Universal Design for accessibility and safety…..

This year, National Falls Prevention Awareness Day is on September 23.  According to the Center for Disease Control, most falls happen at home—every year about 33 million Americans are injured seriously enough to require medical attention. In fact, the most common cause of nonfatal injury in every age group is falling down.¹ Furthermore, “Among people 65 years and older, falls are the leading cause of injury deaths and the most common cause of nonfatal and hospital admissions for trauma. Each year in the United States, nearly one third of older adults experience a fall.”¹ One facet of a home accessibility evaluation is to assess the home to identify fall risks, with the goal to prevent injury and avoid accidents. The integration of environmental modifications can help decrease the risk of falls, and create a safer home environment.

Incorporating Universal Design principles into the design of a home not only allows for the most amount of users to have access, it also provides a layer of safety.  Pulling up throw rugs to allow for a smooth, firm and slip-resistant surface, not only eliminates an obstacle for persons using walkers and wheelchairs, it also removes a possible fall hazard for anyone else.  Removing clutter and rearranging furniture to create as much clear, open space for navigating throughout the home allows for users of mobility devices to have an unobstructed pathway, while decreasing trip hazards that may be in one’s frequently used pathway in the home.  Use of pull-out shelving eliminates the need for far reach and bending, decreasing one’s fall risk while attempting to get that one pot in the far back corner of the cabinet.

Utilizing both natural light as well as light within a room is integral to creating safe pathways in the home.  Exit/entryways, stairwells and bathrooms are of utmost importance.  Having a light switch, preferably a toggle, conveniently located just before one enters/exits the home will allow for an illuminated pathway and decrease chance of falling over unseen obstacles or bumping into furniture. Although important for universal design, it is not just about the height/location and type of light switch that meets the needs of the most amount of users.  It is the addition of extra lighting that also provides a convenience to all of the residents for safely traversing the frequently used pathways in the home.

The integration of grab bars and handrails will also provide a layer of support and safety.  At first, many will just think of the bathroom and the stairwells for need of this type of support.  However, while completing a home evaluation, an Occupational Therapist may determine that supportive bars and other assistive technology may be needed in other areas of the home to assist a homeowner with safely transitioning from sit to stand.  Occupational Therapists are uniquely prepared to contribute to fall prevention efforts because of our attention to diverse influences on occupational performance.  While Universal Design features can create an added layer of safety, each home and homeowners needs are very unique and need to be evaluated individually for falls prevention to determine appropriate recommendations.

On September 23, 2010 the Greater Philadelphia Aging in Place Chapter, local chapter of the National Aging in Place Council, will take part in an event with the Delaware Aging Network to educate consumers about falls prevention.  How will you spread the word?

1. Center for Disease Control and Prevention www.cdc.gov

Participating in CPR training with a disability…..

This past weekend I did my annual health care professional ritual of completing my CPR re-certification.  Although, this time it was not so typical as I started to wonder, could Bill (my handsome husband, who happens to have a C5-C6 incomplete spinal cord injury) perform CPR on me in the event of an emergency?  What accommodations would the Red Cross and/or the American Heart Association make for those who want to be CPR certified and have a disability?

I spoke with a Red Cross representative from my area to get some clarification.  There are three main critical objectives that need to be met for CPR certification 1-to get on the floor, 2-To be able to give an effective breath (making the chest rise) and 3-to be able to give effective chest compressions.  If a participant is able to complete these three main critical objectives, as well as pass the written exam, they will receive the CPR certification card.

The representative reviewed that modifications can be made, as long as the three main critical objectives are still met.  For example, a woman with a congenital birth defect that had left her without forearms or hands recently took the course and completed the  certification.  The Red Cross representative reported that she was able to get on the floor, she was able to give effective breaths, but instead of using her hands to complete the chest compressions, she was able to effectively complete the chest compressions with her foot.

If, however, a person is unable to complete any of the three main critical objectives, a certification card cannot be issued.  Although certification would not be obtained, auditing the class to learn the information is still a viable option.  Learning this information would allow you to instruct others to help with CPR, in case of an emergency.

I thoroughly understand the need for these critical objectives to be met to provide effective CPR, but am delighted to know that modifications can be made.  If you are interested in learning more about what accommodations can be made for completing CPR with a disability, please contact the American Red Cross and/or the American Heart Association for details.

Save a life, learn CPR!

Summer 2010: Accessible Camping, or not….

As part of this blog, I have decided to talk about some of the issues that I have encountered this summer as it relates to living with a wheelchair-user.  I feel it is important to write these stories to generate awareness of some of the trials and tribulations as well as for a bit of comic relief!

Bill, who has C5-C6 incomplete quadriplegia, uses both a manual and/or a power wheelchair for mobility.  He started a tradition of going camping with his young nieces in his Mom’s very large and wooded backyard.  The setup is a large tent for the girls to share, and a tent-cot for Bill and the dog (I did not go on this particular adventure).  A tent-cot is the equivalent of a cot which sits about two feet off the ground enclosed in a tent.  This allows for ease of transfer to and from the wheelchair as the surface is almost level and the cot material is pulled very tight, creating more of a soft but solid surface.  Above the tent-cot was a canopy that was setup to help shield from the weather, just in case of any rain storms.

This setup, although seemingly fool-proof, was a catastrophe waiting to happen.  On the second night, a very severe thunderstorm came through the area.  The top of the girl’s tent ripped, soaking the girls with rain water, and they proceeded to run into the house screaming, leaving their Uncle Bill outside.  The canopy broke from the wind and rainwater build up.  This caused it to crash into the tent-cot below, sending all of the built up rainwater through the tent-cot window, flooding the space that Bill and the dog were sleeping.  Thankfully, the girls woke up Bill’s sister in the house and she was able to help him and the dog get out of the tent-cot and safely into the house.

When morning came, the damage was visible.  The girl’s tent was lost, the canopy was lost and the tent-cot was soaked.  In the clean-up process, Bill was helping to transport the canopy pieces on his lap in his power wheelchair.  In the process of removing the pieces from his lap to throw them in the garbage, one of the broken ends fell from his lap and landed on his bare foot, leaving a long gash down the top of his foot from his ankle to his small toe.  Although Bill took immediate precaution, rinsing with peroxide and bandaging with Neosporin, within two days, the foot was infected.  Decreased circulation due to the spinal cord injury always increases the healing time for any of Bill’s wounds.  To add insult to injury, Bill was also coughing, wheezing and generally not feeling well.  I could feel fluid in his lungs when he would take a deep breath.   The decreased strength of Bill’s diaphragm, due to the spinal cord injury, affects his ability to produce a strong cough and consequently will turn a cold into a respiratory infection a lot faster than someone who is able-bodied.  Off to the doctor you go!

Verdict:  respiratory infection and infected foot.   A tetanus shot and two weeks of solid antibiotics and he will be back to new.  Too bad he had already given me his cold, and I did not even go on the camping trip!  Oh, and need I mention that the dog also developed a bacterial infection on his belly.  It’s just another day in the life with Bill.  This saga is sure to continue…..

For info on the tent-cot go to: KampRite TentCot

New Thinking for Effective Caregiving: A Conversation Between an Occupational Therapist and a Caregiver Coach (Part 3)

Training Family Reinterpretation  (continued from Learned Helplessness, Part 2)

Holly:
This idea of reinterpretation comes up often during caregiver coaching sessions. What other kinds of reinterpretation crop up in your work with clients?

Debra: Well, Holly, it can come up in the way a family member talks about their loved one’s condition. From a medical perspective, I may be working with a client in the kitchen to functionally walk with their mobility device to retrieve items from the cabinets and refrigerator for meal-prep.  The family will say, She’s not walking! I have to counter, No, she’s walking, but she’s doing it differently.  We need to help the family to see the picture differently, to reinterpret what is happening.

Or if someone has had a stroke, and one side has some paralysis, a family member will say, That’s the bad hand” or “bad side.” We have to help them to see that there’s no such thing as good or bad, it’s always a matter of degree of functionality.

Holly:
Oh yes, the words caregivers use directly impact their own peace of mind and that of their loved ones. In my book, “The Caregiver’s Compass,” a main focus is noticing the words one is using, and then switching them to words that are more empowering. The theory is called “action language,” the idea that language doesn’t just describe reality, it creates it. Speaking is an action that generates your experience of your world. Self-talk is an example. But in life, we don’t live in isolation, so we’re like fish swimming in a goldfish bowl—what we say also creates realities or meanings for those around us. A daughter saying to her dad, “You’re not walking!” as he’s inching forward on his walker, is not helpful. It’s disempowering. When I run into someone negative, I’ve been known to say, “Stop pooping in the fishbowl!”

—Holly Whiteside, caregiver’s coach & advocate, is author of “The Caregiver’s Compass: How to Navigate with Balance and Effectiveness Using Mindful Caregiving.” She invented Mindful Caregiving tools during her caregiving decade by applying to herself the life coaching principles that she had been teaching others. Find her book at Amazon.com, or learn more at www.CaregiversCompass.com. Holly can be reached at MindfulCaregiving@comcast.net.