Posts filed under ‘Accessibility’

A critical look at the Americans with Disabilities Act Accessibility Guidelines (ADAAG)

Do you know where the Americans with Disabilities Act Accessibility Guidelines (ADAAG) come from????  

Most people are unaware that these guidelines were created from data that was taken from the military back in the ’60s and the ’70s.  Anthropometric measurements (body measurements) were collected and provided a baseline to create the technical specifications for accessible spaces.  So, essentially, this data was taken from mostly young men, who are in very good physical shape and are now being utilized to represent the disability population.  Are you starting to see the problem here?

It is important to have a baseline, data to draw from, however, please keep in mind that the ADA accessibility guidelines are considered minimum requirements.   This means that they are going to meet the ‘minimum’ need for accessibility within a community space.  This is why use of ADA accessibility guidelines is NOT recommended for a person’s home.  

For example:  ADA grab bar height is 33-36″ above the finished floor.  This may meet some people’s needs, but because it is a minimum requirement, it certainly will not meet all people’s needs and is certainly not very individualized.  Why place a grab bar in your home in a location that is not specified to your needs?  Consider, they do not specify that all walking canes have to be between 33-36″ in height–instead, what is done, is the cane is measured to the height that meets the individual’s needs…..and so should grab bars in your home.  Recommendations from an occupational therapist regarding  installation of grab bars based on ergonomics provides for maximum access and safety by the end-user.

Knowledge is power. ~Francis Bacon

November 17, 2013 at 4:08 pm Leave a comment

Even Lady Gaga can benefit from Universal Design…..

I frequently say we are all temporarily able-bodied.  In a previous blog post titled, “My personal journey with Universal Design”, I stated that we are all temporarily able-bodied.  No one can predict if, when and where illness, injury or disability may strike.  Accidents certainly do not discriminate by age, ability-level or even celebrity status.

In entertainment news I could not help but notice that Lady Gaga is temporarily using a wheelchair after a surgery to repair a torn labrum in her hip.  While she may be rolling around in a leather and 24 karat gold-plated wheelchair (see pictures here), it is a wheelchair nonetheless; one in which she may have never thought she would ever have to use at the ripe old age of 27.  As an occupational therapist that specializes in environmental modifications I start to ask, “how is she getting in/out of her home?  in/out of a shower? How is this environment impacting her ability to participate in daily and meaningful activities?”

Being proactive and incorporating Universal Design (Lifespan Design) features into your home/environment provides you with a layer of convenience now, and flexibility later to meet any changing life needs.  Universal Design features would certainly come in handy for Gaga right about now….what about for you?

March 12, 2013 at 3:26 pm 1 comment

My personal journey with Universal Design

My house is 10 years old.  Unlike the national statistic of the median age of homes in the United States being 36, our house is ten years old.  We built our house ten years ago, incorporating Universal Design features.  It is because my husband has a C5-C6 incomplete spinal cord injury and utilizes a manual and power wheelchair for his mobility that many people will say to me, ‘you built your house for your husband, right?’  My response is, we built the house for the both of us.

The fact that you can walk into my house and never know that a person with a disability lives there is testament that Universal Design can be invisible, beautiful, provide convenience, and be flexible and ready for you when you need it.  It is important to note that my husband is independent in our home; but, so am I, and so is anyone else when they come over to visit.  I was 30 years old when we moved into our new house, and I proudly turned 40 last month.  I am thankful that I have a pretty uneventful medical history, so far, but am more thankful that my house was built with Universal Design in mind, because these features have intermittently been important to me, personally, over the last ten years.

We are all temporarily able-bodied.  No one can predict if, when and where illness, injury or disability may strike.  At age 33 I was in a car accident on the highway.  I was lucky to only walk away with an abdominal contusion and a triangular fibrocartilage complex injury (think pinky finger side of your wrist) of my right (dominant) hand.  I had to wear a brace for 3 months, all day except for when bathing.  Not only was it bulky, I would have pain and difficulty with any task that would rotate or deviate my wrist as well as grip and some pinch.  Automatic can openers never made me so happy!  However, I was even more thankful to have loop/pull handles on cabinets and drawers and lever handles on my doors and even the faucets and shower mix valve!

At age 35, after having many issues with my contact lenses and glasses (which I had worn for over 20 years at that point) I decided to get Lasik surgery.  I was not a candidate for the standard ‘flap’ Lasik surgery, but rather Photo Refractive Keratectomy (PRK) Lasik.  There is a big difference in both procedure as well as recovery time.  Unlike the glamorous ability to see clearly and be ‘work-ready’ within 24-48 hours after traditional Lasik, PRK requires up to a one-week recovery process (no work recommended) and then vision is to full potential in about 6-8 weeks.  Sure, why not!  My initial healing process had me out of work that entire first week.  I was wearing extremely dark goggles throughout the day, due to extreme sensitivity to any light for the first half of the week.  By the end of the week, my vision was at its best 20/40 at times (which allowed me to drive), but would get worse as the day went on.  I found myself sitting at meetings or working with clients and they would be somewhat clear (that was the 20/40) then I would blink and they would be a big blur.  This roller coaster of vision lasted for about two months.  I am now happily 20/20.  However, during this time I was incredibly thankful for the color contrasting within my home to help me distinguish between objects within a space, especially in my kitchen.  I also benefited from the ability to adjust the lights lower when it bothered my eyes in the beginning, and increase the lighting later when I was not quite yet to 20/20.  I was also very thankful that we chose bull-nosed edging for our counter top as I bumped it frequently, without having good acuity and depth perception in the beginning, and was not hurt by any sharp edges.  This was a choice that was specifically originally made with multiple users of the space in mind: one being my husband, and the other was the forward thinking of possibly having children in the home (lifespan design) and looking at creating a safer environment by eliminating sharp edges.  Ironically, I also benefited.   Lastly, having front controls on the stove as well as the washer/dryer provided increased access and safety, as I found myself needing to get closer to locate them and to see the control/cycle.

Last year, I finally learned first hand what it feels like to be in so much back pain that you are literally stuck and can’t move.  We see this scenario in so many comedy sketches and movies, but never really ‘get it’ until it happens.  After having slept on a not so good hotel bed for two days, then a hospital couch for four days while my Mom was hospitalized, along with carrying heavy bags and helping move my Mom’s things, within a week I found myself up in the middle of the night in extreme pain and stuck, seated at the side of my bed.  My 39-year-old back had enough, and my husband, while seated in his wheelchair, had to help me off the bed.  After a doctor visit I was able to get the pain under control, but found that I had difficulty with most reach that was at or above shoulder level as well as below waist level.  This included any bending and reaching, even when I was using the best body mechanics to get the job done.  I was never so thankful for my pullout shelving!  This was truly an amazing benefit that was just a convenience for me, before this injury.  I was also very thankful for having placed many of my frequently used items at an easy level to reach, by using lowered cabinets or adjustable height shelving throughout the spaces within my home, where I did not have to rely on overhead reach or extreme bending for accessing storage.  My washer and dryer, being front loaders, created ease with completing laundry during this time.  Even my side-by-side refrigerator allowed me to access both the fridge and freezer without having to do overhead reach; I am on the shorter side at 5’3” :)    The pullout shelving within the fridge was the icing on the cake.  Even the design and organization of our pantry closet which places the dog and cat food bins at a higher level off the floor, allowing access for both myself and my husband without the need for bending, provided relief and gave me the ability to continue feeding my furry children.

My story is not unique.  In fact, it is pretty typical for the average person to have a temporarily disabling condition that impacts performance of everyday and meaningful activities.  The problem is, it is temporary.  We get back to our busy lives and forget what happened and how our environment made the condition even more disabling; until it happens again.

Frequently, when I talk about Universal Design I hear people say, “I don’t need that yet” or “It’s not for me, but it might help my grandmother”.  Universal Design is not ‘accessible design’.  It is not design just for someone who is ‘old’ or already has illness, injury or disability.     It is design for everyone.  I hope that my journey with Universal Design truly represents the level of convenience it has afforded me when I did not personally need it, but how it became invaluable, when I did.

Here’s to hoping this provides the proverbial A-ha!  moment :)

What is your Universal Design journey?

February 23, 2013 at 8:19 am Leave a comment

Hotel accessibility is like a box of chocolates……

1788Even with the ADA in place, providing a minimum requirement for accessibility, it still never ceases to amaze me that each ‘ADA’ hotel room we encounter, is so very different.  My husband Bill, who uses a manual wheelchair due to a spinal cord injury, is a travel agent and knows this issue all to well.  Our last three hotel stays truly exemplify the fact that you just never know what you are going to get.  Thus, the inspiration for this blog post.

We stayed in Washington, DC for a quick get-away over Thanksgiving and had the opportunity to stay in two separate hotels.  The first accessible hotel room boasted large amounts of space, both in the room and the bathroom.  The room we received had a tub with tub seat and plethora of grab bars.  Bill, who could access the controls to turn on the water, and could transfer onto the flip-down tub seat, had difficulty with reaching across the tub to pull the tub seat down and, our favorite, could not reach the hand-held shower on the opposite short shower wall.  We find that this is a typical scenario in many ‘ADA’ hotel rooms.  Even though it is on a slide, Bill is at the mercy of someone placing the handheld closer to him in the shower, and then hoping that housekeeping won’t put it back on the slide at the top after cleaning the room.

1860In this second hotel room, we encountered a roll-in shower with flip-down seat and once again, a plethora of grab bars.  Bill was once again able to easily transfer from his wheelchair to the bench, but this required that he roll his manual wheelchair into the shower area, and then try to push his chair outside of the shower area once he was seated on the shower bench.  Bill sustained a C5-C6 incomplete spinal cord injury, which resulted in quadriplegia.  Pushing his chair outside of the shower area and then attempting to retrieve it was challenging for his balance, as it required that he hold the front grab bar with his left hand (which only has tenodesis grasp) and rotate his trunk to the right while reaching to the side and behind him with his right arm, which is challenging for his sitting balance, and almost caused him to fall off the shower seat.   Even if he were to be able to do this independently, he now has his front wheelchair wheels within the wet shower area.  Adding another layer of challenge is the handheld shower unthinkingly placed at the top of the slide bar.

774569_10151209850006587_990546174_oFor our recent trip to the International Builders Show in Las Vegas, we once again encountered an ‘ADA’ room with a tub.  We were given the option of a tub with a stand-alone shower seat, or a roll-in shower with a stand-alone shower seat.   Things that make you go hmmm……    Bill made the choice of a tub with stand-alone tub seat, as this was the lesser of two evils.  A roll-in shower sounds great, but using a roll-in shower with a stand alone shower seat is dangerous for Bill as the seat may slide when he is attempting to transfer to/from his wheelchair and it may tip over in the shower if he were to have a muscle spasm.  His thoughts—less area for the stand-alone shower seat to move in a tub than in a large roll-in shower.  Neither was ideal, but we are used to ‘making-do’ in hotels.  Upon making this decision, the hotel changed their mind on the choices and stated that by law we are supposed to be in the room with the roll-in shower.  As I educated the staff about ADA, and the areas of concern with both of their ‘ADA’ rooms, miraculously the ‘hotel engineers’ located a tub bench that can be fastened to the tub!  Ok, so this is a bit better, still no chocolate covered cherry, but better.  As they arrive to the room and we all convene in the bathroom, the first engineer says to the second engineer, “where does it go?”  I politely take over and educate the engineers about the placement of the tub bench to best meet Bill’s needs.  Even though the tub bench allows for increased ease of transfer and increased safety versus a stand along shower seat, the tub seat is very hard and uncomfortable to transfer onto (Bill has sensation below the level of his injury) and he still is at the mercy of the handheld shower being lowered from the top of the slide bar.

Please note:  tub bench was height adjusted and was positioned to accommodate Bill’s long legs swinging over the tub.   The picture actually makes the tub look longer than it is; Handheld in picture is 20” in front of tub seat, which allows Bill to access it when it is in a lowered position.  Also note in the picture that the plumbing under the lav is not covered/insulated.

This blog is a look at how these specific ‘ADA’ hotel bathrooms did not meet Bill’s needs; but what about the many other patrons that will use these spaces?  These bathrooms will be utilized by a number of people of different ages and different ability levels.  A universal design approach would allow for meeting the needs of the majority of patrons that stay within these hotels.  This would not only create a better user experience, it would provide for an added layer of safety and potentially less liability overall for the hotel.

Perhaps we can be very forward thinking and progressive and say, why shouldn’t all guest rooms in a hotel be universally designed? This way it won’t be a matter of saying “we need an accessible room” and hope to get one that we can ‘make-do’ in.  Perhaps…….

February 10, 2013 at 2:53 pm 7 comments

Hybrid Tandem Handcycle

This Thanksgiving Bill and I had a ‘mini-vacation’ in Washington D.C.  I have previously had the opportunity to ride the Metro, D.C.’s public transportation, but this was Bill’s first time and we found it to be very accessible.  The weather was gorgeous these past few days and as we were walking around we spotted a couple riding on a tandem bicycle.  We both said aloud, “I wonder if they make a tandem bicycle that allows for a person pedaling with their feet, and the other with their hands”?  We thought, what a wonderful idea for engineering students to create such a bike.  Thus the Google search to explore if this has already been initiated, and voilà, the Hybrid Tandem Handcycle from Varna pops up!

The Varna hybrid tandem handcycle allows for the person in the front to sit and pedal with their feet and the person in the back to sit and navigate with their hands.  The person in front is also in control of steering and leaning side to side.  The design for the rider in the back is the same for their Varna II handcycle.  Price tag on this toy is $7500.   The company does have a video online, which I have posted for you below.  However, the bike in the video being used is the reverse of what is being sold, with the handcycle portion in the front and the person pedaling with their feet in the back.

Varna Hybrid Tandem Handcycle

This would be a lot of fun to try out—Bill and I would love to be a part of a pilot of this type of project in the future :)

Bill’s comment on whether or not he would prefer to be in the front or back of the bike:  “In the back, that way you won’t see if I stop pedaling.”  Classic.

What do you think of this hybrid tandem handcycle?

November 25, 2012 at 8:47 am Leave a comment

2012 Complete Communities Delaware Summit

Last week Delaware held its first Complete Communities Summit as a means to create awareness and continue planning for meeting future infrastructure needs in Delaware.  As an occupational therapy practitioner that specializes in environmental modifications, this aligns with my position on Universal Design and Livable Communities.

Our keynote, Ed McMahon from the Urban Land Institute, spoke about sustainable communities being “a place of enduring value”.  He quoted Wendell Berry stating, “if you don’t know where you are, you don’t know who you are”.  This aligns with the occupational therapy perspective that home (and a sense of place), is connected with one’s identity.  It is not just physical; it is psychosocial and ties to a sense of familiarity and security.

During our lunch presentation, we had the opportunity to listen to Joe Molinaro, Managing Director, Community and Political Affairs, National Association of REALTORS®, speak about place-making.  He reviewed a Venn diagram which represented Physical Form, Social Activity and Economic Prosperity as three interrelated spheres.  The amount of overlap represents the amount of congruence in these areas, with the center (overlap area) being Place.  The more overlap of these three spheres, the better the sense of place.  This quickly reminded me of both the occupational therapy PEO (Person-Environment-Occupation) model of occupational performance as well as Powell Lawton’s environmental press theory.  This diagram, regarding place, was expressing that within the framework of form, activity occurs.  That may be social activity, economic activity or even socio-economic activity.  However, a sense of place flows from emotion, or human experience.  Therefore:  Form→Activity→Emotion.  The point in this discussion was that when planning for complete communities, you need to get into people’s thinking and emotions about what is a “good place”.

This also made sense to me, as an occupational therapy practitioner, as activities (what we call occupations) are the basis of what we do; we support people, across the lifespan, to promote active engagement in meaningful and purposeful community living as safely and independently as possible.  Participation in these meaningful community activities supports emotional health and well-being and creates a network of social-connectedness.  Here is the ‘emotion’ from the ‘activities’ that is within the ‘form’.  Community as identity.

It is this cohesiveness of thinking that makes occupational therapy practitioners that specializes in environmental modifications uniquely qualified and well suited to consult with architects, planners, community agencies, as well as local, state and federal policymakers with regard to universal design for livable and complete communities.  Occupational therapy practitioners bring a unique perspective; Designers, planners, policymakers and occupational therapy practitioners are necessary pieces of the puzzle, that when assembled, are most likely to best meet client needs with regard to aging in place in livable/complete communities.

For more  information on Livable Communities, check out the Livable Communities Daily at: http://paper.li/EmpowerAbility/1337434767

November 18, 2012 at 9:27 am Leave a comment

Imagine what it would be like to have your first mammogram…while seated in a wheelchair (2012 update)

Almost two years ago I wrote a blog regarding the Access Board planning to set standards for medical diagnostic equipment.  As of February 9, 2012, these proposed accessibility standards were published for comment in the Federal Register.

I am dedicating the re-posting of this blog in an effort to provoke thought about the importance of this issue.

From May 11, 2010:

For women around the world it is almost like a rite of passage: the baseline mammogram. It is advised to get it done prior to age 40 and I crossed that bridge this year. It is an interesting process that I felt more like a mannequin than a person, being positioned in such a way that the mammography machine can take the best picture. As I was standing there, being the compliant patient, I could not help but wonder, how would this process work if I were seated in a wheelchair? If I did not have control over my arms or my torso? Could the machine get a good picture???

In my case I actually needed to return as there was an inconclusive spot on one of my pictures. After a second round with the machine, it was determined that it was a positioning issue that folded the skin in such a way that obscured the picture. Now, if this can happen with an able-bodied person that can twist and contort in any way requested, how can one be sure an accurate picture can be taken for someone with a mobility impairment?

I frequently wonder how my husband manages, with a C5-C6 incomplete spinal cord injury, when he has a medical appointment.  I think about this as I sit in the dentist chair, as I am seated on the family doctor’s exam table, as I am getting up on the x-ray table sitting just so to get the best picture.  Currently, it may take him some extra time, but he is able to complete these functional transfers. What will happen five, ten or twenty years from now when he has less mobility? Less ability to complete functional transfers? How do others with mobility limitations manage this task when the equipment is built for use with able-bodied persons?

According to the Access Board, standards are to be set for medical diagnostic equipment under the new health care reform law. “The ‘Patient Protection and Affordable Care Act’ authorizes the Access Board to develop new access standards for medical diagnostic equipment including examination tables and chairs, weight scales, x-ray machines and other radiological equipment, and mammography equipment.” It is hard to believe that this is actually not addressed under the current ADA.

This is yet another area of accessibility that has been overlooked. I am thankful that there will be regulations for medical diagnostic equipment, but am realistic in knowing that seeing this actually take effect in the doctor offices may take a while.

What are your thoughts/experiences with this issue?

February 26, 2012 at 10:48 am Leave a comment

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