Environmental Factors
SPECIAL POPULATIONS
Examination of the Environment
 Environmental Barriers – physical impediments that
prevent individuals from functioning optimally in
their surroundings
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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
Discussion
 Why should we study environment factors?
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Outcome of PT is for the pt to become fully functional in a
former environment and lifestyle.
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Many times the environment must be adapted for full accessibility
Environment Evaluation
Must look at
Accessibility
Safety
Usability
Function
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
Safety
 Environmental assessment determines the degree of
pt safety and level of function in the physical
environment
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
Function
 Determines need for AD, adaptive equipment or
assistive technology to support and promote
function.
PT Environment Evaluation
Access, Usability, and Safety in
the Home
Intervention Strategies
 5 Major Areas of Environmental
1. Assistive or adaptive devices
 Grab bars, reachers, adaptive eating utensils, canes, walkers
2. Safety devices
 Lighting, smoke detectors, or sensing devices
3. Structural alterations
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Widening doors, installing railings/ramps, removing
doorway threshold
Intervention Strategies: con’t
4. Modification or altered location of environmental
objects
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Disabling a stove, placing locks on door handles, removing
throw rugs, moving furniture
5. Task Modification
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Use of visual, auditory or other sensory cueing
Work simplification
Energy conservation
Joint preservation techniques
Tips for Accessibility: Route of Entry
Select the most accessibly entry point to the home
(most level, closest to the driveway, fewest stairs,
handrails)
2. Walkways should be smooth, well lit, and covered
(cracks should be repaired or alternate route
selected)
3. Steps: no > than 7” with minimum depth of 11”;
non-slip surface should be applied
4. Handrails: height minimum of 34” and maximum
of 38”
1.
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
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.
2. Door locks should be accessible to pt (look at
height and ease of use)
3. Door handle should be easy to turn (door grips or
lever-type handles)
4. Adaptation to door so pt can open and close the
door
1.
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: 32-34 inches
Tips for Accessibility: Furniture Arrangement
and Features
Sufficient room should be made available for
maneuvering AD (w/c, walker etc)
1.
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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
2. Clear passageway between one room and the next
3. Living room chairs should have double arm rests,
firm seating surface, and upright back (90-90-90)
4. Remove rocking chairs and other unstable
furniture
Tips for Accessibility: Electrical Controls
1.
2.
3.
4.
5.
6.
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
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.
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
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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
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
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.
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
Tips for Accessibility: Bedroom Area
 Bed:
 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
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
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Toilet – placed 36” from floor
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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
Tips for Accessibility: Kitchen
 Height of counter should be appropriate (< 31”)
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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
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Shallow sinks allow clearance of legs underneath
 Small cart with castors can be helpful with carting things
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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
Adaptive Equipment
SEE CHART 12.2 PAGE 423 PHYSICAL
REHABILITATION
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.
Lab: Case Studies
DIVIDE INTO GROUPS OF 3-4. READ CASE
STUDY ON PAGE 438. ANSWER THE
QUESTIONS AT THE END OF THE CASE STUDY