Environmental Considerations

What are the qualities of the environment that support or hinder occupational performance?

The environment’s physical and virtual qualities can support or hinder occupational performance depending on accessibility, design, and sensory or contextual factors.

What must occupational therapists understand about environments?

OTs must understand how people experience environments, places, and spaces to provide client-centered care.

What does OT practice consider when assessing function?

OT practice considers the impact of environmental and contextual factors on the functional outcomes of persons, groups, and populations.

What is the definition of lifeworld?

A person or group’s everyday world of taken-for-grantedness, normally unnoticed.

What is the definition of place?

Any environmental locus that gathers individual or group meanings, intentions, and actions spatially (e.g., furnishing, room, building, neighborhood, city).

What is environmental embodiment?

The ways the lived body engages and coordinates with the world, sensorially and through movement, especially with physical aspects.

What is aging in place?

Dwelling that supports an individual’s choice to live in their home from childhood to old age unless illness or impairment is present.

What are the dimensions of home?

Home has physical, personal, social, cultural, and political dimensions; it’s a place of activity, identity, memories, and stability.

What is the OT’s role regarding a client’s home environment?

OTs must understand the client’s home environment for treatment and discharge planning.

Why might DME or home modifications be necessary?

They help the individual access their home and perform daily occupations safely.

What does the Americans with Disabilities Act of 1990 do?

Protects the civil rights of persons with disabilities and ensures access to public spaces.

What did the Architectural Barriers Act of 1968 establish?

Standards for accessible design of federally funded buildings and facilities.

What does the Fair Housing Amendments Act of 1988 prohibit?

Housing discrimination based on race, color, religion, sex, disability, familial status, or national origin.

What does the Fair Housing Act require regarding modifications?

Landlords must allow reasonable access-related modifications to living and common spaces.

What did the Hill-Burton Act of 1946 provide?

Grants and loans to construct and modernize health facilities; required some free or subsidized care.

What is the significance of the Hill-Burton Act?

It helped drive hospital desegregation and modernization before ending in 1997.

What does the Rehabilitation Act of 1973 provide?

Grants to states for vocational rehabilitation, emphasizing services for individuals with disabilities.

What are Uniform Federal Accessibility Standards?

Standards for design, construction, and alteration of buildings to be accessible to people with physical disabilities.

What is the OT role in environmental modifications?

OTs analyze the person, environment, performance skills, and demands to reduce barriers and optimize performance.

What are examples of OT home evaluation tools?

I-HOPE, SAFER-HOME, Home-FAST, Westmead Home Safety Assessment, HSSAT v.5, and Walkability Checklist.

What does a home evaluation include?

Assessment of architectural barriers, both exterior and interior, and measurement of accessibility features.

What exterior elements should be evaluated?

Type of residence, stairs, walkways, railings, driveway slope, surfaces, weather protection, and entrances.

What should be included in an interior home evaluation?

Number of levels, steps, hallways, and rooms such as living room, kitchen, bathrooms, bedrooms, and laundry.

What are strategies to optimize accessibility?

Inclusive/universal design, environmental modifications, assistive technology, and task simplification.

What performance skills may require environmental modification?

Vision, hearing, motor, attention, and communication skills.

What modifications support vision impairments?

Lighting, tactile indicators, raised surfaces, increased contrast, magnification, and reduced clutter.

What modifications support hearing impairments?

Closed captions, minimizing background noise, and vibrating alert devices.

What modifications support motor impairments?

Grab bars, raised seating, modified surface heights, and assistive tech like environmental control units (ECU).

What modifications support attention deficits?

Automated functions, reducing clutter, and minimizing distractions.

What modifications support communication?

Use of ECUs, rearranging furniture, and preprogrammed phone numbers.

What is the standard doorway width for accessibility?

34–36 inches.

What is the maximum door threshold height?

½ inch.

What is the preferred door handle type?

Lever handles instead of knobs.

How wide should hallways be?

36 inches, or 48 inches if decorations are present.

How many accessible entrances should a home have?

At least two accessible entrances.

What is the ADA standard ramp ratio?

1 inch rise for every 12 inches of length (1:12 slope).

What should ramps have for safety?

Non-slip surfaces.

What is the maximum height for light switches?

48 inches from the floor.

What flooring types are preferred for accessibility?

Tile and wood over carpet.

What is the maximum towel rod height?

54 inches from the floor.

What is the standard grab bar height?

33–36 inches from the floor.

What is the ideal kitchen counter height?

34 inches.

What must be ensured under sinks and counters?

Adequate wheelchair space and covered pipes to prevent burns.

How does the ADA define disability?

A physical or mental impairment that substantially limits one or more major life activities.

What do ADA Standards for Accessible Design cover?

Accessibility in new construction, renovations, existing government buildings, and barrier removal in businesses.

What is universal design?

Design of environments usable by all people to the greatest extent possible regardless of age, size, or ability.

What does equitable use mean in universal design?

Useful and marketable to people with diverse abilities without stigma or disadvantage.

What does flexibility of use mean?

Accommodates a wide range of individual preferences and abilities.

What does simple and intuitive use mean?

Easy to understand regardless of user experience or language.

What does perceptible information mean?

Communicates effectively to all users regardless of sensory abilities or conditions.

What does tolerance for error mean?

Minimizes hazards and adverse consequences of accidental actions.

What does low physical effort mean?

Can be used efficiently and comfortably with minimal fatigue.

What does size and space for approach and use mean?

Design accommodates users of all body sizes, postures, and mobility levels.

What does appropriation refer to in environmental considerations?

Providing adequate human help and assistive technology to support personal autonomy.

What does rootedness mean?

Maintaining meaningful daily occupations through retraining or environmental support.

What does regeneration mean?

Considering how modifications may shift daily activities and adapting accordingly.

What does warmth mean in environmental modification?

Working with client values to find compromises that feel comfortable and meaningful.

What are potential funding sources for home modifications?

Private insurance, Medicaid waivers, local independent living centers, and grants or loans.

What organization helps fund home modifications?

Rebuilding Together (https://rebuildingtogether.org/

).

What should you know about ADA standards for entrances and ramps?

Entrances must be accessible, ramps must have 1:12 slope and non-slip surfaces.

What should you know about ADA standards for bathrooms?

Grab bars 33–36” from floor, accessible fixtures, and adequate maneuvering space.