Environmental assessment and modifications

• Environment


  Influences human behavior and provides context where occupational roles are performed
• OTs


  • Uniquely focus on clients' occupations within location of their performance
  • Consider how environment supports and optimizes clients' safe engagement in chosen present and future occupations
• Environmental modifications


  Adaptations applied to physical environment to promote safety and full participation
• OT practice shaped by legislation that supports rights of individuals with disabilities to full societal participation
• Anthropometrics


  Study of human body dimensions such as height, weight, leg length, and body segment length as applied to living and working spaces, furniture, and equipment
• Anthropometrics is the basis for designing spaces that "fit" an individual or group in home, workplace, or community
• Because human dimensions vary with population, age, ethnicity, and clinical conditions, it is important to understand how anthropometric measurements are applied to space planning
• Anthropometric Measurements to Design Space


  1. Identify target user population

  2. Identify criteria that are important to user

  3. Identify important body dimensions

  4. Determine whether space is being designed for one person or for a population

  5. Measure body parts or find data from anthropometric data tables

  6. Consider other factors impacting use of space

  7. Create a mock-up or virtual model that can be tested with a user
• Home Safety and Fall Prevention


  • Fall prevention refers to strategies and modifications designed to minimize fall risk at home and other environments
  • For older adults, falls can have devastating consequences
  • Home safety evaluations address additional hazards (e.g., overloaded electrical outlets and tangled cords in walking paths, etc.)
• Aging in Place


  • AARP estimates 89% of people aged 50+ years considering options for housing express preference for remaining at home
  • Additional considerations—high cost of nursing homes and assisted living facilities
  • Leads to older adults remaining in their homes with supportive services, environmental modifications, and/or renovations
  • Therapists identify clients' current needs and anticipate potential future needs to promote safe aging in place (e.g., relocating a master bedroom and bath downstairs)
• Community Livability


  • Livability addresses structure, accessibility, services, and enhancements that promote quality of life for all community inhabitants
  • Visitability is incorporation of basic features into homes of persons using mobility devices to facilitate ease of entrance, exit, visit, or stay, for any length of time
• Injury Prevention and Productivity


  • Workplace ADA standards promote equal access to job opportunities and public spaces for individuals with disabilities
  • Workplace evaluation—additional foci of preventing injuries and improving productivity
  • Analyses of job tasks and worker body mechanics, work environments are evaluated to examine conditions that promote safety and health, while reducing injury risk
• Home Environment Assessment and Modification


  1. Therapists seek to understand how people interact with their environments to engage in desired occupations

  2. Using occupational profiles, client–therapist interaction determines client's previous roles and occupations, present desires and future expectations

  3. Therapists identify home barriers to participation and make personalized recommendations for modifications
• Creating the Problem List


  1. Compile a list of areas in which client occupational roles cannot be met because of environmental conditions

  2. List should be specific and co-created by clients, therapists, and community stakeholders

  3. List includes criteria to promote desired goal and may yield solutions

  4. Each problem list is unique to client needs

  5. Therapists create personalized intervention plans that address all identified needs
• The Process of Home Assessment and Modification


  1. Upon referral, therapists' visit uses writing instruments (e.g., laptop or pad), tape measures, and cameras

  2. Reasons for home safety evaluation based on client's safety needs and desires for role resumption

  3. Most referrals require evaluation of exterior and interior environments
• Assistive technology can greatly improve clients' quality of life and should be considered when making recommendations for modification of home or daily routine
• Assistive technology


  • Low Technology: rqr min training, less expensive, no complex features, user-friendly (grab bars)
  • Medium Technology: rqr mod training, some complex features, may be electronic or battery operated
  • High Technology: complex devices, rqr training and has computerized components (chair lift, motion-sensor faucet)
• Home safety technologies are advanced systems installed directly in home to enhance client safety. Often recommended when working with clients with low vision or hearing loss
• Workplace Environmental Assessment


  Purpose is to prevent injuries and promote comfort, safety, and productivity for employees and workgroups
• Reasons for workplace environmental assessment


  • Worker's physician or insurance company to promote safe return to work
  • Company safety department to promote injury prevention
  • Human resources for ADA issues
• Preparing for Worksite Visit


  1. Therapists contact company to: (a) identify reason for visit, (b) request a job description, and (c) set a visit date

  2. Job description identifies primary job function and duties essential to job

  3. Including qualifications such as: (a) education, (b) needed experience, (c) skills, and (d) work conditions (hours, location)
• Components of an Environmental Assessment


  1. Observe a worker performing required job tasks to understand how workstation supports job

  2. Clearance refers to sufficient headroom, legroom, and elbowroom in work area

  3. Clearances should always be designed for largest user

  4. Therapist observes, measures, and determines if clients have: (a) legroom, (b) armroom, and (c) headroom

  5. Reach refers to location of controls and materials accessed to perform a task
• Task Requirements and Workstation Design


  • Task requirements of job dictate worker posture and body motions
  • Therapists note visual requirements of job (e.g., location of visual cues, objects to manipulate, or information)
  • These determine worker head position
• Seated Workstations


  • Common in offices, call centers, laboratories, dental offices, and seated assembly workstations
  • Well-designed seated workstations minimize discomfort from prolonged sitting
  • Discomfort arising from low back, neck, or shoulder pain reduces work efficiency
• Standing Workstations


  • Common in industrial settings for assembly tasks, warehousing, and manual materials handlings
  • Standing for long periods (without breaks) on hard surfaces is associated with leg, low back, and foot pain
• Interventions for work environments


  1. Workstation design influences worker's postures, work patterns, workflow, and, ultimately, comfort and productivity throughout day

  2. Therapists ensure that workstation layout—including location of objects, surface heights, and visual displays— is well organized
• Key principles for workplace layout


  • Importance: Place most important items in most easily accessible location
  • Frequency-of-use: Place most frequently used items in convenient, close-to-reach locations
  • Function: Place items with similar functions together (staples, paper clips, scissors)
  • Sequence-of-use: Lay out items in same sequence in which they are used
• Workstation Design


  • Designed specific to tasks performed and promote a worker's neutral posture
  • A neutral posture is achieved when: (a) head is upright, (b) neck is slightly flexed, (c) shoulders are at sides and flexed less than 20◦ to 25◦, (d) elbows are flexed to about 90◦, and (e) wrists are in 0◦ of flexion
  • Work equipment or controls regularly used should be located within a worker's "reach envelope"
• Seated Workstation Adjustments


  • Requires little physiological effort and provides stability for precise work
  • Prolonged sitting increases spinal compression forces and potential for static loading on neck and shoulders
• Standing Workstation Adjustment


  Workers should stand with hips midway between an anterior and posterior pelvic tilt. Foot rails can be used for intermittent foot placement to relieve stress on low back and change leg position
• Guidelines for work surface height

  • Precise work requires a higher work surface to provide proximal stabilization of 2 to 4 inches above elbow
  • Light assembly work surface can be 2 to 4 inches below elbow to best utilize upper extremity musculature forces
  • Heavy work requires a lower work surface—about 4-5 inches below elbow—to leverage body and trunk strength
• Lifting Workstation Adjustments


  • Modification of lifting workstations can minimize injury risk
  • Adjustability is key for multiple individuals using same workstation
  • Use Mechanical Assists to transfer loads
  • Use adjustable surfaces to lift at waist height
  • Reduce size of containers
  • Design handles, hooks, etc. to promote firm grasp
  • Change from pulling to pushing
• Sit-Stand Workstations and Physical Activity


  • Combination of sit– stand—move routines for office workers (sit 20, stand 8, move 2 min)
  • Sit–stand workstations promote postural changes to decrease musculoskeletal strain from either position
• Persons with physical disabilities fully engage in community life when easy, convenient, and safe access is provided
• ADA legislations and universal design principles applied in mainstream approaches to promote access across community settings
• Community Environmental Assessment


  • A number of instruments are available to assess community environments
  • Some assessments: Enable clients to identify home and community environments that hinder desired participation, Ascertain information such as online livability indices, rank environmental areas, services, and amenities that impact life, or Measure built features associated with physical activity and walking including: (a) architectural, (b) traffic, © transportation, and (d) proximity to services
• Community Environmental Modification


  1. Client-Specific Modifications: Therapists work with community stakeholders to present a client's case and feasible solutions that benefit client and community members

  2. Population-Based modifications: OTs serve as consultants for groups desiring community modifications for all members

  3. OTs work as a team member with elected officials, city planners, ADA specialists, business owners, and community members
• accessibility to public buildings, employment settings, and housing choices is fundamental to individual's safety and meaningful community participation


  true
• American national standards institute


  ensure safety and health of US consumers and protection of environment- designs for accessibility
• fair housing act


  accessibility in multi-family housing- ensured rights for ppl w/ disabilities and equal access to housing options