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Physical Examinations IV

Accessibility to Clinical Care for People who use Wheelchairs

Published: April 30th, 2023

1Yale School of Medicine, 2University of Pittsburgh

In the United States, 25% of the general population suffers from one or another type of disability. Ambulatory disabilities, or mobility impairments, represent the most common subcategory, comprising 14% of the country's populace. Different mobility-assistive devices, ranging from canes to scooters, enable increased independence and improved quality of life for those suffering from mobility impairment. Wheelchairs or wheeled mobility devices are the most important among these, and an estimated 2.7 million people in the US use manual and powered wheelchairs annually. In the future, these numbers will increase due to rising chronic health conditions and an aging population. People who use wheelchairs often experience barriers to medical services in healthcare settings due to generalized disability stigma, inaccessible medical settings, inadequately trained clinic staff, and the inability of healthcare providers to understand all of their patients' needs.

Section 504 of the 1973 Rehabilitation Act and the 1990 Americans with Disabilities Act (ADA) are federal civil rights legislations that protect US citizens with disabilities from discrimination, and mandate appropriate accommodation(s) be provided to ensure equal access, opportunities, and care in all sectors of society, including healthcare. Those with mobility impairment who use wheelchairs are therefore protected under law, and must be afforded equal access to clinical care for the prevention and treatment of illness, injury, and disease. Despite the laws, many clinical settings still struggle to provide such an inclusive environment. The US Department of Justice and Department of Health and Human Services' Access to Medical Care for Individuals with Mobility Disabilities summarizes practical strategies that healthcare settings should adopt to create an accessible, ADA-compliant clinical environment. Reviewing and implementing these and other strategies are essential if clinical practices are to offer people who use wheelchairs the same level of care as those who do not.

Most details related to the medical care for people who use wheelchairs are no different than for people without a disability. Such elements of the physical examination will not be reviewed in this video in order to emphasize points where care is often lacking or must be approached differently. Given the prevalence of mobility impairment, the protocol described below should be a standard practice in medical settings, rather than an exception in specially designed office spaces.

1. Creating an Accessible Clinic

  1. When patients make an appointment, they should be asked whether they will need assistance during the examination because of their wheelchair use or disability. If they answer yes, more information should be collected about their disability, the type of wheelchair they have, the usual method for transfer (including assistive equipment needed such as a transfer board, a lift, etc.), and if they require assistance for transfers, changing clothes, and any other task during the cli.......

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