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Miscellaneous Sweden Trip Information [1971-1981] [17]
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Miscellaneous Sweden Trip Information [1971-1981] [17]
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Originally Processed With FOIA(s):
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This is not a textual record. This is used as an
administrative marker by the George Bush Presidential
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Record Group/Collection: Donated Historical Materials
Collection/Office of Origin: Frieden, Lex, Collection
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International
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Countries
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Folder Title:
Miscellaneous Sweden Trip Information [1971-1981] [17]
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5
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7
permobil international
Prof W. Spenzer
JUN 06 1979
Texas Institute
HOUSTON
the
28th May 1979
Dear Professor Spenzer,
Under separate cover, I'11 send you the permobil handbook
including medical illustrations of interest to workers in
the field of dysmobility.
It has been distributed to 16'000 Swedes working in this
sector, including administrators, physicians, physiothera-
pists, occupational therapists and medical engineers.
Although it's written in Swedish, the many illustrations
could give you, not only informations on the permobil program
but also on the permobil philosophy.
The H section contains all, technical aids which are free
available in Sweden to the handicapped. A is medical articles,
M medical illustrations and K a survey of permobil products.
I'm happy to tell you that SAAB Motor Corporation now will
introduce the permobils on the american market, now building
up the service organisation in a small geografic region in
order to be able to sell there in this summer and next year
expand to other regions.
The wienAdapt hand is still under technical and commercial
research. I really hope, it will come into production, but
I have no idea when SAAB will take that decision.
With best wishes
It was so nice meeting you
Ru
Sincer yours
We are happy that Panhils
Per Udden
will be activate alas not yet
Texas .
WORLD REHABILITATION FUND
International Exchange of Experts and Information
400 East 34th Street
New York, New York 10016
PROJECT TITLE
Increasing the Job Placement Capabilities of the Severely Physically
Disabled by the Use of Engineering and Technical Adaptations to the
Disabled Person's Environment
Report Submitted: November 29, 1979
(Covers study performed August 27, 1979
to September 29, 1979)
Hank Graden
Specialist for the Physically Disabled
North Carolina Division of Vocational
Rehabilitation Services
P. 0. Box 26053
Raleigh, North Carolina 27611
(919) 733-5920
WORLD REHABILITATION FUND, INC.
INTERNATIONAL EXCHANGE OF EXPERTS AND INFORMATION
400 E. 34th STREET
NEW YORK, NY 10016
Investigator: Hank Graden
Specialist for the Physically Disabled
North Carolina Division of Vocational Rehabilitation Services
P. 0. Box 26053
620 North West Street
Raleigh, NC 27611
(919) 733-5920
Countries and Cities Visited:
Copenhagen and Arhus, Denmark
Stockholm, Gothenburg, Skovde, Sweden
Project
Title:
Increasing the Job Placement Capabilities of the Severely
Physically Disabled by the Use of Engineering and Technical
Adaptations to the Disabled Person's Environment
Project Methodology: Visits were arranged in a variety of agencies and
facilities in the countries and cities listed above
to provide a cross section of experiential and
discussions relating to the project subject. The
purpose of the visitations was to investigate ways
that technology and engineering were being adapted
both to the employment of handicapped persons and also
to already employed workers in industry. Sheltered
workshops were visited in order to observe the types
of work modifications that were made in order to employ
handicapped persons in those settings. Labor unions
and employer associations were visited to determine
how those two organizations were influencing the
working environment and level of productivity of workers.
A variety of non-vocational agencies were visited in
order to understand the support systems that are
available for handicapped persons as well as observing
types of educational and rehabilitation resources there
are for physically handicapped children.
Public transportation for the physically handicapped
was explored including the public bus system and
privately operated taxis.
A great deal of time was spent in discussing the social
welfare system which has a tremendous influence on
rehabilitation, disabled persons in the labor market
and the influence of the system on the entire society.
-2-
A Volvo manufacturing plant was visited to explore
their special programs for workers who are loosing
productivity because of disability or age. Day care
centers, independent living facilities, apartments
adapted to the handicapped, visits with handicapped
workers, meetings with organizations for handicapped
persons and a general hospital were visited to provide
additional information to understand the numerous
components of the rehabilitation process.
A number of facilities doing research on technical
aides and testing technical equipment, were also
visited. Occupational health and safety and various
types of handicapped research was explored.
Results
Direct application of engineering and technical adaptations to the
working environment for the physically disabled in Scandinavia was not
greatly utilized. Major emphasis for technological changing jobs was
applied to the work place for person's already employed but whose
productivity was becoming less because of age or disability related to
the type of work being performed.
The use of commercially available equipment was applied to the work
place of handicapped persons. A substantial amount of money that the
government has available to purchase equipment seemed to motivate the
Scandinavians towards the purchase of the technical aids rather than
modifying existing work places.
The unions and employer's associations were quite active in pushing
for improved working conditions for the general labor market. The unions
and employer's association minimally supportive in entering large numbers
of new workers who have handicaps into the labor market.
The design of new factories and the general design of machinery was a
strong consideration for all workers.
The modification and redesign of work places was most prevalent in
sheltered workshops.
Utilization Plan
A number of direct applications of the information obtained during
the study will be developed. The first concrete utilization of the
information will be to develop a workbook for vocational rehabilitation
counselors to use in becoming more aware of what is possible in job and
work site and other types of environmental modifications by applying
technology and engineering to the area of job placement. This document
will include illustrations, pictures and information. A second way of
utilizing information will be in the development of training programs
within the North Carolina Division of Vocational Rehabilitation Services
-3-
for engineers and vocational rehabilitation counselors to increase
their knowledge of technological and engineering adaptations to the
rehabilitation process.
A variety of other articles will be written for rehabilitation
journals and other documents to dissiminate information within North
Carolina and throughout the United States in such topics as:
1. Labor unions role in rehabilitation - Denmark and Sweden vs
United States
2. Work place Standard of design and integrating the physically
handicapped into employment
3. Technical aides and adaptations to the work place which is
best to increase the employability of the severely handicapped.
In addition to the utilization strategies listed above visits and
discussions with union representatives about industrial health services
in relationship to disabled workers when they return to work will be
carried out.
The information will also be used to assist the North Carolina Division
of Vocational Rehabilitation Services to develop new programs and policies
relating to independent living programs.
Conclusions and Recommendations
The Social System in Scandinavia that provides for many financial
benefits for handicapped persons influenced the trends towards employment
of handicapped persons in the labor market. There was a tendency to isolate
handicapped persons in sheltered work facilities as well as encourage them
to remain on pension rather than a strong push towards employment of
severely handicapped persons in the labor market.
The application of technology was quite impressive and utilized for
the general labor population. The concept of ergonomics was also applied
to manufacturing and other types of labor market work performances for the
general population which did not necessarily single out that application
in the field of rehabilitation.
Numerous examples of modifications to the work place were observed,
however, there were a limited number of the adaptations applied to the
physically handicapped. This author had to extract many ideas, discussions
and observations seen in the general population and will apply them to
the field of rehabilitation.
4-
Influence of the Social Insurance Systems in Denmark and Sweden on
Rehabilitation
The Social Insurance Systems in both Denmark and Sweden plays
such a dominent role on a person's life that there was less emphasis
on the employment of a disabled worker than was anticipated by this
investigator. The disincentives of going to work are great because
of the extremely comprehensive and large sums of money that are provided
to handicapped persons. The health insurance, pensions of certain types,
industrial injury insurance and other benefits influence the attitudes
of the public regarding an insistence on encouraging handicapped people
to work.
A subjective analysis of the degree of encouragement for a
disabled person to return to work indicated that in Denmark the drive
was not nearly as intense to return handicapped persons to work as it is
in Sweden. The somewhat paternalistic attitude of the Danes seemed to
have a great influence on the legislation in Denmark to make it more
acceptable to remain on pension and receive benefits than to return to
work.
The immense control of the government on a person's life showed a
definite influence on rehabilitation beyond the level of independent
living.
The benefits that were available to the handicapped included a rather
substantial disability pension, money for the purchase of technical aides
up to approximately $11,000 (U. S. dollars) in Sweden for the purchase
of adaptive equipment, benefits to pay for all types of home health
support, financial resources for residence modifications and/or payment
supplements, reduced tax payments in certain areas, payment to purchase
an automobile, and government paid medical care.
Health Care (The Health Care System was not studied in detail)
Primary health care appeared to be of a high quality in both
countries and was reported to have an emphasis on prevention. Patients
did pay a small amount for clinics, physicians and dental services,
however most of the major expenses were covered by the government health
insurance. (Financing of the health care system was by heavy personal
income and employers' payroll tax, tax on products, etc.)
Hospitals appeared quite modern in their construction, had excellent
equipment and facilities and there was reported to be sufficient medical
and support staff to provide a high level of care in the hospitals. The
distribution of hospitals and health care throughout the countries seemed
to be adequate.
Medical Rehabilitation Services
Neither Sweden nor Denmark had a free standing, inpatient, medically
oriented comprehensive rehabilitation center or a specific spinal cord
injury center. There were rehabilitation units in general hospitals,
5-
but spinal cord injuried persons were grouped on a ward or scattered
throughout other parts of hospitals. There was a substantial number
of persons receiving out-patient rehabilitation services from physical
and occupational therapy departments in the general hospitals. There
was also a variety of home rehabilitation services provided including
physical therapy, occupational therapy, home health aides, nursing,
day help and other support services.
Independent Living Residences and Other Arrangements
Denmark and Sweden both had apartments, flats or other living
arrangements for handicapped persons. There were also examples in
both countries of a certain number of handicapped units within a
larger apartment complex for able-bodied persons. Both countries
tended to have some living units where only handicapped persons were
housed and they had health care support located in close proximity.
The emphasis was greater in Denmark than in Sweden for the facility
for only handicapped persons.
The groups of handicapped organizations in Sweden seemed to have
a stronger emphasis on "mainstreaming" for handicapped persons into
their own private residential arrangement rather than in special
facilities.
All of the special living facilities for the handicapped were
financed by the government. Residence modifications are also financed
by the government as well as rent subsidies handled by the government.
Unions and Employer Associations
Unions-Unions play a very important role in the entire cultural
and economic disposition of Sweden and Denmark. Approximately
90 percent of all employed persons in Sweden belong to some type
of organized labor union. Unions have influenced the working
conditions of workers as well as continually increasing the
amount and value of fringe benefits and wages. The labor
organizations seem to have a relatively positive working
relationship with employer associations and a high level of
cooperation. The strong unions seem to counteract the powerful
involvement of the government on people's lives and serve as an
"accountability" system of government activities.
The labor unions in Denmark did not encourage the employment of
handicapped persons in industry but did protect the jobs of the
already employed workers. The high unemployment rate was used
as an excuse for a rather limited governmental push for employment
of a larger number of handicapped persons.
There appeared to be some variance in the emphasis of unions on
encouraging the greater development of sheltered work facilities
for the handicapped as some unions encouraged further development
while others felt that handicapped persons should be integrated
into industry if at all possible rather than directed to sheltered
work facilities.
-6-
Employer's Associations-Employer's Associations have organized into
a strong group to offset some of the power of the labor organizations.
Groups such as the Engineering Employer's Association have taken an
interest in employing handicapped persons as well as protecting the
jobs of workers who are beginning to develop some disability either
related to advancing age or physical limitations imposed on the worker
after a number of years of carrying out the same physical job tasks.
Health and Rehabilitation Support Services
Medical health and rehabilitation support services for the handicapped
are a very strong part of the entire social system in both countries. Not
only was there a variety of housing facilities available to the handicapped
but there was much emphasis on numerous levels of care available including
home nursing, home aides of all types, emergency security systems for the
handicapped in order to call for emergency help, day care programs, "helpers",
drivers, etc. There did not appear to be strong support services in
psychological areas however.
Sheltered Workshops
Sheltered workshops were highly mechanized facilities with a great deal
of prime manufacturing taking place. There was some subcontracting, packaging,
and packing, however the major emphasis on the sheltered workshops visited
was in the manufacture of furniture; textiles (garments); machine shop including
lathe, punch press and welding. Some of the sheltered workshops appeared to
have relatively severely handicapped persons with a mixture of disabilities
including mental retardation, minor physical disabilities, psychological
disability and social handicapped. There were very few persons observed
working who had extensive physical mobility programs. In the six sheltered
workshops visited there were only several persons in wheelchairs.
The trend to employing handicapped persons with psychological and
social handicaps. Although an objective comparison would be impossible
to make between the persons in the sheltered workshops and industry,
observation of workers' productivity in sheltered workshops was that the
productivity was quite high and comparable to the person employed in the
Volvo factory visited.
Emphasis on Technical Aids
The trend in both Denmark and Sweden regarding environmental
modifications for physically handicapped persons is toward the purchase
of commercially available aids, i.e., dictating equipment, special
typewriters, appliances, etc. In reviewing job and work site modifications
as well as other modifications, there is a tendency to buy a variety of
types of equipment rather than modify already existing machines, appliances
or other equipment.
-7-
The availability of government funds to purchase technical aids and
equipment is great and therefore encourages handicapped persons and social
agencies to purchase such equipment.
Advocacy Groups For the Handicapped
There are approximately twenty-five organizations in Sweden that deal
with different types of disability and are made up primarily of handicapped
persons. These groups receive most of their funding from the government.
Some organizations do have independent fund raising drives as well as the
selling of products for the raising of operational funds.
School and Facilities for Physically Handicapped Children
There is a trend and philosophy to mainstream children into the public
school systems. For those children who are severely handicapped, there are
a number of well equipped and relatively new special facilities for them.
Some of the facilities have a residential component to them. There are also
some residential school-living programs for children in adolescence where
they can remain for a number of years to complete their education and
adjust to their physical, social or psychological problems they experience.
Research
Research into the quality and functional use of technical aids and
products for the handicapped was extensive in Sweden and was in the early
stages of development in Denmark. There was a great concern about the
safety and quality of products being used by the handicapped, whether
they were designed for the handicapped or commercially available.
There was also a great deal of research being undertaken in Sweden
relating to improving the working environment for the already employed
worker or the handicapped person who might enter the labor market. The
unions have played a strong role in the aforementioned research.
-8-
Transportation
There are a variety of modes of transportation used to transport
physically handicapped persons in Denmark and Sweden.
Automobile and Other Individual Means of Transportation
A handicapped person who is capable of driving in both Sweden and
Denmark receives a sum of money from the government in order to purchase
an automobile. (The amount of money provided to individuals is discussed
in another section of this report.) To receive a large sum of money to
offset the expense of buying a car, the person must either be moving
toward employment or some type of training or education. In Denmark
people receive a partial subsidy for the purchase of an automobile to
"remedy suffering" which is interpreted to mean an increase in mobility
to participate in any type of activity the person desires.
There appears to be a growing trend, at least in Sweden, that there
is a reduced need for public special transportation because many
handicapped individuals have their own automobiles. This author did
not get the impression that physically handicapped persons were
as
active in advocating for public transit accessibility in these two
countries because of their private accessibility to their own vehicles.
That is not to say however, that the handicapped organizations were not
pushing for accessibility of the public transit system and they were
investing some time and effort into that endeavor.
Handicapped persons also receive a tax break on the purchase of an
automobile and do receive some tax free gasoline each year because of
their disability. They are not reported having any difficulty getting
automobile insurance because of their disability.
Taxis
There is major emphasis on the use of the taxis for transporting
handicapped and elderly persons. It is reported that 50 percent of
the income of the taxi company is generated from government funds
for transporting handicapped and elderly persons.
The handicapped or elderly person pays no more for a taxi than
they would for public transportation. The taxi company submits a
statement to the government transportation department to collect money
for the difference of payment between the actual charge and the money
received from the individual.
It was reported that in some cities, taxi drivers have been trained
on how to physically handle persons in wheelchairs and other persons with
mobility problems. A number of taxi drivers were observed by this author
during the entire trip and they were quite courteous and seemed to have
the capability of handling the physical aspects of persons with mobility
limitations.
-9-
Public Transportation
There was a demand-responsive, lift equipped vehicle subsystem in
both Sweden and Denmark operated by the public transit organization.
The vehicles could transport approximately three to four persons in
wheelchairs as well as several persons on the stationary seats.
There are also private transportation companies with vans and
buses to assist in the transport of persons with mobility problems.
There is an effort to make the older subway and high speed train
stations accessible in both Sweden and Denmark by installing elevators
at the train stations. The most recently constructed (10 years) train
stations in Sweden (Stockholm) were designed with elevators. This writer
observed many women with baby buggies and strollers using the elevators
as well as some persons in wheelchairs.
Intercity train transport did not seem accessible to persons in
heelchairs because of the change of elevations at most train stations.
The Swedish government is in the process of manufacturing 150
new train cars and there has been input from handicapped organizations
on the design of such trains. There is a controversy currently in Sweden
because the input from the handicapped persons has not been utilized
in the design of new cars. The first several cars that have been
manufactured have not been any more accessible than those constructed
in the past.
There are some rather innovative designs that have now been developed
for at least one train car on each train that will be accessible to
persons in wheelchairs. (This author has a copy of the design. )
Safety Devices in Vehicles
No unique or outstanding safety design systems were observed during
the entire trip. Although safety is a major concern, it appears that
not a great deal of effort has been put into developing tie-down and
other safety systems for the buses or trains. There is not a large
number of individually driven vans because of the smaller size vehicles
manufactured in Europe. It is reported that in England the locking devices
on a wheelchair (brakes) are the only system used for safety while a person
is in a van or other type of public transportation.
Volvo
Volvo is manufacturing automobiles that have special driving devices
built into the mechanical system as part of the orginal construction.
They are doing considerable design work on other types of driving systems
for the physically handicapped.
-10-
There is a rather unique experimental program going on financed
by Volvo to make an entire public transportation system accessible
to persons with mobility limitations and without installing mechanical
lifts on the buses. Essentially the buses will be built to have a
level entry into the bus that can be entered from the passenger platform.
A small town in central western Sweden has been designated to have the
entire system made accessible. The major innovations that are being
carried out are in relationship to ramping bus stops so that passengers
can enter from the bus stop directly into the bus at the same level. The
unique aspect of the experimental transportation system is the installation
of a cable in the street which directs a bus to the bus stop so that driver
error is reduced and the bus can be parked parallel to the bus stop very
close to the curbing so that there is not a wide gap between the platform
and the level of the bus. (Volvo produces approximately 50 percent of the
buses manufactured and used in Scandinavia so that new bus design incorporating
total system accessibility is a wise investment for Volvo.)
Technical Modifications to Work Places for Physically Handicapped Persons
Modification of work places and jobs by applying technology for persons
with physical limitations is used quite extensively in Sweden. The emphasis
is to increase the productivity of employed persons by reducing the physical
other types of technical devices to reduce the physical requirements of a
limitations that they are encountering by mechanizing jobs and/or by bringing
job.
The labor unions and employer's associations have been quite active in
the protection of workers and helping to keep their productivity at a high
level. Individuals with a physical reduction of productivity because of
the type of job being carried out are provided with mechanical assists
in many cases.
The entry of large numbers of severely disabled persons into the
labor market was not seen in either Sweden or Denmark although the
emphasis was greater in Sweden for this activity.
Research is being carried out in a number of places in each country
to find new ways to apply technology to the work place so that any
person can carry out the work. New laws have been implemented so that
factories that are being built or renovated must be made accessible to
handicapped individuals.
The application of ergonomics has been applied to many existing jobs
and work in any work setting.
and the design of new jobs so that the entire population can perform jobs
Adjustment Groups
An organizational structure made up of representatives from the National
and Labor Board (AMS), labor unions and employers, has been developed in industry
the maintain productivity of workers whose productivity has been reduced by
to is called "adjustment groups". These groups have been established to try
physical rigors of the job.
natural aging process and/or because of disability created by the
-11- -
There are approximately 50,000 people in 7,000 adjustment groups in
Sweden.
The organizational structure is usually composed of a safety engineer
from the employer, a representative of administration, a physician, nurse,
and someone from the labor union. As persons are identified to enter the
"adjustment group", the committee evaluated the work situation to determine
what solutions should be applied to remedy the problem that has been presented,
i.e., loss of productivity, increased physical limitations. The committee,
in most cases, would be called the Health Service Group.
The committee looks at the general working environment to improve it for
any person working on that type of job.
The labor unions have discussed the fact that the "adjustment groups"
either are not as effective as originally intended or are not being
emphasized to the degree needed to accomplish their goals. There is some
move toward greater encouragement to organize the "adjustment groups"
in a more effective manner. "Adjustment groups" were discussed with a
number of individuals during the visit and there seems to be mixed reaction
about their effectiveness.
-12-
FACILITIES AND ORGANIZATIONS VISITED IN DENMARK
COPENHAGEN
August 27, 1979
Society and Home for the Disabled
Borgervaenget 7
2100 Copenhagen, Denmark
Telephone: 18 26 11
Contact Persons: Ms. Birgit Hedegaard
Mr. Henning Andersen
The Society and Home for the Disabled was the base of my visit in
Copenhagen. Ms. Hedegaard took responsibility for setting up all of
the visits in the Copenhagen area.
The Society and Home for the Disabled has been in operation for over
a 100 years. It was the center for much of the early development of
handicapped programming and legislation in Denmark. It is operated as a
private foundation with the purpose of looking after the interest of
the disabled by running or assisting in the management and advancement of
rehabilitation, including hospitals and hospital departments for special
orthopedic treatment and physical medicine, schools for disabled children
and educational and training institutions for young disabled persons.
In connection with orthopedic hospitals and departments, the Society and
Home for the Disabled operates workshops for the distribution of
orthopedic aids of all kinds.
There is a major reorganization of facilities in Denmark taking
place in January, 1980 and this will take the operation of many facilities
originally administered by the Home and Society for the Handicapped and
place it in the responsibility of the local Kommunes. This will probably
effect the eventual organization of the Home and Society of the Disabled,
however, it should not significantly affect the quality and level of care
provided a handicapped person.
Jaelpemiddelcentralen
Hans Knudsens Plads
2100 Copenhagen, Denmark
This facility is located in a multi-storied apartment building
exclusively for handicapped persons. An exhibit of rehabilitation
equipment and technical aids is located in the building and is available
for handicapped persons to observe, tryout and use prior to the purchase
of such equipment, i.e., wheelchairs, walkers, models of toilets, kitchen
arrangements, etc. These centers are located throughout the country of
Denmark where persons can test out equipment before it is purchased and
to provide them knowledge of the use of the equipment before it comes
under their ownership.
The program is operated, and managed by an occupational therapist
who is trained in the use of the equipment.