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Leadership · Careers
Written by Keely Cat-Wells, Contributor. Forbes contributors publish independent expert analyses and insights. Keely founded Making Space, an organization working to close the disability employment gap.
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Published: Aug 10, 2026, 02:24pm EDT · Updated: Aug 10, 2026, 07:05pm EDT
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Many individuals with hidden or dynamic disabilities delay using mobility aids due to societal judgment, causing health issues and career setbacks. The article champions the social model of disability, framing it as environmental barriers, not individual deficits. It focuses on ambulatory aid users, whose fluctuating conditions benefit from aids that extend capability and conserve energy. Historically, female-predominant conditions were often misdiagnosed as psychological, leading to delayed care. A shift towards pacing, supported by aids, is now recognized. Disability imposes significant financial burdens on individuals, debunking any perceived advantage. Younger generations are normalizing aid use, fostering earlier adoption and career longevity. Employers should cease auditing health, design for fluctuation, ensure default accessibility, and cover costs, recognizing that universal access benefits everyone and retains talent.
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Millennials and Gen Z are the first generations to move through education after the Americans with Disabilities Act, and it shows. They arrive at work having already seen disability represented as an identity with pride attached rather than a private failure to conceal. Creators document life as ambulatory wheelchair users, paint their forearm crutches, style canes as accessories and explain pacing to audiences in the millions. The result is that people are reaching for aids years earlier than they once would have, and staying in work as a consequence.Justin Kaneps
People delay using a mobility aid because they know exactly what will be said when they do. The raised eyebrow, the comment about seeming fine last week, the colleague who saw them walk from the car park. So they stay standing at the networking event, walk the terminal instead of asking for a chair, and turn down the invitation rather than explain the stick.
For anyone living with a hidden or dynamic disability, the pattern is familiar: falls, flare-ups, weeks lost to recovery, and eventually a career that ends up smaller than it needed to be. Disbelief works as a barrier in exactly the same way a flight of stairs does—it keeps people out of rooms they are fully qualified to enter.
Consider a scene that played out recently. An elevator fails at a train station, and a wheelchair user waits. She films station staff trying to carry her chair up the stairs. Near the end of the clip, she gets up and walks them up herself.
There are two possible reactions to that scene. One is to notice that a transport network has placed a single point of failure between a Disabled passenger and the rest of her day. The other is to study her legs.
Which reaction you choose says very little about her and a great deal about the model of disability you are working from. It is worth knowing which model that is, because it determines what you think needs fixing.
The medical model locates disability inside the individual. It treats disability as a deficit to be cured, corrected, or endured until the person can function in a world built without them.
The social model, developed by Disabled activists in Britain in the 1970s and 1980s, draws a cleaner line. A person has an impairment. Disability is what happens when the environment is designed without that person in mind.
Under that framing, the problem to solve is the failed elevator, the fixed nine o'clock start, or the agenda that lands four minutes before the meeting. All of those sit within an organization's control.
This makes the social model a commercial argument as much as a moral one. It moves the work of adaptation away from the individual, who cannot rebuild the station, and onto the institution, which can.
According to the World Health Organization, approximately 1.3 billion people—about one in six worldwide—experience significant disability. Most of these disabilities are invisible to onlookers, and many are dynamic as well. A person’s needs can change by the hour, the week, the season, or the environment.
That brings us to a group most workplaces have never consciously considered: ambulatory mobility aid users. These are people who use a cane, crutches, a rollator, or a wheelchair some of the time rather than all of the time.
A person who walks on Tuesday and rolls on Thursday has learned to read their own capacity and match the tool to the demand. That is a form of resource management most organizations pay consultants to teach.
Yet the language we inherited makes this harder to see. “Wheelchair-bound” describes confinement, when the chair is actually the thing that removes it. A wheelchair is a mobility device in the same way a laptop is a productivity device. It extends range, banks energy, and converts what could be two hours at a conference and a week of recovery into a full day of work and a normal evening.
Several conditions can produce dynamic disability, and each one has its own objective diagnostic criteria.
POTS is diagnosed when a sustained heart rate increase of at least 30 beats per minute occurs in adults within ten minutes of standing or head-up tilt, while adolescents must show an increase of at least 40 beats per minute. The diagnosis also requires the absence of orthostatic hypotension and symptoms that have lasted for at least six months. Confirmation is made through a tilt table test or an active stand test. According to Johns Hopkins Medicine, the condition affects one to three million Americans. A heart rate is a number on a monitor; its existence does not depend on anyone's belief.
Hypermobile Ehlers-Danlos syndrome has international diagnostic criteria that were published in 2017, and it is assessed through clinical examination.
Myalgic encephalomyelitis, often called chronic fatigue syndrome, was reviewed by the U.S. Institute of Medicine in 2015, which concluded that it is a serious, chronic, complex, multisystem disease and that post-exertional malaise is its cardinal feature. The UK's National Institute for Health and Care Excellence reached the same conclusion in its 2021 guideline.
The symptom lists for these conditions overlap with anxiety in notable ways: dizziness, racing heart, exhaustion, and brain fog all appear in both. That overlap is exactly why objective diagnostic criteria matter. But the relationship also runs in the other direction. Adrenergic surges caused by autonomic dysfunction can present convincingly as panic, which is why many patients receive an anxiety diagnosis first and lose years to it.
Around four in five people diagnosed with an autoimmune disease are female, according to the National Institutes of Health. In 2024, Stanford researchers published work in Cell identifying Xist ribonucleoproteins as a driver of female sex-biased autoimmunity. These ribonucleoproteins exist only in cells with two X chromosomes. POTS predominantly affects people assigned female between roughly 15 and 50, at a ratio of about five to one.
The number of people affected by Long Covid continues to grow. Worldwide, an estimated 400 million people have experienced the condition, and Household Pulse Survey data indicate that roughly 17 million American adults have been affected.
Among people with highly symptomatic Long Covid, reviews estimate that around 30% also develop postural orthostatic tachycardia syndrome (POTS). In most of these cases, the initial COVID-19 infection was mild rather than severe.
The broader pattern is consistent with what has long been understood about post-viral illness. Long Covid is a mass disabling event, concentrated in working-age people and skewed toward women. In these ways, it behaves exactly as post-viral illness always has.
Patients in earlier generations had the same physical condition, but they lacked a name for it, and the consequences are documented. In a review of 429 patients clinically diagnosed with hypermobile EDS, 94.4% had previously been told by non-psychiatrist physicians that their symptoms were imagined, that they were fabricating them or seeking attention, or that they had conversion or factitious disorder. A separate survey of 505 people with confirmed hEDS found an average of 10.45 alternative diagnoses before the correct one, which came after roughly ten years and fifteen clinicians. Anxiety and depression were the most common alternative diagnoses.
This is a natural experiment, and it ran for decades. Applying a psychological explanation to this exact population at scale produced ten years of delay per patient, avoidable joint damage, lost education, and lost careers.
The wider track record is poor. Women with multiple sclerosis were diagnosed with hysteria for decades before the disease was reliably recognized in them. Stomach ulcers were attributed to stress and personality until Helicobacter pylori was identified in 1982. Endometriosis still has a diagnostic delay measured in years. The psychological explanation has an extremely poor hit rate, and when the condition is female-predominant, the delay tends to be longest. The cost of running that hypothesis again falls entirely on the patient.
For years, standard advice for post-viral and fatigue-related conditions revolved around graded exercise: patients were urged to push a little further each week, with the expectation that the deconditioning cycle would reverse.
The guidance behind graded exercise therapy has since been rescinded. The CDC removed the treatment from its recommendations in 2017. The Dutch Health Council declined to recommend it in 2018, and the Belgian Superior Health Council did likewise in 2020. NICE withdrew it in its 2021 guideline, instructing clinicians not to offer programs based on fixed incremental increases in activity, after a review found evidence of harm. The deconditioning model did not survive contact with the data, and the reanalysis of the trial that underpinned it is one of the more significant reversals in recent medicine.
What replaced it is pacing and energy management — exactly what a mobility aid delivers in physical form. In rehabilitation medicine, an aid is prescribed to increase activity rather than reduce it. It prevents falls, protects joints, and spends a fixed energy budget on the destination instead of the journey.
Someone who picks up a cane at 24 instead of 34 gains a decade of conserved energy, fewer injuries, fewer sick days, and a career that continues. Pushing through is not free. It is paid for in pain, in recovery time, in resignation letters.
Over the past decade, something has clearly shifted, and much of the credit goes to young Disabled people and the online platforms they have built for themselves.
Millennials and Generation Z grew up and went through school after the Americans with Disabilities Act took effect, and that background shows in how they approach disability. They enter the workforce having already seen disability treated as an identity with real pride attached. Disabled creators now document everyday life as ambulatory wheelchair users, decorate their forearm crutches, treat canes as fashion accessories, and explain pacing to audiences that number in the millions. As a result, people are starting to use mobility aids years earlier than they might have in the past, and many are staying in work because of it.
The backlash tends to follow a familiar pattern. Each wave of visible mobility aid use brings accusations of exaggeration and attention-seeking, and those accusations are aimed almost entirely at young women. It is worth asking what exactly is being sought. Nobody goes through insurance denials, broken lifts, and public commentary about their legs just for the aesthetics.
Researchers at Stony Brook University, the University of Tennessee, National Disability Institute and the Oxford Institute of Population Ageing found that a household containing an adult with a work-limiting disability needs on average 28% more income to reach the same standard of living as a comparable household without one. At median household income that is roughly $17,690 a year, paid in equipment, repairs, transport, medication, accessible housing, delivery fees and hours lost to paperwork.
Mobility equipment is where it bites. Research by the Disability Rights Education and Defense Fund found that 43% of mobility device users surveyed had faced an insurance denial, around half reported their insurance did not fully cover the cost, and out of pocket spending ranged from $100 to more than $20,000. Some people waited years between chairs while they saved.
Ambulatory users hit an additional gate, Medicare assesses whether a mobility device is medically necessary based on activities inside the home. Someone who can manage their own bathroom with a walker can be refused the chair they need to cross a campus or board a plane. The policy funds movement between the bedroom and the kitchen. It declines to fund movement to the office.
Then there is the benefits penalty, the Supplemental Security Income asset limit has sat at $2,000 for an individual since 1989. Save above it, marry the wrong person or accept a raise that crosses a threshold, and you can lose the healthcare and personal care that make working possible.
In 2025 the employment-population ratio for people with a disability was 22.8%, against 65.2% for those without, according to the Bureau of Labor Statistics. Whatever is being obtained here, it is not comfort, and it is certainly not money.
Stop auditing health. Checking whether someone’s disability behaves identically every day is the most damaging thing a manager can do. "But you were fine yesterday" is an accusation, and it teaches your employee to mask until they break. Thank people for the trust and move to the useful question: what do you need.
Design for fluctuation. Rigid attendance, fixed hours and mandatory in-person meetings assume a body that performs identically every day. Few do. Flexible hours, asynchronous options, agendas in advance and the freedom to move between remote and onsite by week will retain your best people and help everyone else.
Build accessibility as default. Seating in every space, step-free routes documented before anyone asks, quiet rooms, captions on, parking that works. Nobody should have to produce a diagnosis in order to sit down.
Close the cost gap. Employers who fund equipment, transport or the portion insurance refuses are removing a barrier no amount of culture work will touch. It is cheaper than replacing the employee.
Remember the curb cut. In the 1970s, Disabled students in Berkeley took sledgehammers to curbs and built ramps themselves. Those curb cuts now serve parents with strollers, travelers with suitcases and workers with trolleys. Access built for one group becomes infrastructure for everyone.
Ambulatory mobility aid users are demonstrating something every organization should want to learn: that capacity varies, that tools extend what people can do, and that a workplace built around a single fixed body is filtering out talent it claims to be searching for.
Talent is evenly distributed, access is not. Fix the access, and watch what your people do with the energy they get back.
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