Factors influencing access to health care among people with disabilities (PWD) include: attitudes of health care providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD. Reducing health care disparities in a population with complex needs requires implementation at the primary, secondary and tertiary levels. This review article discusses common barriers to health care access from the patient and provider perspective, particularly focusing on communication barriers and how to address and ameliorate them. Articles utilized in this review were published from 2005 to present in MEDLINE and CINAHL and written in English that focused on people with disabilities. Topics searched for in the literature include: disparities and health outcomes, health care dissatisfaction, patient-provider communication and access issues. Ineffective communication has significant impacts for PWD. They frequently believe that providers are not interested in, or sensitive to their particular needs and are less likely to seek care or to follow up with recommendations. Various strategies for successful improvement of health outcomes for PWD were identified including changing the way health care professionals are educated regarding disabilities, improving access to health care services, and enhancing the capacity for patient centered care.

Aim Physical activity (PA) among adults with rheumatoid arthritis (RA) is suboptimal. This study assessed PA motivations and perceptions in adults with RA and rheumatologists. Methods Patients and rheumatologists participated in structured interviews led by a behavioral scientist. Sessions were audiotaped, transcribed and coded. Results Twenty-three patients (mean age = 63 [standard deviation = 10], 96% female) and seven rheumatologists (57% male, 29% fellows) participated. Nine themes emerged: communication with the rheumatologist, environment/access, symptom management, social support, mental health, breaking inactivity cycles, integrating PA into routines, staying in control and challenge/intimidation. Highly active patients viewed PA differently than low active patients. The need to compete with RA-free individuals may impede PA. Conclusion Understanding how patients conceptualize PA will enable clinicians to formulate PA strategies to motivate patients.

The purposes of this perspective article are: (1) to explore models of disability from the perspective of the academic discipline of disability studies (DS), (2) to consider the paradox of improving functional capacities while valuing disability as diversity, (3) to identify how physical therapy's use of the International Classification of Functioning, Disability and Health (ICF) disablement model intersects with various disability models, and (4) to apply this broader understanding of disability to physical therapist practice, education, and research. The DS literature has been critical of rehabilitation professionals, particularly targeting the medical model of disability. In contrast, advocates for a social model of disability recognize disability as diversity. It is paradoxical for physical therapy to simultaneously work to ameliorate disability while celebrating it as diversity. The ICF biopsychosocial disablement model offers a mechanism to practice within this paradox and suggests that it is no longer sufficient to conceptualize disability as a purely individual matter that requires attention in isolation from the impact of the larger society.

The purposes of this study were to 1) investigate the sequence of development of head, upper extremity, and lower extremity extension in the prone extension posture in healthy infants; 2) identify the variations in the sequence; and 3) compare these postures within the sequence with the development of prone-on-elbows and prone-on-hands postures. Twenty healthy, full-term infants were observed longitudinally from 8 to 28 weeks of age. Two of the infants could not complete the study, and two infants never used the prone extension posture. The data from 16 of the infants, therefore, were analyzed. The results indicate that the sequence of development of the prone extension posture consists of head extension, followed by lower extremity extension, and then upper extremity extension. The results also indicate that upper extremity extension in the prone extension posture does not appear to be a prerequisite for the prone-on-elbows or prone-on-hands postures. These findings suggest that infants may use different strategies for developing motor control in the head and lower extremities than in the upper extremities. This information adds to our knowledge of the normal developmental process and may have significance in the planning of physical therapy programs.

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