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. SELF REPORT AND PERFORMANCE BASED MEASURES

3. 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 & ½
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