Resources - Chapter 12 Supplement
A Barrier-Free Practice
presented by Tracy Williams founder of Touch/Ability
Health care providers help clients recognize and release barriers that block spiritual, emotional, mental and physical growth. Their services are especially beneficial for people with physical disabilities and special needs. This segment of the population represents a vital and largely untapped market. Alternative health care represents a service they genuinely value and appreciate. Personally, professionally and even financially there are numerous benefits to working with these populations.
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There is a tight network of people with special needs—a tremendous potential source of referrals. Few people have training and experience with such clients, so those who do are widely sought out.
There are unique marketing possibilities for practitioners. Contact rehabilitation centers, hospital wellness clinics, social services agencies, summer camps and support groups to promote your services and create new programs. Educate doctors and medical personnel about the benefits of alternative therapies to people with special needs.
Working with a physically challenged population allows practitioners to confront their own fears and weaknesses, usually an empowering experience. Practitioners who work with clients with special needs report enormous personal and spiritual growth.
Practitioners who create an accessible practice serve all people better. Through working with clients with extreme conditions, you'll gain new understanding of the body's potential, enriching your service to everyone.
Who are People with Special Needs?
People with special needs are those who have a physical or mental impairment that substantially limits one or more major life activities. Their conditions range from arthritis to quadriplegia, from blindness to epilepsy. In addition to being limited in their physical capacities, many are dealing with chronic pain, depression and secondary complications resulting from their conditions. Ostracism and discrimination are also a common experience.
As you might expect, people with disabilities are interested in anything that might improve the quality of their lives. Alternative therapies have much to offer physically challenged individuals, both mentally and physically. People with congenital conditions like cerebral palsy and spina bifida experience relief from chronic pain. Permanently impaired war veterans with missing limbs have discovered that touch therapy, acupuncture and hypnotherapy relieve accumulated stress. People with degenerative diseases such as multiple sclerosis or muscular dystrophy find that bodywork improves flexibility and range of motion. Aquatherapy, acupuncture and shiatsu have helped seniors with arthritis and other conditions.
Like many other minorities, individuals with disabilities began organizing and campaigning in the 1960s for better access and other civil rights and protections. This activism ultimately led to the passage of the Americans with Disabilities Act (ada) in 1991 which guarantees people with disabilites the right to participate equally in mainstream society. The ada has boosted the determination of people with disabilities to fully participate in life.
Safe Body Mechanics
There are a number of techniques that health care providers must learn to ensure safe and comfortable handling of physically challenged clients. Many people with disabilities need complete or partial assistance simply to be put in position for treatment. Competence in body mechanics skills comes from practice; hands-on practical training is essential to learn these sensitive skills. Some practitioners are taught these skills in school (e.g., nurses, physical therapists, and personal care attendants) and are valuable resources to call upon for guidance. Many community colleges and professional organizations offer courses for caregivers.
Of course, your most important teacher is the client. Communicate with your clients and encourage them to communicate with you. Ask questions, outline procedures, listen and follow instructions. People with disabilities know what works for them.
Some clients may be accompanied by a caregiver, who may provide demonstrations and coaching on how best to work with the client.
An authentic therapeutic relationship with a client who has special needs depends on clear, honest, mature and good-humored communication. People with disabilities often have poor self-esteem and are accustomed to being ignored and treated rudely. Even many medical professionals rarely take the time to understand their situation.
Practitioners need to listen carefully to their clients' instructions and reactions, and maintain an approach that is natural and matter-of-fact. There is an etiquette for working with people with disabilities; for example, help should be offered only when requested. It's a good idea to incorporate mobility assistance into the flow of the session so that activities of dressing and undressing, turning, positioning, and propping become stretching and range-of-motion exercises.
In working with people with disabilities, it's extremely important to gather information before beginning treatment. A thorough initial interview takes at least 30 minutes and should establish rapport as well as elicit vital information.
During the session, observe and make note of outstanding qualities about the client's posture, breathing patterns, facial expressions, gait and limb mobility. Pay special attention to personal needs and requests, anatomical changes and vulnerable mental/emotional conditions. Keeping a record of anatomical features from session to session enables you to track progress.
Practitioners gain their clients' respect if they're sensitive to issues people with disabilities face daily and are open to learning about their life experiences. Be aware that your work may trigger emotional reactions for both yourself and your clients. Deep fears about body disassociation, helplessness and isolation may come up. Pay attention to your own reactions—maybe even record your thoughts and feelings in a journal. As you review your notes, you will see your own emotional/spiritual progress.
When working with people with disabilities, be aware that medical problems sometimes arise. At the beginning of your relationship with a physically challenged client, ask your client to have their physician complete a release form covering medically relevant information. During the intake interview, be sure to review the client's health history. It's also important to discuss such personal care issues as bowel and bladder management, skin care and mobility assistance. At all times, respect the clients' feedback as they discover new ways to reach their fullest potential. The client controls the session while you supply the energy and techniques to address their priorities. The team approach keeps everyone safe and satisfied.
If you want to accommodate people with special needs, the inside and outside of your business must be accessible. In selecting a business location, check whether architectural and communication accommodations exist or could be made.
The following guidelines summarize accessibility considerations suggested by the ada. The Internal Revenue Service allows a deduction of up to $15,000 per year for expenses associated with improving access. Small businesses may also qualify for tax credits. For a free code of Federal Regulations (ada), contact the Department of Justice.
- Parking and passenger loading zones must be available as close as possible to the entrance, with ramps and curb cuts to enable easy access. Reserved spaces should have a sign posted showing the symbol of accessibility.
- Ramps should be built with the least possible slope (1:12, or one inch height for every foot in length, or a 4.8° slope). Recommended width is 36 inches (91.5 cm) with level landings at the bottom and top.
- Floor surfaces should be smooth and slip-resistant. Unpaved exterior ground surfaces (as well as deep pile carpeting) can be unsafe for people who use wheelchairs and other mobility aides. Walks, ramps, stairs and curb ramps must be stable and firm. Carpet should be no thicker than ½ inch (1.3 cm) and securely attached with a firm backing.
- Doorways must be 32 inches (81.5 cm) wide with the door that opens 90°. Thresholds at doorways must not exceed ¾ inch (1.9 cm) in height. Ideally, the doors would be automatic or power-assisted. Door hardware (handles, pulls, latches, locks and other operating devices) must be easy to operate for someone with arthritis who has a limited ability to grasp, pinch or twist their wrist. Hardware should be mounted no higher than 48 inches (122 cm) above the floor.
- Restrooms must have enough maneuvering space for a person using a wheelchair to get in and out. A standard accessible toilet stall (five-by-five feet) has a minimum depth of 56 inches (142 cm). Install a raised toilet seat, grab bars, and a full-length mirror. To make sinks accessible to people who use wheelchairs, leave an open space under the basin. Be sure to remember that their legs may touch the plumbing, so insulate the hot water pipe to prevent burns.
- Clear passage for a wheelchair is 32 inches (81.5 cm). Rearrange tables, chairs, vending machines, display racks and other furniture to ensure clearance. A person in a wheelchair needs a clear space of 60 inches (152.5 cm) diameter to make a 180° turn.
- Miscellaneous: The telephone should be easy to reach and the water fountain should have a paper cup dispenser. Also keep on hand a package of disposable pads, a box of rubber gloves, a urinal and a physical therapy transfer belt. These items can be purchased at a medical supply or drug store. Even though you may never need these health care tools, they should be available for exceptional circumstances.
Special populations are a marketing dream come true. People with disabilities have a close network of associates and therefore generate valuable word-of-mouth promotion. As noted earlier, they also tend to be repeat customers. The main challenge is establishing yourself as a credible, empathetic and respectful practitioner. Understanding their situation and using the right language with an appropriate attitude is critical to establishing credibility.
Independent Living is a worldwide political action movement driven by the spirit of the disability-rights movement. Throughout the country Independent Living Centers (ilcs) offer public education and awareness programs to inform the public about the choices, achievements and lifestyles of people with disabilities. These organizations offer a way for practitioners to approach people with disabilities as well as a source of information and educational material.