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Utilizing Universal Design in
the Rehabilitation Plan
Susan Bachner,
Occupational Therapist and
Accessibility/Home Modifications Consultant
CMSA – 10/9/12
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)
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Why Universal Design?
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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
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
Taking a close look at an
evidenced-based case example:
31-year-old woman
covered by Worker’s Comp
Introducing Jane
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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
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continued
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Introduction continued
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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
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
Continued …….
Evaluation points continued
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Kitchen – abilities & existing
structures and appliances
Accessible rooms/storage
Grab bars
Overhead lift/track
Laundry
Water shut-off
Front Entrance
front steps make this an inaccessible route
Back Door
6 ½” brick curb
1” threshold
6 ½” brick curb and 1” un-beveled threshold make this
route inaccessible
Garage Entrance
This existing landing is approximately 48” high
off the finished floor and is 39” X 36”.
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.”
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.
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.”
Transfers
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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”
Evaluating Sure-Hands ceiling
lift capability
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
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.”
Existing kitchen
Inaccessible spaces
Re-evaluating trunk control
33 ½” high
7/14/11
34” high
Implications of going from 30”
to 34” counter height
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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
Evaluating body mechanics for
cooking tasks
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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
31” table height
8/18/11 – frying pan
29” table height
8/18/11 – chili or pasta pot
36” table height
8/18/11 – chili or pasta pot
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.
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Providing a new chair with an
adjustable cut-out for more
customized bowel program
Access to side-hinged oven
Access to
storage and the cook top
Access to
sink and dishwasher
Walkway under constructionstep-less entry at back door
Automated control to open gate
Sure-Hands Ceiling Lift
Charging in Bedroom Corner
Pictorial Summary of
kitchen, bathroom,
bedroom and entrance
modifications
The Vertical Lift in the Garage
Vertical Adjustability
Stove and sink: “up”
position
Stove and
sink:“lowered” position
Adjustable height prep table and
accessible microwave
Front Door Peep-Hole
2/7/12
Water shut-off being relocated from under
the house into a closet in the guest
bedroom
Susan Bachner Consulting, LLC
www.susanbachnerconsulting.com
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) 273-1122