ENVIRONMENTAL MODIFICATIONS

NAKUL RANGA

INTRODUCTION
THE PHYSICAL ENVIRNMENT IN WHICH AN INDIVIDUAL

FUNCTIONS CONSISTS OF A VARIETY OF BOTH BUILT AND NATURAL OBJECTS.

ENVIRONMENT ENCOMPASSES A SUBSTANTIAL RANGE

OF COMPONENTS THAT IMPACT HUMAN FUNCTION AND INCLUDES THE INDIVIDUAL HOME, NEIGHBOURHOOD, COMMUNITY, AND METHOD OF TRANSPORTATION, IN ADDITION TO THE INDIVIDUAL S EDUCATIONAL, WORKPLACE, ENTERTAINMENT, COMMERTIAL, AND NATURAL SETTINGS.

DEFINATIONS

ENVIRONENTAL BARRIERS ACCESSIBILITY ACCESSIBLE DESIGN UNIVERSAL DESIGN ENVIRONMENTAL ACCESSIBILITY

EXAMINATION
1.

INTERVIEW

2.
3.

SELF REPORT AND PERFORMANCE BASED MEASURES

MEASURES OF ENVIRNMENTAL IMPACT ON FUNCTION
Physical Activity Resource Assessment

Home and Community Environment

Safety Assesment of Function and the Environment for rehabilitation Usability in My Home Housing Enabler

Environmental Analysis of Mobility Questionnaire Craig Handicap Assessment and Reporting Technique Craig Hospital Inventory of Environmental Factors ADL Staircase Environmental FIM Functional Performance Measure Environmental Utility Measure

PATIENT- HOME ENVIRONMENT RELATIONSHIP (ACCESS, USABILITY & SAFETY)

ROUTE OF ENTRY
Most accessible route should be accessed.(driveway, levelled surface,

less stairway, handrails etc.)

Cracked uneven surfaces should be repaired or use alternate route. Height, no. and condition of stairs ideally step should not be greater

than 7 inch & with a depth of 11 inch. Nosing or lips of stairs should be
curved overhangs on the front edge of stairs & inch.
But nosing are problematic as they prevent clear transition in

neurological ill and elderly patients. handrails should be installed, it

should measure between a minimum of 34 inch and a max. of 38 inch..

 If possible height adjustable handrails should be

used or one handrail of minimum 12 inch should be there. outside cross sectional diameter of handrail should be 1.25 -2 inch. If attached to wall, gap between wall & handrail should be 1.50 inch. Ramp adaptation require adequate space,if large should be made of wood or concrete , if small should be made of almunium or fibre-glass

 It should be wheelchair accessable i.e. min. inclination should be there

of around 12 inch or 1:12 of running slope. Outdoor ramp exposed to inclement weather such as snow or ice should have inclination of 1:20 of running slope. Ramp should be 36 inch wide. Commercially available vertical platform lifts and stairway inclined lifts are also available for wheelchair bound patients. approx. height of lifts should be 30x40 inch.

ENTRANCE
For wheelchair bound patients entrance platform should be wide so

they can rest and to prepare for entry. with a door which swings in area of 5x5 feet, if it swings away from patient, a space of 3 feet deep and 5 feet wide is required. Door lock should be accessible to the patient. The height of lock should be determined as well as the amt. of force required to turn the key.it also should be properly illuminated. Alternate lock- key systems can be used acc. to patients problems and his accessibility. Eg. Voice or card activated remote control locks keypad electronic security systems face recognition door locks push button padlocks

 The door hand lock should be turned easily by the patient.rubber

doorknob for textured grip or lever type handles. Closing & opening of door knob should be in functional direction. Door strap can be attached around door handle. Door should be light weighted so that it can be easily pulled or pushed. A kick plate(metal guard) may be added to doors frequently entered by individuals using a wheelchair or ambulatory assistive devices.the kick plate should measure 12 in. in height from the bottom of the door.

FURNITURE ARRANGEMENT AND FEATURES

Sufficient room should be there for wheelchair maneuvers or

ambulating with assistive device. restriction should not be there by coffee tables, telephone or electric wires Stability of furniture is required to be maintained using rubber suction cups under the legs. Clear passage between 2 rooms. Height of sofa should be sufficient or can be modified using wooden bars at its legs so that hip and knee at 90-90 position. there should be sufficient space on sofa for caregiver too.there should be space in side & below sofa for keeping assistive devices & wheelchair. Use of unstable furniture such as rocking chairs should be discourged for most patients. Use of leather furniture should also be avoided as it can hinder movement. chair that provide mechanized elevation of the back of seat should be cautiously used as it may be difficult for patient to stabilize the feet as the seat is elevating.this causes the feet(forward tilting) to slide forward resulting in fall.

ELECTRICAL CONTROLS
Unrestricted access to wall switches & electrical outlets, power strips

can be used to improve access.outlets should should be raised and wall switches should be lowered. For wheelchair individuals cord extentions can be used for better control. Some patient may be benifited from replacement of standard toggle electric switches with rocker switches that require less fine motor skill to activate. Occupancy sensor devices also available which automatically turns on light on entering & switch it off on leaving room. Voice directed devices & switches are also available. On light coloured walls dark or coloured switches and outlets can be used , vice-versa. Ground fault circuit interupter(GFCI) shouled be installed in wet locations to prevent earth shock.wounded wires, faulty or cheap appliances should not be used.

 For visual problems in some patients use of higher voltage bulbs,

flurrecent lighting,fall spectrum bulbs or high intensity halogen lamps. Inexpensive proggramable timers can be used to regularly turn lights on & off through out the day & night. Inexpensive night-lights with motion sensors can be placed in strategic locations to provode additional illumination. Touch pad dimmer can be used fro night lamps and small fans. Universal remotes can be used to control lights of whole house.

FLOORS
It should be levelled and nonslip. All floor coverings should be glued & tacked to floor, it prevents

bunching or rippling under wheelchair use. Dense, low pile, low-level carpetting provides easiest wheelchair movement or assistive device. Industrial style indoor outdoor carpetting should be used. Old, uneven, wooden, cracked concrete floors should be properly assesed, repaired or replaced. Place bright coloured tape over affected of repaired areas for patients to avoid such areas. Scatter rugs should be removed, use of non skid waxes should be encouraged. If flooring is to be replaced, matte finishes should be recommended to reduce glare.patien ts with visual impairments will benefit from a contrasting colour border along the perimeter help mark the boundries of the space. Wide-coloured tape can be used too.

DOORS & windows

Remove threshold ramps. Widened doorways for wheelchair entry Frosted window film for diffused sufficient light Noise absorbent heavy window draperies can be applied Remote control systems for opening and closing of doors & windows If automatic openers installed it should be below window so that easily

assessable by wheelchair bound.

STAIRS
Hand rails of min of 12 inch & well lighted area. Free from clutter(confusing) steps. For individuals with decreased visual acuity or frail, adhesive light

reflective tactile warning strips provide contrasting texture on surface. At start and end of rail circular bright tape is placed. Bright contrasting color tape at the border of each rail. Stair lift may be an option

HEATING UNITS
All radiators, pipes, heating vents should be properly screened off or

insulated with pipe covers to prevent burns for people with sensory impairments. Use of space heaters should be discouraged. Smoke alarms and CO detectors should be installed at home.

BEDROOM

BEDROOM

TOILET AND BATHROOM

OFFICE ACCESSIBILY

KICHEN ASSESSIBILITY

TRANSPORTATION

THANK YOU