A Seat at the Table: A New Tool for Inclusion
By Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal
While I am writing this article on my laptop, it is sitting on my tabletop. The table provides a solid, secure, and steady place.
The table is one of the most overlooked, undercelebrated and “taken for granted” inventions.
From the earliest times, it is the table which has been instrumental in allowing people to meet, eat, plan, draw, negotiate, play, and protest. The word table is derived from the Latin word tabula meaning a board, plank, or a flat top piece. The Ancient Egyptians around 2500 BC used wood and alabaster and were often little more than stone platforms used to keep objects off the floor.
The shape of tables has played a significant part in history. We were told about King Arthur and the Knights of the Round Table. They were known as the best knights in the kingdom, and the famous Round Table (a departure from the typical rectangular tables) meant that everyone who sat around it was seen as trustworthy and equal.
In 1879, Thomas Nast (considered to be the Father of the American cartoon) revealed to the world in a series of drawings that Santa's workshop is at the North Pole. He depicted much to the delight of generations of children the tables where the elves produced the gifts given by Santa Claus.
The long-awaited Paris Peace Talks which ended the bloody war in Viet Nam (Jan. 27, 1973) was delayed for months because the parties could not agree on the shape of the table. Thousands of lives were lost because of the delay.
Similarly, many negotiations in the Middle East were delayed or cancelled due to a disagreement on the shape of the table. In his scholarly article about the role of the table in peace talks, Joel Singer offered, “Where you sit is where you stand.”
Most modern tables are rectangular, solid and of a fixed height. It is not uncommon to see people add cushions to chairs because of individual height differences. Likewise, we see people adding footstools to allow their feet to be supported and not dangling. The reality is that we adjust, alter, and accommodate the individual to reap the benefits of the table, not the alternative approach of having the table to meet the needs of the person.
Nowhere is this more pronounced than the often-felt frustration, agony, and discomfort experienced by table-users with disabilities. Astute observers in assisted living and rehabilitation centers, long term care facilities, group and private homes, schools and nursing homes have commented on the obvious disadvantages of a fixed table for people using wheelchairs, various body lengths, use of adaptive equipment and confusion of individual allotted space.
While much was observed and discussed, little was done about it, until Neil Marion, a veteran occupational therapist, set out to find a solution. He shared the pathway from observation to consideration to innovation:
“As an occupational therapist of 26 years, I observed a chronic problem with my patients using large wheelchairs accessing a dining table. Sadly, I witnessed the frustration that my patients endured when having to be placed to a table tray instead of a table, sitting sideways to a table, or even worse being isolated alone – all because their wheelchairs would not fit. After witnessing this problem for years, I knew I had to come up with a solution. I began to design a table that would solve this problem and after many design versions, I finalized my design in 2017. Four years later, in April 2021, I received my patent. (US Patent No. 10,980,338,B1) Since that time, we have built 7 Inclusion Table© prototypes – improving the table with each build, and I am proud to announce that our 7th prototype is ready for mass production! We are very excited here at Marion Innovations LLC, to introduce The Inclusion Table© to the world as the best table for wheelchair accessibility and witness the positive impact it will have for those persons using wheelchairs every day of their lives to feel and be “included.”
The existence and potential of “The Inclusion Table” was brought to my attention by a colleague at the Orange Grove Center (Chattanooga, Tennessee). Olivia Davis is an ICF (Intermediate Care Facility) Program Manager, and after learning about it and “whetting our appetite”, we arranged a demonstration of its application and benefits.
“As an occupational therapist of 26 years, I observed a chronic problem with my patients using large wheelchairs accessing a dining table. Sadly, I witnessed the frustration that my patients endured when having to be placed to a table tray instead of a table, sitting sideways to a table, or even worse being isolated alone – all because their wheelchairs would not fit. ”
Neil brought a table and presented it to the Orange Grove Center staff consisting of physical and occupational therapists, therapy assistants, residential program supervisors, health providers, direct support professionals, case managers and other stakeholders. Having an actual table, as opposed to videos, is a distinct advantage in evaluating any new piece of equipment, device, or instrument. While it was an impressive and “eyebrow raising” demonstration, it required an extended period of “real world” utilization and assessment. We arranged a trial where it would be placed in several settings, overseen by different support staff, teachers, therapists, and a variety of individuals we support.
The key question for the evaluation was summarized by what I have termed the “enchilada question” (for any introduction to a new device, product, program, or policy) and that is “so what?” And while that may not sound like an academic, research-based, publishable query, the reality is that we, (like many providers), live in the real world, and what is critical to our adoption of new technologies is “what makes this indispensable, what are the actual benefits, how does this impact the comfort, safety, security and enjoyment of the individuals this is intended for and could we live without it?”
The Inclusion Table© was placed in a day-time activities program setting where six individuals are supported. During the day they had activities ranging from games, arts and crafts, music, sensory explorations, interactions with staff, visitors, vocational based learning skills, video interactions and of course lunch, snacks, and refreshments. The support staff consisted of three seasoned veterans (10-plus years) and a newly-hired staff (who recently completed her pre-service training and orientation).
The staff received instruction on how to operate the various adjustable components of the table, which included controlling the height of the individual sections of the table both vertically and horizontally to accommodate people using wheelchairs, conventional chairs, standers, “walkers,” and even “Rollators.” Instruction was provided (with the staff having to prove their competency in the use of the features of the table) to the staff on the versatility of the table during various activities, including mealtime, game time, crafts, video viewing, storytelling, and conversations.
We were interested in several conclusions: Did the table encourage “inclusion,” did the individuals appear to favor the new design over the traditional one, did they stay more focused and appear more anxious and ready to spend time at the table, did the table ease any burdens for the staff, did the table allow for any additional activities or allow individuals who previously did not feel comfortable or fully accommodated at the ‘old table’?”
Feedback from the staff (after 5 weeks of using the table) was collected from interviews, using Likert scale questions, demonstrations with the individuals and personal anecdotes of observed behaviors. The majority of the most positive observations included individual wheelchair users. My own interaction with the individuals concluded that they enjoyed the table, made overtures that indicated they preferred The Inclusion Table© especially at mealtime and for interactive craft activities. It was noted that several of the individuals came to the table after a single verbal invitation, as opposed to several of them responding after two or three verbal prompts (when the old table was used).
One of the design attributes of The Inclusion Table© is its versatility. We have seen solid tables requiring wood blocks on the legs to accommodate dimensional differences in seating. The Inclusion Table© allows each individual quadrant of the table to be customized. The tabletops can be adjusted in various vertical and horizontal planes to provide optimal positions for various activities. The adjustments are made without the need for tools and can be made by a single individual. They lock safely in place and are engineered to a high degree of ingenuity. The tables can provide individual work areas while they can also be adjusted to provide a large, shared area with accommodation for a centrally located feature.
In another round of using The Inclusion Table© in another setting (where the individuals were ambulatory and did not use any assistive equipment), the table did not appear to have a significant impact on receptivity behaviors. One staff member commented that one of the individuals (using The Inclusion Table©) appeared to signal the need for immediate toileting attention compared to previously delayed alerts (and averting long standing toileting accidents). One can only speculate on the role (or non-role) of The Inclusion Table© in this new onset behavior.
Two research papers were identified to ascertain if there were any additional ways in which The Inclusion Table© was contributing to enhanced socialization at mealtime: Promotion of Socialization at Mealtimes in an Assisted Living Facility, Michetti and Worthley, Journal of the American Occupational Therapy Association, Sept 2014, and Breaking Bread: The Functions of Social Eating, Dunbar, Journal of Adaptive human Behavior and Physiology, 2017. While both concluded that “those who eat socially more often feel happier and are more satisfied with life, are more trusting of others, are more engaged with their local communities, and have more friends they can depend on for support.” The settings, individuals, and inability to ascertain factors that were either attributable or measurable did not allow us to pursue these results.
We concluded with a high level of assurance and confidence that the employment of The Inclusion Table© in our setting (community provider of services and supports for individuals with intellectual and developmental disabilities) was an attribute that positively impacted both the individuals and Direct Support Providers as well as art, music, and social facilitators.
“The Inclusion Table©” could well be called “The Innovation Table.” The concept, design and production certainly fulfill the definition promoted by American entrepreneur Tom Freston, “Innovation is taking two things that already exist and putting them together in a new way.” In this case the two things being put together are individuals with disabilities and furniture.
If you needed some additional convincing there’s always Thomas Edison, “There’s a way to do it better- find it.” Neil Marion did.
The enthusiasm of how The Inclusion Table© can contribute to improving the overall goals and objectives of table-based activities is best summarized by reporting that the Orange Grove Center placed an order for three more tables. The purchase of the tables was based on standard advertised rates and no financial accommodation was provided for conducting and reporting on the assessment made by Orange Grove Center. Purchase prices reflected discounts for multiple units (available to the marketplace).
In conclusion, the CEO of Marion Innovations LLC, Neil Marion wanted to announce, “tongue in cheek,” that The Inclusion Table© surpasses ADA standards for accessibility, and achieves the essence of the ADA’s motto, “To Boldly Go Where Everyone Has Gone Before,” by allowing all persons to be included. The Inclusion Table© is unlike any table that you have seen, and its potential is limitless due to its one-of-a-kind design concept of adjusting the table to the needs of the person versus adjusting the person to the table. It is a powerful concept that undoubtedly allows all people to have a seat at the table and truly feel “included.” Neil states “I can envision The Inclusion Table© being used in restaurants, schools, nursing homes, assisted living centers, hospitals, rehabilitation centers, businesses, and in the home settings.” The Inclusion Table© is truly a game changer in the world of tables!
For more information, please visit the website: https://inclusiontable.com
HELEN, the Journal of Human Exceptionality published this article in its mission to report on innovative advances in the field of disabilities.