the Rehabilitation Plan

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1 Utilizing Universal Design in the Rehabilitation Plan Susan Bachner, Occupational Therapist and Accessibility/Home Modifications Consultant CMSA 10/9/12

2 Home assessment includes 3 critical variables (P-E-O*) Reflects the belief that there is uniqueness to individuals (person) Recognizes the importance of the interaction between a person and the environment during occupation/activity (P-E-O)

3 Why Universal Design? It is a design approach that equally enables activity and participation for most users regardless of ability It does not have to add cost actually adds value to house (doesn t detract) It is different from ADA mandates It is an everyday design with the capability of adding specialized features for userspecific issues

4 User-specific needs Sometimes the users have additional specific needs and wants (user-specific) which exceed the scope of universally designed products or structural changes Completing an assessment of the 3 variables: patient s abilities, environment and intended activities of daily living will determine the user-specific needs/wants

5 Taking a close look at an evidenced-based case example: 31-year-old woman covered by Worker s Comp

6 Introducing Jane 31 year-old, newly married woman who was working as a consulting dietician at time of car accident (driving from one location to another) Sustained a C-6 (ASIA B) incomplete spinal cord injury Resulted in quadriplegia continued

7 Introduction continued Medications: multiple meds to control neuropathic pain and spasticity Roles: wife, step-mother, friend, family member, patient Interests: cooking, gardening, socializing Goals: To achieve as much independence as possible in self-care, home management (laundry, cooking), accessing outdoors, being with friends

8 Continued. Step 1: Complete a current evaluation of Jane s abilities, functional performance, needs & wants as she pursues ADL s Includes: Entrances/egresses Bathroom abilities & existing structures evaluation includes: toileting (bowel program), showering, tasks at sink/vanity

9 Evaluation points continued Kitchen abilities & existing structures and appliances Accessible rooms/storage Grab bars Overhead lift/track Laundry Water shut-off

10 Front Entrance front steps make this an inaccessible route

11 Back Door 6 ½ brick curb 1 threshold 6 ½ brick curb and 1 un-beveled threshold make this route inaccessible

12 Garage Entrance This existing landing is approximately 48 high off the finished floor and is 39 X 36.

13 Entrance/Egress Recommendations Because the driveway serves as a natural ramp into the garage, I recommend creating one of the two accessible entrances by installing a vertical lift in the garage along with related modifications to prevent injury from the wheelchair rolling down the stairs. This garage entrance/egress would be efficient in terms of location and protection in inclement weather. Further, I recommend creating a second entrance/egress out the back door.

14 Existing Bathroom Existing Jacuzzi (approximately 80 X 46 ) 6 vanity does not allow for a seated user to gain access to the sink while facing it and the mirror.

15 Bowel Program Existing commode chair not working for Jane because the cutout is in the wrong direction. She needs to have a chair with the capability of both adjustable height (to fit over a toilet seat if needed) and moveable cut-out.

16 Transfers Need to protect shoulder integrity Want to create opportunity for independence in getting into wheelchair, getting to the toilet, getting into the shower Recommendation: Evaluate client/patient s success with Sure-Hands Ceiling Lift

17 Evaluating Sure-Hands ceiling lift capability

18 View of bathroom from bedroom This doorway needs widening and special framing to accommodate the Sure-Hands Ceiling Track. Closet: reduce size and relocate entrance to provide space for night table and w/c turning radius beside bed

19 Existing Commode Existing location makes it extremely difficult to utilize. Once the commode is relocated to the area adjacent to the proposed curb-less shower, she will have a minimum of 5 radius. She could access the commode either with a shower commode chair (that would have space to be wheeled over the toilet base) OR with the proposed Sure-Hands Lift.

20 Existing kitchen Inaccessible spaces

21 Re-evaluating trunk control 33 ½ high 34 high 7/14/11

22 Implications of going from 30 to 34 counter height Improvement noted re: trunk control over seven months which affected decisions about a) height of eating surfaces b) height of kitchen counters c) provides 29 clear space for knees d) height and appearance of twin vanities in the bathroom

23 Evaluating body mechanics for cooking tasks Evaluating along with rehabilitation team at local Rehabilitation Hospital (OT, PT); used a mechanical, adjustable height table Separated stove-top cooking tasks into different components (frying, cooking vegetables, stirring chili or pasta) Watched for trunk stability, upper traps, shoulders at different heights

24 31 table height 8/18/11 frying pan

25 29 table height 8/18/11 chili or pasta pot

26 36 table height 8/18/11 chili or pasta pot

27 Conclusions Different stove-top tasks require different table heights in order to preserve shoulder integrity and reduce risk of injury and/or burning. Best cooking surface: Induction cooktop (reduce risk of burning) Best way to handle need for different heights: adjustable vertical height stove-top.

28 Providing a new chair with an adjustable cut-out for more customized bowel program

29 Access to side-hinged oven

30

31 Access to storage and the cook top

32 Access to sink and dishwasher

33 Walkway under construction- step-less entry at back door Automated control to open gate

34 Sure-Hands Ceiling Lift Charging in Bedroom Corner

35 Pictorial Summary of kitchen, bathroom, bedroom and entrance modifications

36 The Vertical Lift in the Garage

37 Vertical Adjustability Stove and sink: up position Stove and sink: lowered position

38 Adjustable height prep table and accessible microwave

39

40

41

42

43

44 Front Door Peep-Hole 2/7/12

45 Water shut-off being relocated from under the house into a closet in the guest bedroom

46 Susan Bachner Consulting, LLC Providing evaluations and consultation services in home modifications and products to promote safety, comfort and accessibility for persons experiencing difficulty with their activities of daily living. (859)

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