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To your last point, it's worth pointing out that making your built environment more easily traversible and usable for people with accessibility needs will pretty much always make it more easily traversible and usable for everyone. It's hard to appreciate this until you visit a country where they haven't spent decades making sure their elevators and hallways are wide enough, there are no unnecessary stupid steps, the sidewalks don't have curbs at crossing points, etc. etc. This is just general societal progress, it makes all of our lives easier and we're so used to it we don't even notice it anymore.

I only truly appreciated this once I had was a pedestrian in a big city with a baby stroller. If a wheelchair can get somewhere, generally the stroller can do it as well. (At least a single wide stroller). Making places more accessible can have a positive impact on large parts of the population.

I've learned to take this approach with software as well. It just makes sense. While he's not universally accepted, Nassim Taleb makes compelling behavioral arguments for why this is better overall (in the context things like kosher salt and such)

https://medium.com/incerto/the-most-intolerant-wins-the-dict...

Canada is unexpectedly one of those countries. Accessibility here is a nightmare, especially in big cities. As another partner of a person with limited mobility, I always notice and appreciate the difference that 40 years of ADA has brought to construction in the US.

(I'd take universal health care over improved building codes any day, but both would be nice.)

Indeed, Canada is a laggard in this area. I work on a university campus where they've gone beyond the bare minimum that's legislated, and it's quite a stark difference from the rest of the city. Another important part of that is sidewalk snow removal. Only within the last 5 years has the city slowly started doing this somewhat right on some streets, whereas campus sidewalks are always plowed and salted.

I'm blind with a retinal disease and it's a similar dynamic. Not all breakthroughs will help a given person. Additionally, most breakthroughs seem to be some version of vaporware, and it might be 10 or 15 years, or never, for most people in that category to benefit. I go through phases of catching up on research, but mostly try not to think about it.

I used to read physorg and other publications and would get really excited by all the new discoveries. But then decades go by and you sadly never see most of them realize.

I completely agree. My mother has been a partial quadriplegic since 1992 after a car accident. The moment there are broad cures for injury related paralysis, it'll be front page news.

The most impactful thing you can do to help people with paralysis is push for better wheelchair accessibility where you live. It's amazing how much of the world is not accessible to someone in a wheelchair.

I guess the real question is, will a dollar spent on wheelchair ramps in buildings across the USA give a greater quality of life improvement to the average american than a dollar spent on medical research that tries to repair spinal nerves?

Obviously "average american" is not intended to reflect the 'typical american', but instead be an average across all people, including those with mobility requirements.

The distinction is that the quality of life improvement can be done now, and can make peoples' lives better immediately. It's not just wheelchair users that can make use of accessible infrastructure, the elderly, and young children can more readily make use of it too.

I don't discount the promise or effect of such research, but the utilitarian in me says that this can make a tangible improvement now, and to more people and not at an indeterminate point in the future.

There are plenty of such tradeoffs... For example, the government could start a helicopter service to help people cross a river today, or they could build a bridge across the river, which will help far more people, but won't be ready for 5 years.

I assume governments have models to make decisions about utility now vs utility later, and the way that trades off with cost now vs cost later.

I don't see why this decision shouldn't just use those models and spend the money on whatever the models say makes sense.

> I assume governments have models to make decisions about utility now vs utility later, and the way that trades off with cost now vs cost later.

I'm curious where this assumption comes from. It seems more likely that it would be made on intuition of what story will seem most defensible to voters or avoid the angry scrutiny of a legislator.

If decisions were made with the high level of rationality you point to, it seems unlikely that the US would have problems like this:

- https://pittsburgh.cbslocal.com/2022/02/07/pittsburgh-warnin...

- https://www.marketwatch.com/story/it-is-a-challenge-the-irs-...

- https://www.irs.gov/newsroom/irs-announces-transition-away-f...

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Looking at your username lets consider a question such as "Should we pay additional money to design London's new Elizabeth Line with step-free access at all stations?"

for such a model to answer such questions, we would need a way to accurately count costs. If could do that, then the line would already be open.

Given perfect hindsight that we have now, at any point in the 20th century you would have to respond "yes, you should also fund accessibility right away" . The answer today is almost certainly the same. Never mind that there are reasons to need accessibility beyond spinal injuries.

> will a dollar spent on wheelchair ramps in buildings across the USA give a greater quality of life improvement to the average american than a dollar spent on medical research that tries to repair spinal nerves?

Yes, I don’t know why this is even a question. Ramps support people who will never need spinal nerve repair. They support strollers, wheeled luggage, canes, crutches, fall risk folks, furniture movers, bike/scooters, etc.

But medical research leads to treatments which may have far better quality of life improvements than ramps. And when discovered, those treatments can be used forever, whereas ramps require constant spending for every new or renovated building.

Both are 'obviously' better than the other, depending on what you look at. Therefore the decision really should be made with more data.

> But medical research leads to treatments which may have far better quality of life improvements than ramps. And when discovered, those treatments can be used forever, whereas ramps require constant spending for every new or renovated building.

I think you make a good point here. Likewise, making software accessible, e.g. to blind people, requires effort for every GUI toolkit and non-trivial application. In the short term, that work has to be done, because it would be wrong to just leave blind people without a way to independently access software that might be critical to jobs, education, etc. But if we started funding research into curing or preventing all of the various causes of blindness now, then we could eventually solve the problem permanently. I'd have to find a different problem domain to work in, but I might be retired by then anyway.

Just like universal design in the physical world, universal design in software has knock-on benefits for everyone. A website that can be properly parsed by a screen reader can be scraped by search engines and archived efficiently. An application with proper tab indexes can be easily navigated by someone with a laptop rather than forcing them to reach for the trackpad.

> curing or preventing all of the various causes of blindness

All of them? Got a list?

> But medical research leads to treatments which may have far better quality of life improvements than ramps.

There is so much wrong with what you say. Just look at the person in the very article. He doesn't walk with a hippity-hoppity bouncy gait. He walks with the help of a wheeled walking frame. He needs the ramps and the handholds to get to places. Do you have a proposal on how to spend all the ramp money to "medical research" that away?

Look at any person who broke their leg and walks with a crutch, or a mother-to-be who is wobbly from all the extra weight of the baby, or an old person who needs a walking frame. Do you think if we just spend more money on medical research these conditions will go away?

How are you proposing to medical research away the need for a baby stroller?

It’s not obviously better because you’re solving for one case when a ramp solves for multiple. At no point does solving nerve damage fix the fact a baby in a stroller has a better time on a ramp, unless you’re proposing a new technology that obviates wheels. But that just makes it the new ramp in its utility.

Hardly!

And what you are omitting is the very high cost to people needing accessibility right now.

Those discoveries are:

Not a sure thing

Not on an easy to quantify timeline

Not broadly applicable.

And this is not zero sum. Every dollar spent on accessibility pays off right now. Starts paying the moment access is improved.

We can always, and should always, be advancing medicine.

There is nothing in the way of better accessibility. We can do it now and it pays us well when we do.

There are things in the way of, "let's just fix the people!" and the fact that we do not know how, do not know when we will know how, is in our way solid, like we can't miss it.

Finally, treatments can be used, until they can't. And "can't" comes up an awful lot. Ramps and other devices just work.

They work even when people do not need them to work, or people do not expect to need them. The world is just easier, and new moms, old people, and many others get the benefit.

So, when "we can't" comes up, what is the answer for those people?

I propose:

Boy those accessibility spends are really helping a lot of people! Sure glad we did that work.

And remember, YOU yourself, right there reading this, very well could be one of those people. You don't know.

None of us does, which is why the work is being done.

And spina bifida, and cerebral palsy, and strokes, and diabetes, and broken bones, and arthritis, and being pregnant, and just getting old, and literally hundreds of other disorders that cause temporary or permanent impairment.

By the time you're finished fixing the reasons people encounter mobility issues, we'll be darn near immortal - and you still won't have magicked away the reasons that able-bodied people benefit from universal design.

I don't know why this has to be framed as an either/or. The US doesn't invest in infrastructure but leads in medical patents, so the low hanging fruit is being ignored. It is cheaper to build ramps than fund good longitudinal scientific research. Also you can have perfect spinal nerves and benefit from accessible infrastructure. Parents with infants in strollers, for example.

Ideally you would build the infrastructure /while/ allowing things like stem cell research but we live in a puritanical theocracy that opposes both for ideological reasons

Whenever I come across an article about walking robots for the military, I am asking myself: What about walking-chairs as a replacement for wheelchairs? Could that be a realistic solution to the access problematic? I am an absolute layperson regarding robotics. Can perhaps anybody with some background explain, what to expect here in the next few years?

It's not exactly my area but I have some related experience. I suspect the big problem with this is power use.

A standard issue wheelchair is very efficient on reasonably smooth and flat surfaces. Beyond the obvious problems with e.g. stairs, you can get around ok using just arm muscle power in lots of places.

This efficiency helps also if you can't use your arms or the slopes are more challenging. Reasonably sized and weighted batteries can extend your scope a huge amount in very practical ways.

As soon as you get away from wheeled locomotion though, the power needs become much more problematic. Not to mention the system complexity is orders of magnitude higher than a basic chair, with all that entails.

So short story, I wouldn't expect any significant impact in the next few years. It's possible that for some very specific use cases you'll see a bit more robotics in assistive technology. It's also possible that we'll learn some good tricks from robots about negotiating particular obstacles (e.g. curbs) which can be retrofitted to "dumb" conveyances and improve things...

No. My wife is paraplegic and we did in fact test a rudimentary exoskeleton at one point.

The reason they don't work is because the mobility she misses the most is the ability to transport a cup of coffee from the coffee maker to her desk, or the ability to go for a jog. It's the little things that have the biggest impact, and no one is going to don an exoskeleton to wear around the house.

Furthermore, the drive to overengineer mobility solutions crashes headlong into the world of manual wheelchairs. Manual wheelchairs are like road bikes: the best ones are the smallest, lightest-weight ones (often made from the same parts and materials). They have as few parts as possible, can turn on a dime, and can be lifted one-handed into the passenger seat of a car.

A walking device of some sort might be a better equivalent to an electric wheelchair for someone with quadriplegia, hemiplegia, muscle spasms, or generalized weakness, but here you have the problem that many electric wheelchair users are at high risk of pressure sores. There's a reason that electric wheelchairs have all sorts of fancy recliner features: sit in any chair for 16 hours a day without the ability to shift around and you're going to do some pretty serious damage to whatever your weight is resting on. An exoskeleton necessarily holds you in a more upright position, putting more weight on fewer body parts.

The solution to the access problem is to build ramps and lifts.

Anything more than a couple PSI over a couple hours comes with tissue damage risk.

That is not very much. People who are not limited in some way are very unlikely to appreciate those hard facts. I didn't, until some professional work brought me into awareness.