Tag Archives: disability employment

sarah casteel wheelchair tennis champion

Sarah Casteel Wheelchair Tennis Champion

Sarah Casteel two time national wheelchair tennis champion suffered a paralyzing spinal cord injury when a drunk driver slammed into the car she was driving on Independence Day in 2002. Tragically her 15 year old brother in the car at the time, did not survive the accident.

sarah casteel wheelchair tennis champion
Sarah Casteel Wheelchair Tennis Champion

Casteel, 18 years of age, was taken to the University of Missouri Hospital where she not only had to cope with the loss of her younger brother but the loss of her mobility. Now a paraplegic, she would not walk again.

Sarah remained in the hospital for three months before returning to her home in Greenville, South Carolina to continue with physical therapy.

Life with Paraplegia

Prior to the accident Sarah Casteel was an all-state volleyball player who excelled in tennis, competing on the boys’ tennis team in high school because there was no girls’ team and later played for Stephens College in Columbia, Mo. In her freshman year of college she wanted to study fashion design and art, but that all changed in an instant.

After the accident Casteel returned to Stephens College where she quickly discovered it was not wheelchair accessible. Many of her classmates were less than compassionate unfamiliar and uneasy with her new found paraplegia.

It was not good. It was weird; my life had changed so much. I found out I didn’t have friends anymore. A lot of people I thought were my friends disappeared. I guess they couldn’t deal with it. It was very hard. I decided this was not the place for me anymore. – Sarah Casteel

Casteel began looking for another school, one that could accommodate her wheelchair and improve her quality of life. She found such a place at the UTA (University of Texas in Arlington). She applied and received a wheelchair tennis scholarship to attend the UTA.

The occupational therapist I worked with in Missouri actually introduced me to wheelchair tennis, so I started looking for a school with a wheelchair tennis program, and the University of Texas actually was offering a scholarship for wheelchair tennis. I made friends there and I was No. 1 on a team of four. I competed against other colleges and in national tournaments. – Sarah Casteel

National Wheelchair Tennis Champion

Sarah Casteel

Sarah Casteel

The two time USTA (United States Tennis Association) national champion 2004-2005 Sarah Casteel has also competed in the World Cup held in the Netherlands. Graduating from Stephens College in 2005 with an Inter-disciplinary Studies degree with a focus on biology, she decided to pursue a career helping others.

A connection made with an occupational therapist in Missouri inspired her to become an Occupational Therapist. This led her to the Medical University of South Caroline (MUSC) where she graduated in 2009 with a Master’s in Occupational Therapy.

Training for a spot on the USA Paralympic wheelchair tennis team to compete in the Beijing Paralympics 2008 was interrupted when the steel plates and screws that fused her spinal vertebrae together began to irritate. After further spinal surgery and several week’s recovery, the unstoppable Casteel was back in training with her coach, Crafton Dicus, and competing nationally. Becoming a member of the U.S. Tennis Association High Performance Wheelchair Tennis Team.

Wheelchair Tennis Paralympic Games

Now with the guidance of pioneering wheelchair tennis coach Chuck McCuen, striving to hold a place in the World Cup Team 30 year old Sarah Casteel, a world-ranked wheelchair tennis champion feels she has a shot at representing her country in the Paralympics Games in London 2012. With the formidable tenacity Sarah Casteel has approached life with and a mean top-spin backhand that could snap your head off, whether Sarah makes the Paralympic team or not she will continue to inspire as all.

Wheelchair service monitoring

Wheelchair Service Delivery

Part three of the provision of manual wheelchairs in  less resourced settings. Published with permission of the World Health Organization. This chapter covers the structural guidelines for wheelchair service delivery systems that provide and improve access to wheelchairs. The need to provide wheelchairs together with these related services is essential. Careful planning, management and sound strategies for wheelchair provision, as well as user instruction and care are needed to facilitate the important link between the user and the wheelchair.

We cover all stages of the service delivery process, from referral to assessment and prescription, funding, ordering, product preparation, fitting, user training and maintenance. Including discussion of the roles of those involved in wheelchair service delivery, from manufacturers and clinicians, to technical and training personnel. Recommendations are made on monitoring, how to obtain feedback from wheelchair users, and evaluating and analyzing information on wheelchair service delivery.

  • Manual wheelchair sourcing supply, manufacture, supply suggest strategies for introducing wheelchair service delivery.
  • Describe basic wheelchair service delivery.
  • Provide practice guidelines.
  • Suggest roles for the personnel involved.
  • Make recommendations on monitoring and evaluation.

Testimonial from a user in Romania, Ciprian is 25 years old and lives in Sfantu Gheorghe, Romania. Three years ago he became paraplegic after falling from a roof while at work and lost any hope that he would ever have a normal and active life again. Sometime after the accident, however, he heard about a local nongovernmental organization that provided support for users. Through the wheelchair service run by the organization, Ciprian received an active-style manual wheelchair that was fitted for him. He was also invited to participate in a peer group training camp. 

Once I got there I realized that I could have an independent life. Through the peer group training, I learnt to use my wheelchair very well. I also had the chance to talk with other users involved in the programme. At the end of the camp, I was asked if I would like to become a peer group trainer. Of course, I was very happy about this chance that had just been offered to me. In January 2006, I started my work as an instructor.
 
Through my wheelchair, and peer training, I have recovered the independence I thought I had lost because of the injury. In addition to my peer group training work, I take part in various competitions and sports activities for people in wheelchairs. Working with people with disabilities makes me feel that I am useful again and that I finally have a normal life after I had had such a hard time overcoming the health problems brought about by the injury. — Cipran of Romania

The purpose of these manual wheelchair service delivery guidelines is to improve the way in which users receive wheelchairs and to ensure that the wheelchairs are appropriate. The implementation of the recommendations in this chapter aim to see more success stories like Cipran come true. We begin with these basic principles: 

  • A greater number of wheelchair services.
  • Better knowledge of wheelchair service delivery among health care and social service workers.
  • Better service quality delivered by existing wheelchair services.
  • A greater number of appropriate wheelchairs provided to users.
  • A greater number of users able to make informed decisions about the most appropriate wheelchair for them.
  • A greater number of users and caregivers receiving training in the use and maintenance of wheelchairs and on how to stay healthy in a wheelchair.
  • Links between users and producers, leading to producers obtaining feedback on the wheelchairs they produce.
  • Coordinate efforts in the planning, implementation and support of wheelchair service delivery among stakeholders.

In the rehabilitation of a person with a spinal cord injury the provision of an appropriate wheelchair is critical. It is important that the wheelchair fits correctly and meets the user’s physical, functional and environmental needs as much as possible. This requires an approach that responds to individual needs. An effective way of meeting the individual needs of users is to promote the provision of wheelchairs through wheelchair services.

Wheelchair services provide the framework for assessing individual user needs, assist in selecting an appropriate wheelchair, train users and caregivers, and provide ongoing support and referral to other services where appropriate. In addition providers of wheelchair services will play a role in the following.

  • Awareness: disseminating basic information about the needs for and benefits of using a wheelchair (this can also be done by personnel involved in community-based rehabilitation, health and education programmes as well as by disabled people’s organizations) and convincing policy-makers about the benefits of investing in wheelchair provision rather than leaving people with disabilities to survive on charity.
  • Identification: using a screening tool to identify those who can benefit from available services.
  • Awareness of referral networks and suppliers: promoting the role of wheelchair services, including participation in activities aimed at educating referral networks and raising the awareness of suppliers and funding agencies regarding the role and importance of wheelchair services. 
  • Sustainability: developing sustainable financial solutions for the continuing provision of mobility equipment through wheelchair services.
  • Training: providing or supporting the training of wheelchair service personnel.
  • Standards: raising wheelchair standards within the country or region through being aware of current wheelchair availability and advocating for improvements in and a greater variety of wheelchair products.
  • Accessibility: supporting or facilitating the adaptation of homes (including toilets, furniture and fittings) and public buildings and places, and lobbying for a barrier-free environment.

Wheelchair Service Delivery Strategies

Wheelchair service delivery requires careful planning and management of resources. There are a number of strategies that can be employed to initiate or further develop wheelchair services. Provide wheelchairs together with services. There are different methods of wheelchair supply to meet the range of contexts in which users live. Whatever the method or structure chosen, it is important to at least deliver the essential wheelchair services.

Utilize existing personnel. It is not necessary to create a new profession to provide wheelchair services. With additional training, many health and rehabilitation personnel would be able to take on the duties required for basic wheelchair service delivery. For example, community health care workers, community-based rehabilitation workers, nurses, physiotherapists, occupational therapists, orthopedists and prosthetists could be trained to fulfil the clinical role in wheelchair services. Likewise, with additional training, skilled craftspeople, mechanics and orthotic and prosthetic technicians could fulfil the technical role.

Meet the needs of users at community level. Some aspects of wheelchair provision can be carried out in the community, through a network of community-based organizations (for example rehabilitation and health programmes) supported by a local wheelchair service delivery centre. The personnel of the community-based programmes could be trained by wheelchair service personnel in basic service delivery. This system of service delivery would best suit users who require a basic wheelchair, without modifications, postural support or pressure management care.

Users with more complex needs are likely to require the skills of personnel with greater training than can be provided to all community-level personnel. This need can be addressed by outreach services coordinated by the wheelchair service centre. If outreach services are not developed, these users would need to travel to the wheelchair service centre. However, once provided with an appropriate wheelchair, they may be supported by community-based personnel.

A wheelchair service can make use of the skills, technologies and capacities of local industries. For example, bicycle repair shops can also repair wheelchairs, and tubular furniture makers have the basic skills and knowledge to build wheelchairs.

Two Tier Wheelchair Service Approach

This shows a possible model of linking a wheelchair service centre with a number of community-based wheelchair services. To provide adequate support to the community-based centres, it may be necessary to first develop the wheelchair service centre. Alternatively, a collaborative effort between existing community based centres could work towards the development of the wheelchair service centre. In either case, the development process should be based on a needs assessment and other aspects of the local context.

The Wheelchair Service Delivery Centre

Characteristics: Centre-based. Facilities (possibly shared with existing health or rehabilitation services): clinical and user training facilities, workshop facilities. Staff: dedicated wheelchair service centre personnel trained to meet the needs of all users.

Key functions: Wheelchair service delivery for all users. Community outreach linking with community based wheelchair services and referral networks. Training, support and supervision of community based wheelchair services and personnel. Education of referral sources. Linking with education, employment and other key development sectors.

Community Based Wheelchair Services

Characteristics: Centre-based, with some wheelchair service delivery carried out entirely in the community. Facilities (shared with other community health and rehabilitation programmes): access to clinic, user training facilities, basic workshop facilities. Staff: community health and rehabilitation workers trained in basic wheelchair service delivery, supervised and supported by wheelchair service centre personnel.

Key functions: Wheelchair service delivery for users requiring basic wheelchairs without custom modifications or postural support components. Identification of users with complex needs, and referral to wheelchair service centre. Where appropriate, support of users with more complex needs for follow-up, maintenance and repair in the community. Support of accessibility, including adaptation of user’s environment such as wider doors and ramps.

Intergrating wheelchair service delivery with other departments can be established within existing rehabilitation services. Such services are already likely to have users accessing the service for health or rehabilitation needs. They would therefore already have much of the infrastructure required. Examples of rehabilitation services well suited to the integration of a wheelchair service include prosthetics and orthotics services and spinal injury centres.

Wheelchair service delivery could play a dual role, providing wheelchairs directly to users and supporting basic services in the community through partnerships with community-level programmes and organizations.

Stakeholders and Resources

Stakeholders directly involved in the planning, implementation and participation in service delivery include: 

  • Users and their families or caregivers.
  • Government authorities, including ministries responsible for health, social welfare and education and other relevant departments and local authorities.
  • Existing health and rehabilitation services (including referral networks) managed by governmental, private, nongovernmental, international nongovernmental or disabled people’s organizations.
  • Supporting organizations providing technical input or funding.
  • Rehabilitation personnel and their organizations.
  • Wheelchair service personnel.

The resources required to implement the recommendations include:

  • A reliable supply of wheelchairs that meet agreed standards.
  • Access to different types and sizes of wheelchair to meet the varied needs of individual users.
  • Personnel with training in wheelchair service delivery.
  • Facilities (which may be shared with existing rehabilitation or health services): clinical facilities providing sufficent space for assessment basic user training and storage of wheelchairs and workshop facilities particularly where modifications to wheelchairs are offered or support is provided.
  • Materials for wheelchair modifications and custom components.
  • Funding to support wheelchair service delivery (products and services).

Wheelchair Service Delivery Network

In Papua New Guinea, an estimated 50 000 people need a wheelchair. Throughout 2003 and 2004, governmental health and rehabilitation organizations and national and international nongovernmental organizations developed a strategy for wheelchair provision. As a result, a pilot wheelchair service network, closely linked to the existing health and rehabilitation services, was set up.

The wheelchair service delivery network consists of a “regional wheelchair service” supporting four “satellite wheelchair services”. The regional service is based at the National Orthotics and Prosthetics Service in Lae. At the regional service, technical personnel from the National Orthotics and Prosthetics Service team and physical therapy personnel from Lae’s Angau Hospital together carry out assessment, prescription, fitting, user training and follow-up. The National Orthotics and Prosthetics Service provides repair services for users. This mixture of clinical and technical facilities has made the setting up of the wheelchair service relatively easy, and the recent provision of dedicated premises for the service has given it a stronger identity.

Two of the satellite services are based in local hospitals, one in a local prosthetic unit and one in a local community based rehabilitation service. The community-based rehabilitation link with each service is strong. The community based rehabilitation networks provide excellent referral, and the personnel work with hospital-based personnel to provide users with a wheelchair.

Training in basic wheelchair service delivery for all of the clinical and technical personnel involved in the service network was provided over two weeks by the international nongovernmental organization Motivation. Further support for both clinical and technical personnel for one year was provided by a volunteer physiotherapist.

The network has the capacity to provide 25 wheelchairs per month. This is still not sufficient to meet the needs in Papua New Guinea. However, through the success of this pilot exercise in using existing services and personnel, much has been learnt about the role of wheelchair services. In future, all stakeholders are keen to see the establishment of more satellite services, as well as an increase in the capacity of the network to meet the needs of users with more complex needs.

Steps in Wheelchair Service Delivery

Wheelchair services are commonly delivered in a sequence of steps. A summary of eight (8) key steps typically involved in wheelchair service delivery are as follows:

  • Referral and appointment The system of referral will depend on existing services in the country. Users may self-refer or be referred through networks made up of governmental or nongovernmental health and rehabilitation workers or volunteers working at community, district or regional level. Some services may need to actively identify potential users if they are not already receiving any social or health care services or participating in school, work or community activities.
  • Assessment Each user requires an individual assessment, taking into account lifestyle, vocation, home environment and physical condition.
  • Prescription (selection) Using the information gained from the assessment, a wheelchair prescription is developed together with the user, family member or caregiver. The prescription details the selected wheelchair type, size, special features and modifications. Also detailed is the training the user needs to effectively use and maintain the wheelchair. 
  • Funding and ordering A funding source is identified and the wheelchair is ordered from stock held by the service or from the supplier.
  • Product preparation Trained personnel prepare the wheelchair for the initial fitting. Depending on the product and service facilities, this may include assembly, and possible modification, of products supplied by manufacturers or production of products in the service workshop.
  • Fitting The user tries the wheelchair. Final adjustments are made to ensure the wheelchair is correctly assembled and set up. If modifications or postural support components are required, additional fittings may be necessary.
  • User training The user and caregivers are instructed on how to safely and effectively use and maintain the wheelchair.
  • Follow-up, maintenance and repairs Follow-up appointments are an opportunity to check wheelchair fit and provide further training and support. The timing depends on the needs of the user and the other services that are available to them. The service may also offer maintenance and repairs for technical problems that cannot be easily solved in the community. It is appropriate to carry out follow-up activities at the community level as much as possible. If the wheelchair is found to be no longer appropriate, a new wheelchair needs to be supplied starting again from step 1.

Understanding Individual User Needs

When planning wheelchair service delivery, it is important to recognize that each user has a unique set of needs. These needs can be categorized as:

  • Physical: the user’s health situation and postural and functional needs.
  • Environmental: where users live and where they need to use the wheelchair.
  • Lifestyle: the things users need to do in the wheelchair to lead their chosen way of life.

Physical Needs. Some users will have a more complex mix of physical needs than others. Users with spinal cord injury, postural deformities, reduced skin sensation and problems with muscle tone (for example spasticity) will require an assessment conducted by personnel with appropriate skills and knowledge. These users will also require more frequent follow-up and support. Here we consider some postural needs of users related to their need for personnel skill and support:

Users of manual wheelchairs without modifications. Children or adults who can sit well without any postural deformities or abnormalities.

Needs: Mobility and postural support for comfort, function and the prevention of postural problems associated with permanent wheelchair use. Mobility and postural support provided through a well-fitted wheelchair and seat cushion.

Users of manual wheelchairs with supportive seating. Children or adults with mild to moderate postural deformities or tendencies. If unaddressed, these deformities will limit comfort, health and function.

Needs: Mobility and postural support to stabilize posture for comfort, function and prevention of further postural problems. Supportive seating provided through individual modifications to a basic wheelchair, or a specialized seating system.

Users of complex supportive seating and mobility equipment. Children or adults with complex, fixed postural deformities. Even with support, many cannot sit normally.

Needs: Mobility and individually prescribed and customized wheelchairs to provide postural support and accommodate fixed deformities. Increased need of skill and support and accommodate fixed deformities.

Environmental and lifestyle needs. These factors require consideration during the assessment. They will influence the choice of a wheelchair, based on performance characteristics, durability and other features. How many users require more than basic wheelchair provision?

In a survey of 147 users conducted at the Western Cape Rehabilitation Centre in South Africa in 2006, it was found that 58% of users required some form of wheelchair modification or basic postural support. Some 22% required complex postural support, while only 20% were able to use a basic manual wheelchair without any modification. A supervisory chief physiotherapist states:

Since our service began, we have found that many users need more than just a basic wheelchair. Many have deformities from living so long without a wheelchair and now need their wheelchair modified so that it fits them. We also have more and more children with cerebral palsy coming to us, and they need wheelchairs with extra postural support. — WCRC Chief Physiotherapist

Good Practice in Wheelchair Service Delivery

This section covers planning and initiating wheelchair service delivery and evaluating existing services. Recommendations are presented in nine areas: good practice in overall service and for each of the eight key steps in wheelchair service delivery. Good practice in wheelchair service delivery includes the following: 

  • Wheelchair services recognize users as clients of the service and adopt a “client-centred approach”. This means, inter alia,that: Users receive information about the process the wheelchair service will use to provide a wheelchair, and the rights and responsibilities of the user in this process. Users are actively involved as members of the service team in all steps leading to the provision of their wheelchair. Services actively collect feedback from users about their opinion of the service and how it may be improved.
  • The service is equally accessible to all users, regardless of gender, age, ethnicity, religion or social status.
  •  The service has personnel trained in its clinical, technical and training roles, who work closely with users to provide advice, assessment, prescription, fitting, training and follow-up.
  • The service has a designated service manager or coordinator.
  • A referral network is in place.
  • The service is well integrated with other rehabilitation and health services.
  • Services are knowledgeable about the range of wheelchairs available locally.
  • Services are able to offer more than one type of wheelchair, giving the user a choice based on the assessment.
  • Wheelchairs are sourced from a range of suppliers, including local and international, depending on their appropriateness and affordability.
  • Services carry out quality control to ensure that every wheelchair is assessed for safety before the user tries it and for safety and correct fit before each user leaves the workshop or rehabilitation centre with the wheelchair.
  • Repair services are available to provide continuing support to users.
  • Services identify local needs and measure their effectiveness in meeting these needs through regular monitoring and evaluation.
  • Services promote teamwork between clinical and technical personnel in providing service to users.

Referrals and Appointments

Objective: The objective of good practice in referrals and appointments is to ensure that users have equitable access to wheelchair service delivery, to increase the efficiency and productivity of the service, and to minimize waiting lists.

Referral System: This pertains to the way in which users access the service. This may be through “self-referral”, whereby users contact the service directly, or through a “referral network”, whereby users are referred by another organization.

Appointment System: This refers to the method of establishing appointment times with users for assessment and prescription, fitting, basic user training and follow-up. The most common method is to list appointment times in a service diary, which are then filled as users are referred. The benefits of an appointment system include reduced waiting times and increased work efficiency.

Waiting Lists: Where there is high demand for the wheelchair service, a waiting list will need to be established. Users on the waiting list can be offered an appointment as the service works through the list. The administration of appointments will depend on the context.

Good Practice in Appointment and Referral Systems

  • When a user is referred to the service, a file is established and an appointment is made or the user is put on the waiting list.
  • Services provide training for referral network personnel to increase their awareness of wheelchair service delivery and to show them how to refer users to the service.
  • Services develop and distribute a form for referral network agencies to complete when referring users.
  • Services use clear guidelines to prioritize appointments. This is particularly important where there are waiting lists. Examples of high-priority users include those with a terminal illness and those at risk of developing life-threatening secondary complications such as a pressure sores.
  • Services set targets and measure their performance in relation to the number of referrals, the length of time between referral and appointment, and reduction of waiting lists.
  • Services have a screening procedure to minimize the scheduling of inappropriate referrals.

Assessment

The objective of good assessment practice is to accurately assess the needs of each individual user in order to prescribe the most appropriate wheelchair available.

Every user requires an individual assessment, carried out by a person or persons with the appropriate skills. The assessment should be holistic, taking into account the lifestyle, living environment and physical condition of the user. It is important that the user and, if appropriate, the family are fully involved in the assessment. Depending on the complexity of the needs, an assessment can take up to two (2) hours.

  • Assessments are carried out in a private, quiet and clean space. This may be a dedicated space within the wheelchair service, at another health care or community facility, or at the user’s home.
  • Assessments are carried out by trained personnel. Culture, age and gender sensitivity while carrying out assessments increases credibility and acceptability.
  • Equipment for the assessment is readily available, including an assessment bed (plinth, mat, table), measuring tape, device for measuring angles (goniometer), foot blocks and infection control supplies.
  • Assessment takes into consideration the user’s physical condition; home, school, work and other environments where the wheelchair is used; lifestyle; size and age.
  • Assessments are clearly documented on an assessment form and filed for future reference.
  • Where a service is unable to meet the user’s needs owing to the lack of an appropriate product or personnel with sufficient skills, the service either; refers the users to another service that is staffed and equipped to service the user, hosts outreach visits of more qualified personnel or, documents the user’s needs to help build a picture of unmet need to guide future service development.

Prescription

The objective of good prescription practice is to match the needs of the user, as identified through the assessment, with the most suitable wheelchair available. Wheelchairs need to be available in different types and sizes and with different options. The prescription (or selection) represents the process of matching the needs of the user with the most suitable available wheelchair. The completed prescription form is a full description of the wheelchair required and selected by the individual user.

  • Users are given the opportunity to see and, where possible, try samples of wheelchairs, cushions and postural support components. This assists users and personnel together in selecting a wheelchair and the necessary features.
  • The importance of features is prioritized to help to make the most appropriate choice from what may be a limited range of available wheelchairs.
  • Each wheelchair prescription is documented, either on the assessment form or on a dedicated prescription form. The prescription details; the type and size of wheelchair, any additional components required (for example pressure-relief seat cushion), any modifications or custom comments required and, the information or skills the user needs to know, or be able to perform, before leaving the service with a new wheelchair.
  • Wheelchair service personnel are given time to write up assessment and prescription notes immediately after each appointment.
  • Services give users an estimate of when their wheelchair will be ready (depending on funding, see below). Where possible, an appointment for the user’s fitting is made at the time the prescription is made.

Funding and Ordering

Objective: The objective of good practice in funding and ordering is to order or procure the selected wheelchair for the user, as early as possible.

Funding: Following prescription, it is possible to closely estimate the cost of the product being recommended. For most services, it will be essential to ensure a funding source has been identified before an order can be placed for equipment. Wherever possible, this should be in the hands of administrative rather than clinical or technical personnel.

Ordering: When not in stock, wheelchairs need to be ordered from an external supplier or procured from the wheelchair service workshop, which usually maintains a stock of different sizes and types of wheelchair.

  • If a wheelchair is not immediately available, services inform the user when the wheelchair will be ready for fitting.
  • Services maintain a stock of wheelchairs and components to ensure faster delivery times.
  • Services encourage suppliers to develop clear order forms and procedures.
  • Services agree with suppliers on delivery times and aim to minimize delays.
  • Services ensure ordering is completed within two working days of completing the user’s prescription, provided that funding is in place.
  • Services have a system in place to monitor pending orders from suppliers.
  • Services have a system for providing feedback to suppliers about quality issues.

Product Preparation

The objective of good practice in product preparation is to prepare the wheelchair for the fitting, including modifications or custom postural support components. Good practice in product preparation include:

  • Each wheelchair being prepared is labelled with the user’s name and a serial number or bar code.
  • Modifications to wheelchairs (permanently altering the frame or a component of the wheelchair) are carried out only by personnel with the appropriate knowledge and skills, since any such modification may have structural and functional implications.
  • The production and installation of custom seating systems or individual postural support components should be carried out by personnel with the appropriate knowledge and skills. This work should also be done in close collaboration with the assessment personnel.
  • All mobility equipment is checked for quality and safety before the user tries it.

Fitting

The objective of good practice in fitting is to ensure that the selected wheelchair has been correctly assembled and to make final adjustments to ensure the best fit. Fitting is a critical step. At the fitting, the user and clinical and technical personnel ensure that the wheelchair fits correctly and supports the user as intended. A fitting may take between 30 minutes and 2 hours or more, depending on the complexity. During fitting, the user and competent personnel together check that:

  • The wheelchair is the correct size.
  • The wheelchair is correctly adjusted for the user.
  • Any modifications or postural support components are fitting correctly.
  • The wheelchair meets the user’s mobility and postural support needs and minimizes the risk of the user developing secondary deformities or complications.
  • All users have their wheelchair individually fitted by personnel trained to do so.
  • Whenever possible, fitting is carried out by the same personnel that assessed the user.
  • The fit of the wheelchair (including any seating or postural components) is first assessed with the user sitting in the stationary wheelchair. When the fit is acceptable, it is then further assessed while the user self propels or is pushed.
  • If the wheelchair fit is not acceptable, further adjustments are made. If an acceptable fit cannot be achieved, alternative equipment or a reassessment may be necessary. The wheelchair cannot be provided to the user until the fit is acceptable.
  • There is provision for more than one fitting appointment for users with more complex needs, such as those with postural deformities.

Training of Users Families and Caregivers

The objective of good practice in training is to ensure that all users are given the information and training they need to be able to use their wheelchair safely and effectively. Key areas of training include:

  • How to transfer in and out of the wheelchair.
  • How to handle the wheelchair.
  • Basic wheelchair mobility.
  • How to stay healthy in the wheelchair, for example prevention of pressure sores.
  • How to look after the wheelchair and cushion and, if appropriate, dismantle and reassemble the wheelchair.
  • Who to contact in case of problems.
  • A user training checklist is completed together with the user, covering the skills the user needs to have in order of priority. The checklist is used by the trainer, and as each skill is taught and demonstrated by the user it is checked off.
  • Where possible, peer trainers (active users with strong wheelchair skills and training in how to teach and support other users) provide basic user training, with supervision by clinical personnel.
  • Wheelchair services link closely with any user groups in the community, providing peer training to strengthen training given at the service.
  • Written or visual materials, including pamphlets or posters in local languages, are used to assist the training of users.

Follow-up Maintenance and Repair

The objective of good practice in follow-up, maintenance and repair is to evaluate the effectiveness of the wheelchair in maximizing the user’s functioning, comfort and stability, and to ensure that the equipment has been maintained appropriately and is in good condition. Follow-up should include a review of:

  • How well the wheelchair has worked for the user.
  • Any problems the user has had in using the wheelchair.
  • The wheelchair’s fit, in particular checking that the wheelchair is providing good postural support for the user.
  • The user’s skills, and whether further training is required.
  • The condition of the wheelchair and whether any adjustments or repairs are required.
  • The user’s ability to care for and maintain the wheelchair, and whether any further training is required.

The frequency of follow-up will depend on the individual needs of the user. Some users should be followed up more frequently than others. As a guide, follow-up appointments are usually made within six months of receiving a wheelchair. Basic wheelchair repair work can often be done locally at bicycle or car repair workshops.

  • Whenever possible, all members of the wheelchair service team are involved in follow-up appointments. This includes clinical, technical and training personnel.
  • The frequency of follow-up is determined by the individual needs of the users.
  • Follow up appointments are given as a priority to users in the following categories: children (whose needs change as quick as they grow), users at risk of developing pressure sores, users who have a wheelchair with postural support modifications or additions, users or family members or carers who have difficulty following the basic training given at the service.
  • Services use follow-up appointments as an opportunity to gather feedback from the user to help evaluate the quality of the service provided.

Manufacturers or Suppliers

Wheelchair services usually receive wheelchairs from manufacturers or suppliers. The scope of these guidelines does not allow a discussion of all production and supply personnel, but a few points are made here concerning managers and technical production personnel.

Management: As well as day-to-day management, managers of wheelchair production facilities are responsible for design selection and production quality. It is therefore important that managers receive feedback from users and wheelchair services about how well their wheelchairs meet their needs.

Technical production personnel: Technical production personnel are concerned with the technical side of wheelchair production. They are not necessarily involved in the fitting or modification of wheelchairs for individual users. This differs from technical personnel in wheelchair services, who are involved in the assembly, modification and fitting of wheelchairs for specific individuals. Nevertheless, some technical personnel, typically those in smaller workshops, may be involved in both the manufacture and fitting of wheelchairs. The term “technical production personnel” as used in these guidelines is limited to wheelchair manufacturers and does not include the provision of services to individual users.

Referral Networks

Referral networks play a crucial role in wheelchair service delivery. Well-functioning referral networks help to ensure services are accessible to users. Referral networks may consist of health and rehabilitation personnel or volunteers working at community, district or regional level.

The importance of a strong link between specialist services and rehabilitation or health care programmes is stressed in a joint statement of the International Society for Prosthetics and Orthotics and the World Health Organization.

Wheelchair services are an example of a specialized service that cannot always be fully provided within every community. In developing countries, the majority of those people with disabilities live in rural areas and find it difficult to access rehabilitation services, which are often restricted to large cities. Health and rehabilitation workers therefore need to play a proactive role in ensuring that people living in rural areas can also access wheelchair services without difficulty. The role of referral networks in wheelchair service delivery can include:

  • Identifying and referring people requiring wheelchairs.
  • Liaising between the users, their families and the wheelchair services to facilitate assessment, fitting and follow-up.
  • Reinforcing wheelchair service training such as pressure sore prevention, prevention of secondary complications, wheelchair maintenance and mobility skills.
  • Providing support, advice and possibly assistance in adapting the user’s home environment.
  • Encouraging measures to facilitate accessibility in the community.
  • Providing information to the wheelchair services about the acceptability and use of prescribed wheelchairs.
  • Assisting the user to arrange repairs.
  • Promoting the benefits of wheelchairs.

Wheelchair Service Delivery Personnel Roles

Wheelchair service personnel carry out managerial, clinical, technical and training duties. These roles may be fulfilled by personnel from a range of training and educational backgrounds. They may also overlap: in a small service, for example, one person could carry out both the clinical and technical roles. In another scenario, one person could carry out the clinical, training and management roles with the support of a part-time technician.

At times, particularly when working with users who have complex needs, personnel may draw on the expertise of other specialists such as occupational therapists, physiotherapists, speech and language therapists, paediatricians, neurologists, physiatrists, orthotists, prosthetists and orthopaedic specialists.

Management Role: For a wheelchair service to operate effectively, a designated manager is critical. The manager ensures a framework is in place to enable the wheelchair service to operate. This includes adequate staffing, facilities, funding, products, referrals and appointment systems. Managers also play a key role in promoting wheelchair services. The manager therefore requires a thorough understanding of wheelchair service delivery in addition to general management skills. The duties of wheelchair service managers should include.

  • Building awareness of wheelchair service delivery among all stakeholders.
  • Developing a referral network through promotion of the wheelchair service and its functions.
  • Organizing training opportunities for referral network personnel.
  • Ensuring the service is accessible to all users within the service area, including women, children and minority groups.
  • Managing waiting lists.
  • Identifying and securing sources of funding to support the service.
  • Facilitating the development and training of service personnel.
  • Evaluating the effectiveness of the service in meeting users’ needs.
  • Continuously improving service quality.
  • Developing links with disabled people’s organizations and community-based rehabilitation programmes.
  • Asssisting in the formation of wheelchair users’s groups.

Clinical Role: Clinical personnel work directly with the user in assessment, prescription, fitting and follow-up. Ideally, the clinical personnel work closely with technical personnel, particularly on prescription and fitting. The main duties of clinical personnel include:

  • Wheelchair service delivery, following the eight-step process listed earlier.
  • Quality control to ensure equipment is adjusted correctly and is safe for each user.
  • Training users in mobility and health issues, or supervision of such training provided by a trainer.
  • Follow-up with users to ensure that equipment continues to be appropriate to their needs.
  • Record keeping and documentation.
  • Education of referral network personnel.
  • Keeping up to date with the range of available wheelchairs.
  • Participation in overall service evaluation.

Technical Role: Technical personnel ensure that the technical requirements of the prescription are met through the correct assembly or modification of the wheelchair. Technical personnel have direct contact with users, at least in the prescription and fitting stages. When working with a user who requires modifications or postural support, it is increasingly important that technical personnel are directly involved in the user’s assessment, fitting and follow-up. The main duties of technical personnel include:

  • Assembling or preparing wheelchairs according to prescription.
  • Making or assembling modifications or custom postural support.
  • Training users in wheelchair maintenance and basic repair, or supervising such training provided by a trainer.
  • Ensuring that each wheelchair and any modifications are technically safe before each fitting and before the user leaves the service with the new equipment.
  • Keeping records and documentation.
  • Following up users to ensure equipment continues to be appropriate.
  • Facilitating maintenance and repairs of wheelchairs and associated equipment.
  • Participating in overall service evaluation.

Training Role: One of the key steps in wheelchair service delivery is basic skills training for wheelchair users. The bulk of the training may be fulfilled by clinical or technical personnel or by dedicated trainers. They also provide users with the necessary advice on maintaining their wheelchair. Experienced, well trained wheelchair users (“peer trainers”) are useful in training other users.

Provided with the right resources and training, peer trainers may have some advantages over trainers who are not users. Such advantages include an ability to empathize and to draw on first-hand experience. For those receiving a wheelchair for the first time, there is added value in training given by a peer trainer. By working with peer trainers, users are better able to recognize their own potential. The main duties of trainers include:

  • Training users and caregivers, individually or as a group, in: transferal in and out of the wheelchair, wheelchair handling, basic wheelchair mobility, health issues specific to wheelchair use (pressure sore prevention, etc.), wheelchair maintenance.
  • Participating in routine and more intensive follow-up for those users at risk, or who require additional training and support.
  • Educating referral network personnel.
  • Participating in service evaluation, focusing on the needs of users.

In addition, trainers could become involved in: 

  • Activities to promote the wheelchair service.
  • Liaison with disabled people’s organizations and community-based organizations.
  • Referral of users to relevant community programmes such as disabled people’s organizations, vocational schemes and peer group training.

For 11 years now, the Motivation Romania Foundation (MRF) based in Bucharest has provided peer training. The MRF wheelchair service and peer training programme is based on the principle that all wheelchair recipients should undergo peer training (including, but not limited to, wheelchair skills) to maximize their independence. The peer training team currently consists of four users and a physiotherapist. Each year, some 160 users access the peer training programme, which includes:

  • Training in wheelchair skills
  • Individual and group discussions, in which users can talk about the challenges they have faced and try to find solutions together.
  • Provision of information, for example about dealing with health problems.
  • Participation in sports and social activities to facilitate the development of outgoing, people-oriented attitudes and prevent isolation.

Peer training is carried out at the MRF centre and through regular peer training camps. Peer trainers are recruited from among former recipients of peer training. They receive training in teaching and counselling from experienced peer group trainers, thus enabling them to take on the role themselves.

The costs of the peer training programme are covered by the Romanian Ministry of Labour and Social Protection, the National Authority for People with Disabilities, and national and international donors. 

An overview of the clinical, technical, training and management duties of wheelchair service personnel. 

Overview of the duties of wheelchair service personnel

Monitoring and Evaluation

The need to measure performance. Monitoring and evaluation of a wheelchair service can help identify those areas that are successful and those that can be improved. Monitoring is the regular ongoing collection and analysis of information to track the quality and effectiveness of the wheelchair service. Evaluation refers to an overall evaluation, usually conducted over a short period of time. Evaluations are often carried out annually or sometimes biannually.

Information gained through regular monitoring is often used as part of an overall evaluation. It is recommended that services establish a system for regularly monitoring the service, and conduct annual overall evaluations to assess service performance and impact. Monitoring and evaluation can provide important information that enables services to:

  • Improve the quality of services and products.
  • Improve service processes such as referral, appointments and follow-up.
  • Contain costs by increasing efficiency.
  • Demonstrate the benefits of wheelchair service delivery for users.
  • Demonstrate the effectiveness of the service.
  • Identify and quantify unmet needs.
  • Plan further development of the service.
  • Allocate resources appropriately.
  • Justify current and proposed service funding.
  • Develop stronger partnerships with service recipients.
  • Enhance credibility and funding opportunities. 

Monitoring

Regular monitoring can be established as follows:

  1. Identify the areas and activities of the service that should be routinely monitored. Examples are the rate of referrals, waiting times, the number of users receiving wheelchairs, the types of wheelchair prescribed, the number of follow-ups and the level of user satisfaction.
  2. Set “performance targets” for these areas and activities. A performance target is a statement of how well the service would like to perform in that area. This may often be linked to funding. For example, funding may have been provided to the service based on agreed objectives or targets. Performance targets should be realistic, taking into account the resources available.
  3. Identify the information that needs to be collected in order to be able to monitor service performance for each area – and how it will be collected. Ideally, gathering information should be part of the service’s normal record keeping, and should thus require very little additional work by service personnel.

Now we visit an example of service areas that could be monitored, performance targets, and ways to collect information for each service area. It is important to note that the performance targets are examples only; actual targets need to be worked out according to the resources available to each service. Examples of service areas that could be monitored, performance targets, and ways of collecting information:

Wheelchair service monitoring

Feedback from users: In addition to the routine collection of monitoring information, it is recommended that services establish methods of regularly gathering feedback from users and their families. There are several ways in which such feedback can be gathered.

  • A few questions about the service can be formulated and put to users after they have received their wheelchair.
  • A short questionnaire can be developed, asking users for their thoughts on the performance of the service. This could be offered to every user or to a specified number of randomly selected users each month.
  • Users can be encouraged to write down their impressions of the service and post them in a “feedback box”. Feedback can be anonymous, thus allowing people to feel more comfortable about providing honest feedback. It is important to note that this type of system is open only to those with a sufficient level of literacy, and should therefore not be the only method used to gather feedback.

Analysing the collected information. The information collected through regular monitoring and user feedback will be most useful if it can be centrally stored and organized. A basic database can be very useful for this where computers and personnel are available. Alternatively, information can be organized and analyzed manually.

Once information is organized, it is possible to measure how the service is performing against the performance targets. A regular analysis of information can be used to identify problems and action can be implemented to solve the problems. For example, if fewer referrals than expected are being received, a service may choose to contact all referral sources to remind them about the service or offer additional training.

Evaluation

An overall evaluation is more comprehensive than ongoing monitoring. An evaluation provides an overview, highlighting the service’s strengths and weaknesses. Previous evaluation reports can be used as a basis for subsequent evaluations.

Service evaluations can be carried out externally or internally. An external evaluation involves having one or more people from outside of the service carrying out the evaluation. This can be useful, as external evaluators will view the service from a different perspective. Internal evaluations can be carried out by one or more personnel who have been designated the responsibility to gather and analyse the necessary information. The use of computers in data collection, programme monitoring and follow-up will facilitate the evaluation of service provision.

Suggestions for gathering evaluation information for some key service areas. 

Quality of service delivery. The good practice recommendations made in Section 3.3 of these guidelines can be used as criteria to assist in evaluating the quality of service delivery.

Users served and the intervention they received. Information from ongoing monitoring should enable evaluators to quantify the number of users provided with a wheelchair, training and follow-up; the different types of wheelchair provided; and the number of users with needs that could not be met by the service. A thorough evaluation would also include information on users accessing the service, including age, gender, ethnicity, disability and home location.

Cost of service, including cost of products and service delivery. Information from ongoing monitoring should enable evaluators to review and summarize the cost of the service. An audit of accounts may also be used to determine the cost of products and services.

Staffing, numbers of personnel and their roles and competences. Evaluators can assess numbers and roles of personnel by talking to service management or reviewing personnel records. Staff competences can be assessed by observing personnel carrying out their duties. Good practice recommendations=, the personnel roles, and the clinical competences, are criteria to assist in evaluating personnel competence. Staff educational records should be reviewed to help determine competences and professional development. Feedback from users and individual interviews with personnel can help to identify strengths and weaknesses in the staffing structure.

Facilities and equipment available to the service. Evaluators can assess the suitability of facilities and equipment by observing the service in practice. Feedback from users and individual interviews with personnel can help to identify any strengths and weaknesses in service facilities.

Impact on users and their families. Information may be gathered from users and their families on the impact of the service. Measures can include increased participation in family or community activities (for example education, employment in or outside of the home, participation in social activities) and increased earning potential of wheelchair users or their families. Methods of gathering information include the following:

  • Evaluators may review assessment and follow-up forms. Assessment forms can provide information about users and their families before they receive a wheelchair through the service. Follow-up reports can provide information about how the service has affected the lives of the user and his/her family. 
  • Home visits will enable evaluators to meet the users of the service and see for themselves what impact there has been. Home visits may provide additional information not gained through a follow-up appointment carried out at the service. 
  • A detailed survey may be developed to assess the service impact on the quality of life of users, including participation in school, employment and other activities.
  • Users (and family members) may be gathered as a focus group to provide evaluators with information about how they believe the service has affected them.

Conclusions

Wheelchairs need to be provided together with services. Existing rehabilitation personnel can be utilized to provide wheelchair services. Integrating wheelchair services with existing health or rehabilitation services is recommended. Where possible, the needs of users should be met at community level. Wheelchair services facilitate the assessment of individual user needs, provide an appropriate wheelchair, train users and caregivers, and provide ongoing support and referral to other services.

Each user has a unique set of physical, environmental and lifestyle needs. Groups of personnel involved in wheelchair service delivery include manufacturers and suppliers, referral networks and service personnel. The main roles of service personnel are managerial, clinical, technical and educational. Peer trainers play an important role in wheelchair provision. Wheelchair provision should be regularly monitored and evaluated, especially in helping to identify those areas that are successful and those that need to be improved.

Resources

  1. Rushman C, Shangali HG.Wheelchair service guide for low-income countries. Moshi, Tanzanian Training Centre for Orthopaedic Technology, Tumani University, 2005.
  2. Sheldon S, Jacobs NA, eds. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bangalore, India, 6–11 November 2006. Copenhagen, International Society for Prosthetics and Orthotics, 2007 http://homepage.mac.com/eaglesmoon/WheelchairCC/WheelchairReport_Jan08.pdf, accessed 8 March 2008).
  3. McCambridge M. Coordinating wheelchair provision in developing countries. In: Proceedings of the RESNA 2000 Annual Conference: Technology for the New Millennium, Orlando, Florida, 28 June – 2 July 2000. Atlanta, GA, RESNA, 2000:234–236. 
  4. The manual wheelchair and its use. Stockholm, Swedish Institute of Assistive Technology, 1990 (In Swedish).
  5. Oderud T. Design. In: Report of a Consensus Conference on Wheelchairs for Developing Countries, Bangalore, India, 6–11 November 2006. Copenhagen, International Society for Prosthetics and Orthotics, 2007. 
  6. The relationship between prosthetics and orthotics and community-based rehabilitation. A joint ISPO/WHO statement. Copenhagen/Geneva, ISPO/WHO, 2003 http://www.who.int/disabilities/technology/po_services_cbr.pdf, accessed 10 March 2008).
  7. Helander E. Prejudice and dignity: An introduction to community based rehabilitation, 2nd ed. New York, United Nations Development Programme, 1999
  8. Empowering the rural disabled in Asia and the Pacific. Rome, Food and Agriculture Organization of the United Nations, 1999 http://www.fao.org/sd/PPdirect/PPre0035.htm, accessed 10 March 2008).

 

Dating Paraplegic Girls

Dating Paraplegic Girls

This is the story of how I met Jeff and our first date together.  Dating paraplegic girls isn’t for everyone.  Jeff doesn’t seem to mind dating paraplegic girls or that I’m handicapped.  We have really hit it off.  I still can’t believe, if I wasn’t running late for work that day, we may have never met.  Being in a rush, I decided to go in my wheelchair, without the leg braces I usually wear.  I am a paraplegic, paralyzed from just above my waist down to my feet.  I have been a paraplegic since I was a little girl.  I’ve really never known anything different.

My legs are very thin and flaccid, but I still think of myself as attractive, even sexy.  I’ve have long flowing hair over a pretty face and large breasts over a tiny waist.  My ample breasts are my best feature so I like to show them off a little with a tight blouse.  Most men say I’m attractive but are not interested in dating paraplegic girls or dating wheelchair girls in general.  I guess it’s just hard for some men to commit to a relationship with a handicapped girl. Most of the reasons I have been given for not dating paraplegic girls are based on false beliefs.

Wheelchair Friendly Workplace

I work in a big wheelchair friendly office building where I have to go from room to room a lot. About a year ago I started wearing long leg braces and using crutches to maneuver around the building. It’s much easier than getting a wheelchair through crowded hallways and elevators. The braces start at the tops of my thighs and go down to knee locks so I can bend my legs if I’m sitting. From there they go down to my ankles where I can attach any number of shoes I like to wear.

I have all kinds of shoes from athletic shoes to sandals for the summer.  My favorites though are the high heels I wear at work.  I have all kinds, mostly around three inch.  My right leg is also a little shorter than my left one, another part of my disability.  My right leg just stopped growing when I was about 13 and my left leg continued to grow until I was about 17.  It’s really not that much difference, but to make up for it most of my shoes have a built-up sole on the right side, and are one size smaller since that foot is smaller.

Why Use a Wheelchair Leg Braces and Crutches

dating disabled girls in wheelchair crutches and leg braces

Dating disabled girls leg braces

I’ve learned to use my leg braces pretty well and walk with a swing through gait. That means I put both forearm crutches out in front of me and swing both legs through the middle.  Since I don’t have any control of my waist or legs my shorter right leg kind of swings first and my left drags the floor just a little as it swings through.  Wearing leg braces under slacks is difficult.  I am used to people staring at my legs as I am almost always in a skirt or dress.  Once it would have made me uncomfortable.  Now I even like to show the leg braces off a little.  Sometimes my skirts barely cover the thigh straps on the tops of my braces.

I’ve become used to wearing pantyhose too which I never used to do.  Without the pantyhose, the pads on the braces rub my legs too much.  But that day I was just in my wheelchair wearing a little skirt just above my knees.  The blouse was a little on the tight side with pantyhose and my two inch platform style heels.  Getting around in my leg braces on crutches is slow and I’ve fallen many times.  My wheelchair is safer and faster but I cannot stand up to reach things without the leg braces. So I mostly use both wheelchair and leg braces together. Guys into dating paraplegic girls are often into stockings and pantyhose as well.

Meeting Paraplegic Girls

When I use my wheelchair I don’t need a pair of shoes with a build-up.  There’s no reason to and it’s hardly noticeable.  The footrests on my chair are in the middle and close together. The right footrest plate is just a little higher to make up the difference in my leg length.  I was on the way to the file room when I took a corner too fast and actually ran into this very handsome man in a suit.  I was so embarrassed!  Not so much because I ran into him, but when I did, my right foot actually came off the footrest, knocking my shoe off.

Not having any feeling in my legs or feet I didn’t know my shoe was off until I noticed the man kept looking down.  I looked too and could see the pink polish on my toenails through my tan pantyhose.  Now most everyone has seen my legs of course, but I realized at that moment no one at work has ever seen my bare feet.  They are so limp and thin. I was really was embarrassed. This man had to see me pick my leg up with my hands and get my foot back on the footrest of the wheelchair.

I’ve noticed before that people like to stare.  Especially men dating paraplegic girls.  They like to see how a handicapped girl moves her legs with her hands getting out of a car, and things like that.  Sometimes, when I know I have an audience, I put on a little show.  I struggle a little more than I really have to.  Not this time.  After the man noticed my red face, he quickly looked away, fumbling around reaching for my shoe.  He handed the shoe to me awkwardly.  He looked so cute now blushing just as much as I was.  I thanked him and pulled my leg up by lifting under one knee.  This makes my foot point down. I hooked my toes with the shoe and pulled it onto the heel of my foot.  He introduced himself as Jeff. We both made our apologies and started talking about where we were going, what our jobs were, who we knew and things like that.

Somehow we got on the subject of baseball. Jeff asked me if would like to watch the game that night with him at a bar a few blocks from the office.  I really didn’t know what to say at first.  I would love to go on a date with this handsome, polite man.  But I get so nervous on first dates.  I’m also very cautious of guys only interested in dating paraplegic girls.  Being in a wheelchair we are a bit more vulnerable.  I always feel like my disability is just hanging out there.  Like, I know men new to dating paraplegic girls, want to ask me about my disability.  But if I start offering information about my disability, or ask them about dating paraplegic girls, they seem to get uncomfortable.  So I took a chance and just said yes.  That I would like to see him after work.  We made a meeting place and parted ways for the afternoon.

I am having a very hard time of going from one end of the desirable scale to the other virtually overnight. My ego is shot to bits as I am constantly passed over. Imagine having someone hounding you to get together but they have failed to read the profile. When they finally learn I am in a wheelchair they suddenly do a fast reverse as they run for the hills. The reality of the situation is I am still able to do most everything I did before. I downhill ski, enjoy my water access only cottage, I drive my car, I work. I still crave all the emotional and physical needs we all want. – Little Lady 57, on dating paraplegic girls.

Dating Paraplegic Girls Vulnerable to Insecurities

dating paraplegic girls in wheelchairs

Dating paraplegic girls in wheelchairs

That evening, we met as expected and walked, well I wheeled, down to the bar for a few drinks.  Nothing serious just good conversation and all to soon I was home.  It wasn’t even dark!  Walking me to my car I couldn’t help but think he didn’t like me.  My disability was a turn-off.  Oh well, just another guy not interested in dating paraplegic girls I thought.  I tried to push all my insecurities to the back of my mind.  Just then, he asked me how I came to be in a wheelchair.  Jeff confided that he had noticed me around the office but only knew me as, “the girl who wears leg braces.”  I was greatly relieved when he told me he thought I was sexy.  He had wanted to approach me many times but was too shy to talk.  He said he knew nothing about dating paraplegic girls.

Back at my car Jeff offered to help me get in.  Of course I told him I could manage as I did it every day.  We made plans for dinner the next evening.  He pecked me on the cheek and walked away to where his car was parked.  I slid my butt into the seat of my Volvo and put my legs in one at a time.  My car has hand controls and a wheelchair lift that keeps the chair over the roof.  I don’t have to get the wheelchair into the car after I get in it.

Intensions Dating Paraplegic Girls

Our dinner date the next evening couldn’t come fast enough.  He dropped by my office around lunch on his way to a meeting to say hi and to make sure he was still picking me up at 7:30.  That day I was in my wheelchair wearing my leg braces as usual.  I couldn’t help but notice his glancing eyes when he came in my office.  I was wearing a longer skirt, around mid-calf, so he could only see a little of my braces and my black three inch high heels. I was still curious about his exact intension dating paraplegic girls.

Jeff asked if I would be “walking or riding” that night (meaning was I going to be using my braces or wheelchair).  We shared a laugh at his cleverness and I asked which would he prefer.  He told me he was interested in seeing me use my leg braces.  Admitting he had no experience dating paraplegic girls. He had never been out with a disabled woman before, only regular girls.  That was exactly what I needed to hear. I immediately thought, I have just the outfit for you handsome.  Again feeling aroused at the thought of him wanting to see me.  Before I got to wet I eagerly agreed to use the leg braces and he went on to his meeting.

Shower and Dressing Handicapped Style

That evening when I arrived home I bathed myself in the shower. I have a special shower chair just for bathing.  Most mobility handicapped folks use one.  It stays in the shower. I transfer from my wheelchair into it and back out again.  Sitting on just a towel, naked in my wheelchair, I dried my hair and my upper body.  Then I pulled each leg up to my lap and dried them off.  I put on some makeup and teased my hair then went to dress.  First I needed just the right bra.  A sexy bustier to push my breasts up would work.  Skimpy and lingerie like enough to be inviting. If Jeff proves okay with dating paraplegic girls, he would be getting to see a whole lot more of me, than on our first date.

[nggtags gallery=bra]

I went with a silky, dark purple bra with black lace over most of the cup.  The mirror over my dresser told me with a close look you could actually see my nipples through the lace.  My nipples hardened as my thoughts drifted off to my date seeing me in my delicate bra.  I smiled taking panties that matched the bra and a pair of tan pantyhose from my dresser and wheeled to my bed.  Shifted my butt to the bed and pulled my legs up behind me.  One foot at a time through the panties and up my legs got them to the tops of my thighs.  I bunched up the waistband and with a quick bum hop motion slid my bottom into my panties.

The pantyhose were next.  Still sitting up with my lifeless paralyzed legs out in front of me, I pulled one leg up to my chest.  Bunching up one leg of the hose, I worked it over my small foot and over my ankle.  By letting my leg fall back into place, I pulled the nylon up along my leg to around my knee, and repeated the process with the other leg.  I straightened the hose around my feet and calves, making it a little tighter.  Then I worked the hose up my legs and to my thighs just like the panties. A tip for any guys dating paraplegic girls. We go to a lot of trouble to look nice for you, be sure to compliment us.

With the pantyhose, I have to lay back on the bed and kind of lift my bottom as I pull the hose to my waist.  I’ve known other paraplegics my whole life, and just about all of them find it easier to wear thigh-high hose, so they only have to worry about dressing one leg at a time.  My problem is my legs are so thin around my thighs. Those type of hose would actually end up sliding down my legs before I made it to my car.  My legs just aren’t big enough to hold them up, so the full pantyhose are my only choice.

[nggtags gallery=pantyhose]

I rolled over to the side of the bed and picked up both leg braces, laying them on the bed beside my legs.  Using one hand, I lifted my leg from just above my ankle.  I could feel the pantyhose under my hand.  I wondered what it felt like for a woman that could feel her legs.  Wonder what it would feel like to have your legs wrapped in pantyhose.  Feeling them rub against each other under your skirt, or what pantyhose felt like over your feet.  I guess I’ll never know. I just enjoy the feeling that comes from my hand.  I took my other hand and laid the leg brace under my leg. Where I could place my leg in the shiny steel cradle of the brace.  The strap under my knee gets tightened first, then above my knee, then my thigh strap.

I do the same with my right leg, lifting the leg into the brace and fastening the straps tightly on my legs.  I still can’t walk with the braces yet because I don’t keep any shoes attached to the braces.  I unlock the knees so my legs will bend and slide myself back to my waiting wheelchair.  I can lift my legs now using my hands on the braces, so I lift them one at a time into the footrests of the chair and go to my shoes.  The dress I’ll be wearing is a cute one piece black one, so my black pumps would probably look best.  I place the shoes in my lap, now it’s back to the bed.  Once in the bed, knees still unlocked, I pull each leg up so I can reach my foot, still naked in its nylon.

My shoes have to be tight to support my weight with the braces so it’s a little hard getting them on.  Putting a high heel shoe onto a foot that you can’t stiffen is not an easy task.  So with a little work I get the shoes onto my feet and attach them to the braces.  Now lowering my legs to the floor, I lock the leg braces straight and reach for my crutches.  Standing, slowly at first to keep my balance, I begin to take my first swinging step to my closet.  I’ve been using these leg braces for a year now, and I still can’t believe how stiff they keep my paralyzed legs. 

[nggtags gallery=leg-braces]

After spending 28 years not being able to walk, sometimes I can’t actually believe it’s my legs I’m standing on. Showered and dressed in my bra pantyhose and leg braces, I can stand to wiggle into that tight black dress.  I know it will make Jeff’s eyes pop!  I can stand without crutches as long as I have something to balance myself on. I just can’t take any steps without crutches.  So I balance against the dresser and lean the crutches against the bed.  I pull the dress over my head and around my body, smoothing out the soft fabric and letting it fall just above my knees. 

There’s a slit in the side that almost exposes the very top of my braces, and probably will once I sit down somewhere.  After a few looks in the mirror I decided I was ready for the evening date and crutched it back to my wheelchair.  I told you dating paraplegic girls go to a lot of trouble.

Pre Disability Dating Nerves

I use the wheelchair at home even if I’m wearing the braces.  It’s just easier and it keeps my hands free.  Since the one footrest is a little higher for my shorter leg, and I was now wearing my braces with the built up shoe on that foot, my right leg sits up higher than my left.  I like to cross my right leg over my left, which I did of course by picking the right leg up and pulling it over the left.  I took notice of the slit in my dress when I did that to see just how much of my leg was exposed.  I could see to just under the thigh strap of my brace, perfect I grinned.  It should be just enough to get Jeff wanting to see more.  I was very keen to make his first time dating paraplegic girls enjoyable.

I sat staring at my disabled legs in braces wondering how the events of the evening would go.  I heard the knock at my door I had been waiting on.  I turned my wheelchair and headed for the door.  When I got to the door, I invited Jeff in, the door was open.  He entered looking great and holding flowers. He immediately complimented me on my choice of dress.  It’s like this guy swallowed the book on dating paraplegic girls.

I retreated to the kitchen with the flowers for a vase as he sat down in the living room.  We made typical small talk about work that day while I tended to the flowers.  Then I went to the bedroom for my crutches and returned to Jeff swinging my legs a little slower than usual, and dragging that left leg a little more than usual.  I had already decided that I wanted to put on a good show for Jeff.  He would see just how crippled I really am, a kind of acid test to sort the men from the boys.

With my thin legs wrapped in the nylons and leg braces, and my sexiest black pumps Jeff couldn’t take his eyes off my legs.  I could feel his eyes burning on me as I descended the ramp off my front porch and to his car where he held the door open.  I ask him to take my crutches for me, which of course he did, and I transferred myself down into the car seat, still stiff-legged.  I showed him how the leg brace knee locks work (in case he wanted to know for later).  I pulled both legs in at once to keep my dress from opening up for the world to see. Jeff stowed the crutches and wheelchair and off we went.

Sexy Handicapped Women and Public Reactions

The valet at the restaurant couldn’t believe his eyes when he opened the car door.  The common public reaction to seeing a sexy handicapped girl is one of confusion.  Many have trouble connecting the two, sexy and handicapped.  They often look my date up and down for signs of a disability.  Like they think you have to be disabled to be dating paraplegic girls.

I swung my braced legs out and let the knee locks snap into place.  Jeff quickly came around with my crutches and helped me to my feet.  Jeff sternly pointed out to the valet how the wheelchair ramp was blocked with a sign that had fallen from the building.  I told them I could manage the four steps up to the entrance.  I was actually secretly excited that Jeff would get to see me conquer the steps.

I told Jeff I needed him to hold one of my crutches and stand behind me in case I slipped.  With my left crutch on the first step, and my right hand on the handrail, I pushed against the crutch and let my legs drag behind me up onto the step.  My right leg came first as usual, and then my left.  I had to twist my body a little to get my left foot over the step.  I could then stand to move my crutch to the second step.  I took the steps slowly, giving Jeff plenty of time to see the braces through the slit in my skirt and enjoy my struggling up the steps.  I made it to the door fine, where the doorman held the door for us both.

A True Gentleman Dating Paraplegic Girls

Dinner was perfect, with a little wine Jeff seemed to be enjoying his first experience dating paraplegic girls.  Wine gets people talking and it certainly did its trick on us.  Jeff confided that he had never known my legs were different lengths and was interested in the thick sole on my right shoe.  I explained how my shoes were of different sizes due to my right foot being smaller.  He told me how gracefully I moved in the leg braces, and how beautiful he thought I was.  This one is a keeper I thought to myself.  Despite never dating paraplegic girls before Jeff remained a true gentleman sensitive to my dsability.  I hadn’t felt so safe and comfortable to just be me in a long time.  When it comes to dating paraplegic wheelchair girls, and dating women with a disability, being called special is very different from being made feel truly special.  A true gentleman knows the difference.

One time I shifted under the table and moved my leg out just far enough for him to feel my brace against his leg.  I saw his cheeks blush and gave him a little smile.  I quietly reassured him that I was okay with him touching the braces and that I admired him very much.  I even pushed my chair in a little where the pad on the knee was rubbing the inside of his thigh.  We sat like this through dinner and through our second bottle of wine by the time the check came.  Jeff kept his hand around my waist as we made our way outside and down those steps to the car.  Jeff took my crutches without my asking and I pulled my legs into the car.

Disability Parking and No Stopping Short

We leaned into each other on the ride back to my house. Jeff’s hand wandered over to my thigh where he politely asked, “May I?”  His hand rubbed gently, first on my dress, then around through the slit and between the upright parts of my brace.  His strong warm hand paused when he softy touched the skin of my silky smooth thigh making me gasp.   I couldn’t exactly feel his hand, but knowing it was there gave me chills, and greatly aroused me.  Even though I’m paralyzed, I can still function sexually, and feel an orgasm.  The physical part is a little hard, since I can’t really move my waist or legs, but the feeling is there all the same.

dating paraplegic girls lovers emnbrace

Paraplegic lovers embrace

When we got home, I invited him in and got out of the car where he was waiting with my crutches.  I crutched up to the door, again with his hand on my waist only it was a little lower this time.  We went in and I started making coffee, crutching with my braced legs around the kitchen.  I told him I was going to take my braces off so we could get comfortable on the couch when he said something that shocked me.  He ask me if he could help take my leg braces off.  I could see that he was beginning to get aroused and thought I could have lots of fun with this, as I was aroused too.  So I said he could and swung my legs through my crutches over to the couch.

I thought about getting my wheelchair first so I wouldn’t be totally helpless after my braces were off but then thought better or it.  Jeff had gotten this far, perhaps he would like carrying me to my bedroom.  I sat on the couch with my legs straight out in front of me with feet resting on the floor.  I instructed Jeff to move my skirt to the side and unlock my knees so my legs would bend in.  He released the locks and pulled the lower parts of my legs in toward the couch.  He was fast becoming an expert at dating paraplegic girls.

I suggested, “I’d like to lay back if you could pull my legs to the couch for me.”  With a nod I reclined and he pulled my legs to the couch and up into his lap.  He did them together so as not to spread. My skirt rode up anyway past the tops of the braces and revealing the darker part of my pantyhose.  He said sorry and pulled my skirt back over my legs.  I told him it was okay.  I kind of knew it would happen and didn’t mind one bit.

dating paraplegic girls removing leg brace

Removing paraplegic girls leg brace

I have to say I’ve never had a man touch me like this and help me with my leg braces. I was getting extremely turned on by watching his hands on my thin flaccid legs and touching my braces.  I asked if he would mind taking the upright part of the leg braces off of the shoes.  Then slide my shoes off of my feet.  I bit on my bottom lip as he did so eagerly but gently. 

I watched him slowly ease my pumps off revealing my left foot then my smaller right foot.  He took a minute to study the difference in my feet.  All the things I thought were a drawback in dating paraplegic girls.  My disability, spinal cord injury, the wheelchair crutches and leg braces, my flaccid legs and crippled feet.  To Jeff these things are a bonus that regular girls dont come with.  He noted the nail polish on my toes and rubbed my feet for a few minutes. I could tell he liked the feeling of my feet in the pantyhose.

He began undoing the straps on my calf and leaned in just far enough to kiss me when he reached up my skirt for the thigh band.  One hand was caressing my leg as the other took the thigh band apart, the whole time kissing me more and more intently.  After the leg brace was loose around my leg he picked my leg up letting the foot dangle. Placing the brace on the floor he moved in closer gently pushing my shoulder.  I realized I was awfully tensed up and relaxed back on the couch. 

dating paraplegic girls making love

Making love to paraplegic girls

He has the most beautiful smile.   He lay on top of me with his hands around my face.  Caressing my waist and my legs he slowly began coming closer to my breasts.  I wanted him to touch my breasts and lick my nipples so badly I could hardly stand it.  Since my right hand was already pulling his shirt from his pants, I used my left to guide his hands into my blouse.

Here I was on the couch, one leg brace on and one off, still pretty much dressed, under this man I couldn’t wait to get to my bedroom.  My blouse was off and on the floor, sexy bra not far behind.  My nipples stood erect with pleasure. I had his shirt off admiring is shoulders and chest.  The bulge in his pants told me he was erect with pleasure as well.  He pulled away just long enough to take my other brace from my leg. My skirt bunched up around my waist revealing both thin limp legs in tan pantyhose.

I now felt Jeff was very comfotable with dating paraplegic girls.  I whispered to him to carry me down the hall to the bed, and with much pleasure he did just that.  One hand around my waist, the other under my knees letting my legs fall where they wanted, he carried me down the hall to my bedroom.  He moved my wheelchair with his leg so he could place me on the bed, then fell on top of me.  He pulled my skirt off first, sliding it slowly down my nylon-clad legs and letting is slip under my feet and off to the floor.  We rolled in the bed a little longer, me just in my hose and panties underneath now, which were becoming more wet with every minute.

Paralyzed Legs Don’t Disable Lovers

Paralyzed and lusting heavily my lover took control.   His willingness to dating paraplegic girls was about to pay off.  We were ready to shift up a gear to sex with paraplegic girls.  He rolled me over wrapping my legs around his waist where I would be comfortable.  I tugged his belt off unfastened the front of his bulging pants and pulled him hard against my naked breasts.  He was huge now fully erect.  I slid his pants and shorts off his waist.  He pulled and kicked them the rest of the way off and began pulling at the waist of my pantyhose.

He slid my pantyhose down both legs at once thin and pale they are.  As he was sliding my feet out of the nylons I was already pulling my panties down, eager for him to enter me.  He was on top and had spread my legs wide at first, pulling them together around him as he came in at me.  He was lunging harder and harder.  It wasn’t long sex but I’ve never had better.  We moved together in furious rhythm.  Reaching orgasm at the same time both collapsing exhausted.

We lay laughing together for a long time talking about the act we had so passionately committed.  Jeff went to the bathroom to wash off.  I waited for him to finish and had him to bring me a towel for my wheelchair.  I put the towel in the chair and slid over into it.  My paralyzed legs followed.  Wrapping the towel around my midsection I put my feet in their rests.  Naked except for the towel, I too washed off and returned to bed where we both slept. Knowing soon we both would have to prepare for work.

Disability Lovers Finding New Legs

This morning was almost as exciting as last night. I got to do something I’ve never done before.  Jeff had a change of clothes in his car which he got while I was bathing.  While he showered I went about getting ready as usual.  I chose my outfit for the day:  Red skirt and black top, jet-black pantyhose, and the same black pumps from the night before.  I retrieved my braces and heels from the front room using my wheelchair.  As I was returning to the bedroom Jeff came in.  His hair wet and oh so sexy fresh from the shower.  He took my leg braces and put them on the bed for me, asking if he could put them on.  Wow I thought, of course I didn’t mind, I was excited by the idea.  I had to keep reminding myself Jeff was actually new to dating paraplegic girls.  I had to take things slowly.

I needed to get my panties and pantyhose on as I was still naked except for the towel.  He picked me up from the wheelchair like the night before and laid me on the bed.  He actually picked up the clothes I laid out and began dressing me!  First the panties which he slid one foot at a time through them and pulled them up my legs.  He stopped me when I tried to help and I couldn’t help but smile. I laid back, and let him lift my bottom while his free hand pulled the panties around my waist.  He took the black pantyhose, and lifting one foot at a time, pulled each stocking onto my feet and legs, and up to my thighs where he had to lift my bottom again.

dating paraplegic girls

Dating paraplegic girls

He smoothed my legs out and picked up the brace for my left leg.  He placed my thin leg into its brace and fastened the straps in reverse order from the night before.  Lifting my foot a little, he wiggled it into the high heel pump and attached it to the brace.  Then he ask me if I could walk using only one leg brace.  Well I didn’t know if I could or not as I had never tried.  Thinking it might turn him on to see me try I wanted to see if I could.  My man would there to catch me if I couldn’t.

Jeff retrieved my crutches from the front room and I lowered my leg onto the floor.  The knee clicked into its locked position.  I balanced on the one stiff leg at first.  Noticing with the three inch heel, my shorter right leg dangled about five inches above the floor.  So I extended the crutches, and pulled my body forward letting my right leg swing freely.  Pulling my left behind it dragged a little more than before on the floor.  My firm naked breasts jiggled as I struggled around the bedroom.  Dating paraplegic girls does have its perks.  My bouncing boobs were two of them. 

I could actually do this I thought. Walking on one brace only if I wanted, leaving my shorter leg hanging.  I got Jeff to take another one of my high heels without the brace attachment made into it and slide it over my right foot.  This almost made up the difference to the floor. Making the toe of the shoe point downward and barely touching the floor.  I crutched around for a few minutes.  Leaning on my one stiff braced leg and dragging the other limp leg behind.  I let the toe of the pump slide on the floor.

Like the night before I could see Jeff becoming aroused at the sight of my frail paralyzed legs. I realized he was attracted not only to me but my disability as well.  I became excited at the idea.  It was nice to know I didn’t have to try and be like any other woman he had been with.  I could be comfortable about my handicap knowing Jeff liked dating paraplegic girls.  He was more than okay with my spinal cord injury.  He liked my wheelchair, leg braces, crutches and my disability.

After crutching around a bit I went back to the bed and pulled myself bottom first onto it.  I pulled my right leg to my chest and took off the smaller pump revealing my foot in only the pantyhose.  I took the other leg brace and laid it under my leg.  Jeff helped me with the straps and put my other pump on.  The one with the build-up on the bottom and attached it to the brace.  He also helped me on with my skirt while I put my bra and blouse on.

Jeff thoroughly enjoyed his first time dating paraplegic girls.  I’m so glad it was with me!  We didn’t bother asking about taking separate cars to work.  He drove and I’m sure after work today he’ll drive me home. We’ll spend another exciting night together as disability lovers.  Maybe tonight I’ll show him how I sometimes drag myself from room to room in the house.  Let him see me pull my thin lifeless legs around without the braces crutches or the wheelchair.  Dating paraplegic girls does require a little patience and understanding.  And with that, I wish you all the happiness and love in dating paraplegic girls, that I have come to find.

Kristi Eden

Resources

Quid Pro Quo stars Vera Farmiga and Nick Stahl

Quid Pro Quo

Quid Pro Quo Poster

Quid Pro Quo Poster

Latin meaning “this for that” an equal exchange, Quid Pro Quo is the first feature film by Carlos Brooks released by Magnolia Pictures in 2008. Actor Nick Stahl who played John Connor in Terminator 3: Rise of the Machines, as well as roles in Spin City, The Thin Red Line, Bully, Safe Passage, and Sleepwalking, plays the central character Isaac Knott, a semi-paraplegic wheelchair reporter in Quid Pro Quo.

As a New York public radio reporter Isaac Knott begins to recount a story about himself live on-air. Telling when he was eight, his mother and father died in an automobile accident that left him in a wheelchair. Almost forcing us to feel the dark curiosity that turns heads when passing an accident scene Isaac lays his trauma out welcoming.

[nggallery id=21]

Continuing his story, Isaac reports that he recently received an anonymous tip from someone identified only as “Ancient Chinese Girl.” She tells him a perfectly able-bodied man walked into an emergency ward downtown, and attempted to bribe a doctor into amputating his leg. 

In the course of his investigation, he meets Fiona played by Vera Farmiga, the aforementioned Ancient Chinese Girl. Though she is neither ancient nor Chinese, she is nevertheless supremely attractive, highly intelligent and therefore very secretive keeping to herself. Fiona guides Isaac to a netherworld of people afflicted with a seemingly perverse desire to be disabled.

Seduced by her beauty and intelligence Isaac is quick to suspect that Fiona herself may be a “wannabe.” When he confronts her she protests, “I don’t want to be paralyzed, I already am paralyzed.“ Isaac realizes he must decipher the puzzle of her fantasy motivations before they manifest into an all-too-real, if not fatal, reality.

Along the way, he navigates a semi-surreal world of talismanic items like an antique Milwaukee Brace, a pair of shoes called “spectators,” and a paralyzing chemical called “Ginger Jake.” Events become increasingly extraordinary as Isaac discovers that Fiona does indeed have a terrible agenda, one that resonates in long buried memories of his own past.

Production Notes

Many of the best detective stories evolve in such a way that the story ends up that the detective has actually been investigating himself. Quid Pro Quo’s modern day detective is a public radio investigative reporter Isaac Knott (Nick Stahl) who just happens to be confined to a wheel chair. In the course of doing a story about disability wanna-be’s, Isaac traverses a surreal world of fetishism and transgressive eroticism that recalls the unique perspectives of Luis Bunuel and Alfred Hitchcock.

In many ways, Isaac’s “story” is really a journey into his psyche and personal fears. And the totemic clues he discovers during his investigation: a wheelchair, a Milwaukee brace, a pair of shoes are always more than their literal reality. In the context of the film, these items are objects of fetishistic worship. And as such, they become transcendental. A wheelchair is a wheelchair, until it is viewed as a device that possesses the power to delineate someone as “special,” in other words, “handicapped.”  It then becomes not so much a conventional transport as a machine that creates pity and empathy.

Granted, all this presupposes a perverse perspective into the way we look at things. But in the course of Isaac’s investigation, he finds Fiona (Vera Farmiga) — or she finds him — and she offers him a window into a dark place that exists somewhere between reality and dreams. Her life’s aspiration is to be crippled, or at least perceived as such. She’s beautiful and successful, yet she longs to be physically destroyed to regain some spiritual transcendence in her life. Her complexity, along with her erotic compulsions, prove irresistible to Isaac. 

This quixotic entanglement between reality and its reinterpretation through desire is the heart and soul of Quid Pro Quo. Isaac is drawn to Fiona’s dark side because somewhere in the strata of her perversion lies an underlying truth about himself.  He is confined to a wheelchair because of an accident. What can he possibly learn about himself from Fiona’s desire to be like him? In Quid Pro Quo the answer of course is everything.

Carlos Brooks Director

Commenting on the tone of his first feature film, director Carlos Brooks noted:

uid Pro Quo Director Carlos BrooksI told the actors in rehearsal to think of the story as unfolding entirely within that moment that transpires between deep sleep and wakefulness. So from the earliest rehearsals and creative discussions, all the way through scoring and final sound design, we approached the film within that framework, that the film itself should be experienced as a kind of dream.  Even to the extent that we avoided the usual overtly “dreamy” film making and editing tricks, in favor of a straightforward style that would, like an actual dream, invite you to perceive it as real.” — Carlos Brooks

This article images and content has been produced here with permission of Magnolia Productions to streetsie.com and may not be reproduced elsewhere without express written permission from the respective works and copyright holders.

Graham Streets
MSC Founder

Resources

Phoenix Radio Live Online SCI Interview

Phoenix Radio SCI Interview

Phoenix Radio Episode:

Date: 28.01.2011 Time: 2.07pm (double segment).

Interview

Graham Streets talking on life with a spinal cord injury.

Presenters

Simon Baker and Suzanne.

Click the image below to stream interview audio.

Transcript

  • Simon: We have our next guest on the phone there. Graham Streets is an enterprising man who has experienced some setbacks in life. Graham had to struggle to get anything he has after a motorbike accident in 1994 saw him become a quadriplegic. He had his own electrical contracting business and things were busy but pretty good. Graham had to struggle to get everything he has since he was a sole driver of a vehicle in Queensland and there is no insurance for the driver in a single vehicle accident. Graham is on the phone to tell us about his struggle and what he is doing to get things changed. Welcome to the program Graham.
     
  • Graham: Thankyou.
     
  • Simon: Graham, let’s start by telling us about your experience of the legal side of your case as far as your application for compensation and what your lawyer advised you?
     
  • Graham: Currently in Queensland there is no automatic financial cover for people injured in a single vehicle accident as you mentioned. On the Gateway Arterial Highway where I had my motorcycle accident the corner was poorly constructed. Several people had lost their life on this corner. When looking into compensation I was told I had a good chance of winning several million dollars, that it would cost around a million dollars to launch such a law suit against the Department of Main Roads. My lawyers weren’t willing to risk fronting that kind of money and I didn’t have it.
     
  • Simon: Suzanne, you’ve got the next question…
     
  • Suzanne: What did this mean for you and your business?
     
  • Graham: After 11 months of recovery and rehabilitation in the Princess Alexandra Hospital, I was unable to continue working, my electrical business pretty much folded. I sold off some stock and gave most tools and equipment to friends in the trade.
     
  • Suzanne: This placed a lot of burden on your family?
     
  • Graham: Yes, for most people with a disability support and assistance comes mainly from family and friends. A spinal cord injury like any disability is not only a difficult time for the person who receives the injury. Often family and friends also struggle and the emotional and financial burdens can be massive. I had few options but to move back in with my aging parents with my Mother as my primary carer. Instead of me looking after them in their retirement years they were having to look after me again at their own cost.
     
  • Suzanne: Is there any funding available for you to apply through the State Government for personal carers?
     
  • Graham: There was and there currently is, however these waiting lists are long and many languish on them for years and years, only a small percentage secure that kind of permanent funding.
     
  • Suzanne: Graham, tell us about your mobility please?
     
  • Graham: I’m a C4 quadriplegic. I rely on a power-chair and require assistance with getting into and out of bed, showering, meal preparation, basically a fairly high level of personal care needs.
     
  • Suzanne: Tell us about your time in Rehabilitation and did you meet people with similar issues to your own?
     
  • Graham: Yes, as they say there’s always someone worse off and that can help acceptance of a disability through rehabilitation and while counselors and such are great, talking with others who actually are going through the same problems, and facing the same day-to-day issues as you is a great comfort as well.
     
  • Simon: You’re with Suzanne and Simon this afternoon and you’re listening to Ipswich Connections on Phoenix Radio online. We are going to have a quick music break and when we come back in a few minutes we’ll continue talking with Graham and we’re going to talk about life with a spinal injury and we might cover a couple of other things.

Music Break

  • Simon: Welcome back to Ipswich Connections. A radio program committed to giving people with disabilities a voice. You’re listening to Phoenix Radio online. This program is supported by University of Southern Queensland and Cerebral Palsy League of Queensland. We are talking with Graham Streets who became a quadriplegic back in 1994 from a motor vehicle accident. Graham, so what’s the one thing that is missing for you to have a relatively normal life?
     
  • Graham: Simon, I’d have to say the ability to drive is something I miss terribly. Getting around to see friends, getting re-connected in the local community, without having to rely on maxi taxis and that sort of thing. It can get quite expensive, public transport and getting around that way.
     
  • Simon: Yes and the fact, because you have to rely on public transport, it’s not always there when you want it. They get delayed through obviously no fault of their own, it’s just the nature of the work that they do too.
     
  • Graham: Yes exactly, it also makes it hard in that respect to hold down a full time job.
     
  • Simon: Yes, Yes that’s right. Okay, Suzanne…
     
  • Suzanne: What did Australian’s disability support system do for you?
     
  • Graham: Suzanne, I was able to receive a disability support pension and after eight years on a constant battle and struggle to get where I am today, the Queensland Department of Housing supplied me with housing, and I have permanently funded carers who assist me into and out of bed morning and night. I’m one of the lucky ones really.
     
  • Suzanne: Did you trial any respite centres?
     
  • Graham: There’s a fantastic four bed respite centre in Petrie called Backstop House, they take four wheelchair bound people at one time. It’s a great temporary break for my parents.
  • Suzanne: What needs to be done to change the laws?
     
  • Graham: Currently there’s a big push to bring in a scheme called NDIS, a National Disability Insurance Scheme.
     
  • Simon: Yes and with that, it’s a no-fault scheme where it doesn’t matter how you acquired your disability, you’ll always have the support that’s needed.
     
  • Graham: Yes it’ll be a great safety net whether you’re born with, or acquire a disability be it spinal cord injury, or any kind of disability later in life.
     
  • Suzanne: Is this the same throughout the whole country?
     
  • Graham: Yes it would be a nation-wide scheme that will automatically cover all Australian residents.
     
  • Suzanne: I believe you have developed some new skills and are now employed?
     
  • Graham: Yes, I currently work from home part-time as an accountant and I also do a bit of web design and I’m a webmaster.
     
  • Simon: So give yourself a plug, tell the people how to get in contact with you.
     
  • Graham: Well, my domain name is streetsie.com
     
  • Simon: Graham, we certainly wish you all the best and if you’ve got something happening there please drop us a line, give us a call, say hello, don’t be a stranger, and we’ll certainly be talking to you again sometime in the future.
     
  • Graham: Thankyou for your time Simon and Suzanne.
     
  • Simon: That was Graham Streets talking on his life with a spinal injury and what needs to be done to see that others in severe cases when you acquire a severe disability you have some opportunities there with the NDIS scheme that’s coming in. Thankyou very much for listening in today. You’re listening to Ipswich Connections on Phoenix Radio, supported by USQ, and our program Ipswich Connections is with the Cerebral Palsy League.

Resources

dsp recipients by medical condition

Disability Support Pension Myths And Facts

In 2005 the Australian Council Of Social Service (ACOSS) agreed with the Government that Australia needed to bring more people of workforce age with a disability into employment. ACOSS stated that compared with other wealthy countries, we have a poor record in this area. Only 9% of disability pensioners have income from employment compared with an average of about 30% for other wealthy countries. Comparing the ACOSS report from 2005 to todays reports and outcomes for people with diabilites in 2010 sadly little has changed.

Intended to ensure people with disabilities have adequate levels of income and maximum opportunity to participate in society the Disability Support Pension (DSP) is still widely regarded as “the end of the line” for people’s career prospects.

Until 10 May 2005, people qualified for the Disability Support Pension if they had an impairment that prevented them from working (or being re-skilled to work) for 30 hours a week at or above the minimum wage for at least the next two years. This changed from 30 hours a week to 15 hours a week for some working age people applying for this income support payment between 11 May 2005 and 30 June 2006, and for all new claimants from 1 July 2006 through 2010.

proportion of working age peple receiving income support payments

Proportion of working age people recieving income support payments

Source: Australian Government Department of Education, Employment and Workplace Relations.

At 1.7% in June 1972 there was only 138,818 people receiving a Disabiliy Support Pension. It took 34 years for the percentage of people receiving a DSP to rise to 5.3% in June 2004 with 696,742 people receiving a DSP, an average increase of 0.05% per year. Over the last 5 years given the eligibily criteria dropped to 15 hours/week, and that the number of people living with a disability increases every year, it is suprising the percentage of people who recieve a Disability Support Pension has remained much the same. In fact, the proportion of working age people receiving a Disability Support Pension actually dropped to 5.2% in June 2009.

COMMON DISABILITY SUPPORT PENSION MISCONCEPTIONS

  • It’s easy to get the disability pension.
  • Many people on DSP don’t have “real” disabilities, just “bad backs.”
  • People who can work part time don’t have a “real” disability and shouldn’t be on DSP.
  • DSP has become an early retirement payment for older men, and that’s the reason the number of recipients doubled over the last 15 years.
  • Governments have made it easier to get DSP in order to hide unemployment.
  • Australia has more people on disability payments than comparable countries.
  • If we don’t make it harder to get the pension now, Governments won’t be able to afford the DSP in future as the population ages and more people have disabilities.
  • If the Government made it harder to get DSP, a lot more people with disabilities would find jobs and go off welfare.

 
No solid evidence has been presented to back these claims. They are myths, not facts. While it’s true that the number of DSP recipients has grown, these are not the reasons. In the interests of a constructive debate over welfare reform, this paper debunks these and other myths surrounding the Disability Support Pension (DSP).

THE TRUTH ABOUT THE DISABILTY SUPPORT PENSION

People only get DSP if they have a severe disability that has been assessed by medical or other experts chosen by Centrelink.

  • People with poor vision or hearing, or who use wheelchairs, are not the only ones with disabilities that stop them from working fulltime. For example, over a quarter of DSP recipients have a mental illness.
  • If your only problem is a back condition, you would have to be in almost constant pain or be unable to sit or move around properly to get the DSP.
  • Many people, such as multiple sclerosis sufferers and people with recurring mental illnesses, are able to work part time but can’t hold down a full time job. Allowing them to keep the pension while they work part time (as the present DSP rules do) is sensible because it encourages DSP recipients to look for work.
  • The strongest growth in DSP recipients over the 1990s was among mature age women, not older men. The main reason was that alternative payments for mature age women, such as Age Pension for women under 65 were closed off, so those with disabilities claimed DSP instead.
  • About 5% of Australians of workforce age are on DSP; around the average for wealthy (OECD) countries.
  • The Productivity Commission estimates that the increase in the cost of DSP over the next 40 years due to population ageing will be more than offset by a reduction in unemployment, as the supply of younger workers dries up.
  • Only 6% of DSP recipients participate in employment programs and only 9% have a part time job, but the reason for this is not simply reluctance to look for work. Until recently, employment programs were not comprehensively promoted among DSP recipients. Even if they were, there are queues for employment and rehabilitation services for people with disabilities because funding for these programs is capped. The Government could change this, without making it harder for people with disabilities to get the pension.
  • It’s not easy for DSP recipients to get work, even with help. Even if all DSP recipients with some capacity to work participated in employment programs, official evaluations of these programs indicate that less than one on five would get an ongoing full time job in the mainstream labour market within 12 months of starting the program.

TEN MYTHS AND FACTS ABOUT THE DISABILITY SUPPORT PENSION:

MYTH 1: IT’S EASY TO GET THE DISABILITY SUPPORT PENSION (DSP)

FACT 1: YOU CAN ONLY GET DSP IF YOU HAVE A SERIOUS MEDICAL CONDITION THAT HAS BEEN INDEPENDENTLY ASSESSED BY DOCTORS AND OTHER EXPERTS

Assessment for DSP involves:

  • completion of a detailed written application form;
  • a face-to-face interview at Centrelink;
  • written contributions from the applicant’s treating doctor and possibly specialists;
  • assessment of the applicant by medical and/or work capacity assessment experts chosen by the Government, using standardised tests of impairment or work capacity.

 
A person must:

  • have a serious medical condition that, of itself, would prevent them within the next 2 years from working 30 hours a week or more in any job paying award wages that is available anywhere in Australia; and
  • be unable to achieve the capacity to work 30 hours a week at award wages even with the benefit of retraining or rehabilitation (except that for a person aged 55 or over, only retraining that would enable them to get a job in their local labour market is considered).

 
More than a third of all applications for DSP are rejected.

MYTH 2: MANY DSP RECIPIENTS DON’T HAVE “REAL” DISABILITIES

FACT 2: THE MEDICALLY VERIFIED DISABILITIES OF PEOPLE ON DSP ARE DIVERSE, RANGING FROM SPINAL CORD INJURY TO MENTAL ILLNESS

Medically qualifying for DSP a disability is considered to be a restriction on a person’s ability to engage in the workforce and community life. This is not confined to people who were born with hearing impairments or who have lost the use of their limbs in an accident. The medically verified disabilities of DSP recipients are diverse. For example, one third have musculo-skeletal disabilities (e.g. loss of mobility or limbs), one quarter have psychiatric illnesses, and one tenth have intellectual or learning disabilities (See Figure 1 below).

dsp recipients by medical condition

DSP recipients by medical condition

Data source: FaCS 2003a, Characteristics of Disability Support Pension Customers June 2003

Not a great deal has changed from 2003 when at 33.0% the most common medical condition was musculo-skeletal and connective tissue then psychological / psychiatric conditions 25%, followed by intellectual / learning conditions 11%. This is consistent with data collected for June 2008 at 31.1%, 27.6% and 11.2% respectively.

Of the medical categories from 2003 to 2008 again no significant changes in percentages occured, females outnumber males in three groups. These groups are a poorly defined cause (unable to diagnose the exact problem (143 per cent)), chronic pain (13 per cent) and gastro-intestinal system (36 per cent).

Male recipients make up 79 per cent of the amputation medical condition group. The next highest male dominated group is acquired brain impairment with 71 per cent followed by circulatory system with 68 per cent.

Some argue, without providing evidence, that many DSP recipients simply have a sore back. Leaving aside the personal insult attached to these claims, the physical reality for a person with a back injury that would qualify them for DSP is different. They would typically have very restricted movement, be unable to sit or stand for any length of time (often both), and are likely to be suffering severe and often chronic pain with a history of failed efforts to deal with it. For obvious reasons, these conditions are often associated with depression, which is a disability in itself.

Another argument that is sometimes raised is that if DSP recipients can work for up to 30 hours a week, their disability can’t be too serious. As indicated above, DSP recipients must be unable due to the disability to work for 30 hours or more in any job. Many people with severe disabilities, such as multiple sclerosis or recurring mental illnesses, can work part time but not full time.

If these people are excluded from DSP, this would discourage them from working:

  • Those who are still granted DSP would be discouraged from undertaking part time work for fear of losing the pension, and would come to view DSP as the end of the line for their careers.
  • Many of those who would be excluded from DSP would receive Newstart Allowance (unemployment benefit) instead. But Newstart Allowance has a much stricter income test than the pension that discourages part time work (recipients lose up to 70 cents of their Allowance for every dollar earned, compared with 40 cents if they received the pension).

 

For these reasons, since 1991, disability pensioners have been allowed to engage in part time work for up to 30 hours a week without automatically losing the pension. This was a sensible reform to encourage workforce participation. The New Zealand Government recently introduced similar changes for the same reason. Many organisations around the world are appealing for a greater integration of all people with disabilities into the workforce.

MYTH 3: GOVERNMENTS HAVE PUT PEOPLE ON THE DSP TO HIDE UNEMPLOYMENT

FACT 3: THAT’S NOT THE MAIN REASON MORE PEOPLE ARE ON DSP. THE NUMBER OF PEOPLE IDENTIFIED AS HAVING A DISABILITY HAS RISEN, BECAUSE DISABILITIES THAT WOULD HAVE GONE UNNOTICED IN THE PAST HAVE BEEN IDENTIFIED AS EMPLOYERS DEMANDED A MORE PRODUCTIVE WORKFORCE AND SOCIAL SECURITY REQUIREMENTS WERE TOUGHENED

From 1990 to 2003, the number of DSP recipients rose from 317,000 to 673,000 – an average increase of about 6.5% each year. Some claim this was due to a deliberate easing of eligibility requirements to conceal unemployment. There is no evidence to support this view. It rose by around 2.1% per year from 2003 to June 2008 reaching 732,367 which served to only fuel such beliefs. ACOSS believe they have identified 3 main causes of the faster than usual growth in DSP recipients from 1990 to 2003.

1. There has been an increase in the identification of disabilities. The Australian Bureau of Statistics estimates that the number of Australians of workforce age identifying a core activity restriction rose from 1.2 million in 1988 to 1.5 million in 1998 (see Figure 2 below). The strongest growth was in severe and profound disabilities, including mental illness. Factors leading to this increased identification of people with disabilities include employers seeking higher productivity from their workers, and stricter social security requirements to actively seek employment and participate in training programs.

Growth in DSP and people with disabilites

Growth in DSP and people with disabilites

Source: ACOSS 2002

2. Closure of alternative payments such as Wife Pension, Mature Age Allowance, and Age Pension for women aged 60-65 years. People with disabilities who previously would have received these payments now claim DSP.

3. The recession of the early 1990s led to a big jump in new DSP claims, as did previous recessions.  The points of upturn in the rate of growth of DSP numbers coincided with the early recession periods of fast rising unemployment in 1982-83 and 1991-93 (see Figure 3 below).

Disability support pension inflow and unemployment rates

Disability support pension inflow and unemployment rates

Source: Cai & Gregory 2002 P 133. The unemployment rate was in February each year and taken from Labour Force, Australia, ABS cat. no. 6202.0.

MYTH 4: THE DSP HAS BECOME A DEFACTO EARLY RETIREMENT PAYMENT FOR MATURE AGE MEN

FACT 4: THE FASTEST GROWING CATEGORIES OF DSP RECIPIENTS ARE MATURE AGE WOMEN AND YOUNG MEN

A common misconception is that many mature age men on DSP have only minor disabilities, so the pension has become a defacto early retirement payment. This view is based on the experience of the 1970s and 80s when many low skilled male blue collar workers were pushed into early retirement, or suffered injuries at work. Many received the former Invalid Pension because they had disabilities like badly damaged backs or limbs after working for years in industries with unsafe work practices. In addition, their age, social circumstances and employability were taken into account in assessing Invalid Pension eligibility concessions that was mostly removed in 1991 in favour of a stricter emphasis on medical incapacity.

Since the early 1990s, the fastest growing categories (see Table 4 below) of new recipients were mature age females (mainly due to the closure of alternative payments) and younger men (possibly due to the higher incidence of mental illness and survival from motor vehicle and other accidents). The predominance of mature age men among DSP recipients is likely to diminish further as work and safety practices improve, the proportion of employees involved in manual labour falls, and labour shortages encourage employers to keep mature age workers.

Table 4: Growth in DSP recipients, by sex and age (1990-2003)
DSP recipients by sex and age As percentage of all recipients in 1990 As percentage of all recipients in 2003 Increase (1990-2003)(number) Increase (1990-2003)(percentage)
Males under 50 26% 27% 101,000 127%
Males 50 & over 48% 34.5% 81,000 53%
Females under 50 17% 18.5% 71,000 131%
Females 50 & over 10% 20% 104,000 329%
All recipients 100% 100% 357,000 113%
Data sources: FaCS 2003a, ACOSS 2002

 

“Many older men on disability benefits do not suffer from a serious injury or disease. Often they are on the disability pension because this is a humane alternative to the Job Search Allowance when work is in short supply.” –Canberra Times, 28 November 2004 p31: Pensioner Politics Unpopular.

 

MYTH 5: AUSTRALIA IS TO SOFT, WE HAVE MORE PEOPLE ON DISABILITY PENSIONS THAN OTHER COUNTRIES

FACT 5: AUSTRALIA HAS ABOUT THE SAME PROPORTION OF PEOPLE OF WORKFORCE AGE ON DISABILITY PAYMENTS AS OTHER WEALTHY COUNTRIES

At 5% of the workforce age population, Australia lies about in the middle of disability payment recipiency rates in wealthy countries surveyed by the OECD (see Figure 5 below). The highest rate is in the Netherlands (7%) and the lowest is in Japan (2%). Both the United Kingdom (6%) and the United States (6%) have higher levels of disability benefit receipt than Australia.

Proportion of workfoce age population DSP recipients per country

Proportion of workfoce age population DSP recipients per country

Data source: OECD 2003a Table 4.A1.1 p224.

Of concern is that a relatively low proportion of Australian disability pension recipients are employed (under 10%, compared with an OECD average of just over 30%). This proportion would fall even further if the pension were denied to people with disabilities who are able to work part time.

A major reason for the low employment rate among disability pensioners in Australia is that they are less likely to receive help to get a job, or rehabilitation or training. The Australian Government only spends about two thirds of the OECD average expenditure on these services, in proportion to the size of our economy. To contain costs, the number of places available in the main specialist program of employment assistance for people with disabilities “open employment services” are capped, so there are queues for help. As a result, in Australia a relatively low proportion of disability pensions recipients receives help with employment or training (see Figure 6 below).

Percentage of DSP recipients in employment programs per country

Percentage of DSP recipients in employment programs per country

Source: OECD 2003b, Chart 5.2 p 116. OECD 2003b Chart 3.7 p 39. OECD 2003b.

MYTH 6: FUTURE GOVERNMENTS WON’T BE ABLE TO AFFORD TO PAY DISABILITY PENSIONS UNLESS THE RULES ARE TIGHTENED NOW

FACT 6: AN AGEING POPULATION WILL INCLUDE MORE PEOPLE WITH DISABILITIES, BUT THE PRODUCTIVITY COMMISSION ESTIMATES THAT GROWTH IN DSP COSTS WILL BE MORE THAN OFFSET BY FALLS IN UNEMPLOYMENT

The recent Productivity Commission Draft Report on the Economic Effects of Population Ageing estimated that expenditure on DSP would rise from 0.9% to 1.1% of Gross Domestic Product (GDP) over the next 40 years – an increase of 0.2%. But spending on unemployment allowances was estimated to fall from 0.8% to 0.3% of GDP – a reduction of 0.5%, due to a reduction in the annual growth in the workforce as the population ages.

MYTH 7: AUSTRALIANS WOULD SUPPORT A “GET TOUGH” APPROACH TO DISABILITY PENSIONS

FACT 7: AUSTRALIANS BELIEVE PEOPLE WITH DISABILITIES SHOULD BE SUPPORTED TO PARTICIPATE IN THE JOBS MARKET TO THE BEST OF THEIR CAPACITY

The Social Policy Research Centre (SPRC) at the University of New South Wales undertook a survey of the Australian community’s attitudes towards unemployment, activity testing and mutual obligation for the Government in 1998. It found that about half felt it was reasonable to ask disability pensioners to participate in some form of retraining, to participate in their community, or improve their literacy skills.

However, there was only very limited support for people with disabilities to be asked to look for work (33%), complete a “dole diary” (26%), take part in a “work for the dole” scheme (25%), or accept any paid job offered (18%) – conditions normally attached to receipt of Newstart Allowance.

In relation to both people with disabilities and older people, they concluded:

“Where there was more widespread support for some expectations being placed on these other groups, it was mainly in the areas of training, requiring them to undertake useful work in the community and remedial literacy. This suggests that the Government may need to be cautious about the extension of mutual obligation to these groups if it wants to carry public opinion with it. Certainly it seems that emphasis would need to be placed on providing effective assistance and support to make it possible for older people and those with a disability to get back to work.”

Other research for the Government on public attitudes towards welfare reform drew similar conclusions.

MYTH 8: THE GOVERNMENT HAS TO REIN IN GROWTH IN DSP TO REDUCE “WELFARE DEPENDENCY” AMONG PEOPLE WITH DISABILITIES

FACT 8: STOPPING PEOPLE FROM GETTING DSP WOULD DIVERT THEM TO OTHER WELFARE PAYMENTS

Many people with disabilities already receive social security payments other than DSP. If the Government makes it harder to get DSP, most future recipients would simply be diverted to these other payments. For example, there are 50,000 Newstart Allowance (unemployment benefit) recipients identified as having an illness or disability, and their number grew strongly throughout the 1990s. (see Figure 7 below).

proportion of unemployed sickness allowance customers 1993-1998

Proportion of unemployed sickness allowance customers 1993-1998

Source: Warburton et al, 1999

There are many people with disabilities on other payments as well. For example, a recent study estimated that one in five sole parents on Parenting Payment suffer from depression.

When the Government proposed to restrict access to DSP in its Disability Reform Bill (2002), officials estimated that all but 2% of people who would have missed out on the pension would instead receive another social security payment, mainly the lower-paid Newstart Allowance.

Productivity Commission 2004b. The report implies that the Government’s proposed changes would have the effect of roughly freezing DSP expenditure as a proportion of GDP (despite growth in the proportion of people of workforce age with disabilities, due to population ageing), effectively reducing spending by about 0.2% of GDP in about 40 years’ time.

MYTH 9: GETTING PEOPLE OFF DSP WOULD OPEN UP TRAINING AND EMPLOYMENT OPPORTUNITIES FOR THEM

FACT 9: THE GOVERNMENT COULD OFFER THOSE OPPORTUNITIES TO PEOPLE ON DSP

Most people of workforce age who have disabilities want to work, provided they can find employment within their capacity. When people with disabilities on social security payments have been asked to voluntarily participate in employment programs, take up has been strong.

The greatest barrier to employment for people with disabilities is often community attitudes to disabilities rather than the disability itself or a reluctance to return to work.

Another problem is that until recently, Governments have made no systematic attempt to enrol DSP recipients in job and rehabilitation programs. Those who want to participate are often confronted with waiting lists due to a shortage of places in employment and training programs that specialise in helping people with disabilities – Disability Employment Assistance and CRS (Rehabilitation). Funding for these programs is capped.

The Job Network is an alternative employment program where places are not capped, presumably because Job Network places are much cheaper. But only 6,500 DSP recipients participated in “intensive assistance” services provided by the Job Network in 2002 (just 2% of all participants in intensive assistance). The main reason for this very low level of participation is that the Job Network is not properly resourced to meet their needs.

The highest level of assistance within the Job Network is now Customised Assistance, during which providers can draw on a “Job Seeker Account” to fund training, job placements and other help to overcome barriers to employment. But the amount available for each highly disadvantaged job seeker is only about $1,300. This won’t buy much rehabilitation or training. Job Network funding is well below that available to the specialist programs of employment assistance for people with disabilities described above.

As a result of this under-investment in employment assistance for people with disabilities, only about 6% of the overall number of people on DSP in 2002-03 participated in an employment program (see Table 8 below). It is not surprising, then, that many recipients regard DSP as “dead end payment.” But this is not inevitable – people can and should be encouraged to participate in rehabilitation and training and to take on part time work while still on the pension.

Table 8: Places in employment programs filled by DSP recipients (2002-03)
  Open Employment services for people with disabilities CRS (rehabil-itation) Job Network (Intensive Assistance) Personal Support Program Total
DSP recipients in program 26,313 5539 6500 4000 42,352
Total program places 42,161 22,704 280,000 40,185 385,050
Proportion of program on DSP 62% 24% 2% 5-10% 11%
Proportion of DSP population over the year (728,273) in a program 3.6% 0.8% 0.9% 0.6% 6%
Data source: FaCS 2003a, 2003c, 2003d, DEWR 2003.

MYTH 10: RECENT PILOT PROGRAMS SHOW THAT MANY DSP RECIPIENTS CAN GET A JOB WITH ONLY MINIMAL EMPLOYMENT ASSISTANCE AND TRAINING

FACT 10: EMPLOYMENT PROGRAMS DO HELP PEOPLE WITH DISABILITIES INTO JOBS, BUT OFTEN FURTHER INVESTMENT IN REHABILITATION, TRAINING AND SUPPORT IS REQUIRED AT THE WORKPLACE

Employment assistance is a worthwhile investment both for people with disabilities and for Government. But we should be realistic about the job prospects of disability pensioners in the short to medium term. It is estimated that the chances that an average DSP recipient will obtain ongoing full time employment in a mainstream job within 12 months of participating in one of these programs are ess than one in five. That is, at least four fifths of program participants who are on DSP miss out on secure full time work that would take them off social security.

This estimate is based on the findings of a number of official evaluations of employment assistance programs and trials for people with disabilities. They include the recent Job Network pilot program for people with disabilities, in which less than 10% of participants obtained a job for more than 15 hours a week and sustained it for more than 3 months.

This underscores the difficulties facing people with disabilities in today’s jobs market. Full time jobs with low skill or productivity requirements — such as labouring or basic clerical jobs — have been diminishing over the past decade and a half. From 1990 to 2000, there was a net loss of 200,000 low skilled full time permanent jobs, while over the same decade there was a net increase of 387,000 full time permanent managerial or professional jobs. There are more part time and casual jobs, but they typically don’t provide enough regular income for people to move off social security.

People with disabilities are a very diverse group – from former labourers to university professors. But on average, they come from lower skilled occupations and have lower education levels. These two factors, together with the high levels of productivity demanded by employers today, have worked against them in today’s jobs market.

This means that helping people with disabilities who have a capacity to work into secure, well paid employment requires a big investment in rehabilitation and other employment assistance, and major changes in the workplace. There are no cheap or easy options. In the meantime they need adequate, secure income support through the social security system.

OUTCOMES FOR DSP RECIPIENTS IN EMPLOYMENT PROGRAMS

A number of studies and data sources support estimates that less than 20% of DSP applicants who participate in employment programs obtain “substantial employment” within 12 months. We use as a benchmark of “substantial employment” a “mainstream” job of at least 20 hours’ employment for at least 13 weeks within 12 months of commencing a program. This is almost enough regular employment to remove a person from Newstart Allowance.

1. Assessment and contestability trial (2000-2002):
After 1 year on the trial, with labour market assistance, only 10% of participants were in open employment for more than 20 hours per week. One quarter of participants were employed after 1 year, but most were employed for less than 20 hours a week.

This trial was voluntary and only 30% took up the option, so those assisted were less disadvantaged than the overall target population (technically speaking, there was a selection bias). A majority of participants were on Newstart or Youth Allowance rather than DSP, and were likely to be less disadvantaged in the labour market than average DSP recipients or applicants (though the long term DSP recipients in the trial were probably more disadvantaged than new DSP applicants – the group likely to be affected by any DSP changes).

2. Case based funding trial (2001):
After 18 months of assistance from an open employment assistance provider, less than 20% of participants were in full time mainstream employment for more than 6 months, and most were employed as casuals. Most of these outcomes were achieved within the first 12 months (of those not placed in employment within that time, only 8% obtained a job within the next 6 months).

This trial population was a less disadvantaged one than for the Assessment and contestability trial, excluding those in supported employment (i.e. “business services”). Half were on DSP and they achieved lower outcomes than the rest. Participation was voluntary and providers rejected some applicants so there was selection bias favouring people “easier to place” in employment. Outcomes were relatively low for psychiatric conditions, brain injury, and vision impairment.

3. CRS (2002-03):
In 2002-03, of DSP recipients in CRS over about a 12 month period, 23% obtained a mainstream job for 13 weeks or more, but an unknown proportion of the jobs were casual, or less than 20 hours.

4. Job Network DSP pilot (2003-04):
After 10 months of participation in this pilot scheme, in which people were offered Intensive Support from Job Network providers, less than 10% of those participating in the pilot secured employment of more than 15 hours a week for at least 13 weeks (a “primary outcome”).

The trial population comprised 1,130 DSP recipients who voluntarily met with specialist disability Job Network members (an unknown number declined to participate). Of these, 790 (70%) commenced Intensive Support after being assessed as suitable. For this reason, and due to the voluntary nature of the pilot, there was a selection bias favouring people “easier to place” in employment. Ten were placed in full time jobs, 75 in part time work and 135 in casual jobs. Over the course of 10 months of Intensive Support, 64 primary outcomes were achieved, with a further 9 pending.

The highest level of funding available to assist a job seeker through the Job Network is around $7,600 (only paid if the person achieves sustained employment) , compared with funding levels of $5,600 $8,500 $12,300 and $18,000 for open employment services for people with disabilities, depending on the severity of the disability. In fact, the Government has already acknowledged that these funding levels for open employment services are inadequate, and budgeted in 2003 to raise them substantially.

In 1998, 44% of men with disabilities and 49% of women with disabilities (of workforce age) did not complete high school, compared with 28% of other men and 36% of other women of workforce age.

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WEBSITES

Australian Bureau Of Statistics (ABoS), http://www.abs.gov.au
Australian Council of Social Service (ACOSS), http://www.acoss.org.au
Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA), http://www.facs.gov.au