Frequently, a patient will ask me if he or she can get a disability-parking placard.
In the state of Rhode Island, these have become quite coveted items.
In Rhode Island, the guidelines for approval of a disability-parking placard are actually relatively strict.
The patient must meet these criteria:
- Cannot walk without the use of an assistive device, such as a brace, cane, crutch, wheelchair, prosthetic device or another person.
- Suffers from lung disease to the extent that FEV1 is less than 1 liter, or arterial oxygen tension is less than 60 mm Hg on room air at rest.
- Needs portable oxygen.
- Has a cardiac condition resulting in functional limitations classified in severity as Class III or Class IV, according to American Heart Association standards.
- Legally blind.
Without a doubt, many patients benefit greatly from having a disability placard. For them, the ability to park in a handicap-accessible spot helps maintain their independence.
Unfortunately, there also is a significant amount of disability-placard abuse. Sometimes an able-bodied person will use a late relative’s card. In other cases, someone may continue to use an expired card that was issued only for a temporary condition.
Abuse of these placards, however, is not my focus of concern here — other than to say that, for disabled persons who do need to use handicap parking, such abuse limits their parking options and also makes it harder for them to obtain the placards. Rather, my concern is with patients who want a placard for convenience. It may not be in a person’s best interest, either physically or emotionally, to limit his or her ambulation.
Isaac Newton’s first law of motion states that an object at rest stays at rest, and an object in motion stays in motion. While he wasn’t talking about the physical movement of humans, the concept is still applicable. For example, moving around may be painful for people with fibromyalgia. But in the long run, it may hurt them more if they are less active. For other conditions as well, inactivity causes patients to have further de-conditioning, leading to even more health issues, including increased risk of falls.
When a patient pressures me to sign a disability placard request that I am uncomfortable signing, I refer him or her to the state’s guidelines and put it on the state’s shoulders. To be fair, most patients who have these placards use them appropriately and only when needed. In fact, often my elderly placard holders will proudly tell me that they try not to use them — and instead park a little further away at the grocery store and use a cart as an assistive device so they can increase their level of activity.
Another mobility-related request from patients is for a motorized scooter. Most commonly, this request comes from patients who have chronic congestive heart failure, chronic lung disease, debilitating arthritis or neurological disorders. This is another situation where having a motorized scooter does greatly benefit some patients in terms of increasing their independence. However, I also have seen overall health deteriorate in patients once they get a scooter. And, in fact, evidence shows that cardiovascular risk and especially insulin resistance increase after obtaining a scooter.
It is important to keep these factors in mind when counseling patients regarding interventions that, while designed to improve their quality of life by increasing their mobility, may end up harming their health by reducing their physical activity. As with most interventions, there are both risks and benefits.