Midterm

what is universal design?

the intent of simplifying life for everyone by making products, communications, and the built environment so they are more useable by as many people as possible with little or no extra cost

universal design aims to produce a product or environment that is more usable by…

everyone- regardless of age or ability

what is the most important benefit of universal design solutions?

they do not segregate users and do not become less usable by persons who are not disabled

what are examples of universal designs?

a level entrance

wider hallways, doors, or washrooms

color contrasts between walls and floors or stairways and entrances

wayfinding

lever door handles

why is universal design used?

to address the aging society

human rights laws

changes in building codes and standards

desire for more function designs

what was the independent living movement?

economic, architectural, or support systems in an environment can be supports or barriers to occupation, this movement aimed to ensure those were supports to those with disabilities through the process of using universal design

what are the goals of universal design?

body fit

comfort

awareness

understanding

wellness

social integration

personalization

cultural appropriateness

what does ‘body fit’ mean in regards to universal design?

the accommodation of a wide range of sizes and abilities

what is used when determining body fit?

static and active body measurements

what is the goal of be aware of ‘body fit’ when designing an environment?

everyone is able to interact with the environment

what is ‘comfort’ when it comes to universal design?

keeping demands within desirable limits of body function

what kind of understandings are used to determine if an environment has a level of comfort?

biomechanics- in order to adjust and reduce the level of effort required to complete a motor action in an environment

what is ‘awareness’ in regards to universal design?

ensuring that critical information for use is easily perceived

what is ‘understanding’ regarding universal design?

making methods of operation and use intuitive, clear, and unambiguous

what is incorporated in a universal design showing understanding?

universal symbols (such as handicap signs)

what is ‘wellness’ regarding universal design?

contributing to health promotion, avoidance of disease, and preventing injury

what is ‘social integration’ regarding universal design?

treating all groups with dignity and respect

its important to provide ________ and _________ spaces to achieve social integration in a universal design?

public, semi-public

what is personalization regarding universal design?

incorporating opportunities for choice and the expression of individual preferences, aiming to give the choice to engage

what is ‘cultural appropriateness’ regarding universal design?

respecting and reinforcing cultural values and the social and environmental context of any design project- reducing discrimination

what is equitable use?

is useful and marketable to any group of users

how does a occupational therapy skill set relate to equitable use?

knowledge of human rights legislation, policies, and laws not well developed

what is flexibility in use?

accommodates a wide range of individual preferences and abilities

how does a occupational therapy skill set relate to flexibility in use?

knowledge of human functioning

what is simple and intuitive use?

use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level

how does a occupational therapy skill set relate to simple and intuitive use?

knowledge of cognitive function and activity analysis

what is perceptible information?

design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities

how does a occupational therapy skill set relate to perceptible information?

knowledge in terms of needs of persons with visual and hearing disabilities; cognitive disabilities

what is tolerance for error?

design minimizes hazards and the adverse consequences of accidental or unintended actions

how does a occupational therapy skill set relate to tolerance for error?

knowledge of human functioning, disability, and occupational analysis

what is low physical effort?

design can be used efficiently and comfortably with a minimum of fatigue

how does a occupational therapy skill set relate to low physical effort?

knowledge of energy conservation and work simplification principles

what is size and space for approach and use?

appropriate size and space is provided for approach, reach, manipulation, and use regardless of user’s body size, posture, or mobility

how does a occupational therapy skill set relate to size and space for approach and use?

knowledge of activity analysis, human-functioning, assistive technology, and human-environment interactions

what can lead to further development or universal design?

knowledge of the universal design theory

knowledge of codes, standards, and guidelines

skills to interact with designers, architects and builders

knowledge of best practices in universal design

knowledge of environments beyond housing

ability to review architectural drawings

what are new frontiers for occupational therapists regarding universal design?

providing consultations with the universal design team on building projects

providing education to designers, architects, contractors

serving on accessibility committees and building codes and standards committees

developing new assessment tools

working as researchers with a universal design team

how can an OT develop their knowledge in universal design?

self study

attending conferences and workshops

serving on access, codes, and standards committees

networking

collaborating with people in other fields

keep up to date on new developments in the fields

what is study outcome 1 regarding the use of universal design?

adding a new environmental assessment tool that uses universal design principles to the OT assessment protocol and keeping track of the results

what is study outcome 2 regarding the use of universal design?

asking clients to be user-experts and identify what they need in terms of universal design and environmental modifications

what is study outcome 3 regarding the use of universal design?

developing a “best practice protocol” for universal design in an area of practice and evaluating the protocol over a specific time period

what is study outcome 4 regarding the use of universal design?

setting up a program evaluation of new services that use universal design principles and including client questionnaires or interviews as part of the evaluation

what is the difference of universal design and universal learning?

one focuses on adapting and making environments accessible while the other focuses on adapting and making learning accessible

The ______ ____________ is one of the most essential contexts in which this intervention can occur, and it is within the home that individuals perform some of their most valued occupations

Home environment

What is occupational performance?

The result of complex interactions among person, environment, and occupation

What can home modifications do?

Enhance functional independence

I prove occupational performance

I prove safety and reduce the stress placed on caregivers

Reduce home hazards to prevent falls or other injuries

Cost effectiveness- home mods. are less that institutionalization or hospitalization

Who are home modifications for?

All ages

A broad range of health conditions

Individuals with impairments in different or multiple functional areas- behavioral, cognitive, physical functioning, etc

Acute temporary to chronic progressive disease processes

What steps are involved in the home modification process?

Comprehensive evaluation of personal and environmental factors

Intervention plan to resolve the incompatibilities between the person and the environment

Obtaining and installing modifications

Training in the use of modifications

What are the six dimensions of home?

Physical

Social

Personal

Occupational

Temporal

Societal

What is the physical dimension of home?

Structure, services and facilities, space, ambient conditions, and location of the home

What is the social dimension of the home?

Relationships with others inside and outside of the home

What is the occupational dimension of the home?

It’s a place of meaningful activities, doing, being, belonging, and becoming

What is the societal dimension of the home?

Political and economic influences

What is the temporal dimension of the home?

Routines and order, involves the past, present, and future

What is the personal dimension of the home?

Safety and security, privacy, control, freedom and independence, and connectedness

What is the new clinical framework based on? (Regarding home modification)

PEO model

The new clinical framework for home modification focuses on…

Seeing client in their homes, the true context of their performance to review their environment

If barriers are present, the OT can uses a comprehensive client-centered approach to remove barriers and introduce supports

Intervention strategies are implemented

What are examples of intervention strategies used with home modification?

Caregivers education

Architectural modification

Equipment training

Program referral

What are the goals of a clinical application framework that aims to support provision of home modifications in homes of individuals with disabilities?

Improve occupational performance in the home

Improve QOL of those with disabilities and their family members

Build family’s and client’s skills and knowledge of resource to support independence

Decrease the risk of premature institutionalization

Ensure environmental modifications address client’s (and family’s) goals, skills, and needs

Train the person on how to use the modifications

Increase the capacity of caregivers to provide supportive care

Provide assessment and intervention in the everyday context of a person’s life

What settings do we see OTs working on home modification efforts?

Inpatient rehabilitation setting

Home Health

What role do OTs play in an inpatient rehabilitation setting, regarding home modification?

Visit the client’s home prior to discharge from the hospital to identify the type of environment barriers are present in the home of an individual with a newly acquired disability

What is an OTs role in a home health setting, regarding home modification?

Observation of the home environment and recommendation of appropriate equipment and modifications

Use simple strategies during intervention such as providing the client with training and education on the use of DME

What are the different types of environment modifications?

Changes to the physical environment

Modification of the occupation

Supports from people

What are changes to the physical environment?

Modifying the layout

Provide adaptive equipment

Architectural modifications

What are modifications of the occupation?

Education about how to use the environment in a different way

Use of everyday items to achieve goals

What are examples of supports from people (outside or inside the home)?

Caregivers education

Engage in social services (like home delivered meals)

What is the role of the client in environment modification?

Participates in the evaluation of performance of daily activities at home

Reviews the range of intervention options available and selecting their preferences

Receives training in the use of home modification interventions after installation

What are the roles of family members regarding environmental modification?

Provide additional input for changes in shared spaces

Understand the roles and occupations of the family members currently living in the home

May receive training in the use of home modification interventions after installation

What is the role of an occupational therapist regarding environment modifications?

Evaluates patient’s occupational performance within the home

Identifies supports and barriers

Identifies options for removing barriers and maximizing supports (in collab with team members)

Communicates recommendations to the inter professional team

Implements intervention in collaboration with team members

Provides follow-up education and training to the client and family members to integrate home modifications into daily performance patterns

Whose a part of the environment modification team?

Client

Client’s family or caregiver

OT

Contractors

Interior designers

Architect

What are the roles of contractors regarding environment modification?

Understand building construction

Provide guidance

Estimate cost

Installing home renovations

Hire and supervise subcontractors as needed

Understand building codes

Coordinate complex teams of building professionals

What are the roles of interior designers regarding environment modification?

Assist with design of interior spaces (looks at lighting, organization, storage, compliance with building codes, accommodation of special needs, etc)

Help identify potential intervention options

What are the roles of architects regarding environment modifications?

Designs the physical layout of the space

Prepares plans needed to obtain building permit

Understands local building codes and regulations

Coordinates complex teams of building professionals

What is the occupational therapy process of home modifications?

Referral

Evaluation

Occupational profile

Analysis of occupational performance

Consideration in assessments

Interventions

Considerations during intervention planning

Targeting of outcomes

Discharge

What is an important thing to consider when you get a referral to look into home modifications for a client?

The level of priority of the referral

What categories play a role in determining if a referral is high, moderate, moderate to low, or low priority?

Response- when to visit the client

Consequences of not modifying the home ASAP

Likelihood of adverse events

Type of limitations

Ability to function

Alternatives that are possible

Available support

Timing (prognosis of condition)

Solution type- what level of modifications are needed

What should be considered during the assessment of home modifications?

Ownership or control of the dwelling

How will the environment modifications be paid for

Consultations vs direct service

Home modifications v. home audits and accessibility (audits to not take into account the client’s performance skills and abilities, solely looks at the home environment)

Client preferences

Culture

Needs of all residence

Condition and layout of the home

What does the ‘prevent’ intervention approach?

Prevent issues before they occur- prevent decline in health, occupational participation and performance, and wellbeing

What is the ‘modify’ intervention approach?

Adaptation of the specific activity, task demands, environmental supports, and therapeutic approaches based on the individual clients needs and goals

What is the ‘create or promote’ intervention approach?

Create or promote skills that improve a person’s performance and ability to participate in meaningful occupations

What is the ‘maintain’ intervention approach?

Aiming to preserve a client’s current functional abilities, focusing on maintaining their participation in desired occupations

What outcomes are being targeted when using environment modification?

Occupational performance

Prevention

Health and wellness

QOL

Participation

Role competence

Well-being

Occupational justice

When should discontinuation of OT services for home modification occur?

When the client achieves their established goals through the delivery of home modifications and subsequent education and training in their use

The client has achieved maximum benefit from OT services

Home modifications are no longer needed

What are something you will look at when doing a systematic review of home modification in OT?

Fall reduction/prevention

Frail older adults

Improving functional performance

Significant functional impairment

Postoperative hip repair

Low vision

Schizophrenia

Caregiving for functional limitations and dementia

Improving ability to provide care for people with dementia

Improving function for care recipients with dementia

Reducing caregiver hours for people with early-onset dementia

What is a child’s occupation?

Play

What is the importance of play as an occupation?

It’s the primary occupation of children

It is used to interest the child in therapeutic activities

Children develop skills for adult life

Play is viewed as a freely chosen occupation for children and children should be engaged in the process of playing

Contributes to social, cognitive, emotional, and physical development

Play should be…

Pleasurable, self-motivating, engaging

How does play facilitates problem-solving?

Creativity, flexibility, achievement, motivation, morality, and social attitudes

When is play most common?

During the preschool years

Aspects of the environment can either ____________ or _________ functioning and participation in daily activities

Facilitate, hinder

What does research showing regarding a child’s environment?

When a child’s early years are not emotionally and physically supportive and spent in less stimulating environments, then the brain can develop in adverse ways

A non-beneficial environment leads to…

Cognitive, social, and behavioral delays

Children who have ____________, __________, and/or _________________ tend to be more vulnerable to environmental barriers during play

Developmental, physical, learning disabilities

Environments can either _________ or _________ influence children’s mental health and development of social relationships

Positively, negatively

If a child’s environment hinders their ability to play, what is negatively impacted?

Their health

When in a supportive and stimulating environments that offer opportunities to explore and problem-solve, what can be fostered?

Resourcefulness

What are important things to consider when looking at and potentially modifying a child’s environment?

Have a family-centered approach (involving the parents)

Potentially do a PEO analysis

When does an environment enable play?

When the child feels safe and secure in the environment

The child has trust and confidence with social world through experiences of secure attachment

Caregivers provide environmental context for play

Children with disabilities generally assume _______ roles during play

Passive

Who must assist to enable a child to gradually become more active in play?

The caregiver