environmental modifications

7/30/2019 ENVIRONMENTAL MODIFICATIONS

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ENVIRONMENTAL

MODIFICATIONS

NAKUL RANGA


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INTRODUCTION

THE PHYSICAL ENVIRNMENT IN WHICH AN INDIVIDUALFUNCTIONS CONSISTS OF A VARIETY OF BOTH BUILT ANDNATURAL OBJECTS.

ENVIRONMENT ENCOMPASSES A SUBSTANTIAL RANGEOF COMPONENTS THAT IMPACT HUMAN FUNCTION ANDINCLUDES THE INDIVIDUAL HOME, NEIGHBOURHOOD,COMMUNITY, AND METHOD OF TRANSPORTATION, INADDITION TO THE INDIVIDUAL S EDUCATIONAL,

WORKPLACE, ENTERTAINMENT, COMMERTIAL, AND

NATURAL SETTINGS.


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DEFINATIONS

ENVIRONENTAL BARRIERS

ACCESSIBILITY

ACCESSIBLE DESIGN

UNIVERSAL DESIGN

ENVIRONMENTAL ACCESSIBILITY


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EXAMINATION

1. INTERVIEW

2. SELF REPORT AND PERFORMANCE BASED MEASURES

3. MEASURES OF ENVIRNMENTAL IMPACT ON FUNCTION

Physical Activity Resource Assessment

Home and Community Environment

Safety Assesment of Function and the Environment for rehabilitation

Usability in My Home

Housing Enabler


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Environmental Analysis of Mobility Questionnaire

Craig Handicap Assessment and Reporting Technique

Craig Hospital Inventory of Environmental Factors

ADL Staircase

Environmental FIM

Functional Performance Measure

Environmental Utility Measure


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PATIENT- HOME ENVIRONMENTRELATIONSHIP

(ACCESS, USABILITY & SAFETY)


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ROUTE OF ENTRY

Most accessible route should be accessed.(driveway, levelled surface,

less stairway, handrails etc.)

Cracked uneven surfaces should be repaired or use alternate route.

Height, no. and condition of stairs ideally step should not be greater

than 7 inch & with a depth of 11 inch. Nosing or lips of stairs should be

curved overhangs on the front edge of stairs & inch.

But nosing are problematic as they prevent clear transition inneurological ill and elderly patients. handrails should be installed, it

should measure between a minimum of 34 inch and a max. of38 inch..


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If possible height adjustable handrails should beused or one handrail of minimum 12 inch shouldbe there. outside cross sectional diameter of

handrail should be 1.25 -2 inch. If attached to wall,gap between wall & handrail should be 1.50 inch.

Ramp adaptation require adequate space,if largeshould be made of wood or concrete , if small

should be made of almunium or fibre-glass


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It should be wheelchair accessable i.e. min. inclination should be thereof around 12 inch or 1:12 of running slope.

Outdoor ramp exposed to inclement weather such as snow or iceshould have inclination of 1:20 of running slope. Ramp should be 36inch wide.

Commercially available vertical platform lifts and stairway inclined liftsare also available for wheelchair bound patients. approx. height of liftsshould be 30x40 inch.


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ENTRANCE

For wheelchair bound patients entrance platform should be wide sothey can rest and to prepare for entry. with a door which swings in areaof 5x5 feet, if it swings away from patient, a space of 3 feet deep and 5feet wide is required.

Door lock should be accessible to the patient. The height of lock should

be determined as well as the amt. of force required to turn the key.italso should be properly illuminated.

Alternate lock- key systems can be used acc. to patients problems andhis accessibility.

Eg. Voice or card activated

remote control locks

keypad electronic security systems

face recognition door locks

push button padlocks


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The door hand lock should be turned easily by the patient.rubberdoorknob for textured grip or lever type handles.

Closing & opening of door knob should be in functional direction.

Door strap can be attached around door handle.

Door should be light weighted so that it can be easily pulled or pushed.

A kick plate(metal guard) may be added to doors frequently entered byindividuals using a wheelchair or ambulatory assistive devices.the kickplate should measure 12 in. in height from the bottom of the door.


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FURNITURE ARRANGEMENT ANDFEATURES

Sufficient room should be there for wheelchair maneuvers orambulating with assistive device. restriction should not be there bycoffee tables, telephone or electric wires

Stability of furniture is required to be maintained using rubber suctioncups under the legs.

Clear passage between 2 rooms.

Height of sofa should be sufficient or can be modified using woodenbars at its legs so that hip and knee at 90-90 position. there should besufficient space on sofa for caregiver too.there should be space in side &below sofa for keeping assistive devices & wheelchair.

Use of unstable furniture such as rocking chairs should be discourged

for most patients. Use of leather furniture should also be avoided as it can hinder

movement. chair that provide mechanized elevation of the back of seatshould be cautiously used as it may be difficult for patient to stabilizethe feet as the seat is elevating.this causes the feet(forward tilting) toslide forward resulting in fall.


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ELECTRICAL CONTROLS

Unrestricted access to wall switches & electrical outlets, power stripscan be used to improve access.outlets should should be raised and wallswitches should be lowered. For wheelchair individuals cord extentionscan be used for better control.

Some patient may be benifited from replacement of standard toggle

electric switches with rocker switches that require less fine motor skillto activate.

Occupancy sensor devices also available which automatically turns onlight on entering & switch it off on leaving room.

Voice directed devices & switches are also available.

On light coloured walls dark or coloured switches and outlets can beused , vice-versa.

Ground fault circuit interupter(GFCI) shouled be installed in wetlocations to prevent earth shock.wounded wires, faulty or cheapappliances should not be used.


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For visual problems in some patients use of higher voltage bulbs,flurrecent lighting,fall spectrum bulbs or high intensity halogen lamps.

Inexpensive proggramable timers can be used to regularly turn lightson & off through out the day & night.

Inexpensive night-lights with motion sensors can be placed in strategic

locations to provode additional illumination. Touch pad dimmer can be used fro night lamps and small fans.

Universal remotes can be used to control lights of whole house.


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FLOORS

It should be levelled and nonslip. All floor coverings should be glued & tacked to floor, it prevents

bunching or rippling under wheelchair use.

Dense, low pile, low-level carpetting provides easiest wheelchairmovement or assistive device.

Industrial style indoor outdoor carpetting should be used. Old, uneven, wooden, cracked concrete floors should be properly

assesed, repaired or replaced.

Place bright coloured tape over affected of repaired areas for patients toavoid such areas.

Scatter rugs should be removed, use of non skid waxes should beencouraged.

If flooring is to be replaced, matte finishes should be recommended toreduce glare.patien ts with visual impairments will benefit from acontrasting colour border along the perimeter help mark the boundriesof the space. Wide-coloured tape can be used too.


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DOORS & windows

Remove threshold ramps.

Widened doorways for wheelchair entry

Frosted window film for diffused sufficient light

Noise absorbent heavy window draperies can be applied

Remote control systems for opening and closing of doors & windows If automatic openers installed it should be below window so that easily

assessable by wheelchair bound.


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STAIRS

Hand rails of min of 12 inch & well lighted area.

Free from clutter(confusing) steps.

For individuals with decreased visual acuity or frail, adhesive lightreflective tactile warning strips provide contrasting texture on surface.

At start and end of rail circular bright tape is placed. Bright contrasting color tape at the border of each rail.

Stair lift may be an option


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HEATING UNITS

All radiators, pipes, heating vents should be properly screened off orinsulated with pipe covers to prevent burns for people with sensoryimpairments.

Use of space heaters should be discouraged.

Smoke alarms and CO detectors should be installed at home.


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BEDROOM


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BEDROOM


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TOILET AND BATHROOM


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OFFICE ACCESSIBILY


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KICHEN ASSESSIBILITY


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TRANSPORTATION


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THANK YOU

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