Mobility Disabilities

Demographics

11% of adults in the US have mobility disabilities.

No stats on manual dexterity issues or body structure disabilities.

Medical Details

A Large Category

There are so many conditions and specific presentations that can interfere with a person's ability to move around, and the CPACC doesn't really have time for all of them.

Instead of focusing too much on the individual conditions that cause movement disabilities, we are encouraged instead to look at three symptom profiles: impairment in manual dexterity, impairment in ambulation, and muscle fatigue.

The IAAP also lopes in the specific consideration of 'size or shape' disabilities in this category. Examples of these include gigantism and acromegaly, alongside dwarfism. And obesity.

General Symptoms

Manual Dexterity

Manual dexterity or fine motor control describes the ability to do intricate hand and wrist movements. With fine motor control, a person can write, use a keyboard, manipulate small objects, and tie knots.

Some people completely lack manual dexterity due to paralysis or a limb difference. Others may have poor manual dexterity due to physical injuries like RSI or broken bones. Poor manual dexterity also might result from ataxia, loss of motor skills due to neurological things such as cerebral palsy or a stroke. Then again, a person may lack the cognitive ability to execute these detailed movements, as might be the case with Autism Level 3.

Ambulation

Ambulation is the ability to walk.

Impairment in ambulation is a spectrum. There are some people who can walk some of the time. There are some people who can walk with the use of a cane, walker, crutches, or a prosthetic. There are people who have no walking ability. There are people who walk without devices, but require frequent breaks.

According to Case Western University, (linked in the Body of Knowledge), four common causes of impaired mobility are congenital diseases, missing/malformed legs, spinal cord injury, and neuromuscular disorders.

Muscle Fatigue

According to Healthline, a linked Body of Knowledge source, muscle fatigue is a symptom that decreases your muscles' ability to perform over time. Muscle fatigue results in soreness, localized pain, shortness of breath, muscle twitching, trembling, cramps, and weak grip strength. Altogether, it can result in difficulty performing daily tasks. It isn't abnormal when people feel it after exercises, but it can also develop in people who have anemia, fibromyalgia, hepatitis C, mood disorders, and many others.

According to Scottish Muscle Network, a linked BoK source, muscle fatigue is different than the fatigue that most able-bodied people experience. It doesn't let up after a period of rest and doesn't really respond to intervention except temperature regulation. It can be progressive, variable or persistent. It is caused by neuromuscular disorders and can result in weakness, pain, a dip in self confidence, and even joint damage. People with this condition must plan, pace, and prioritise, recognizing that their battery is not on the same level as most of their peers. 'Normal' fatigue can happen on top of muscle fatigue, in which case it is called 'secondary fatigue.' People may seek to maintain physical health, nutrition, sleep, and exercise routines to ensure secondary fatigue doesn't happen as easily. This still doesn't change the presence of muscle fatigue. It's all about managing symptoms.

Body Size and Shape

Acromegaly

According to Mayo Clinic's article on Acromegaly, a linked BoK source, Acromegaly is when your body produces too much growth hormone. It's an uncommon hormonal disorder and is primarily caused by the presence of noncancerous tumours at the pituitary gland.

Acromegaly is what it's called when growth hormone is overproduced in adulthood. In children, it is called gigantism.

Children with excess growth hormone have an increased height. Adults with acromegaly don't gain height; instead the bones in their hands, feet, and face often lengthen, their voice may drop, and they may experience increased health problems including muscle fatigue, pain, mobility issues, amongst others. The condition may have a very slow progression, which makes it hard to recognize.

Dwarfism

According to Mayo Clinic's article on Dwarfism, a linked BoK source, Dwarfism is a classification one receives when they have an adult height of 4'10" (147cm) or less. People with this classification are commonly referred to as little people.

For most little people, dwarfism is the result of some genetic condition, many of which happen due to spontaneous mutation. Most people have the disproportionate type. For example, the limbs may be disproportionately shorter than the torso, and the head may be disproportionately larger to the rest of the body.

People with the proportional type are more likely to have had their dwarfism caused by some kind of growth hormone malfunction.

Both types can result in further health complications. The folks with the disproportionate type tend to have more mobility complications, while folks with the proportionate type tend to have more issues with internal organs.

Obesity

The Body of Knowledge also considers obesity to fit into this category. I am compelled to critique this, I have placed a small essay for those interested in my critique below the 'Accommodations' section.

Accommodations

In the Physical World

People with ambulatory issues may use manual or electric wheelchairs and motorized scooters. They may use walkers, canes and crutches. They may not be able to use stairs so ramps, lifts and elevators are necessary for access. Walkways that are too narrow or obstructed and doors that don't open easily or automatically can also bar someone from entering a space.

Chair users may also have the additional concern of requiring tables that have enough clearance underneath, reachers or roll-out inserts that help them reach into the very back of cupboards, cupboards that aren't placed too high, etc. Many products and equipment require a standing position to operate.

Little people may share some access needs with chair users in that things may be located too high or out of reach in order to operate or perceive.

In the Digital World

There are thousands of assistive technology devices out there on the market. Here are a few different kinds available.

Voice Control

Software like Dragon Naturally Speaking is software that allows a person to control the computer by speaking commands aloud. Users may experience problems when the programmatically associated names of controls do not match how they are labelled visually.

Eye-tracking Devices

Eye trackers watch the movement of your eyes and control your computer that way. Sometimes a person using an eye tracker will 'click' by making a noise with their mouth. It can also be set up in different ways. When feasible, eye trackers may be paired with voice recognition software. Eye trackers are quite costly, however.

Mouth Stick

Mouth sticks are very inexpensive. A person can control a keyboard or touch device with a small stick with a rubber tip at the end. Users may experience issues when touch targets are super small and require intense precision.

Head Wand

Similar to mouth sticks, but the stick comes out of a headband hat thing and requires you to perform larger movements to achieve a similar effect.

Switches

Switches are used by people with very limited mobility. They are these big buttons that can be placed by the area where the person has mobility. A person can make selections with this button. Switch control depends on all interactive components on a page being accessible via keyboard.

Sip-and Puff

This is a kind of switch device, but instead of a button, 'on' and 'off' states are indicated by a person who sips and puffs into a little straw by their mouth.

Obesity as a Disability?

Currently, the mainstream medical paradigm obligates us to consider obesity as a disease in and of itself. This idea is thought of as being 'common sense' and we are nearly never invited to question this.

Obesity is viewed as a disease primarily because people who are fat get sick and die much more easily than people who are not fat. Their rate of disability is much higher than the thin population. But is this entirely because of extra adipose tissue?

For example, Indigenous people get sick and die more easily than the white settler population does. Their rates of disability are much higher. But does this mean that being Indigenous is itself a disease? No. It is societal factors, not biological factors, that account for the sickness, mortality, and disability rates of Indigenous people. It is not intrinsic to the fact that people are Indigenous. If we fixed the way that society functioned, those rates would stabilize.

When we discuss the sickness, mortality and disability rates of fat people, we often hyperfixate on 'symptoms' and 'comorbidities' and we don't talk about the controllable societal factors that lead to poor outcomes. Research shows that fat people experience high rates of clinician disengagement, clinician tunnel vision, and clinician aggression. Medical equipment is literally not designed to hold fat people. Medical care will sometimes be withheld from people on the condition that they 'must exercise' or 'go on a diet' first.'

When medical professionals conduct obesity research, they do not control for the medical mistreatment that fat people routinely face and rely on outdated paradigms (BMI for example). This is not surprising. The stigma against fatness is such a foundational belief to not just the medical establishment, but to society at large. Critical fat studies scholar Monica Kriete puts it this way:

Obesity is a particular way of thinking and communicating about fatness. It centers some beliefs and some evidence about fatness and health while excluding or cropping out other information, particularly methodological critiques and evidence about the futility of pursuing intentional weight loss. The illness construct of obesity makes the public health goal of obesity prevention sound logical and necessary, but it sets us up for a cultural pattern of belief that fatness is bad, fat bodies are disgusting, and fat people need intervention to initiate healthy behavior

Critical fat studies does not count out the fact that there are likely health risks associated with excess adipose tissue, but it agitates for a rethinking about how these issues are researched, for a push to rethink which correlations are in fact causation, and pushes for doctors to take the health of their fat patients seriously.

In agitating against a culture of anti-fatness in our institutions (especially our medical institutions), it's important that we rhetorically draw a line against merely accepting that 'obesity' is what causes poor health outcomes in fat people. We must not continue to deflect the blame away from "common sense" practices that predispose fat people to higher rates of sickness and death. We have to acknowledge the problem in order to fix it.