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There are approximately one billion people with all kinds of disabilities all over the world. While blindness and deafness are usually, but not always, accommodated within device technology, the needs of those with physical disabilities (arthritis, cerebral palsy, and other conditions that affect fine motor skills) are often not. The world has become increasingly reliant on smartphones and mobile devices in the recent decade, specifically Apple iPhones. If all users are not able pick up their devices and immediately use it, they are missing out on valuable social and economic interactions and opportunities, such as engaging in conversation and activities with current or potential friends or participating in the market of buying and selling digital services. In this way, despite the advancements in mobile technologies and Apple’s great pride in their alleged accessibility, iPhones still fail to meet universal design standards and remain inaccessible to all users.


While their mortality rate is currently lower than ever, people with disabilities were not always able to live long, social, and active lives. People with disabilities tend to experience higher risk of secondary conditions that adversely affect overall health, such as cardiovascular disease, muscular dystrophy, and infections, usually because of behaviors caused by their primary condition. For instance, a person with paralysis or chronic pain would be more likely to be physically inactive, which can lead to pressure sores, which can in turn lead to infection. Before antibiotics, this would mean a certain and untimely death. However, these secondary conditions are now more treatable than they were in the past, thanks to the reach of modern medicine. This means that people with disabilities, along with the general population, are living longer, more fulfilling lives. Because they are more able to be well and integrate with society now more than ever, we must accommodate them as we would anybody else. 

In order to establish the need for laws to protect them from social discrimination and programs that support their independent living, people with disabilities founded the Disability Rights Movement shortly after the Civil Rights Movement. Similar to the Civil Rights Movement, activists contacted legislators and staged protests, notably the Denver public bus protest in 1978, where activists physically blocked the roads until representatives of the Regional Transportation District were willing to talk about the absence of wheelchair-accessible buses.

The hard work of these activists resulted in many laws being passed in regards to disability rights. The Individuals with Disabilities Education Act gave children with disabilities the right to attend the same schools and receive the same free public education as children without disabilities, as opposed to attending separate institutions or not receiving an education at all. The Rehabilitation Act “prohibits discrimination on the basis of disability in programs conducted by federal agencies, in programs receiving federal financial assistance, in federal employment and in the employment practices of federal contractors” (Employer Assistance). Most importantly, the American Disabilities Act protects against discrimination in the workplace, in public spaces and programs, and within communication. “Within communication” refers to a person who is hearing or speaking impaired, as they must be provided a sign-language interpreter or a communication device.


With the disability rights movement came disability rights advocates such as Robert Mace. Robert Mace was an architect who became involved with creating the first building code for accessibility in the United States. He coined the term “universal design” in the early 1970s to describe the concept of  “designing all products and the built environment to be aesthetic and usable to the greatest extent possible by everyone, regardless of their age, ability, or status in life”. Universal design became a model for accessibility standards, and the UK 2005 Disability Act extended the definition to “...the design and composition of an environment so that it can be accessed, understood and used to the greatest extent possible by all people, regardless of their age, size or disability. This includes public places in the built environment such as buildings, streets or spaces that the public have access to; products and services provided in those places; and systems that are available including information and communications technology (ICT)”. The inclusion of information and communications technology brought universal design as a reinforceable concept into the digital age.

It is interesting to note that this notion of design is centered around usability rather than aesthetic. This likely stems from the one of the core definitions of design as seen in the Oxford dictionary, “purpose or planning that exists behind an action, fact, or object”. Design is not just the practice of attention-grabbing visuals, but the strategy and functionality behind them.

Universal design has seven principles as defined by the Center for Universal Design at North Carolina State University: Equitable use, providing the same means of use, experience, security, and aesthetic for all users, identical when possible, equivalent when not; flexibility of use, providing options for methods of use, adaptability for the user’s pace, and accommodating the user’s accuracy and precision; simple and intuitive design, eliminating complexity, being consistent with user intuition, accommodating a wide range of literacy and language skills, and providing an understandable hierarchy of information; perceptible information, providing contrast between essential information and its surroundings, maximizing legibility, and providing compatibility with assistive techniques or devices; tolerance for error, providing adequate warnings of hazards and errors, providing fail-safe features, and discouraging unconscious destructive actions; low physical effort, encouraging a neutral body position and minimizing repetitive actions and sustained physical effort; and size and space for approach and use, providing a clear line of sight to important elements, making reach comfortable, providing clear space for any assistive technologies for any seated or standing user. 


Apple does not advertise its products as being universally accessible, but claims to provide adequate settings for accessibility. This is defined by the New Oxford American Dictionary as having the quality of being able to easily be reached or entered, obtained or used, and understood or appreciated. These settings can be accessed through its accessibility options under the “Settings” and “General” tabs. These include accommodations for touch and interaction, such as “reachability”, the users ability to reach across the screen with their thumbs as a standard user would, and “ignore repeat”, for when a user unintentionally taps the screen multiple times and only one of these touches must be recognized. While accommodations such as these greatly improve the specific user’s ability to complete tasks on their phones, there is no way for them to configure them during initial set up. This is the difference between being accessible and universally accessible: Apple has considered people with disabilities enough to create accommodations for them, but not enough to create a way for them to use the phone with complete independence. Why stop there?

As it stands now, all generations of the iPhone require a significant amount of physical handling during the onboarding process, which is the process of integrating and familiarizing a new user into an organization, product, or service. Users are first asked a variety of different questions, such as their preferred language, geographic location, and privacy preferences. The whole set up process is, at minimum, 26 steps that involve extensive motor movement such as scrolling, reaching and selecting multiple buttons in different areas across the screen, manipulating small objects for actions that require precision and accuracy, and manipulating the fingers to performing subtle movements, as seen in Figures 1 and 2.

Not one of these settings is related to accessibility, since there is no option to set up accessibility preferences, sync with assistive technology, or set up vocal commands. Siri, Apple’s artificial intelligence platform and device companion activated by vocal commands, can be set up at the very end of onboarding, but vocal commands cannot be used throughout the process. For a user with motor impairments, these tasks would be extremely difficult without assistance. 

Keeping universal design in mind, this current process is not enough. Not immediately providing accessibility options at the beginning of phone setup leads to inequitable use. Use is not flexible if there are no options for method of use, such as voice commands or screen readers, and if there is no accommodating user’s accuracy and precision, especially in the instance of installing the SIM card. Information is potentially not perceptible if there is no immediate compatibility with assistive technologies and devices. Extended, repetitive physical effort is required in terms of touch, dexterity, and manipulation of hands and fingers on the screen. While “size and space for approach and use” does not seem relevant here because the iPhone is a small device and not a large object in the environment, the “comfortable reach” aspect of this principal is broken by the thumb reach required to complete many actions within the setup process, as the “reachability” option (which, upon command, brings the top of the screen down into reach) is not accessible at this point. Thus, in the first five to 10 minutes of contact with the user, the iPhone has already failed to provide five out of the seven principles of universal design. 


Nicole Pizzolato OTR/L CHT, Occupational Therapist, Registered, Licensed, Certified Hand Therapist, of Hand Therapy NYC works with patients with upper extremity impairments stemming from a variety of conditions: orthopedic such as arthritis, fractures, and breaks; soft tissue such as tendonitis, ligament tears, tendon ruptures/tears/repairs, and muscle weakness; and neurologic such as nerve palsy, nerve damage, and nerve repair after damage. Since any of these conditions can impact the use of their hands, her practice works with patients to rehabilitate and strengthen their motor skills so that they can independently and adequately perform activities of daily living. Smartphone use is considered an activity of daily living in our digital age. In an interview, she noted that many patients have trouble texting with their thumbs and hitting keys accurately.  While many make do with the additional time and struggle it will take to complete tasks on their smartphones, she reports that the majority of her patients are not aware of all the accessibility features found on smartphones that are available to them. She reportedly only knows about them herself through an adaptive technology course taken during Occupational Therapy school, and believes that more education for the general population on accessibility options on their smartphones would be greatly beneficial.

Why do these accessibility options exist if they are not openly accessible or advertised? The most plausible answer is that Apple is business first, primarily selling to the non-disabled majority of their customer pool. This can be emphasized by the fact that all accessibility settings are secondary options that need to be activated, with the primary settings optimized for non-disabled users. Despite this, it would be inaccurate to say that Apple does not care about its disabled demographic. The research and development of the current operating systems that support accessibility require a lot of money, and in 2006, Apple spent $712 million on research and development alone. This implies that there is no lack of resources or interest in investing in accessible technology.

However, creating a device that is not accessible from the beginning of use implies that Apple believes that people with disabilities cannot ever function independently, or that their ease of use is not worth changing the experience of the larger, able demographic. Having the accommodations that so greatly impact their ease of use buried three tabs deep into Settings implies that they were considered after designing the phone for the larger able demographic, and this phone was not originally intended for them.


In order to truly design for the 100%, a new mental model of inclusion is necessary. During the set-up process, Apple asks questions knowing that the user can be from any country, speak any language, and have any kind of privacy preferences. What they don’t consider is that the user can also have any disability. The set-up process should begin by asking about abilities and disabilities, and drop down into personalized questions based on the user’s abilities and accessibility needs. This will include a few cosmetic changes as well as software changes.  

Before the phone can even be set up, it needs to be taken out of the box. The box is usually wrapped in a hard-to-remove shrink wrap which is not necessary since all phones are contained in either a shipping container or bag before use. The box, currently a tight-fitting top and bottom that requires grip and strength, should instead be a container with a loop within a sleeve for easy, tuggable access. All accessories within the box should also be accessible with a tuggable loop.   The iPhone comes with a plastic wrapper that protects the glass screen, currently removable via a small tab on the bottom. This tab should be a larger loop for easy grip, and the plastic should be textured so that vision-impaired users immediately know that it’s there. The removal of the plastic wrapper should then trigger the phone to turn on. 

From there, the phone should speak and display the first question: “Hello, welcome to your iPhone. Do you require special assistance?”. The user should be able to speak or type their answer using Siri, and subsequently set up accessibility preferences (Fig. 3 and 4). After these initial questions that require Siri and screen reading, users that do not need these tools should have the option to turn them off (Fig. 5). Since users were able to set up their required preferences at the very beginning, they are now able to proceed with the rest of their iPhone set-up and use in a way that works for them.

This solution still leaves some steps open ended. How would language be addressed if the phone is the first to speak? How should SIM card installation be addressed? If the current capabilities of the iPhone are ignored, it’s possible that the user could use a vocal command in their preferred language to turn the phone on, thus initiating the rest of the set up process in the recognized language. In a perfect world, phones could be authenticated without a SIM card, which stores subscriber data for service providers. This would eliminate the need for physical installation of the SIM card, and make the physical phone truly accessible. However, we do not live in a perfect world. This solution focuses on the current capabilities of the iPhone and re-utilizes them in a way that establishes a universally-designed user experience.


Not everybody requires universal design in their devices, but everybody benefits from it. Even able-bodied individuals are likely to experience vision, hearing, and dexterity issues as they age. When businesses respect the needs, dignity, and abilities of all of their potential consumers, it results in increased market reach and better public reputation. In the case of a business with as influential of a reach as Apple, adhering to universal design standards can lead to a more connected, informed public.


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