DESIGNING FOR SPECIFIC GROUPS

Joke H. Grady-van den Nieuwboer

In designing a product or an industrial process, one focuses on the “average” and

“healthy” worker. Information regarding human abilities in terms of muscular strength,
bodily flexibility, length of reach, and many other characteristics is for the most part
derived from empirical studies carried out by military recruitment agencies, and reflects
measured values valid for the typical young male in his twenties. But working
populations, to be sure, consist of people of both sexes and a broad range of ages, to say
nothing of a variety of physical types and abilities, levels of fitness and health, and
functional capacities. A classification of the varieties of functional limitation among
people as outlined by the World Health Organization is given in the accompanying box.
At present, industrial design for the most part takes insufficient account of the general
abilities (or inabilities, for that matter) of workers at large, and should take as its point of
departure a broader human average as a basis for design. Clearly, a suitable physical load
for a 20-year-old may exceed the capacity to manage of a 15-year-old or a 60-year-old. It
is the business of the designer to consider such differences not only from the point of
view of efficiency, but with a eye to the prevention of job-related injury and illness.

The International Classification of Functional Limitation in People

The WHO (World Health Organization) introduced in 1980 a classification of functional

limitation in people; the ICIDH (International Classification Impairment, Disability and
Handicap). In this classification a difference is made between illness, limitations and handicap.

This reference model was created to facilitate international communication. The model was
presented on the one hand to offer a reference framework for policy makers and on the other
hand, to offer a reference framework for doctors diagnosing people suffering from the
consequences of illness.

Why this reference framework? It arose with the aim of trying to improve and increase the
participation of people with long-term limited abilities. Two aims are mentioned:

· the rehabilitation perspective, i.e., the reintegration of people into society, whether this means
work, school, household, etc.

· the prevention of illness and where possible the consequences of illness e.g., disability and
handicap.

As of January 1st, 1994 the classification is official. The activities that have followed, are
widespread and especially concerned with issues such as: information and educational measures
for specific groups; regulations for the protection of workers; or, for instance, demands that
companies should employ, for example, at least 5 per cent of workers with a disability. The

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classification itself leads in the long term to integration and non-discrimination.

Illness

Illness strikes each of us. Certain illnesses can be prevented, others not. Certain illnesses can be
cured, others not. Where possible illness should be prevented and if possible cured.

Impairment

Impairment means every absence or abnormality of a psychological, physiological or anatomic

structure or function.

Being born with three fingers instead of five does not have to lead to disability. The capabilities
of the individual, and the degree of manipulation possible with the three fingers, will determine
whether or not the person is disabled. When, however, a fair amount of signal processing is not
possible on a central level in the brain, then impairment will certainly lead to disability as at
present there is no method to “cure” (solve) this problem for the patient.

Disability

Disability describes the functional level of an individual having difficulty in task performance
e.g., difficulty standing up from their chair. These difficulties are of course related to the
impairment, but also to the circumstances surrounding it. A person who uses a wheelchair and
lives in a flat country like the Netherlands has more possibilities for self-transportation than the
same person living in a mountainous area like Tibet.

Handicap

When the problems are placed on a handicap level, it can be determined in which field the main
problems are effective e.g., immobility or physical dependency. These can affect work
performance; for example the person may not be able to get themselves to work; or, once at
work, might need assistance in personal hygiene, etc.

A handicap shows the negative consequences of disability and can only be solved by taking the
negative consequences away.

Summary and conclusions

The above-mentioned classification and the policies thereof offer a well defined international
workable framework. Any discussion on designing for specific groups will need such a
framework in order to define our activities and try to implement these thoughts in design.

The progress of technology has brought about the state of affairs that, of all the
workplaces in Europe and North America, 60% involve the seated position. The physical

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load in work situations is now on average far less than before, but many worksites,
nonetheless, call for physical loads that cannot be sufficiently reduced to fit human
physical capabilities; in some developing countries, the resources of current technology
are simply not available to relieve the human physical burden to any appreciable extent.
And in technologically advanced countries, it is still a common problem that a designer
will adapt his or her approach to constraints imposed by product specifications or
production processes, either slighting or leaving out human factors related to disability
and the prevention of harm due to the workload. With respect to these aims, designers
have to be educated to devote attention to all such human factors, expressing the results
of their study in a product requirements document (PRD). The PRD contains the system
of demands which the designer has to meet in order to achieve both the expected product
quality level and the satisfaction of human capability needs in the production process.
While it is unrealistic to demand a product that matches a PRD in every respect, given the
need of unavoidable compromises, the design method suited to the closest approach to
this goal is the system ergonomic design (SED) method, to be discussed following a
consideration of two alternative design approaches.

Creative Design

This design approach is characteristic of artists and others involved in the production of
work of a high order of originality. The essence of this design process is that a concept is
worked out intuitively and through “inspiration”, allowing problems to be dealt with as
they arise, without conscious deliberation beforehand. Sometimes, the outcome will not
resemble the initial concept, but nonetheless represents what the creator regards as his or
her authentic product. Not seldom, too, the design is a failure. Figure 29.46 illustrates the
route of creative design.

Figure 29.46 Creative design

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System Design

System design arose from the need to predetermine the steps in design in a logical order.
As design becomes complex, it has to be subdivided into subtasks. Designers or subtask
teams thus become interdependent, and design becomes the job of a design team rather
than an individual designer. Complementary expertise is distributed through the team,
and design assumes an interdisciplinary character.

System design is oriented to the optimal realization of complex and well-defined product
functions through the selection of the most appropriate technology; it is costly, but the
risks of failure are considerably reduced as compared with less organized approaches.
The efficacy of the design is measured against the goals formulated in the PRD.

The way in which the specifications formulated in the PRD are of the first importance.
Figure 29.47 illustrates the relationship between the PRD and other parts of the system
design process.

Figure 29.47 System design

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As this scheme shows, the input of the user is neglected. Only at the end of the design
process can the user criticize the design. This is unhelpful to both producer and user,
since one has to wait for the next design cycle (if there is one) before errors can be
corrected and modifications made. Furthermore, user feedback is seldom systematized
and imported into a new PRD as a design influence.

System ergonomic design (SED)

SED is a version of system design adapted to ensure that the human factor is accounted
for in the design process. Figure 29.48 illustrates the flow of user input into the PRD.

Figure 29.48 System ergonomic design

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In system ergonomic design, the human being is considered part of the system: design
specification changes are, in fact, made in consideration of the worker’s abilities with
respect to cognitive, physical and mental aspects, and the method lends itself as an
efficient design approach for any technical system where human operators are employed.

For example, to examine the implications of the worker’s physical abilities, task-
allocation in the design of the process will call for a careful selection of tasks to be
performed by the human operator or by the machine, each task being studied for its
aptness to machine or human treatment. Clearly, the human worker will be more effective
at interpreting incomplete information; machines however calculate much more rapidly
with prepared data; a machine is the choice for lifting heavy loads; and so forth.
Furthermore, since the user-machine interface can be tested at the prototype phase, one
can eliminate design errors that would otherwise untimely manifest themselves at the
phase of technical functioning.

Methods in User Research

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No “best” method exists, nor any source of formulae and sure and certain guidelines,
according to which design for disabled workers ought to be undertaken. It is a rather a
common-sense business of making as exhaustive search of all obtainable knowledge
relevant to the problem and of implementing it to its most evident best effect.

Information can be assembled from sources such as the following:

· The literature of research results.

· Direct observation of the disabled person at work and description of his or her
particular work difficulties. Such observation should be made at a point in the worker’s
schedule when he or she can be expected to be subject to fatigue—the end of a work
shift, perhaps. The point is that any design solutions should be adapted to the most
arduous phase of the work process, or else such phases may fail to be performed
adequately (or at all) owing to the worker’s capacity having been physically exceeded.

· The interview. One has to be aware of the possibly subjective responses which the
interview per se may have the effect of eliciting. It is a far better approach that the
interview technique be combined with observation. Disabled persons sometimes hesitate
to discuss their difficulties, but when workers are aware that the investigator is willing to
exert special thoroughness on their behalf, their reticence will diminish. This technique is
time-consuming, but quite worthwhile.

· Questionnaires. An advantage of the questionnaire is that it can be distributed to large

groups of respondents and at the same time gather data of as specific a sort as one wishes
to provide for. The questionnaire must, however, be constructed upon the basis of
representative information pertaining to the group to which it will be administered. This
means that the type of information to be sought must be obtained on the basis of
interviews and observations carried out among a sample of workers and specialists that
ought to be reasonably restricted as to size. In the case of disabled persons, it is sensible
to include among such a sample the physicians and therapists who are involved with
prescribing special aids for disabled persons and have examined them regarding their
physical capabilities.

· Physical measurements. Measurements obtained from instruments in the field of bio-

instrumentation (e.g., the activity level of muscles, or the amount of oxygen consumed in
a given task) and by anthropometrical methods (e.g., the linear dimensions of body
elements, the range of motion of limbs, muscular strength) are of indispensable value in
human-oriented work designs.

The methods described above are some of the various ways of gathering data about
people. Methods exist, too, to evaluate user-machine systems. One of these—simulation
—is to construct a realistic physical copy. The development of a more or less abstract
symbolic representation of a system is an example of modelling. Such expedients, of
course, are both useful and necessary when the actual system or product is not in
existence or not accessible to experimental manipulation. Simulation is more often used

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for training purposes and modelling for research. A mock-up is a full-size, three-
dimensional copy of the designed workplace composed, where necessary, of improvised
materials, and is of great use in testing design possibilities with the proposed disabled
worker: in fact, the majority of design problems can be identified with the aid of such a
device. Another advantage to this approach is that the motivation of the worker grows as
he or she participates in the design of his or her own future workstation.

Analysis of Tasks

In the analysis of tasks, different aspects of a defined job are subject to analytical
observation. These manifold aspects include posture, routing of work manipulations,
interactions with other workers, handling tools and operating machines, the logical order
of subtasks, the efficiency of operations, static conditions (a worker may have to perform
tasks in the same posture over a long time or with high frequency), dynamic conditions
(calling for numerous varying physical conditions), material environmental conditions (as
in a cold slaughterhouse) or non-material conditions (as with stressful work surroundings
or the organization of the work itself).

Work design for the disabled person has, then, to be founded on a thorough task analysis
as well as a full examination of the functional abilities of the disabled person. The basic
design approach is a crucial issue: it is more efficient to elaborate all possible solutions
for the problem in hand without prejudice than to produce a single design concept or a
limited number of concepts. In design terminology, this approach is called making a
morphological overview. Given the multiplicity of original design concepts, one can
proceed to an analysis of the pro and con features of each possibility with respect to
material use, construction method, technical production features, ease of manipulation,
and so on. It is not unprecedented that more than one solution reaches the prototype stage
and that a final decision is made at a relatively late phase in the design process.

Although this may seem a time-consuming way to realize design projects, in fact the
extra work it entails is compensated for in terms of fewer problems encountered in the
developmental stage, to say nothing that the result—a new workstation or product—will
have embodied a better balance between the needs of the disabled worker and the
exigencies of the working environment. Unfortunately, the latter benefit rarely if ever
reaches the designer in terms of feedback.

Product Requirements Document (PRD) and Disability

After all information relating to a product has been assembled, it should be transformed
into a description not only of the product but of all those demands which may be made of
it, regardless of source or nature. These demands may of course be divided along various
lines. The PRD should include demands relating to user-operator data (physical
measurements, range of motion, range of muscular strength, etc.), technical data
(materials, construction, production technique, safety standards, etc.), and even
conclusions arising out of market feasibility studies.

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The PRD forms the designer’s framework, and some designers regard it as an unwelcome
restriction of their creativity rather than as a salutary challenge. In view of the difficulties
at times accompanying the execution of a PRD, it should always be borne steadily in
mind that a design failure causes distress for the disabled person, who may relinquish his
or her efforts to succeed in the employment arena (or else fall helpless victim to the
progress of the disabling condition), and additional costs for redesign as well. To this end,
technical designers should not operate alone in their design work for the disabled, but
should cooperate with whatever disciplines are needed for securing the medical and
functional information to set up an integrated PRD as a framework for the design.

Prototype Testing

When a prototype is built, it should be tested for errors. Error testing should be carried
out not only from the point of view of the technical system and subsystems, but also with
a view to its usability in combination with the user. When the user is a disabled person,
extra precautions have to be taken. An error to which an unimpaired worker may
successfully respond in safety may not afford the disabled worker the opportunity of
avoiding harm.

Prototype testing should be carried out on a small number of disabled workers (except in
the case of a unique design) according to a protocol matched to the PRD. Only by such
empirical testing can the degree to which the design meets the demands of the PRD be
adequately judged. Although results on small numbers of subjects may not be
generalizable to all cases, they do supply valuable information for the designer’s use in
either the final design or in future designs.

Evaluation

The evaluation of a technical system (a work situation, machine or tool) should be judged
on its PRD, not by questioning the user or even by attempting comparisons of alternative
designs with respect to physical performance. For instance, the designer of a specific
knee brace, basing his or her design on research results that show unstable knee joints to
exhibit a delayed hamstring reaction, will create a product that compensates for this
delay. But another brace may have different design aims. Yet present evaluation methods
show no insight as to when to prescribe what kind of knee brace to which patients under
what conditions—precisely the sort of insight a health professional needs when
prescribing technical aids in the treatment of disabilities.

Current research aims at making this sort of insight possible. A model used to obtain
insight into those factors which actually determine whether or not a technical aid ought to
be used, or whether or not a worksite is well designed and equipped for the disabled
worker is the Rehabilitation Technology Useability Model (RTUM). The RTUM model
offers a framework to use in evaluations of existing products, tools or machines, but can
also be used in combination with the design process as shown in figure 29.49 .

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Figure 29.49 Rehabilitation Technology Useability Model (RTUM) in combination
with the system ergonomic design approach

Evaluations of existing products reveal that as regards technical aids and worksites, the
quality of PRDs is very poor. At some times, the product requirements are not recorded
properly; at others they are not developed to a useful extent. Designers simply must learn
to start documenting their product requirements, including those relevant to disabled
users. Note that, as figure 29.49 shows, RTUM, in conjunction with SED, offers a
framework that includes the requirements of disabled users. Agencies responsible for
prescribing products for their users must request industry to evaluate those product before
marketing them, a task in essence impossible in the absence of product requirement
specifications; figure 29.49 also shows how provision can be made to ensure that the end
result can be evaluated as it should (on a PRD) with the help of the disabled person or
group for whom the product is intended. It is up to national health organizations to
stimulate designers to abide by such design standards and to formulate appropriate
regulations.

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WORKERS WITH SPECIAL NEEDS
Joke H. Grady-van den Nieuwboer

Designing for Disabled Persons is Designing for Everyone

There are so many products on the market that readily reveal their unfitness for the
general population of users. What evaluation should one make of a doorway too narrow
to comfortably accommodate a stout person or pregnant woman? Shall its physical design
be faulted if it satisfies all relevant tests of mechanical function? Certainly such users
cannot be regarded as disabled in any physical sense, since they may be in a state of
perfect health. Some products need considerable handling before one can force them to
perform as desired—certain inexpensive can openers come, not altogether trivially, to
mind. Yet a healthy person who may experience difficulty operating such devices need
not be considered disabled. A designer who successfully incorporates considerations of
human interaction with the product enhances the functional utility of his or her design. In
the absence of good functional design, people with a minor disability may find
themselves in the position of being severely hampered. It is thus the user-machine
interface that determines the value of design for all users.

It is a truism to remind oneself that technology exists to serve human beings; its use is to
enlarge their own capabilities. For disabled persons, this enlargement has to be taken
some steps further. For instance in the 1980s, a good deal of attention was paid to the
design of kitchens for disabled people. The experience gained in this work penetrated
design features for “normal” kitchens; the disabled person in this sense may be
considered a pioneer. Occupationally-induced impairments and disabilities—one has but
to consider the musculoskeletal and other complaints suffered by those confined to
sedentary tasks so common in the new workplace—similarly call for design efforts aimed
not only also preventing the recurrence of such conditions, but at the development of
user-compatible technology adapted to the needs of workers already affected by work-
related disorders.

The Broader Average Person

The designer should not focus on a small, unrepresentative population. Among certain
groups it is most unwise to entertain assumptions concerning similarities among them.
For example, a worker injured in a certain way as an adult may not necessarily be
anthropometrically quite so different from an otherwise comparable, healthy person, and
may be considered as part of the broad average. A young child so injured will display a
considerably different anthropometry as an adult since his muscular and mechanical
development will be steadily and sequentially influenced by preceding growth stages.
(No conclusions as to comparability as adults ought to be ventured as regards the two
cases. They must be regarded as two distinct, specific groups, only the one being included
among the broad average.) But as one strives for a design suitable for, say, 90% of the
population, one should exert fractionally greater pains to increase this margin to, say,

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95%, the point being that in this way the need for design for specific groups can be
reduced.

Another way to approach design for the broader average population is to produce two
products, each one designed roughly to fit the two percentile extremes of human
differences. Two sizes of chair, for instance, might be built, the one with brackets
allowing it to be adjusted in height from 38 to 46 cm, and the other one from 46 to 54 cm;
two sizes of pliers already exist, one fitting larger and average sizes of men’s hands and
the other fitting average women’s hands and hands of smaller men.

It would be a well-advised company policy to reserve annually a modest amount of

money to have worksites analysed and made more suitable for workers, a move that
would prevent illness and disability due to excessive physical load. It also increases the
motivation of workers when they understand that management is actively trying to
improve their work environment, and more impressively so when elaborate measures
sometimes have to be undertaken: thorough work analysis, the construction of mock-ups,
anthropometrical measurements, and even the specific design of units for the workers. In
a certain company, in fact, the conclusion was that the units should be redesigned at every
worksite because they caused physical overload in the form of too much standing, there
were unsuitable dimensions associated with the seated positions, and there were other
deficiencies as well.

Costs, Benefits and Usability of Design

Cost/benefit analyses are developed by ergonomists in order to gain insight into the
results of ergonomic policies other than those that are economic. In the present day,
evaluation in the industrial and commercial realms includes the negative or positive
impact of a policy on the worker.

Methods of evaluating quality and usability are currently the subject of active research.
The Rehabilitation Technology Useability Model (RTUM), as shown in figure 29.51 , can
be utilized as a model for evaluating the usability of a product within rehabilitation
technology and to illuminate the various aspects of the product which determine its
usability.

Figure 29.51 The Rehabilitation Technology Useability Model (RTUM)

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From the strictly economic point of view, the costs of creating a system in which a given
task can be performed or in which a certain product can be made can be specified; it
scarcely needs mentioning that in these terms each company is interested in a maximum
return on its investment. But how can the real costs of task performance and product
manufacturing in relation to financial investment be determined when one takes into
account the varying exertions of workers’ physical, cognitive and mental systems? In
fact, the judging of human performance itself is, among other factors, based on the
workers’ perception of what has to be done, their view of their own value in doing it, and
their opinion of the company. It is actually the intrinsic satisfaction with work that is the
norm of value in this context, and this satisfaction, together with the aims of the
company, constitute one’s reason for performing. Worker well-being and performance are
thus based on a wide spectrum of experiences, associations and perceptions that
determine attitudes towards work and the ultimate quality of performance—an
understanding upon which the RTUM model is predicated.

If one does not accept this view, it becomes necessary to regard investment only in
relation to doubtful and unspecified results. If ergonomists and physicians wish to
improve the work environment of disabled people—to produce more from machine
operations and enhance the usability of the tools used—they will encounter difficulties in
finding ways to justify the financial investment. Typically, such justification has been
sought in savings realized by prevention of injury and illness due to work. But if the costs
of illness have been borne not by the company but by the state, they become financially
invisible, so to speak, and are not seen as work-related.

Nevertheless, the awareness that investment in a healthy working environment is money

well spent has been growing with the recognition that the “social” costs of incapacities
are translatable in terms of ultimate costs to a country’s economy, and that value is lost
when a potential worker is sitting about at home making no contribution to society.
Investing in a workplace (in terms of adapting a work station or providing special tools or
perhaps even help in personal hygiene) can not only reward a person with job satisfaction
but can help make him or her self-sufficient and independent of social assistance.

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Cost/benefit analyses can be carried out in order to determine whether special
intervention in the workplace is justified for disabled persons. The following factors
represent sources of data that would form the object of such analyses:

1. Personnel

· Absence. Will the disabled worker have a satisfactory attendance record?

· Is it likely that extra costs may be incurred for special task instruction?

· Are personnel changes called for? Their costs must be considered also.

· Can accident compensation rates be expected to increase?

2. Safety

· Will the job being considered for the disabled worker involve safety regulations?

· Will special safety regulations be involved?

· Is the work characterized by a considerable frequency of accidents or near accidents?

3. Medical

· As regards the worker whose disability is being examined with a view to his or her
re-entry into the workplace, the nature and seriousness of the incapacity must be
assessed.

· The extent of the disabled worker’s absence must also be taken into account.

· What is the character and frequency of the worker’s “minor” symptoms, and how are
they to be dealt with? Can the future development of related “minor” illnesses capable of
hampering the worker’s efficiency be foreseen?

As concerns time lost from work, these calculations can be made in terms of wages,
overhead, compensation and lost production. The sort of analyses just described
represents a rational approach by which an organization can arrive at an informed
decision as to whether a disabled worker is better off back on the job and whether the
organization itself will gain by his or her return to work.

In the preceding discussion, designing for the broader population has received a focus of
attention heightened by emphasis on specific design in relation to usability and the costs
and benefits of such design. It is still a difficult task to make the needed calculations,
including all relevant factors, but at present, research efforts are continuing that
incorporate modelling methods in their techniques. In some countries, for example the
Netherlands and Germany, government policy is making companies more responsible for

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job-related personal harm; fundamental changes in regulatory policies and insurance
structures are, clearly, to be expected to result from trends of this sort. It has already
become a more or less settled policy in these countries that a worker who suffers a
disabling accident at work should be provided with an adapted work station or be able to
perform other work within the company, a policy that has made the treatment of the
disabled a genuine achievement in the humane treatment of the worker.

Workers with Limited Functional Capacity

Whether design is aimed at the disabled or at the broader average, it is hindered by a

scarcity of research data. Handicapped people have been the subjects of virtually no
research efforts. Therefore, in order to set up a product requirements document, or PRD,
a specific empirical research study will have to be undertaken in order to gather that data
by observation and measurement.

In gathering the information needed about the disabled worker or user it is necessary to
consider not only the current functional status of the disabled person, but to make the
attempt to foresee whatever changes might be the result of the progression of a chronic
condition. This kind of information can, in fact, be elicited from the worker directly, or a
medical specialist can supply it.

In designing, for instance, a work action to which data about the worker’s physical
strength is relevant, the designer will not choose as a specification the maximum strength
which the disabled person can exert, but will take into account any possible diminution in
strength that a progression in the worker’s condition might bring about. Thus the worker
will be enabled to continue to use the machines and tools adapted or designed for him or
at the work station.

Furthermore, designers should avoid designs that involve manipulations of the human
body at the far extremes of, say, the range of motion of a body part, but should
accommodate their designs to the middle ranges. A simple but very common illustration
of this principle follows. A very common part of the drawers of kitchen and office
cabinets and desks is a handle that has the form of a little shelf under which one places
the fingers, exerting upward and forward force to open the drawer. This manoeuvre
requires 180 degrees of supination (with the palm of the hand up) in the wrist—the
maximum point for the range of this sort of motion of the wrist. This state of affairs may
present no difficulty for a healthy person, provided that the drawer can be opened with a
light force and is not awkwardly situated, but makes for strain when the action of the
drawer is tight or when the full 180-degree supination is not possible, and is a needless
burden on a disabled person. A simple solution—a vertically placed handle—would be
mechanically far more efficient and more easily manipulated by a larger portion of the
population.

Physical Functioning Ability

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In what follows, the three chief areas of limitation in physical functional ability, as
defined by the locomotion system, the neurological system and the energy system, will be
discussed. Designers will gain some insight into the nature of user/worker constraints in
considering the following basic principles of bodily functions.

The locomotion system. This consists of the bones, joints, connective tissues and
muscles. The nature of the joint structure determines the range of motion possible. A knee
joint, for example, shows a different degree of movement and stability than the joint of
the hip or the shoulder. These varying joint characteristics determine the actions possible
to the arms, hands, feet, and so on. There are also different types of muscle; it is the type
of muscle, whether the muscle passes over one or two joints, and the location of the
muscle that determines, for a given body part, the direction of its movement, its speed,
and the strength which it is capable of exerting.

The fact that this direction, speed and strength can be characterized and calculated is of
great importance in design. For disabled people, one has to take it into account that the
“normal” locations of muscles have been disturbed and that the range of motion in joints
has been changed. In an amputation, for instance, a muscle may function only partly, or
its location may have changed, so that one has to examine the physical ability of the
patient carefully to establish what functions remain and how reliable they may be. A case
history follows.

A 40-year-old carpenter lost his thumb and the third finger of his right hand in an
accident. In an effort to restore the carpenter’s capacity for work, a surgeon removed one
of the patient’s great toes and he replaced the missing thumb with it. After a period of
rehabilitation, the carpenter returned to work but found it impossible to do sustained work
for more than three to four hours. His tools were studied and found to be unfitted to the
“abnormal” structure of his hand. The rehabilitation specialist, examining the
“redesigned” hand from the point of view of its new functional ability and form was able
to have new tools designed that were more appropriate and usable with respect to the
altered hand. The load on the worker’s hand, previously too heavy, was now within a
usable range, and he regained his ability to continue work for a longer time.

The neurological system. The neurological system can be compared to a very

sophisticated control room, complete with data collectors, whose purpose it is to initiate
and govern one’s movements and actions by interpreting information relating to those
aspects of the body’s components relating to position and mechanical, chemical and other
states. This system incorporates not only a feedback system (e.g., pain) that provides for
corrective measures, but a “feed-forward” capability which expresses itself anticipatorily
so as to maintain a state of equilibrium. Consider the case of a worker who reflexively
acts so as to restore a posture in order to protect himself from a fall or from contact with
dangerous machine parts.

In disabled persons, the physiological processing of information can be impaired. Both

the feedback and the feed-forward mechanisms of visually impaired people are weakened
or absent, and the same is true, on an acoustic level, among the hearing-impaired.

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Furthermore the important governing circuits are interactive. Sound signals have an effect
on the equilibrium of a person in conjunction with proprioceptive circuits that situate our
bodies in space, so to speak, via data gathered from muscles and joints, with the further
help of visual signals. The brain can function to overcome quite drastic deficiencies in
these systems, correcting for errors in the coding of information and “filling in” missing
information. Beyond certain limits, to be sure, incapacity supervenes. Two case histories
follow.

Case 1. A 36-year-old woman suffered a lesion of the spinal cord due to an automobile
accident. She is able to sit up without assistance and can move a wheelchair manually.
Her trunk is stable. The feeling in her legs is gone, however; this defect includes an
inability to sense temperature changes.

She has a sitting workplace at home (the kitchen is designed to allow her to work in a
seated position). The safety measure has been taken of installing a sink in a position
sufficiently isolated that the risk of burning her legs with hot water is minimized, since
her inability to process temperature information in the legs leaves her vulnerable to being
unaware of being burned.

Case 2. A five-year-old boy whose left side was paralysed was being bathed by his
mother. The doorbell rang, the mother left the boy alone to go to the front door, and the
boy, turning on the hot-water tap, suffered burns. For safety reasons, the bath should have
been equipped with a thermostat (preferably one that the boy could not have overridden).

The energy system. When the human body has to perform physical labour, physiological
changes, notably in the form of interactions in the muscle cells, take place, albeit
relatively inefficiently. The human “motor” converts only about 25% of its energy supply
to mechanical activity, the remainder of the energy representing thermal losses. The
human body is therefore not especially suited to heavy physical labour. Exhaustion sets in
after a certain time, and if heavy labour has to be performed, reserve energy sources are
drawn upon. These sources of reserve energy are always used whenever work is carried
out very rapidly, is started suddenly (without a warm-up period) or involves heavy
exertion.

The human organism obtains energy aerobically (via oxygen in the bloodstream) and
anaerobically (after depleting aerobic oxygen, it calls upon small, but important reserve
units of energy stored in muscle tissue). The need for fresh air supplies in the workplace
naturally draws the focus of discussion of oxygen usage toward the aerobic side, working
conditions that are strenuous enough to call forth anaerobic processes on a regular basis
being extraordinarily uncommon in most workplaces, at least in the developed countries.
The availability of atmospheric oxygen, which relates so directly to human aerobic
functioning, is a function of several conditions:

· Ambient air pressure (approximately 760 torr, or 21.33 kPa at sea level). High-
altitude task performance can be profoundly affected by oxygen deficiency and is a prime
consideration for workers in such conditions.

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· For workers doing heavy labour, ventilation is necessary to ensure refreshment of the
air supply, allowing the volume of air respired per minute to be increased.

· Ambient oxygen makes its way into the bloodstream via the alveoli by diffusion. At
higher blood pressures, the diffusion surface is enlarged and thereby the oxygen capacity
of the blood.

· An increase in oxygen diffusion to the tissues causes an increase of the diffusion

surface and consequently of the oxygen level.

· People with certain heart problems suffer when, with increased cardiac output
(together with the oxygen level), the blood circulation changes in favour of the muscles.

· By contrast with oxygen, because of the large reserves of glucose, and especially fat,
the energy source (“fuel”) need not be continuously delivered from the outside. In heavy
labour, it is merely glucose, with its high energy value, that is used. With lighter work, fat
is called upon, at a rate varying with the individual. A brief, general case history follows.

A person suffering from asthma or bronchitis, both of which are diseases affecting the
lungs, causes the worker severe limitation in his or her work. The work assignment of this
worker should be analysed with respect to factors such as physical load. The environment
should be analysed as well: clean ambient air will contribute substantially to workers’
well-being. Furthermore, the workload should be balanced through the day, avoiding
peak loads.

Specific Design

In some cases, however, there is still a need for specific design, or design for very small
groups. Such a need arises when the tasks to be performed and the difficulties a disabled
person is experiencing are excessively large. If the needed specific requirements cannot
be made with the available products on the market (even with adaptations), specific
design is the answer. Whether this sort of solution may be costly or cheap (and aside from
humanitarian issues) it must be nonetheless regarded in the light of workability and
support to the firm’s viability. A specially designed worksite is worthwhile economically
only when the disabled worker can look forward to working there for years and when the
work he or she does is, in production terms, an asset to the company. When this is not the
case, although the worker may indeed insist upon his or her right to the job, a sense of
realism should prevail. Such touchy problems should be approached in a spirit of seeking
a solution by cooperative endeavours at communication.

The advantages of specific design are as follows:

· The design is custom made: it fits the problems to be solved to perfection.

· The worker so served can return to work and a life of social participation.

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· The worker can be self-sufficient, independent of welfare.

· The costs of any personnel changes that the alternative might involve are avoided.

The disadvantages of specific design are:

· The design is unlikely to be used for even one other person, let alone a larger group.

· Specific design is often costly.

· Specifically designed products must often be handmade; savings owing to mass

methods are most often not realizable.

Case 1. For example, there is the case of a receptionist in a wheelchair who had a speech
problem. Her speech difficulty made for rather slow conversations. While the firm
remained small, no problems arose and she continued to work there for years. But when
the firm enlarged, her disabilities began to make themselves problematic. She had to
speak more rapidly and to move about considerably faster; she could not cope with the
new demands. However, solutions to her troubles were sought and reduced themselves to
two alternatives: special technical equipment might be installed so that the deficiencies
that degraded the quality of some of her tasks could be compensated for, or she could
simply choose a set of tasks involving a more desk-bound workload. She chose the latter
course and still works for the same company.

Case 2. A young man, whose profession was the production of technical drawings,
suffered a high level spinal cord lesion due to diving in shallow waters. His injury is
severe enough for him to require help with all his daily activities. Nevertheless, with the
help of a computer-aided design (CAD) software, he continues to be able make his living
at technical drawing and lives, financially independent, with his partner. His work space
is a study adapted for his needs and he works for a firm with which he communicates by
computer, phone and fax. To operate his personal computer, he had to have certain
adaptations made to the keyboard. But with these technical assets he can earn a living and
provide for himself.

The approach for specific design is not different from other design as described above.
The only insurmountable problem that may arise during a design project is that the design
objective cannot be achieved on purely technical grounds—in other words, it can’t be
done. For example, a person suffering from Parkinson’s disease is prone, at a certain
stage in the progression of his or her condition, to fall over backwards. An aid which
would prevent such an eventuality would of course represent the desired solution, but the
state of the art is not such that such a device can yet be built.

System Ergonomic Design and Workers with Special Physical Needs

One can treat bodily impairment by medically intervening to restore the damaged
function, but the treatment of a disability, or deficiency in the ability to perform tasks, can

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involve measures far less developed in comparison with medical expertise. As far as the
necessity of treating a disability is concerned, the severity of the handicap strongly
influences such a decision. But given that treatment is called for, however, the following
means, taken singly or in combination, form the choices available to the designer or
manager:

· leaving out a task

· compensating for a worker’s deficiency in performing a task element by using a

machine or another person’s help

· differentiation of the task order, that is, dividing the task into more manageable
subtasks

· modification of the tools used in the task

· special design of tools and machines.

From the specific ergonomic point of view, treatment of a disability includes the
following:

· modification of the task

· modification of a tool

· design of new tools or new machines.

The issue of efficacy is always the point of departure in the modification of tools or
machines, and is often related to the costs devoted to the modification in question, the
technical features to be addressed, and the functional changes to be embodied in the new
design. Comfort and attractiveness are qualities that by no means deserve to be neglected
among these other characteristics.

The next consideration relating to design changes to be made to a tool or machine is

whether the device is one already designed for general use (in which case, modifications
will be made to a pre-existing product) or is to be designed with an individual type of
disability in mind. In the latter case, specific ergonomic considerations must be devoted
to each aspect of the worker’s disability. For example, given a worker suffering from
limitations in brain function after a stroke, impairments such as aphasia (difficulty in
communication), a paralysed right arm, and a spastic paresis of the leg preventing its
being moved upwards might require the following adjustments:

· a personal computer or other device enabling the worker to communicate

· tools that can be operated with the remaining useful arm

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· a prosthetic system that would serve to restore the function of the impaired foot as
well as to compensate for the patient’s loss of ability to walk.

Is there any general answer to the question of how to design for the disabled worker? The
system ergonomic design (SED) approach is an eminently suitable one for this task.
Research related to the work situation or to the kind of product at issue requires a design
team for the purpose of gathering special information relating either to a special group of
disabled workers or to the unique case of an individual user disabled in a particular way.
The design team will, by virtue of including a diversity of qualified people, be in
possession of expertise beyond the technical sort expected of a designer alone; the
medical and ergonomic knowledge shared among them will be as fully applicable as the
strictly technical.

Design constraints determined by assembling data related to disabled users are treated
with the same objectivity and in the same analytical spirit as are counterpart data relating
to healthy users. Just as for the latter, one has to determine for disabled persons their
personal patterns of behavioural response, their anthropometrical profiles, biomechanical
data (as to reach, strength, range of motion, handling space used, physical load and so
forth), ergonomic standards and safety regulations. But one is most regretfully obliged to
concede that very little research indeed is done on behalf of disabled workers. There exist
a few studies on anthropometry, somewhat more on biomechanics in the field of
prostheses and orthoses, but hardly any studies have been carried on physical load
capabilities. (The reader will find references to such material in the “Other relevant
reading” list at the end of this chapter.) And while it is sometimes easy to gather and
apply such data, frequently enough the task is difficult, and in fact, impossible. To be
sure, one must obtain objective data, however strenuous the effort and unlikely the
chances of doing so, given that the numbers of disabled persons available for research is
small. But they are quite often more than willing to participate in whatever research they
are offered the opportunity of sharing in, since there is great consciousness of the
importance of such a contribution towards design and research in this field. It thus
represents an investment not only for themselves but for the larger community of disabled
people.

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