]
G. Hawthorne and R. Osborne, “Population norms and meaningful differences for the Assessment of Quality of Life (AQoL) measure,” Australian and New Zealand Journal of Public Health, vol. 29, no. 2, pp. 136–142, 2005.
[31]
A. Barbara and M. Curtin, “Gatekeepers or advocates? Occupational therapists and equipment funding schemes,” Australian Occupational Therapy Journal, vol. 55, no. 1, pp. 57–60, 2008.
[32]
J. Wee and R. Lysaght, “Factors affecting measures of activities and participation in persons with mobility impairment,” Disability and Rehabilitation, vol. 31, no. 20, pp. 1633–1642, 2009.
[33]
E. Steinfeld and G. S. Danford, Enabling Environments: Measuring the Impact of Environment on Disability and Rehabilitation, Kluwer Academic/Plenum, New York, NY, USA, 1999.
[34]
F. Kronenberg, S. S. Algado, and N. Pollard, Occupational Therapy without Borders: Learning from the Spirit of Survivors, Elsevier Churchill Livingstone, London, UK, 2005.
[35]
H. Dong, “Shifting paradigms in universal design,” in Universal Access in Human Computer Interaction: Coping with Diversity, C. Stephanidis, Ed., pp. 66–74, Springer, Berlin, Germany, 2007.
[36]
R. Nissim, Universal Housing—Universal Benefits: A VCOSS Discussion Paper on Universal Housing Regulation in Victoria, VCOSS, Melbourne, Australia, 2008.
[37]
D. Fouarge, Costs of Non-Social Policy: Towards an Economic Framework of Quality Social Policies—And the Costs of Not Having Them, European Commission, 2003.
[38]
I. Schraner and N. Bolzan, “Inclusion—what does it cost and how do we measure this?” in Assistive Technology from Adapted Equipment to Inclusive Environments, P. L. Emiliani, L. Burzagli, A. Como, F. Gabbanini, and A. Salminen, Eds., pp. 777–782, IOS Press, Amsterdam, The Netherlands, 2009.
[39]
D. De Jonge and I. Schraner, “Economics of inclusiveness: can we as a society afford not to provide assistive technology or use universal design?” in The State of the Science in Universal Design: Emerging Research and Developments, J. Maisel, Ed., pp. 132–143, Bentham Science, Buffalo, NY, USA, 2010.
