Redesigning the Medical Examination Table for Improved Accessibility; Bridging the Accessibility Gap: Addressing Healthcare Disparities for Mobility-Impaired Veterans in Non-VA Medical Facilities

While my technical and STS projects address different facets of healthcare accessibility, they are grounded in the shared motivation of improving medical outcomes for individuals with limited mobility. My technical project aims to develop an accessible examination chair that enhances comfort and usability for patients and providers alike, while maintaining affordability for widespread clinical use. While my STS research investigates structural accessibility barriers faced by mobility-impaired Veterans in non-VA healthcare facilities. Both projects stem from a commitment to addressing structural inequities in healthcare access and represent two sides of the same problem, technological design limitations and sociopolitical inaction.

Technical Report:
Our design replaces powered adjustment systems in current accessible exam chair options with mechanical alternatives to lower costs while maintaining accessibility standards. Using Autodesk Fusion 360 and SolidWorks, we've created detailed CAD models of the seat, backrest, armrests, and headrest, both ergonomically inspired by automotive chair design. The fully modeled turntable mechanism features a 66-ball bearing structure and physical stops that limit rotation to 100°, supporting up to 500 lbs. with minor modifications based on early simulations. For the reclining mechanism, we chose a ball screw linear actuator for its smooth, strong motion. It is manually operated via a crank and gear system, housed beneath the seat and integrated into the backrest, and allows the backrest to move from 90 to 180 degrees. The hi-low scissor lift mechanism contains simplified worm gears, with stresses and strains being ignored for the sake of simplicity, as none of our group has this specific knowledge. This mechanism allows the chair seat to move from 17 inches to 32 inches from the ground. Due to time constraints, force simulations and stress testing are planned for future prototyping.
We conducted a detailed material cost analysis. Polyvinyl chloride (PVC) was selected as upholstery material for its durability and clinical suitability. Additionally, EVA foam was selected for comfort and 304 stainless steel for structural integrity of the chair frame. Supplier quotes from the East Coast estimate material costs at $759.42 per chair. Labor estimates based on secondary research range from $150–$300, bringing the total to roughly $1,100, far cheaper than powered alternatives. To ensure clinical relevance, we launched a survey on March 24th targeting UVA Health providers in Family Medicine, Internal Medicine, Orthopedics, and more. These surveys were distributed via department heads. The survey reached attendings, fellows, nurses, and medical students. Using a Likert scale, the survey assessed current exam table accessibility. The responses are planned to guide future design refinements based on provider needs.

STS Research Paper:
In this paper, I examine how structural inaccessibility in non-VA healthcare settings contributes to persistent health disparities for Veterans with mobility impairments. While VA medical facilities are typically built with accessibility in mind, a significant portion of Veterans receive care outside the VA system, where accessibility standards are often lower or poorly enforced. These Veterans face a dual challenge: navigating physical disabilities compounded by service-connected mental health conditions like PTSD and anxiety, which further complicate their ability to access equitable healthcare.
Through a comprehensive literature review, policy analysis, and application of the Design for All (DfA) A.U.D.I.T. framework, I discovered how outdated infrastructure, inconsistent policy enforcement, and a lack of standardized accessibility guidelines in non-VA facilities result in delayed care, reduced preventive services, and increased psychological stress. I argue that while solutions like telehealth, home visits, and assistive technologies offer some relief, they are not sufficient substitutes for physically accessible environments. The DfA A.U.D.I.T. framework, grounded in Universal Design principles, provides a proactive and inclusive approach to improving healthcare accessibility by considering physical, sensory-cognitive, and social aspects of facility design.
My findings emphasize the need for systemic change, specifically, the adoption of universal accessibility standards across all healthcare systems, stronger enforcement of existing laws, and the inclusion of disabled Veterans’ voices in the design and renovation of medical facilities. I advocate for tying federal funding to compliance with rigorous accessibility benchmarks and increasing training for healthcare providers on the unique needs of this population. In the end, addressing structural inaccessibility is not only a matter of legal compliance but a moral obligation to ensure equitable, dignified care for those who have served.

Working on both projects concurrently deepened my understanding of accessibility as not just a technical challenge, but a social one. Designing a physical device made me think more critically about who designs for whom, and how “affordability” must be weighed against the lived realities of marginalized patients. Meanwhile, my STS research revealed just how often good technology fails to make an impact because of poor policy enforcement or lack of institutional buy-in. The interplay between both projects taught me that truly equitable healthcare requires both innovative design and structural change, as well as engineers and policymakers must work in tandem. This dual focus made me a more reflective designer and a more technically grounded sociotechnical thinker.

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisor: Mori Morikawa

STS Advisor: MC Forelle

Technical Team Members: Afsara Chowdhury, Ashtin Jannuzzi