Saturday, 27 October 2012

Time For A New Powerchair

If it were a horse, I'd take my old Quantum 6000 out back and shoot it.   I have a love-hate relationship with the powerchairs.  I'm eternally grateful that in this day and age we have such equipment, yet hate the fact that I'm reliant on such equipment.

With the mobility that these power wheelchairs provide, I shudder to think of a time not so long ago when paraplegics were condemned to wheeling about in rickety wooden framed, wicker seated, solid tire, manual chairs.  The occupant of this two-wheeled weapon had to combat the environment - to do battle with sidewalk curbs with no ramped entry, doors with no automated openers, washrooms only built for the ambulatory etc.  Life is better with advances in wheelchair technology as well as a society with some understanding and compassion for disabled citizens.  Yet, life is not easy...

I never thought that six years post injury, I'd still be in a wheelchair.  Then again, I never imagined that I would ever be in a wheelchair, period! Nobody in a chair ever does.... But here I am....

Back to the subject of this post.  My old Quantum 6000 served me well.  It gave me very few reasons to curse it though a few times it did die on me and for a paraplegic totally dependent on a powerchair - there is no opportune time for a breakdown to occur.  A flat tire at the start of a workday, a joy-stick controller which had a mind of its own in determining when the chair should shut off (first time was in a revolving door!).  Bearings in the castors that froze, drive motors which refused to drive, etc. I also contributed to this chairs demise.  I had driven into obstacles and bent the leg rests into the shape of pretzels as well as having destroyed the padded arm rests by driving to close to the bus' chair lift and shredding the foam like cheese on a grater.  I found parts on the ground and had no idea where on the chair they came from!  Yet the chair held together and hauled my ass around for six years,...and still on the original battery!

I decided it was time for a new chair however I had no idea if the government would once again provide assistance in my acquiring a new powerchair.  The Canadian province of Ontario has a program, the Assistive Devices Program (ADP) which eases the financial burden on people with disabilities by paying 3/4 of the price of assistive devices (wheelchairs, walkers, braces etc.).  When I was discharged from the hospital, I was paralyzed from the chest down and so a powerchair with a tilt mechanism was imperative. The powerchair for my paralysis and the tilt to shift my weight so as to minimize the development of 'pressure sores' which can easily become infected.  Now, some six years later, I can move my legs with ease, stand and even move some toes with determination.  Those pressure sores never materialized. However, I still can't walk without assistance.

So, the question was whether I would once again be entitled to government assistance for a powerchair, or any wheelchair for that mater?  With the current state of the economy, most government programs are being cut back. Would the qualifications be tightened as to who could expect government assistance?  Would only those most disabled, the most in need, be granted assistance?  I have great upper body strength.  Would I only be entitled to a manual chair? (which I already have).

The situation was this.  I cannot perform my duties at work with a manual chair as I have to physically move about the workplace frequently and have to carry items.  I cannot carry items in a manual chair as both hands are used in propelling the chair.  With the powerchair I have one had free to carry items while I control the chair with the other hand on the joystick. I need to stand to reach items on shelves.  With my manual chair, I cannot stand up as the brakes are not strong enough to hold my weight when I brace against the seat.  I would push the chair backwards and  fall backwards into it. Only another powerchair would do.

Now, a new powerchair costs between $10,000 and $18,000 depending on type (tilt, etc.) and accessories. I simply cannot afford to pay that on my salary, every 5-6 years.  By the time I would pay down the chair, it would be time to buy a new one!   So the alternatives seemed to be:

  1. The government, through their ADP program would once again assist me by paying 3/4 of the cost of the new powerchair which would then allow me to continue to work, be self sufficient and pay taxes to that very same government.
  2.  The government would decline my ADP request for assistance, leaving me unable to do my job and forcing me to quit.  No longer self sufficient, I would have to apply for government disability and no longer would be paying income tax to the government.
It seems to me, the government would end up paying one way or another  The first alternative seemed the most productive and positive.

Through an acquaintance, obtained the name of an ADP representative who would evaluate my needs and submit the funding application to the government on my behalf.  I was delighted to find the ADP representative to be most professional, friendly and receptive to my dilemma.  Over two meetings she determined the best seating for my needs and put me in touch with the a sales representative colleague who then suggested various wheelchair makes and models which would best suit my needs.

Still, it took about a half year before everything came together.  My only major request was that the chair would have a 'retractable' foot rest which would fold upright, stowed out of the way, somewhere under the seat.  This would replace the two separate foot supports that hung from the front corners of the chair - the ones I always managed to bend.

What I ended up choosing was the Permobil M300 motorized wheelchair.  My 6 year old Quantum 6000 and the new Permobil M300 are pictured below.

Click on Photo to enlarge for better viewing

Above is the old Quantum 6000:  Front leg hangers are removed.  Castors on front an back are bald, the tread worn off years ago.  The seat was partially hard foam at the front edge with a gel bag at the rear which would mould to the butt.  The tilt motor can be seen in the photo on the right.  It died long ago and as I didn't really need it, I opted not to have it fixed or replaced.  Even if covered by my private insurance company, I couldn't justify the price!  Cushion are rests are missing and only the steel tubular frame remains.

Click on Photo to enlarge for better viewing

Above is the New Permobil M300:  I have a one piece cushion seat.  The castor wheels are 8" in diameter, much larger than the enclose round castors on the Quantum in the previous photo.  The photo at the left shows the foot plate in the extended (down) position  The first prototype delivered had a foot plate so large it actually interfered with the turning of the castor wheels.  A new footplate was developed for my need.  The Permobil M400 was developed with European standards in mind and therefore has reflectors all around (2 clear in front (left photo) and four red at the rear (right photo) as well as two amber on the side (center photo).  The control unit has buttons to turn on headlights, signals and hazard lights however these buttons are inactive on my Permobil chair as this lighting package which is mandatory in Europe, is optional in Canada and costs an extra $1000.  So, I have a bunch of dummy switches on my controller which do light up when depressed (activated) but actually do not turn anything on.

Some problems which had to be overcome while others I simply have to get used to;
  • The large 8" radius front castors on the Permobil are great for climbing obstacles, however when the chair stops after a turn, at least one wheel points (extends)  towards the center of the wheelchair and is partially in my way if I want to stand up.
  • The top edge of the foot rest plate cuts into the back of my legs when I stand and put pressure against it.  To minimize this, the seat plate was moved as far forward as possible so that the plate is almost under the seat.  I obtained a rather large, ~2" diameter hose from a local hardware store and sliced one side lengthwise.  I slid this hose over the front edge of the seat pan to further extend it outwards by about a quarter of an inch and it acts as a cushion as well.
  • The old Quantum 6000 had square arm rest frames made from tubular material (round tubes assembled into a square frame).  Pouches or bags could be hung from the horizontal arms of the tubular arm rest frame in which I could keep personal items such as keys or a cell phone, etc.  The vertical tubular armrest supports could be removed and a  ring or clip could be added before replacing the frame.  The rings could be used to secure a wallet which then could be placed into a pouch hanging from the frame. (ie. a removable pouch within another pouch).  The Permobil has a curved armrest frame from which a single rectangular post extends to hold the armrest.  Both the curbed frame and single rectangular post don't offer an easy way to hand personal bags or pouches.  The Permobil website does offer an aftermarket side pouch but the small bag has a price of about $200, far to much for a small bag to hold a wallet.  My only option is to remove an armrest cushion and sling a small "saddle bag" like pouch over the bar, then screwing the armrest cushion back onto the frame.  I've yet to do this so I don't know how feasible it will be.
  • As I mentioned earlier, the controller has extra "dummy" button switches on it for the non-existent European lighting package. These buttons turn on and flash but do nothing.  The may be a entry point for dirt and water thereby shortening the life of the controller.  My main dislike of this controller is that it goes through a self check each time the chair is turned on and that takes about 3 seconds before the chair is moveable.  Now that may not sound like much but just imagine if an able bodied person would have to wait 3 seconds each time - between the time they decided to get up off their chair and start walking.  It would be a major irritant!.  My old Quantum fired up and would move in less than one second.  An important feature if you find yourself having to escape danger quickly!  So my only option is to leave it on all the time which may present a safety hazard if I hit the joystick inadvertently.
Anyways, another long-winded post but I try to get the issues across best I can in hopes that someone else might benefit.

I'll let you know how things go after I've had more time to live with this chair.  Getting used to a new chair after you've lived in one for six years is so much more different than just getting used to a new pair of shoes!

Saturday, 8 September 2012

Summer's Gone

Well, its been a while since my last post for although things still change, it is  far to slow for my liking.  This has been a challenging summer on several fronts.

No Continuing Physiotherapy:
Those who have followed this blog know that I no longer receive physiotherapy.  Not my choice however with all levels of  government crying poverty, funding cuts are passed on to the community.  Community hospitals which once provided the level of expertise in physiotherapy that an injury as severe as mine requires now had to deal with a frozen operational budget.  The provincial government however had the funds to create LHINs (Local Hospital Integration Networks) which were are an "arms length" agency that in a sense does the government's dirty work for them.  They suggest what services should be eliminated from hospitals under the premise that they are already available in the community by private providers.  This in theory would duplication of services available in the community and funds saved could be channeled into core hospital programs.  Of course governments often fail to see the big picture.  Hospitals provided that level of expertise (spinal cord, stroke, brain injury) that private community physiotherapy clinics who deal with primarily with sports injury or minor trauma rarely see.  Expertise developed not only through continuous encounters with people suffering from such catastrophic injuries but also in the acquisition and use of specialized equipment to aid in rehabilitation which smaller private clinics simply can't justify buying.

With the closure of hospital physiotherapy (and other) clinics, patients either terminated their therapy or attempted to find nearby private clinics which would continue their therapy on some level.  It was quickly apparent that the sudden influx of new clients quickly overwhelmed the private clinics.

The irony was that outpatient physiotherapy clinics actually brought outside monies (insurance or self-pay) into the hospital, above and beyond the government funding.  Go figure!

*the private clinic I attended over the winter of 2009-2010 was chosen primarily because of location.(it was nearby).  Perhaps more specialized clinics could be found on the other side of the city or in the next town however travel time was a significant factor, dependant on public disability transportation service scheduling.
The private clinic I attended had no handicapped automatic door opener, had no parallel bars and had to rent a walker for my use.  Hardly equipped for my needs.

Disability Transport Goes On Strike:
As mentioned above, provincial governments have cried poverty and indicated that budgets would be frozen for the foreseeable future.  Yet, at a time when most are grateful just to hang onto their jobs, the union for the public disability transportation service which takes me to and from work each day coerced members into strike action.  So in mid summer they took to the picket line leaving the non-unionized transit management scrambling to meet their obligation.  Rides were quickly outsource to a private cab company that usually just handles the overflow from the provincially funded disability transportation service.  While I was prepared to leave my powerchair at work and have my wife shuttle me back and forth by car with my manual chair, the cab service worked extremely well, so much so that my times were usually better resulting in a shorter commute.  While priority for rides was assigned by necessity - medical appointments, work, and leisure, I never was without timely transportation.   After about six weeks the strike ended with not much being accomplished.  Drivers sacrificed a pay-cheque for this time away however did retain their benefits in the new contract which was a big issue.  The transportation agency probably saved some money on salaries, fuel and  vehicle maintenance but as they had to pay the cab company for service, the savings were probably not substantial.  It was a lose-lose-lose situation between drivers, management and clients...

New Powerchair:
It has been over six years since my injury and my acquisition of an electric wheelchair.  The chair was presented to me while an inpatient at Toronto's Lyndhurst Rehabilitation Hospital.  I had no input as to the vendor, model or specification as with no previous experience, I relied on the hospital's expertise.  All in all, they did a fine job in matching the chair to the person (me) - or perhaps, because I had no previous experience with a powerchair, whatever I was given seemed right.  I had nothing to compare it to.
Well, after six years of use and abuse, my first and current chair "on it's last legs" (no pun intended).  The detachable leg supports have been bent, straightened, re-bent, replaced and re-bent.  They splay out and twist in, stick out and catch on any obstacle, however small, that extends above flat ground.  The arm rests were some of the first luxury items to go,  Shredded off like cheese on a grater while rubbing along the sides of the bus lift.  The tilt motor stopped working years ago - once considered a necessity to shift my weight in order to prevent pressure sores.  Skin issues never materialized and so when the motor stopped operating, I decided against submitting a claim to my insurance company for unreasonable cost of replacing the unit.  The front and back castors rubber treads are all but warn off.  The original battery still takes a charge but loses it much more quickly. The chair creaks and groans but continues to run in spite of the abuse I inflict on it daily.  However, I cannot continue to push my luck  It was time to look into getting a new powerchair.

Am I entitled?
When I received my first powerchair while completely paralyzed from the chest down.  Things have improved greatly since my discharge from the hospital to where now I can even wiggle a few toes to some degree.  As I work at a hospital, I see wheelchair bound people daily, some elderly, some with visible physical deficiencies, yet using manual wheelchairs.  I had to wonder if it was their own choice to propel themselves using their own power, or did they settle for the less expensive manual chair because of their limited finances?   Even with the provincial government's ADP's assistance (Assisted Devices Program), the 25% cost the client must pay can be prohibitive.
Even with my decent income, the full cost of a new powerchair would make it out of reach for me.(my first powerchair with tilt cost $18,000) - A "Catch 22" situation - I would be working only to pay for the chair and I would need the chair only so that I could work.

So the question was;
As I have excellent upper body strength and am able to propel a manual chair with ease, would I still qualify for ADP assistance for a powerchair, in light of many other people with less ability using manual chairs as their sole source of mobility?  I would find it a significant financial burden to buy one without their assistance yet I need a powerchair to do my job.  I need one hand free to carry items and I need the braking mechanism in the powerchair so that I can brace against it to stand up (a manual chair's brakes are not sufficient to keep it from rolling back.
The choices are - would the government prefer to assist my purchase of a powerchair which would keep me a productive taxpaying citizen, or to deny assistance, leaving me unable to do my job which would result on my falling back on disability and having the taxpayers support me.

The Result:
With the help of an acquaintance, I contacted a sympathetic ADP authorized occupational therapist.  She assisted in getting authorization for the ADP assisted purchase of a new chair.  As a seating specialist she also recommended and provided seating much superior to what I currently was using.  She contacted the sales representative for a powerchair supplier and started the process.  I'll have more about my chair selection process in an upcoming post.

Sunday, 1 January 2012

The Same In Spite Of Change

It has been a while since I posted as although my situation continues to change, my ultimate goal of walking unassisted has not been attained. Here are a few observations and thoughts...

Pain; When the inflammation receded in early January of 2007, movement in my legs began to return but along with it, the pain generated by damaged nerves. I found that no drug relieves this neurogenic pain as most analgesics (pain killers) block the transmission of pain generated in the pain sensors to the nerves and ultimately the spinal cord (an oversimplified explanation). The spinal cord itself generates this pain and all drugs available have little or no effect on my level of pain (Gabapentin, Lyrica, Nortryptiline, Amytriptyline). Nortryptiline may exhibit very minor relief. As such, I've taken myself off Gabapentin and found no increase in my level of pain. Why take medication if it does nothing?

I have to wonder how my pain compares to others with similar spinal cord injuries. As my injury was from infection I have to wonder how damage cause by bacterial enzymes & toxins compares to that caused by traumatic (crushing or severing) injury. That is, how does my pain generated by intact but damaged nerves compare to someone whose nerves are actually severed. Do neuro-pathways that are damaged still conduct more pain than nerves that are cut and not connected. Is my pain more, less or the same regardless of method of injury? Can such magnitude of pain even be measured?

Regardless, while movement continues to improve to some degree, the pain which began to be felt almost 5 years ago to the day has neither increased or decreased.

Movement; Having been told on leaving the hospital 5 years ago that I would never walk again, I arrived home paralyzed from the chest downwards. Since that time, movement has slowly but steadily returned to the point where I can wiggle some toes on both feet to some degree. Plantarflection (standing on my tip-toes) is not an effort at all. Dorsiflection, (lifting my foot off the ground with my heels on the floor) was slow to return. I was lead to believe that this was a neurological problem but with increased walking and stretching, I feel it has more to do with the tendons and ligaments having shortened with disuse. Like trying to rejuvenate dried up & cracked weathered leather, it is very hard to stretch out and restore the supple nature of tendons. I can stretch out for an hour but in the next hour they tighten again. It is sort of a 'catch 22" situation where I would have to be walking constantly have them stretch out properly but as they aren't stretched out, I can't walk constantly. Perhaps the dreaded 'Tone' plays a role here as well.

So after 5 years post prognosis, I can stand in place upright unassisted but there is an unsteadiness that is difficult to overcome. As if all muscles don't work in concert and hold the body perfectly taut. Being upright and walking more would help this but again, the 'catch 22".
I can walk some distances with the aid of a walker and walk between the parallel bars with almost a normal gait as long as I hold on. Close, but not there yet. The next challenge is to be able to stand one one foot. Right now I can't correct those small wavering movements to hold my self taut and upright. On one foot I start leaning in one direction or another and can't correct fast enough to regain my upright position. If I can continue to improve the dorsiflection, I'm hoping that I can take steps without any major orthotic apparatus. Trying to walk too fast, I find my toe will catch the floor/carpet and I may trip myself.
So, I can stand unassisted and walk some distances assisted and things are still changing.
People talk about "muscle memory" where your body (muscles) remember what they are suppose to do after a period of disuse. I've not found that. I've found that muscles have to come back in their own sequence and at their own schedule. I have repeatedly stood and toppled over onto my chair or bed until one time I tighten or engage some muscle and find myself saying "oh, that's how its done". No "muscle memory" - I have to relearn and tell them what to do. It is interesting to notice the sequence of how the muscles come back and what they do. Things that able bodied people do not notice or take for-granted. It reminds me of the American Stealth B-1 Bomber which flies by computer where the software makes thousands of corrections to the flight surfaces every second, allowing it to fly. Standing upright, thousands of tiny muscle fibers fire as necessary in an ever changing sequence to keep on upright. This complex orchestration goes unnoticed by the healthy individual.

Tone; That muscular tightness not due to lack of exercise but rather some signal from the injured spinal cord (or brain) still plagues me. It has diminished somewhat over the years but is present. How much that remains is 'Tone' and home much is still due to muscles not fully returned to pre-injury state is yet to be determined. Walking upright involved the back muscles to a great degree and I find they fatigue the quickest when upright. However, the more I force myself to stand upright I find improvement follows. I stand upright at work and file papers which forces me to twist and turn on the spot. I do this until the muscles begin to burn and the body begins to shake with fatigue. Slowly, it becomes a bit easier with each passing week. I find it amazing that 6 months of complete inactivity in a hospital bed can cause the muscles and tendons to shorten so much that it takes 6 years to return them somewhat to their pre-injury state.

Spasms; These still show up but fluctuate. Most often at night when I try to relax after a workday, The left hip or the right leg will start off slowly, twitching, then jumping - sometimes for minutes and sometimes for hours. Very, very annoying,

Sciatic Nerve Pain; Still bothers me but with perhaps more good days than in previous years. I am convinced that this was not really the result of my neurological injury but rather that I lay in a hospital bed for so long in one position where lying towards one side was favored. I believe it is more a function of the muscles that are located in the lower back and pelvis that control the action at the hip, have become disproportionally shortened and therefore pull the hip out of alignment with resulting pain. Continued exercise may eventually reduce this to tolerable levels.

The bottom line is that I experience constant severe pain on my bad days and extreme discomfort on my good days. This is during all my waking hours (I don't feel pain while asleep) for the last five years and most likely for the rest of my life. Having your mind drawn away from your daily tasks every few minutes is really is no way to live.

Work; I have been back at my workplace now for over two years without any major problems. They have been accommodating however I need very little special consideration. I can stand without any problem (I just can't step away from my chair). I can reach down unassisted and pick a sheet of paper off the floor without major effort. I can operate instruments with foot switches with no problem. There is very little that I can't do however it remains a very big nuisance to be attached to and dependant upon this wheelchair.

Future; I'm not certain if further physiotherapy would be of any help. I've wondered if a chiropractor could help with my sciatic pain. I've checked into local pools with disability access however have yet to take advantage of any. I'm sure that this could help with movement as well as burning off calories and weight gained from just sitting.

Wheelchair; My electric wheechair had gone through many repairs over the last 5 years and it, like me, may be on it's last legs. I fear that I have regained too much mobility to qualify for monetary assistance in acquiring a new chair. The one I currently have cost $18,000 of which 3/4 was subsidized by the government. If I don't qualify, the entire cost would be mine alone to bear. I'm not sure if I could afford that amount, yet I need a motorized wheelchair to do my job. (one hand on the joystick to drive, and one to carry items). I could not do my job with a manual chair. Nor would one of those 'Hover-round' motorized scooters work as the ones I've seen have a steering column out front and can't be parked under a desk.
So, do I spend big $$ to continue working or will I be forced to quit, retire early, go on disability when the service company can no longer repair this old buggy?
You'd think that the government would be happier to see me as a productive citizen paying taxes rather than sitting at home draining disability from others that may truly need that assistance. But then again we're talking government and logic often eludes them. We shall see...

Summary; What I've come to realize that with my injury, the paralysis is the most insignificant problem that I can work on and overcome. It is all the rest that tags along with this injury that destroys one - the constant extreme pain, the tightness and the spasms.


Techno-Zombies - A name I gave to those annoying, self absorbed idiots who cannot wait for a few moments and find an appropriate (safe) location to check their voicemail, their e-mail, their Tweets or update their Facebook status. Head down, thumbs-a-flashin', plodding along, weaving down the sidewalk or hallway, oblivious to people and obstacles - bouncing off both with nary an apology. Self absorbed in their own world and by their own importance. Education & intelligence have no bearing on who becomes mesmerized by the hand-held device. Teens having to reply to their BFF immediately lest they miss out on some party. Physicians checking their patient's status on the run with diverted attention makes for bad medicine - or perhaps Doc is just checking how his stocks are doing or booking a golf game.

Then there are the human obstacles who like hair & grease in a plugged drain block the free movement of people who actually have a purpose and destination. Wheeling down some hallway I frequently have to stop and wait while others, oblivious to my presence, refuse to share the space. Then there are the others, again so self absorbed, that they watch me wheel up, give me a momentary glance, and resume their conversation. Does my presence not register in that pea-brain of theirs or do they just not care? When my path is otherwise blocked, do I really have to roll up to one inch of your knees and shout excuse me to be noticed? My presence is an annoyance. I've heard it said that if you are in a wheelchair, you fly under society's radar and go unnoticed. You become a non-person.
Some of the human flotsam & jetsam that impedes the orderly flow of traffic are include, but are not restricted to those below;
* * *
  • The Weaver (aka Zig-Zagger) - doesn't pick a side of the hallway but drifts from left to right and back again repeatedly.
  • The Obstacle - stops dead in the middle of the hallway to check their hand-held for messages. Like a rock in a river, other traffic must flow around both sides.
  • The Orangutan - walks down the hallway with arms swinging out from their sides threatening to slap anyone who attempts to pass. A variation of this adds shoulder bags, purses, shopping bags, etc to the arsenal attempting to bombard the passerby.
  • The Coffee Clutch - like a log jam in a river, may start small with one or two people engaged in a hallway meeting, but often grows as more people get snagged and join into what eventually becomes a full fledged hallway seminar.
  • The Ping-Pong Ball - walking full speed down the hallway, suddenly realizes they've forgotten something from where they came and instantly change direction back, usually running into whomever is immediately behind them. The true ping-ponger may remember, then decide it isn't important, then reconsider, then change their mind again, seemingly bouncing back and forth in a three foot span of space in the middle of the hall.
  • The Darter - Darts out of side doorways without looking to see if the hallway is clear. Storm out of a doorway looking only in the direction of their travel while others have to stop short to avoid rear-ending each other.
  • The Racer - Doing the lap around a corner these folks cut the corner sharply (right side of hallway to left side of new hall) to avoid a few extra steps and save a few microseconds. The racer often bumps head-on the the person rounding the corner in the opposite direction.
  • The Salmon - like the fish that swims upstream to reproduce, these folks resist the flow of current in one direction and try to maneuver upstream through that flow dividing oncoming traffic.
  • Deer In The Headlights - confront them head on and they just stand there with a blank "deer in the headlights" look in their eyes. Hello! I said excuse me - I can't dematerialize and roll through you. Why do you think I've stopped here inches from your knees?
  • The Brit - (no disrespect to my British friends) - The unwritten convention is to walk on the same side of the hallway as the side of the road you drive on. Here in North America that being the right side. This prevents people from meeting head-on and having to do the Tango or 'play chicken' as they decide if or who will move and to which side.
  • The Line Dancers - Side by side, two, three, more...hold hands or have arms entwined as they sweep down the hallway refusing to break for anyone.
  • The Lousy Shepherd - Unconcerned parent with kids that stray in every which direction with no discipline or control. Like trying to herd cats! Control your offspring or leave them at home.
  • Darwin's Legacy - the most dangerous, often to themselves. Walking, texting, i-pod blasting through earphones, disengaged, lost in thought and oblivious to all dangers around them. These are the clowns that run into you and crumple into your lap, that in their oblivion walk into traffic, & fall down staircases.

There are numerous other variations as you can imagine...

There is also the opposite, the over considerate person who immediately decides that because you are in a wheelchair that they must do everything in their power to help you, even if you politely decline their assistance. Thank you, its my feet that don't work well, you don't have to exit and then re-enter the elevator to push my floor button for me. It's my feet, not my ears - you don't have to speak louder because I'm in a wheelchair. I try not to discourage these people, politely declining assistance I don't require but accepting what they insist on offering. Perhaps the next wheelchair bound person will need such help.

Offer assistance if you see me struggling, otherwise assume I'm doing fine - and Thanks anyways.

People, please be aware of your surroundings for the benefit of others and for your own safety. Civilization means we are civilized and should act in a civil manner towards each other. Offer common courtesy to all you encounter and you will probably receive respect in return. Most of all, just Think!

Thank you for your attention!