“Enabling the Disabling Environment: Paraplegia” (adult) Jayna Vaccaro OT 5162 March 21, 2005

Description of Disabling Condition: Paraplegia Motor and Sensory impairments at the thoracic, lumbar, or sacral segments of the spinal cord Due to damage of the neural elements inside the vertebral canal Results in impairment of the trunk, legs, and pelvic organs (dependent on lesion location) (Trombly, 2002)

Task Analysis Occupation: Preparing a meal (IADL: complex activities or tasks that a person does to maintain independence in the home and community) (Trombly, 2002) Description: Using the kitchen space to safely prepare a meal. Preparing a meal is one example of a valuable activity to maintain independence as an adult with paraplegia. Safety: A person in a wheelchair will encounter barriers in the kitchen environment due to being seated at a lower height, but various solutions can improve upon these and help the person feel comfortable and safe while cooking.

Key Performance Components Sensorimotor:  Coordination/Praxis  Range of Motion/Muscle Tone  Visual Perception (depth perception, figure- ground, position-in- space)  Strength/Muscle Tone  Proprioception  Stereognosis  Kinesthesia  Pain Response  Balance/Posture  Touch  Pressure  Hearing  R/L Discrimination

Key Performance Components Cognitive:  Attention  Recognition  Sequencing  Initiation  Problem Solving  Orientation  Concept Formation Psychological/Psychosocial:  Role Performance  Self-Expression  Mood/Affect  Behavior  Perception  Thought Content

Performance Contexts Physical Environment – Kitchen Social Environment – Expectations of significant others Ex: Cooking for family members, friends, co-workers Potential Barriers – Entry accessibility, stove, knobs on stove, sink, cabinets, and design of refrigerator.

Barrier: Width of door frame does not allow accessibility to kitchen

Solution: ADAGG Accessible Doorway Wider doorway allows a person in a wheelchair to be able to access their kitchen. Doorways shall have a minimum opening of 32 inches. ADAGG

Barrier: Height of Kitchen Cabinets

Solution: Adjustable Kitchen Cabinets By pressing a button, any individual can adjust the cabinets to their specific needs. Cabinets can lower to meet a standard height counter or one that is 34 inches. Automatic shut-off safety feature. Cost: $1,150

Barrier: Depth of Kitchen Cabinets

Solution A: Pull-out Shelves Enables user to obtain items from front and back of shelves. Can safely reach items without having to bend over in a wheelchair. Cost: Begins at $26.95 per shelf at kitchenshelves.com

Solution B: Lazy Susan By installing this in the lower cabinets, it is another solution for hard to reach products. Shelf heights can be adjusted on the lazy susan. Fits cabinets of 24 to 31 inches. Cost: $

Barrier: Accessibility of Kitchen Sink

Solution: Adjustable Sink Press a button and the sink raises and lowers to optimal heights inches (can be used from seated position) Knee-space beneath the sink benefits a user in a wheelchair. Cost: $995

Barrier: Refrigerator Door Handle Accessibility

Solution: Side-by-Side Refrigerator with full-length door handles Adult with paraplegia in a wheelchair will have access to both sides rather than having difficulty reaching freezer. Has roll-out baskets on both sides for obtaining hard-to- reach items. Shelves within can raise and lower for various heights. Cost: $1992

Barrier: Accessibility of Stove

Solution: Stove-top with front knobs and staggered burners Staggered burners allow user to safely reach all areas of stove. Front knobs provide easy accessibility. Cost: Varies from $200- $1600 at Sears.com

Barrier: Height of stove hinders user to visualize cooking

Solution A: Attach an angled mirror above the stove Mirror enables a person in a wheelchair to visualize cooking from all heights. Helps the user to feel safe while cooking. Cost: $

Solution B: Adjustable Cooktop By pressing a button, user can lower the stove to match their needs. Provides knee-space so that a person in a wheelchair can roll under to cook. Cost: $995