Module 3: Accommodations for Motor Impairments
Types of Motor Impairment
Motor impairments may effect movement of the upper or lower extremities. According to the U.S. Census (http://www.census.gov/prod/2001pubs/p70-73.pdf), approximately 25 million people over the age 14 had an ambulatory disability (having difficulty walking a quarter mile or up a flight of stairs, or using a mobility aid).
About 2.2 million Americans use a wheelchair and another 6.4 million use some other ambulatory aid such as a cane, crutches or walker. In addition, 18 million Americans report difficulty using their arms or hands (lifting and carrying a 10-pound object or grasping small objects).
A variety of conditions may result in motor impairments. Arthritis, painful inflammation of one or more joints, can cause reduced range of motion of those joints and can then impact mobility, reach, grip, or fine motor tasks depending on the joints affected.
Traumatic brain injury or stroke can result in difficulty with motor control or even partial paralysis (e.g., paralysis of one side of the body) depending on the part of the brain affected. Muscular dystrophy (MD), including ALS / Lou Gehrigís disease, is a condition involving the degeneration of muscle cells and resulting weakness or paralysis.
People with multiple sclerosis (MS), a condition affecting signal transmission along the nerves, may experience loss of coordination, tremors or spasticity, or muscle weakness or paralysis. Individuals with cerebral palsy (CP) may experience either high muscle tone and involuntary uncontrollable movements impacting precision of movements, or low muscle tone affecting strength.
Other motor impairments include amputations, repetitive stress injuries (e.g., carpal tunnel syndrome), or spinal cord injury (paraplegia if only the lower extremities are affected; quadriplegia if both legs and arms are affected).
Lower extremity limitations impact an individualís ability to travel between two points. If the person uses a mobility device, such as a wheelchair, the individual may also have trouble reaching objects or using their hands while also using the mobility device.
Upper extremity limitations impact an individualís ability to reach, lift, grip and carry objects. They also impact an individualís ability to operate many products, where manipulation requirement include certain levels of force, accuracy, and coordination.
Accommodation strategies are tied to the specific motor limitation of the individual.
- Change the task so that the motor-related barrier is avoided. A task might be performed in a different manner that does not pose a barrier.
- Seek assistance with minor tasks that are creating a barrier. Students or fellow teachers may be able to provide assistance on occasion. For example, a student might be asked to pass out papers.
- Minimize effort and distance required to travel. People with lower extremity limitations may have difficulty walking any distance, may walk very slowly, or may be using their arms to propel their body when using a wheelchair. It will take less effort and time to reach intended destinations if travel distance is reduced.
- Remove barriers along travel routes and in work areas. Barriers located along travel routes (e.g., obstacles, steps, steep slopes, narrow entranceways) can impede or prevent a person from getting between work areas, especially if the person uses any type of mobility aid.
- Minimize reach distance / items accessible from a seated position. People who use mobility aids such as wheelchairs or scooters may not be able to reach as high or as far as someone who is able to stand. Tools and materials should be located within reach whenever possible.
- Minimize or eliminate need to use upper extremity while operating mobility device. It can be difficult to carry items while holding a cane or walker or while operating a wheelchair. It may be useful to look for "hands-free" ways to carry objects, freeing the hands to use the mobility aid.
- Minimize reach. Place of objects nearby to compensate for range of motion limitations.
- Minimize force. Minimize the force needed to grip an object, manipulate it, or activate controls to compensate for reduced strength.
- Provide larger, more distinct targets. Use larger or more pronounced targets on controls to compensate for spasticity and difficulty moving hands to a specific point in space.
- Reduce sensitivity of controls. Use controls that require less manipulation precision and force, and which are not time sensitive to accommodate individuals who have limited fine motor control.
- Eliminate need for bi-manual operation. Accommodations that enable a task to be performed with only one hand (either side) may help individuals who can not use one arm or hand.
- Eliminate use of upper extremities. Try "hands-free" approaches when an individual has multiple or more significant limitations.
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