1. Environmental Factors
Special Populations

2. Examination of the Environment
Environmental Barriers – physical impediments that prevent individuals from functioning optimally in their surroundings
Includes safety hazards
Access problems
Home design difficulties
Workplace design difficulties
Requirements for public and commercial buildings are regulated by the accessibility guidelines of ADA

3. Discussion Why should we study environment factors?
Outcome of PT is for the pt to become fully functional in a former environment and lifestyle.
Many times the environment must be adapted for full accessibility

4. Environment Evaluation
Accessibility
Safety
Function
Usability
Must look at

5. Accessibility
Assessment identifies design barriers that may impact usability or compromise performance of customary tasks or activities
Makes realistic recommendations regarding accessibility and accommodations to the pt, pt’s family, workplace, or government buildings

6. Safety
Environmental assessment determines the degree of pt safety and level of function in the physical environment

7. Usability
Assist in preparing the pt and support network for pt’s return to a former environment and to help determine whether further services may be required

8. Function
Determines need for AD, adaptive equipment or assistive technology to support and promote function.

9. PT Environment Evaluation

10. Access, Usability, and Safety in the Home

11. Intervention Strategies
5 Major Areas of Environmental
Assistive or adaptive devices
Grab bars, reachers, adaptive eating utensils, canes, walkers
Safety devices
Lighting, smoke detectors, or sensing devices
Structural alterations
Widening doors, installing railings/ramps, removing doorway threshold

12. Intervention Strategies: con’t
4. Modification or altered location of environmental objects
Disabling a stove, placing locks on door handles, removing throw rugs, moving furniture
5. Task Modification
Use of visual, auditory or other sensory cueing
Work simplification
Energy conservation
Joint preservation techniques

13. Tips for Accessibility: Route of Entry
Select the most accessibly entry point to the home (most level, closest to the driveway, fewest stairs, handrails)
Walkways should be smooth, well lit, and covered (cracks should be repaired or alternate route selected)
Steps: no > than 7” with minimum depth of 11”; non-slip surface should be applied
Handrails: height minimum of 34” and maximum of 38”

14. Tips for Accessibility: Route of Entry: con’t
5. Ramp: (large-wood or concrete; small-aluminum or fiberglass) minimum ramp grade-for 1 inch height should be 12 inches of depth; minimum 36” wide with non-slip surface

15. Tips for Accessibility: Entrance
For those with w/c, entrance should have a platform large enough to allow the pt to rest and prepare for entry; if the door swings out, area should be 5’ x 5’; if the door swings in, area should be 3’ deep and 5’ wide.
Door locks should be accessible to pt (look at height and ease of use)
Door handle should be easy to turn (door grips or lever-type handles)
Adaptation to door so pt can open and close the door

16. Tips for Accessibility: Entrance: con’t
5. Remote control automatic door openers can open/close/lock doors 6. intercom allows people to “see” who is at the door 7. Raised threshold should be removed 8. Doorway width: inches

17. Tips for Accessibility: Furniture Arrangement and Features
Sufficient room should be made available for maneuvering AD (w/c, walker etc)
Move furniture against walls to prevent sliding during transitions
Place rubber suction cups under the legs of sofas and chairs.
Remove coffee tables, foot stools, and wires
Clear passageway between one room and the next
Living room chairs should have double arm rests, firm seating surface, and upright back ( )
Remove rocking chairs and other unstable furniture

18. Tips for Accessibility: Electrical Controls
Provide access to wall switches and electrical outlets (use power strips)
Change overhead toggle switches with rocker switches or sensor devices.
Use higher wattage light bulbs and fluorescent lighting.
Can use timers to turn on lights if needed
Night lights with motion sensors can be used
Touch pad dimmer switches can be used to activate lamps

19. Tips for Accessibility: Floors
Non-slip and level
coverings should be tacked down
Short-pile carpet should be used
Unlevel spots should be refinished, covered with furniture, or marked with bright colored tape.
Scatter rugs should be removed
Matte finishes on floors to reduce glare are recommended
Use tape to mark edges/perimeters of the room for those with visual impairments.

20. Tips for Accessibility: Doors
Raised thresholds should be removed to provide flush surface; if unable to be removed, transition wedges can be installed
Doorways widened if less than 32 inches wide
Increase door clearance
Install pocket doors
Remove wood strips on inside of doorframe
Use offset hinges (swing-clear hinges) which swing the door clear of the frame
Change the door to a curtain
Check door handle for accessibility

21. Tips for Accessibility: windows
Use film on windows to reduce glare
Heavy drapes can be used with the benefit of absorbing background noise
Can install remote control systems for closing/opening window coverings

22. Tips for Accessibility: Stairs
Stairwells should have handrails
Make sure stairwell has enough light
Handrail should extend 12-inches past top and bottom of the stairs
Keep stairs free of obstacles
Use bag to carry things up and down the stairs
Use tape or lights to designate edge of stairs for those with vision issues
Motorized stair lift can be used for those that cannot get up and down stairs.

23. Tips for Accessibility: Heating Units
Radiators, heating vents, and hot water pipes should be screened off or insulated with pipe covers especially for those with sensation issues
Might need to adapt for heat controls
Heating source away from combustible material
Smoke alarms and carbon monoxide detectors should be in the home

24. Tips for Accessibility: Bedroom Area
stationary and positioned to provide ample space for transfers (put bed against wall/rubber suction cups under feet of bed)
Height of bed can be raised or lowered as appropriate
Mattress should be firm – can add wood board below mattress to encourage firmness
Bedside table should be convenient to patient
Closet clothes bar may need to be lowered for access

25. Tips for Accessibility: Bathroom
If the pt cannot get in the bathroom, they can transfer into a chair with wheels at the door
Use elevated toilet seat if appropriate
Grab bars should be placed on a reinforced wall
Toilet – placed 36” from floor
Length of grab bars 42-54” on the side wall 24-36” on back wall
Bath – 33-36” from the floor of the tub and the second 9” above the rim of the bathtub
Tub transfer bench can be used
Collapsible seat may be permanently attached to the shower wall
Non-skid strips to the bottom of the bathtub
Detachable shower head can be used

26. Tips for Accessibility: Kitchen
Height of counter should be appropriate (< 31”)
w/c armrests need to fit under the counter
Need counter depth of at least 24”
Look at faucet of sink – use lever arm or electronic sensors
Shallow sinks allow clearance of legs underneath
Small cart with castors can be helpful with carting things from place to place in kitchen
Height of table should be checked
Objects in cabinets should be easily reached
Use electric not gas stoves
Dishwashers should be elevated 6” and should be front loading

27. See chart 12.2 page 423 physical Rehabilitation
Adaptive Equipment
See chart 12.2 page 423 physical Rehabilitation

28. Review
Differentiate between the roles and responsibilities of the PT and PTA in examination of the environment.
What is the importance of environmental accessibility in optimizing patient function.
Identify some strategies to improve patient function through environmental modifications.
Describe examination instruments used to measure environmental impact on patient function.

29. Lab: Case Studies
Divide into groups of Read case study on page Answer the questions at the end of the case study