Environmental Assessment

physical environment involves…

• buildings

• structures

• people

• uneven terrain

environmental barriers

physical impediments that prevent individuals from functioning optimally in their surroundings

• safety hazards

• access problems

• home/workplace design difficulties

accessibility

degree to which an environment affords use of its resources with respect to an individual’s level of function

accessible design

structures meet prescribed standards for accessibility by:

• American National Standards Institute

• Fair Housing Amendments Act of 1988

• Uniform Federal Accessibility Standards (UFAS)

• Americans with Disabilities Act (ADA) Standards for Accessible Design – for public and commercial buildings

universal design definition

Designing products and spaces so everyone can use them easily, without needing special changes.

• emphasis social inclusion

• life span design

• address changing needs across life span

• applied from inception of a building plan

universal design elements

• Step-less entrances

• Wide hallways and doorways

• No doorway thresholds

• Nonslip floors

• Lever door handles

• Rocker light switches

• Single handle sink faucets

• No step shower access

• Reinforced walls capable of supporting grab bars and handrails

what are the 7 principles of Universal Design

1. Equitable use

2. Flexibility in use

3. Simple and intuitive use

4. Perceptible information

5. Tolerance for error

6. Low physical effort

7. Size and space for approach and use

Equitable Use

for those with diverse abilities

• ex. entrance power doors with sensors

Flexibility in use

accommodates wide range of preferences and abilities

• Ex. ATM with visuals, tactile, and audible feedback; tapered card opening; palm rest

Simple and intuitive use

easy to understand regardless of experience, knowledge, or language skills

• ex. moving sidewalk; instruction manual with drawings and no text

Perceptible information

design communicates necessary information effectively to the user

• ex. tactile, visual, and audible cues and instructions on thermostat; redundant cueing in airports and train stations

Tolerance for error

minimized hazards and adverse consequences of accidental or unintended actions

• ex. double cut car keys fits either way; undo feature in computer software

Low physical effort

can be used efficiently and effectively with min fatigue

• ex. lever door and faucet handles; touch lamps

Size and space for approach and use

appropriate size, space provided for approach, reach manipulation regardless of body size, posture, or mobility

• ex. controls on front of appliances; clear floor space around appliances and mailboxes; wide gates at subway stations

Goal of an environmental assessment?

to help the patient be safe and independent in their usual home and lifestyle

environmental assessment includes:

• Determine degree of patient safety and level of function

• Identify design barriers that impact usability or compromise performance of daily tasks

• Make realistic recommendations to pt, family, workplace, 3rd party payers

• Determine need for adaptive equipment or assistive technology

• Assist in preparing pt and support network for return to former environment

Tests and Measures:

Current and potential barriers

• checklists

• interviews

• observations

• questionaries

Tests and Measures:

Physical space and environment

• Compliance standards

• Observations

• Photographic assessments

• Structural specifications

• Technology-assisted assessments

• Video assessments

what is an on-site visit in rehab?

A visit to the place where the patient will live after discharge.

• Done before leaving the facility

• Reduces stress for patient/caregiver

• Helps find safety risks or barriers

• Gather info ahead of time:
  • Patient’s function
  • Support at home
  • Finances/insurance
  • Future goals

Assistive or adaptive devices examples for …

• grab bars

• reachers

• canes

• walker

safety devices examples…

• lighting

• smoke detectors

structural alterations examples …

• widening doorways

• ramps and rail installation

modifications or altered location of environmental object examples…

• removing throw rugs

• adding door handle extensions

• moving furniture

task modifications examples…

• use of visual

• auditory or other sensory cuing

• work simplification

• energy conservation

Exterior Accessibility:

Route of Entry

• Smooth, level surface; Good lighting

• If steps – no greater than 7” ht; 11” min depth

• Handrails- extend 12” beyond foot and top of stairs

• Ramp – 12” of ramp length per 1” of height

  • 36” wide minimum

  • Overall rise no greater than 30”

Exterior Accessibility:

Entrance

• Platform area for w/c – 5’ x 5’ area

• Accessible door locks with possible alternate lock system

• Door handle which turns easily (lever preferred)

• Door strap to help w/c pt close door

• Intercom system for visitors

• Removal of raised thresholds

• 32-34” doorway width

• Kickplate

Interior Accessibility:

Furniture Arrangement and Features

• Adequate w/c clearance

• Clear passages

• Firm and stable seating with armrests – no overstuffed sofas

Interior Accessibility:

Electrical Controls

• Unrestricted access to wall switches and outlets

• Rocker switches

• GFCI outlets

• Motion sensor lighting

• Remote controls for lights and appliances

Interior Accessibility:

Floors

• Nonslip and level

• Remove rugs

• Problematic areas should be repaired ; or put furniture over the area

Interior Accessibility:

Doors

• Remove thresholds or use threshold ramps

• 32” minimum width (may need to remove jambs)

• Can reverse doors or remove them

• Consider pocket doors or sliding doors

• Offset/ swing clear hinges – provide 2” more space

• Door handles – levers

Interior Accessibility:

Windows

• films to reduce glare

• remote control window coverings

Interior Accessibility:

Stairs

• Hand rails

• Well lighted

• Clutter free

• Adhesive, light reflective strips for visually impaired

• Motorized stair lift

Height requirement for:

Ramp

• 12” run for every 1” rise

• 60” x 60” landing area if direction change

• length = 20 ft

Height requirement for:

doorway

> 32”

Height requirement for:

Hallway clearance

36” width

Height requirement for:

WC turning radius

60” x 60”

to increase independence, speed, skill, and efficiency

• bathing

• personal care

• dressing

• meal prep

compensatory training approach

focus on achievement of highest level of function possible by using remaining abilities

• alternative techniques

• energy conservation

• joint preservation

• adapting environment

assistive technology

items used to increase, maintain, or improve functional capabilities of individuals with disabilities

assistive technology:

aids for daily living

• grab bars

• lifts

• ramps

assistive technology:

augmentative communication

• communication boards

• electric page turners

• mouthsitcks

assistive technology:

computer applications

enhance computer access

assistive technology:

environmental control systems

remote controls

assistive technology:

hearing technology

closed captioning, amplification systems

assistive technology:

mobility technology

power w/c, vehicle modifications

assistive technology:

seating and positioning

w/c seats, backs, supports

assistive technology:

vision technology

talking and voice-activated devices

examination of workplace:

work hardening

individualized intervention program designed to return the pt to work

• Addresses productivity, safety, physical tolerance, and worker behaviors

• Progressive function-based exercise programs

• Focus on Ergonomics and Body Mechanics

• Simulated work activities

examination of workplace:

external accessibility

• parking spaces - close proximity

  • 96” width with adjacent access aisle 60” width

examination of workplace:

internal accessibility

• Workstation

• Lighting

• Temperature

• Access to equipment and supplies

• Access to bathrooms, phones, drinking fountains

• Functional sitting reach: 15” to 48” above floor

workstation ergonomics

1.Monitor screen top slightly below eye level

2.Body centered in front of monitor and keyboard

3.Forearms level or tilted up slightly

4.Back supported by chair

5.Wrists free while typing

6.Thighs horizontal

7.Feet resting flat on floor

Americans with Disabilities Act (ADA)

• Most comprehensive of the civil rights laws enacted for those with disabilities

• Equal opportunity in areas of government services, employment, public transportation, and public accommodations

• Requires reasonable accommodations

• Unless “undue hardship” is imposed

• Provides federal tax credit for accommodations made

Fair Housing Act - 1988

prohibits discrimination in housing

Rehabilitation Act of 1973

• access must be provided in all federally funded buildings

• prohibits discrimination in federal employment

Architectural Barrier Act of 1968

federally financed buildings must be accessible