How we roll: An inclusive way to think about medical design

03 Dec 2018 9min read

Door handles and light switches have a lot in common. These everyday objects were all improved from their ancestors with the user at heart. Designing universal products offers advantages for all users, not only for users with disabilities. Now, step back in time and picture door handles as door knobs and flat light switches as old ‘flip’ switches. Imagine what it would be like to open doors or put the light on without your hands… it wouldn’t be easy for anyone, whether you have a hand disability or your hands are full of grocery bags. Fast forward to today and we can all use both these objects with our elbows.

Designers and engineers have a wealth of resources to draw upon for advice, including the diverse and vibrant disabled community. The history of how this improved understanding came about is fascinating as it marks how the disabled community found its voice. If you have never listened to the 99% Invisible podcast, I would urge you to do so. It’s a fascinating and very well-designed podcast focussing on the impact that design has on society and vice versa. They released a programme in May of 2018 that began with the discovery of a custom-designed powered wheelchair at the Smithsonian Museum in Washington DC. The wheelchair had a worn blue leather seat, a large Velcro chest strap and a headlight to help the user find their way at night time. The wheelchair was the property of Ed Roberts, a post-polio quadriplegic who was dependent on a respirator to breathe. Paralysed from the neck down, Roberts was the first severely disabled student to enter the University of California at Berkley¹ earning an MA in Political Science in 1966. Ed Roberts is also regarded as the father of the independent living movement.

One of the key elements of the narrative that 99% Invisible reported was the role that people with disability had in defining their own destiny and human rights – something that they demanded for their own dignity rather than gratefully received from a patronising telethon host. I still shudder when I hear the term ‘God’s mistakes’ used by Jerry Lewis to describe those with disabilities, and the podcast does an outstanding job of capturing the frustration that led the disabled community to insist their voice was heard.

One of the monuments to this struggle was the creation of ‘curb cuts’, the discreet little ramps that drop the height of the pavement (sidewalk) down to the level of the road and allow wheelchair users to get around so much more easily. Without these simple features, wheelchair users were compelled to travel with an assistant, ask strangers for help or desperately search for driveways they could negotiate on wheels. The simple addition of gently sloping ramps at intersections made a huge difference to the independence of wheelchair users.

But it wasn’t just the wheelchair users who benefitted – all those who ‘roll’ found a benefit. Parents with pushchairs, children on scooters, delivery drivers with wheeled trollies; they all found advantage in the curb cuts. This is why it is better to think in terms of universal or inclusive design – rather than design for the disabled. Products, services and the built environment should be accessible to the largest number of people – regardless of any physical impairment they have.

Another practical upshot of the work of the disability rights activists was the American’s with Disabilities Act – the ADA. This act of congress requires American companies to implement practical measures that give those with disabilities equal access to products and services. Attempts to water down this legislation or offer loop-holes have been met with angry responses from disability rights activists. The 99% Invisible discussion cites the example of paraplegic disability rights activists pulling themselves up the steps of the legislature building with their own hands to make their point – it’s hard to argue against accessible design in the face of such inequity.

The European Union still lags some way behind the USA when it comes to enshrining the rights of the disabled. The rights of disabled users are protected under UK law by the Equalities Act (2010) which superseded the Disability Discrimination Act (2005), but even this legislation only really focuses on access to employment rights and access to services. There is little direct provision that focuses on how to make products more accessible. So, what should you do if you’re a designer, an engineer or a member of a standards body and you want to make products better and more accessible?

This is the position that my colleague (and Team’s founder) Andy Fry and I found ourselves in during our work for ISO. Andy and I both represent the interests of BSI as part of Technical Committee 84 (TC84) charged with developing standards for needle-based injectors. Back in 2013 Andy and I joined a number of our colleagues from international organisations across Europe, Asia and the USA to try and determine guidelines to help visually impaired users. A lot of the work on the 11608 series of standards has been developed from insulin injectors and this work was driven by the high incidence of visual impairment that people with diabetes suffer with.

One of the things that the committee had done right from the beginning was to involve a blind person with diabetes, Tom Tobin, who could explain to us the challenges that blind people face and how they cope. (I remember one particular moment where Tom demonstrated the speech-only interface for the iPhone to help visually impaired users access their phone. He then had to help several sighted committee members change their phones back as they were struggling to navigate the blank screen). In addition to users and industry experts we also benefitted from the insight shared by a subject matter expert (SME), Ann Williams PhD, a researcher who has done extensive work with visually impaired insulin users.

Tom and Ann were able to explain to the group the different coping strategies that visually impaired users employed, the kind of assistive technologies available and the biggest frustrations they experienced. Ann explained to us the different ways vision loss can affect insulin users and how their visual acuity can vary with their health, even within a very short space of time. Tom gave us valuable insight into the different ways users with no vision at all cope with their regimen. Tom explained how important tactile and good quality audio feedback becomes when using devices and how blind users rely on the distinctive smell of insulin to confirm that their pens are properly primed. Tom also illustrated examples of what he considered to be effective designs and showed how blind users improvise around tasks designed with sighted people in mind.

The resulting standards guidance was far more relevant thanks to the input of these two SMEs. The group was chaired by Robert Nesbitt (of Abbvie) who was later awarded and ISO Excellence Award for his work chairing this committee and ensuring that the standard was written with input from research experts and individuals with visual impairment.

All of which brings me back to my starting point – making products more universal isn’t just the right thing to do morally; it makes products better for everyone. Just as the way that the curb cuts helped pushchair owners and wheelchair users alike, tactile pavements help visually impaired walkers and prevent smartphone zombies walking into traffic. Presenting information in multiple persistent ways helps all users – not just those deficient in one or other sense.

In the next article, Kay Sinclair and I explore some of the resources available to product designers and describe some of the approaches that can be employed to make your designs more inclusive.

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