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

2. 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)

3. 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.

4. 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

5. 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

6. 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.

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

8. 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 4.13.5 www.access-board.gov/

9. Barrier: Height of Kitchen Cabinets

10. 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 http://www.blvd.com/storefront/

11. Barrier: Depth of Kitchen Cabinets

12. 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

13. 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: $46.35 http://www.shelvesthatslide.com/

14. Barrier: Accessibility of Kitchen Sink

15. Solution: Adjustable Sink Press a button and the sink raises and lowers to optimal heights. 28-36 inches (can be used from seated position) Knee-space beneath the sink benefits a user in a wheelchair. Cost: $995 http://www.assis-tech.com/products.htm

16. Barrier: Refrigerator Door Handle Accessibility

17. 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 http://www.abtelectronics.com/

18. Barrier: Accessibility of Stove

19. 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

20. Barrier: Height of stove hinders user to visualize cooking

21. 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: $39.95 www.sammonspreston.com/

22. 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 http://www.assis-tech.com/products.htm