Dot Nary

Dorothy E. Nary, M.A., NIH Doctoral Trainee, The University of Kansas Gerontology Center

One day last spring, after lots of rain, the weather cleared briefly. My husband and I leashed the dog and took him for a long walk. An hour later we returned home, invigorated from exercise and sunshine, but finding a layer of mud on the front casters, wheels, and some upholstery of my wheelchair. While my husband could wipe his shoes in the grass and easily wipe the dog's feet off, it took some rags, a bucket of water, and about 30 minutes to scrub, rinse, and wipe my chair in the driveway.

Why am I relating this experience? To illustrate how, for many people with disabilities, getting exercise is rarely as spontaneous as it can be for others. After the walk, I wished I'd switched wheelchairs before the walk. In the garage, I keep an old wheelchair with larger casters that I use for gardening, camping, and other activities that are messy and/or require me to travel over unpaved surfaces. While I would still have had to wipe the old chair down, it would not have had to be done as completely. However, the old chair is often covered with boxes, etc., in our crowded garage. It is not nearly as comfortable and lightweight as my usual titanium chair. And, sometimes, as was the case this day, I am in too much of a hurry to switch chairs, along with the accompanying cushion, backpack, etc.

Yet, I am aware that I am fortunate to have a backup chair and a place to store it. I know that many people are unable to convince their health care insurers to pay, even partly, for a new chair before their current one is no longer usable. Still, others living in apartments lack space to store an extra chair. And this does not even begin to address problems experienced by folks who lack health coverage or other means to purchase new equipment and who must keep their only chairs cobbled together with duct tape and hope.

This incident reminds me of a consumer at the independent living center where I worked years ago. He was nineteen, young, and strong, and had just moved to an apartment from the rural area where he grew up. Without a car, and wanting to take advantage of this newly found freedom, Rick was out and about all the time in his manual wheelchair. In fact, he traveled so far and so often, that his chair wore out within 12 months of his move—one of the footplates broke, the upholstery was torn, tires bald, and the whole thing just loosened up and was unable to be tightened. When we worked with him to complete the paperwork to obtain a new chair from Medicaid, the request was denied several times. Why? A decision was made that he was "abusing" the chair, because it looked dirty and beat-up, and he had not had the chair for the requisite number of years that it was supposed to last. How frustrating to have to negotiate lots of red tape because a 19-year old man was doing exactly what he should be doing for his mental and physical health—actively exploring his community with the only means he had.

These situations lead me to ask questions about the ability of people using wheelchairs and other adaptive equipment to engage in physical activity.

• Is having backup equipment a necessity or a luxury?
• Do some people avoid some health-enhancing activities in order to preserve equipment that is becoming increasingly difficult to replace when it wears out?
• Do we have any data on the effect of some types of physical activity on the durable medical equipment used?
• Are some people deterred from engaging in outdoor activity by the hassle of maintaining equipment that must remain neat and functional for work, and other indoor activities?

We must keep questions like these in mind as we encourage people with disabilities to explore new ways to incorporate physical activity into their lives. Being adventurous and open to new activities is great—and important in promoting health-enhancing physically active lifestyles for everyone. However, we must also work to make resources available to support these lifestyles so that people who require mobility equipment are not accused of "abusing" their equipment in the pursuit of better physical and mental health.

Some ways that we can do this are to:

• Advocate for "reasonable use" policies with health care insurers to discourage "punishment" for equipment use.
• Encourage the availability of "loaner" equipment from recreational programs.
• Explore how state assistive technology programs might facilitate recreational opportunities—and publicize model programs already doing this.
• Search for innovative ways to create storage for backup and recreational equipment—maybe a shared utility shed in an apartment complex?

Our goal of promoting physically active lifestyles for all must be accompanied by attention to equipment issues that will ensure "access for all!"