Neuro-Environmental Considerations

What 3 factors can physical and virtual environments influence?

1. Human health

2. Well-being

3. Productive occupations

What must occupational therapists understand in order to provide client-centered care?

How people experience environments, places, and spaces

What 3 functional outcomes does occupational therapy practice consider the impact of environmental and contextual factors on?

1. Persons

2. Groups

3. Populations

Lifeworld

A person or group's everyday world of taken-for-grantedness normally unnoticed

What is a person or group's lifeworld hidden as?

Phenomenon

Place

Any environmental locus that gathers individual or group meanings, intentions, and actions spatially

Examples of Places

Furnishing

Room

Building (e.g. "this is where I went to school")

Neighborhood

City

Region

Environmental Embodiment

The various ways, sensorially and movement wise, that the lived body engages and coordinates with the world at hand, especially the physical aspects

Aging in Place

Dwelling that supports an individuals choice to occupy a home unit from childhood to old age unless illness or impairment are present

Home

A place of activity, identity, and memories

What does a home act as a center for?

Stability and continuity

5 Dimensions of a Home

1. Physical

2. Personal

3. Social

4. Cultural

5. Political

7 Key Pieces of Legislation for Accessibility and Design

1. Americans with Disabilities Act of 1990

2. American National Standards Institute

3. Architectural Barriers Act of 1968

4. Fair Housing Amendments Act of 1988

5. Hill-Burton Act of 1946

6. Rehabilitation Act of 1973

7. Uniform Federal Accessibility Standards

What legislative act protects the civil rights of persons with disabilities (e.g. physical or mental) access to public spaces?

Americans with Disabilities Act of 1990 (amended in 2008)

What 2 regulations did the Americans with Disabilities Act of 1990 implement in the United States?

1. Accessibility guidelines (2004)

2. Accessibility standards (2012)

What legislative act enforced standards for accessible design of buildings and facilities that are designed, built, or altered with federal funds after 1968?

Architectural Barriers Act of 1968

What legislative act prohibits housing discrimination on the basis of race, color, religion, sex, disability, familial status, and national origin?

Fair Housing Amendments Act of 1988

What type of tenants does the Fair Housing Amendments Act of 1988 require landlords to allow?

Tenants with disabilities to make reasonable access-related modifications to their private living space, as well as to common use spaces

What legislative act provided grants and loans to construct and modernize hospitals, nursing homes, and other health facilities?

Hill-Burton Act of 1946

What are hospitals receiving federal monies obligated to provide for their patients under the Hill-Burton Act of 1946?

Free or subsidized care to a portion of their indigent patients (e.g. charity care)

Charity Care

Medically necessary care for patients who can not afford to pay

What was the Hill-Burton Act of 1946 the driver of in hospitals?

Desegregation

When did the Hill-Burton Act of 1946 program stop providing funds?

1997

What legislative act provides grants to states for vocational rehabilitation services, with special emphasis on services to individuals with disabilities?

Rehabilitation Act of 1973

What legislative act describes standards for the design, construction, and alteration of buildings to be accessible to physically handicapped persons in accordance with the Architectural Barriers Act of 1968?

Uniform Federal Accessibility Standards

What do occupational therapists analyze?

Person

Environment

Performance skills

Functional demands

Environmental demands

What do occupational therapists develop based off their analysis?

Strategies to minimize barriers and optimize occupational performance

When are environmental modifications warranted?

Change in patient function

What do environmental modifications promote?

Productive aging (*specialty certification available*)

Who completes a home evaluation?

completed by examining architectural barriers in the exterior and interior of the home

When evaluating the home, what external things should you consider?

- Type of residence (apartment, duplex, townhome, single home, etc.) - assess elevator or stairs present, walkways, and railings

- Note weather protection - what surfaces does the client have to travel to access the home (concrete, gravel, bricks, mud, etc.)

- Examine driveway - width, slope, can the driveway accommodate a wheelchair van if needed?

- Surrounding area - trees, location of mailbox

What do you evaluate when assessing all entrances to and throughout the home?

width, height, thresholds, doorknobs, locks

Interior evaluation is organized room by room and should include what?

- Number of levels in a home

- Count and measure all steps and staircase dimensions

- Living Room

- Hallways

- Bedrooms

- Bathrooms

- Kitchen

- Laundry

- Basement

4 Strategies to Optimize Accessibility

1. Inclusive and universal design

2. Environmental modifications

3. Assistive technology

4. Task simplification strategy

5 Performance Skills

1. Vision

2. Hearing

3. Motor

4. Attention

5. Communication

What potential environmental modifications can be made for patients with visual deficits?

- Lighting

- Tactile indicators

- Raised surfaces

- Increase contrast

- Magnification/angled surfaces

- Medication management

- Modifying spaces to increase organization

- Decrease clutter

What potential environmental modifications can be made for patients with hearing deficits?

- Closed caption

- Minimize background noises

- Vibrating devices

What potential environmental modifications can be made for patients with motor deficits?

- Installation of grab bars

- Elevated chairs (to assist with sit to stand transfers)

- Modify surface heights

- Use of assistive technology (e.g. environmental control units)

What potential environmental modifications can be made for patients with attention deficits?

- Automated functions (e.g. medications)

- Decrease clutter

- Minimize distractions

What potential environmental modifications can be made for patients with communication deficits?

- Environmental control units

- Rearrange furniture (e.g. turn to face each other)

- Preprogrammed numbers

- In Home Occupational Performance Evaluation (I-HOPE)

- Safety Assessment of Function and the Environment for Rehabilitation - Health Outcome Measurement and Evaluation (SAFER-HOME)

- Home Falls and Accidents Screening Tool (Home- FAST)

- Westmead Home Safety Assessment

- Home Safety Self Assessment Tool (HSSAT v.5)

- Walkability Checklist

What are these OT assessments for?

environmental modifications

Home Safety Self-Assessment Tool (HSSAT v.5)

A patient-reported measure used to increase perceived knowledge of home safety and identify unsafe activities as well as develop a home safety plan to reduce the risk of falls

How wide should doorways be?

34-36 inches wide

How tall should door thresholds be?

No more than 1/2 inch

Are door levers or door knobs preferred?

Door levers

How wide should hallways be?

36 inches wide

How wide should hallways with decorations be?

48 inches wide

How many accessible entrances should there be? Why?

At least two in case of an emergency

What is the accessibility rule for ramps?

1 inch increase in height for every 1 foot increase in length (rise/run)

What is the measurement of a standard, nonslip ramp?

1 inch: 12 feet

How high should light switches be from the floor?

No more than 48 inches

Is tile, wood, or carpet flooring preferred?

Tile and wood

How high should towel rods be from the floor?

No more than 54 inches

How high should horizontal grab bars be from the floor?

33-36 inches

How tall should kitchen counters be?

34 inches

What should occupational therapists ensure there is under skinks and counters to prevent burns?

- Adequate space (for wheelchair)

- Pipe coverings

How does the Americans with Disabilities Act define disability?

As a physical or mental impairment that substantially limits one or more major life activities

What do job applicants or employees who have a mental health condition that meets this criteria have under the Americans with Disabilities Act?

Workplace rights

What standards does the American Disabilities Act for Accessible Design along with Title II and Title III regulations say is required for a building or facility to be physically accessible to people with disabilities?

- Newly constructed buildings and facilities

-Alterations/ renovations made to buildings and facilities

- Architectural changes to provide "program access"

- Removing architectural barriers that are easily accomplishable

Universal Design

The design and composition of an environment so that it can be accessed, understood, and used to the greatest extent possible by all people, regardless of their age, size, or disability

What places does universal design include?

- Public places in the built environment (e.g. buildings, streets)

- Spaces that the public has access to

- Products and services provided in those places

- Available systems (e.g. information communication technology)

7 Principles of Universal Design

1. Equitable use

2. Flexibility of use

3. Simple and intuitive use

4. Perceptible information

5. Tolerable for error

6. Low physical effort

7. Size and space for approach and use

Equitable Use

Useful and marketable to people with diverse abilities

What does equitable use not stigmatize or disadvantage?

Any group of users

Flexibility of Use

Accommodates a wide range of individual preferences and abilities

Simple and Intuitive Use

Easy to understand regardless of user's experience, knowledge, language skills, or concentration level

Perceptible Information

Communicates effectively to user regardless of encompassing conditions or sensory abilities

What does the tolerance for error minimize in Universal Design?

Hazards and adverse consequences of accidental or unintended actions

Low Physical Effort

Can be used efficiently, comfortably, and with minimum fatigue

Size and Space for Approach and Use

Can be used regardless of user's body size, posture, or mobility

4 Considerations of Environmental Modifications

1. Appropriation

2. Rootedness

3. Regeneration

4. Warmth

How can occupational therapists support personal autonomy?

By providing adequate human help and assistive technology (appropriation)

What do occupational therapists need to ensure meaningful daily occupations can be maintained through?

Retraining or environmental supports (rootedness)

What do occupational therapists need to consider when making environmental modifications?

How modifications may shift daily activities (regeneration)

Why should occupational therapists work with client's values when making environmental modifications?

To find compromises (warmth)

What funding and resources can patients use to make environmental modifications?

- Private insurance companies

- Medicaid waivers for home modifications

- Local independent living centers for additional grants or loans

- Rebuilding together

Rebuilding Together

Helps patients with disabilities live in their homes safely by changing different aspects of their environment