Therapist Perspective
John Pynoos is one of the founders of the University of Southern California Home Modification program and one of the foremost experts in the field of home modification in the country and world. He advocates strongly for, and I think it is important for us to educate other people on the importance of the functional perspective, and when it comes down to it, the therapist’s approach. He quotes, “Knowledge about available accessible products is the single LEAST important aspect of a successful home modification project. Instead of considering what products are available or what you used in the last project, think about what features and attributes are needed to help the client meet his or her needs and realize his or her goals.” When we look at products, we do not look at the ADA label for the home for what is going to work the best for accessibility for an individual. We need to look at what about that product is going to help an individual to become more independent in their home. We may find something that does not have the ADA label on it, and if we are looking at the features of that product that will help us, we may find something that is more aesthetic, less expensive, and functionally works better for the individual. We may also find it in a product that does have the ADA label. The essence is that we need to look at the features of products, whether it be a sink, a fixture, a grab bar, or whatever it may be, that will help people individually to become more independent in the home.
Customized Plan Versus ADA
The ADA, or Americans with Disabilities Act, was enacted in 1992 provides standards for commercial settings or public settings for accessible construction. These are guidelines that are required for public situations and public institutions, but are not directly bound into local codes for residential remodeling. I have to say with a caveat that for every region, every municipality, where you live, the local codes can adopt portions of the ADA guidelines. ADA is a federal law and you should see if it is adopted locally. Before someone starts a major project or before they set a fixed ramp into place or do permanent ramping to their home, it is important to check with the local municipality. Generally, we are not bound to the ADA guidelines and I would argue that that is a good thing, as long as we have knowledgeable people who are thinking about design. It can be restrictive and it can be more costly. Again, we need to look to individualized codes and not to ADA. From the therapist’s perspective, we are going to incorporate a lot of different aspects including sensory needs, individual’s cognitive ability, their physical requirements, and psychological needs for the individual.
Functional Task Analysis Based Approach
When we do our modifications, we want to think from a functional based standpoint. We want to focus on task analysis. Task analysis is breaking down overall tasks, such as toilet transfers, toileting, or managing stairs, into individual, smaller components. For example, we take the task of doing a transfer from wheelchair to toilet. This can be accomplished in many different ways for people who are approaching that differently. However, we want to think about every element in terms of doing the task and in terms of what is required for that task, such as balance, flexibility, and strength. What is needed in terms of support if someone is doing a scooting transfer with a BZ board or with a slide board versus a pivot transfer? What components are needed in terms of getting the feet placed and getting the leg rest managed? What do they need to in terms of weight shifting if they need to place a slide board? What do they need to weight shift to have mobility, as well as support for balance and how do they do scooting over? We break this down into the smallest components that we can to really understand what the essential needs are for a specific task.
