Environmental Factors Special Populations

Examination of the Environment Environmental Barriers – physical impediments that prevent individuals from functioning optimally in their surroundings Includes safety hazards Access problems Home design difficulties Workplace design difficulties Requirements for public and commercial buildings are regulated by the accessibility guidelines of ADA

Discussion Why should we study environment factors? Outcome of PT is for the pt to become fully functional in a former environment and lifestyle. Many times the environment must be adapted for full accessibility

Environment Evaluation Accessibility Safety Function Usability Must look at

Accessibility Assessment identifies design barriers that may impact usability or compromise performance of customary tasks or activities Makes realistic recommendations regarding accessibility and accommodations to the pt, pt’s family, workplace, or government buildings

Safety Environmental assessment determines the degree of pt safety and level of function in the physical environment

Usability Assist in preparing the pt and support network for pt’s return to a former environment and to help determine whether further services may be required

Function Determines need for AD, adaptive equipment or assistive technology to support and promote function.

PT Environment Evaluation

Access, Usability, and Safety in the Home

Intervention Strategies 5 Major Areas of Environmental Assistive or adaptive devices Grab bars, reachers, adaptive eating utensils, canes, walkers Safety devices Lighting, smoke detectors, or sensing devices Structural alterations Widening doors, installing railings/ramps, removing doorway threshold

Intervention Strategies: con’t 4. Modification or altered location of environmental objects Disabling a stove, placing locks on door handles, removing throw rugs, moving furniture 5. Task Modification Use of visual, auditory or other sensory cueing Work simplification Energy conservation Joint preservation techniques

Tips for Accessibility: Route of Entry Select the most accessibly entry point to the home (most level, closest to the driveway, fewest stairs, handrails) Walkways should be smooth, well lit, and covered (cracks should be repaired or alternate route selected) Steps: no > than 7” with minimum depth of 11”; non-slip surface should be applied Handrails: height minimum of 34” and maximum of 38”

Tips for Accessibility: Route of Entry: con’t 5. Ramp: (large-wood or concrete; small-aluminum or fiberglass) minimum ramp grade-for 1 inch height should be 12 inches of depth; minimum 36” wide with non-slip surface

Tips for Accessibility: Entrance For those with w/c, entrance should have a platform large enough to allow the pt to rest and prepare for entry; if the door swings out, area should be 5’ x 5’; if the door swings in, area should be 3’ deep and 5’ wide. Door locks should be accessible to pt (look at height and ease of use) Door handle should be easy to turn (door grips or lever-type handles) Adaptation to door so pt can open and close the door

Tips for Accessibility: Entrance: con’t 5. Remote control automatic door openers can open/close/lock doors 6. intercom allows people to “see” who is at the door 7. Raised threshold should be removed 8. Doorway width: 32-34 inches

Tips for Accessibility: Furniture Arrangement and Features Sufficient room should be made available for maneuvering AD (w/c, walker etc) Move furniture against walls to prevent sliding during transitions Place rubber suction cups under the legs of sofas and chairs. Remove coffee tables, foot stools, and wires Clear passageway between one room and the next Living room chairs should have double arm rests, firm seating surface, and upright back (90-90-90) Remove rocking chairs and other unstable furniture

Tips for Accessibility: Electrical Controls Provide access to wall switches and electrical outlets (use power strips) Change overhead toggle switches with rocker switches or sensor devices. Use higher wattage light bulbs and fluorescent lighting. Can use timers to turn on lights if needed Night lights with motion sensors can be used Touch pad dimmer switches can be used to activate lamps

Tips for Accessibility: Floors Non-slip and level coverings should be tacked down Short-pile carpet should be used Unlevel spots should be refinished, covered with furniture, or marked with bright colored tape. Scatter rugs should be removed Matte finishes on floors to reduce glare are recommended Use tape to mark edges/perimeters of the room for those with visual impairments.

Tips for Accessibility: Doors Raised thresholds should be removed to provide flush surface; if unable to be removed, transition wedges can be installed Doorways widened if less than 32 inches wide Increase door clearance Install pocket doors Remove wood strips on inside of doorframe Use offset hinges (swing-clear hinges) which swing the door clear of the frame Change the door to a curtain Check door handle for accessibility

Tips for Accessibility: windows Use film on windows to reduce glare Heavy drapes can be used with the benefit of absorbing background noise Can install remote control systems for closing/opening window coverings

Tips for Accessibility: Stairs Stairwells should have handrails Make sure stairwell has enough light Handrail should extend 12-inches past top and bottom of the stairs Keep stairs free of obstacles Use bag to carry things up and down the stairs Use tape or lights to designate edge of stairs for those with vision issues Motorized stair lift can be used for those that cannot get up and down stairs.

Tips for Accessibility: Heating Units Radiators, heating vents, and hot water pipes should be screened off or insulated with pipe covers especially for those with sensation issues Might need to adapt for heat controls Heating source away from combustible material Smoke alarms and carbon monoxide detectors should be in the home

Tips for Accessibility: Bedroom Area stationary and positioned to provide ample space for transfers (put bed against wall/rubber suction cups under feet of bed) Height of bed can be raised or lowered as appropriate Mattress should be firm – can add wood board below mattress to encourage firmness Bedside table should be convenient to patient Closet clothes bar may need to be lowered for access

Tips for Accessibility: Bathroom If the pt cannot get in the bathroom, they can transfer into a chair with wheels at the door Use elevated toilet seat if appropriate Grab bars should be placed on a reinforced wall Toilet – placed 36” from floor Length of grab bars 42-54” on the side wall 24-36” on back wall Bath – 33-36” from the floor of the tub and the second 9” above the rim of the bathtub Tub transfer bench can be used Collapsible seat may be permanently attached to the shower wall Non-skid strips to the bottom of the bathtub Detachable shower head can be used

Tips for Accessibility: Kitchen Height of counter should be appropriate (< 31”) w/c armrests need to fit under the counter Need counter depth of at least 24” Look at faucet of sink – use lever arm or electronic sensors Shallow sinks allow clearance of legs underneath Small cart with castors can be helpful with carting things from place to place in kitchen Height of table should be checked Objects in cabinets should be easily reached Use electric not gas stoves Dishwashers should be elevated 6” and should be front loading

See chart 12.2 page 423 physical Rehabilitation Adaptive Equipment See chart 12.2 page 423 physical Rehabilitation

Review Differentiate between the roles and responsibilities of the PT and PTA in examination of the environment. What is the importance of environmental accessibility in optimizing patient function. Identify some strategies to improve patient function through environmental modifications. Describe examination instruments used to measure environmental impact on patient function.

Lab: Case Studies Divide into groups of 3-4. Read case study on page 438. Answer the questions at the end of the case study