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onsumers, families, and health care professionals

Barrier-Free Design: A
Review and Critique of C agree that a physical setting that fosters inde-
pendent living is often the critical factor that al-
lows persons who are frail and disabled to live in the
cominunity instead of in an institution. Although thig
the Occupational statement may seem self-evident, policymakers have
heen slow to acknowledge it (Liston, 1971; Shaw, 1971;
Therapy Perspective Taira, 1984). Changes made over the past 20 years in the
form of new regulatory legislation and the adoption of
more stringent bUilding standards, however, are gradual-
Barbara Acheson Cooper, Uriel Cohen, ly beginning to have an impact on the problem (Martin,
1987; Steinfeld et aI., 1979; Taira, 1984). Low-cost units
Betty Risreen Hasselkus
specially designed to accommodate the needs of specific
groups have been and are being erected; communitie~
Key Words: architectural accessibility. are hecoming increasingly aware of the need to provide
access to public buildings, services, and the neighbor-
environmental design. literature review
hood at large; and heightened multidisciplinaly concern
is evident (Taira, 1984).
The occupational therapy profession has a declared
This review of the occupational therapy literature on interest in barrier-free design. According to Mosey
barrier-free design identifies both a pauci~v of related (1986), a fundamental aspect of
occupational therapy research on the topic and a
lack of a common conceptual base with which to the practice of occupational therapy is concern for and use of thc
nonhuman cnvironment. The nonhuman cnvironment is viewed
gUide the development and use of environmental as- as an entity to be mastcred, an aid 10 facilitate the pcrformance of
sessments. Nonetheless, two fledgling themes can be ex- life tasks. and a vehicle for assisting in the development of senso-
trapolated: tbe consistent reference to the concepts of ry, perceptual, cognitive, and motor skills and need-fulfilling intra-
accessibili~v) mobility, function, and safety and an in- personal ancl interpersonal relationships. (I'. 3)
creased awareness among occupational therapists re-
garding the accessibility standards developed by the Mosey's (1986) views are supported hy the profes-
American National Standards Institute (ANSI) (ANSI, sion as a whole, as evidenced by educational curricula
1971, 1980). A problem-solving model suggested by de- that include as a basic component the teaching of meth-
signersfor the 1979 revision of ANSI standards that in- ods used to conduct home assessments and modifica-
corporates these conceptual themes is described and tions for both architectural and functional features. Fur-
discussed. ther endorsement comes from the American
Occupational Therapy A~sociation (AOTA), which identi-
fies and lists the ability to conduct home evaluations as
essential for various specialized roles (e.g., AOTA, 1981a,
1981b, 1983).
A conservative estimate of between 1.7% and 2.2% of
the population are directly affected by barrier-free design.
A more liberal view states that up to 11.6% would benefit
Barbara Acheson Cooper, MHSC, Oil' POT, is A~sistant Professor, from the implementation of more stringent standards of
A~sociate Dean, and Director of the School of Occupational accessibility (Steinfeld et al., 1979). Persons who are el-
Therapy and Physiotherapy, IJ 11 Health Sciences Centre, derly and those who are physically disabled have been
McMaster University, 1200 Main Street West, Hamilton, Ontar-
identified as the two major groups requiring assistance
io, Canada IBN 3Z5. She is currently enrolled in the doctoral
with environmental modification. Barrier-free environ-
program for environment behavior studies, School of Archi-
ments, both in the home and the wider community, are
tecture and Urban Planning, University of Wisconsin-Milwau-
kee, Milwaukee, Wisconsin. essential to successful independent living for these at-risk
populations. Both the disabled and elderly populations
Uriel Cohen, DArch. is Associate Professor, School of Architec-
are increasing in number, primarily as a result of im-
ture and Urban Planning, University of Wisconsin-Milwaukee,
proved health care. This factor, the growing awareness of
Milwaukee, Wisconsin.
the expense and negative effects of institutionalization,
Berry Risteen Hasselkus, PhI), OTK, is Assistant Professor, De- and the profound desire of these persons to remain in the
partment of Therapeutic Science, and Chair, School of Occu- community are increasing the demand for appropriate
pational Therapy, University of Wisconsin-Milwaukee, Milwau-
community-based, barrier-free housing, both new and
kee, Wisconsin.
modified. Because of their training and skills in functional
Tbis article was Clccepted!or publication August 30, 1990. assessment and environmental adaptation, occupational
----

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therapists are well suited to function as facilitators for the cannot be precisely outlined" (p. 773). She cited cultural,
independent-living movement (Hasselkus & Kiernat, economic, and personal preference variables as barriers
1973). Thus, we can reasonably predict that the volume of to a universal approach. Nonetheless, she suggested two
requests for our input will increase in the immediate ways of conceptualizing the environment for treatment
future. purposes. First, she built on ideas from Barris, Kiel-
The framework within which occupational therapy hofner, Levine, and Neville (1985) to propose a model of
organizes its therapeutic approach to assessing the phys- four concentric circles. From inner to outer, these circles
ical environment thus becomes particularly important. represent the nonhuman environment, required func-
The independent-living thrust defines the term environ- tional tasks, roles, and culture. Second, she suggested
ment broadly and clearly considers community accessibil- Kielhofner and Burke's (1985) Model of Human Occupa-
ity to be as important as residential accessibility for those tion as a broad organizational base that could provide a
whom it serves. The conceptualization used in the future theoretical umbrella for specific treatments and theories
by therapists, therefore, needs to be broad enough to used in community health care.
include all possible bUilding types and settings. It must, Trombly and Versluys (1989) discussed the evalua-
however, also allow the profession's focus on individual tion of architectural features within the home and com-
function to be maintained as the unit of analysis. Ideally, munity for clients with physical disabilities Although a
this framework must be equally acceptable and useful to sample questionnaire is provided, no overall conceptual
all occupational therapists, regardless of their area of framework is suggested. The authors stressed the impor-
practice. Given that no one clinical strategy is currently tance of site visits and the inclusion of the client and
agreed on, such a framework for environmental assess- family in the assessment process, which is organized to
ment would also need to be flexible enough to accommo- address function, safety, mobility, and accessibility in var-
date diverse formats. Professional consensus regarding ious architectural zones or rooms.
the conceptualization of barrier-free design and assess- Information relevant to barrier-free design is some-
ments would provide a consistent method for data collec- times buried in texts on other topics. For example, in a
tion without restricting its subsequent clinical use. An text on mental health assessments, a chapter by Hassel-
additional benefit would be the provision of a collective, kus and Maguire (1988), which may be a useful source of
uniform base from which issues related to occupational knowledge for barrier-free design, may be missed by
therapy and environmental access could be researched. therapists working in specialty areas other than gerontol-
The present paper reviews and critiques the occupa- ogy. Environmental assessments such as Maguire's
tional therapy literature on barrier-free design, particular- (198'5) 'l'ri-Level ADL Assessment organizes and rates six
ly concerning the conceptual approach now used in edu- c,negories of activities of daily living by environmental
cation, research, and practice. It suggests a model by level: personal, home or sheltered, and community.
Steinfeld et al. (1979) as one that might provide the pro- Two other sources of environmental assessments for
fession with an appropriate but more comprehensive al- occupational therapy are provided by home-evaluation
ternative to our present situation-specific approach and and home-safety checklists. The former are often devel-
yet allow the focus on individual function to be oped by health care units and institutions to meet their
maintained. own needs and vary greatly in length and breadth. Similar
organiZing constructs, however, such as safety and per-
formance, arc usually used. These checklists rerresent an
Lllcramrc R \'jew icl iosyncratic approach that has been common in occupa-
tional therapy in the past. Home-safety checklists are spe-
Education and Practice
cific examples of the organiZing construct of safety and,
The major instructional texts in occupational therapy usu- like the home assessments, are varied and idiosyncratic
ally include sections on the topic of barrier-free design in (cf. Tideiksaar, 1986)
the sections that deal with physical disahilities or home In summary, major occupational therapy texts and
care. The classic general text, Willard and Spackman's practice sources illustrate that environmental assess-
Occupational Therapy (Hopkins & Smith, 1988), ad- ments are viewed by the profession primarily as situation-
dresses the need for architectural modifications but pro- specific and centered on the home. These are often struc-
vides only brief general gUidelines for making these tured as room-by-room checklists to be completed by the
changes. Additional information in chapters by Malik therapist on site in collaboration with the client and fam-
(1988) and Levine (1988) discuss activities of daily living ily. None of the checklists appear to have been tested for
and independent community living, respectively. Malik reliability or validity. Although no overriding conceptual
(1988) listed broad areas to be considered when maklllg framework can be identified, there is the suggestion that
home modifications, which can be restated as issues of two different approaches guide the gathering of informa-
acceSSibility, mohility, function, and safety. Levine (1988) tion: a consistent cluster of concepts (safety, mobility,
stated that "the best approach for the therapist to use accessibility, and performance) and the relatively new

The American journal of Occupational Therapy 345
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application of theoretical frameworks such as the Model Compliance was measured by the percentage of specifica-
of Human Occupation. tions met by each of the buildings on a scale developed by
Martin for the study. No building was shown to be 100%
compliant, but improved accessibility for persons in
journal Articles
wheelchairs, particularly in the more recently constructed
A computer search of the major occupational therapy buildings, was found.
journals (i.e., American journal o/Occupational Ther- In the fourth survey, McClain and Todd (1990) rated
apy, Australian Journal 0/ Occupational Therapy, the accessibility of 20 grocery and convenience stores in
Canadian Journal 0/ Occupational Therapy, Occupa- urban and rural settings using a scoring system based on
tional Therapy in Health Care, Occupational Therapy relevant sections of the 1982 gUidelines of the Architec-
in Mental Health, Occupational Therapy journal o/Re- tural and Transportation Barriers Compliance Board. The
search, Physical/Occupational Therapy in Ceriatrics, survey was conducted by one of the authors and it is
and Physical/Occupational Therapy in Pediatrics) re- unclear if accessibility was judged by her or with the help
vealed that in spite of the emphasis placed by the profes- of someone using a wheelchair. It is also unclear how the
sion on the importance of barrier-free design, few articles sample of stores was selected. Descriptive results indicat-
of relevance have been published over the past 20 years. ed no overall differences between rural and urban stores
Those identified can be categorized as pOSition papers, but greater acceSSibility of grocery over convenience
surveys, and clinical intervention strategies. stores in both settings. The results of the survey were sent
The earliest of all the articles found was a position to all 20 stores. A 6-month follow-up indicated that 5 of
paper by Shaw (1971), which presented a historical per- the stores had complied further with accessibility stan-
spective on the issue of architectural barriers and the dards. The authors concluded that occupational thera-
problems faced by persons with physical disabilities. Ac- pists can be effective advocates for community accessibil-
cessibility needs were categorized and discussed under ity and thus facilitate independent liVing for clients.
the headings of housing, education, employment, trans- An intervention study (Wittmeyer & Stolov, 1978)
portation, and recreation. Shaw ended with an emotional tested the effectiveness of an occupational therapy visual
appeal to the health care community to take up the cause instructional module of common architectural obstacles
of promoting barrier-free design. A more recent paper by on the ability of persons with spinal cord injuries to iden-
Taira (1984) also presented a historical overview but fo- tify specific barriers accurately. This was part of a program
cused more on the needs of older people. She Cited, as to foster independent liVing skills in recently injured pa-
particularly useful to occupational therapy, a series of tients. The 1971 ANSI standards were used to develop
publications from the U.S. Department of Housing and both the visual instructional module and a 359-item
Urban Development (HUD). Taira commented on the checklist organized around the setting and the clients'
importance of considering consumer preferences and needs. Ten clients with spinal cord injuries were random-
weighed the merits of architectural modifications versus ly allocated to a control or an experimental group (5
new construction. She also issued a challenge to the pro- persons per group) and tested on their personal assess-
fession to recognize the need to become more involved, ment of potential living accommodations at two points in
both as practitioners and as consultants. time. Instruction was provided to the experimental group
Four surveys are reported in the literature. Two of by means of the visual instructional mode prior to Time 2.
these (I<iernat, 1972; Liston, 1971) were undertaken as The group receiving instruction demonstrated an in-
occupational therapy class projects. Liston surveyed creased ability to choose a more functional environment,
buildings at Queen's University, Kingston, Ontario, Can- as compared with the control group (p < .05 andp < .01
ada, for internal and external accessibility. Kiernat evalu- on two global measures). Sampling and methodological
ated campus facilities at the University of Wisconsin in issues prevent the generalization of the interesting results
Madison as well as some community structures. Shaw's of this study, but the results do indicate questions related
(1971) five categories were used to guide the data gather- to intervention strategies worth investigating by occupa-
ing of the second survey. Both grou ps of students report- tional therapists. Unfortunately, this has apparently not
ed that they were able to influence local attitudes and that occurred.
as a result of their surveys, a number of structural changes A multidisciplinary intervention, Project Open
were made. Data for both surveys were collected in the House, was reported by Colvin and Korn (1984). This
traditional manner by architectural zone; results are re- undertaking proVided professional input and funding for
ported in a descriptive manner. the making of situation-specific architectural modifica-
A funded study by Martin (1987) addressed the ques- tions in the homes of low-income, physically disabled
tion of ease of accessibility of public buildings by the residents of New York City. The occupational therapist
disabled population. Martin surveyed 13 public bUildings was responsible for completing the initial client needs
of valying age for compliance with 1971 American Nation- assessment, for recommending the architectural
al Standards Institute (ANSI) (ANSI, 1971) specifications. changes, and for training the client and family in the use

346 April 1991, Volume 45, Numher 4
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of the modifications. The assessment form used was de- 1. The identification of particularly difficult design
veloped with the use of AJ'JSI standards and a concern for problems and their solutions
safety (United Cerebral Palsy of New York City, 1984). The 2, Laboratory testing of design criteria
authors stated that evaluations of the program suPPOrt 3, The collaborative development of design criteria
this as a cost-effective way of improving the quality of life 4, A study of the cost of erecting accessible buildings
for these persons and enabling them to remain in the 5, An analysis of economic costs and benefits,
community, The effectiveness of the intervention itself,
Six reports were published by Steinfeld et a!. (1979)
however, cannot be determined from the data reported
as a result of the contract (these would appear to be the
in the article,
same series cited by Taira [1984]), One report is of par-
The present review indicates that occupational ther-
ticular interest to occupational therapists. Two sections-
apy research on barrier-free design is in an early phase of
the scope of barrier-free design and human factors re-
development and cannot be said to demonstrate any well-
search - contain ideas that might provide the common
defined thrusts, Although elderly people have been iden-
conceptual base that is needed by occupational therapy,
tified as a target group in need of barrier-free design, no
studies specific to this group were found, The home-
based checklist orientation espoused by education and Ban-ier-Free Design
practice is strongly evident but, again, no common con- Most gUidelines and architectural assessments have fo-
ceptual framework could be identified, As with the educa- cused on accessibility for persons in wheelchairs on the
tion and practice literature, conceptual trends were noted assumption that an environment that is suitable for such
or could be inferred, Primarily, these were the use of ANSI persons will be equally suitable for persons with other
standards, followed by the use of clusters of constructs, disabilities, This, however, is not always the case; for
either Shaw's (1971) or those of accessibility, mobility, example, the installation of curb cuts, so useful to those in
safety, and function, wheelchairs, is hazardous for persons who are blind, For
The lack of a clearly defined conceptual base pre- the latter, the lack of a clear-cut boundary eliminates the
sents a primary obstacle to further professional develop- warning of the immediate presence of the street and the
ment, lending itself to idiosyncratic interpretations and dangers of traffic: supplementary cuing methods, such as
variations of architectural assessments that cannot be varying the texture of the pavement, are then reqUired,
compared, Fledgling conceptual frameworks can be ex- Issues of this type pose a problem for the making of
trapolated, the most distinct being the use of ANSI stan- environmental changes to improve accessibility in public
dards as well as the focus on individual needs as catego- areas, In the absence of a universal solution, whose needs
rized by a number of different constructs, The strongest should take precedence?
and most pervasive of these thrusts, the use of ANSI RecogniZing that much of the literature on barrier-
standards, is discussed below, free design presented a reductionistic view, Steinfeld et
al. (1979) proposed an ideogram called the Enabler (see
Figure 1), which would allow a broader and simpler con-
~l Swndard ceptualization of disability and, by providing a method for
The use of ANSI standards in construction is currently identifying problems, facilitate design decision making,
voluntary, but they have been adopted by federal agen- The Enabler model represents four general areas of hu-
cies and 50 states to form the basis for most of the cur- man disability that should be considered in the designing
rently used gUidelines on barrier-free design (Martin, of environments: (a) mental functioning, (b) the senses,
1987; Steinfeld et aI., 1979), These standards were revised (c) internal body regulation, and (d) motor impairment,
in 1980 (AJ'JSI, 1980) with input commissioned by HUD These subsume 15 specific areas of disability,
from the University of Syracuse in New York. Phase 1 of Steinfeld et al. (1979), using expert opinion and re-
the research contract, supervised by Steinfeld et al. search findings, then developed 13 problem identifica-
(1979), addressed six factors: tion matrices, These matrices represent aJl the movement
and functional patterns possible in the environment With-
1. The history of the barrier-free movement
out being specific to area, room, or building type (see
2, The extent of the problem
Figure 2), Table 1 depicts an exhaustive list of movement
3, Existing legislation
and functional patterns. Each matrix sets the enabler on
4. The scope of barrier-free design problems
the abscissa and places the design factors on the ordinal.
5, Relevant research
This scheme allows problem areas to be mapped and
6. The effects of barriers on the life-styles of persons
graded according to severity for each design concern
with disabilities and ways of mitigating these
generated.
effects.
Advantages and limitations of this approach are dis-
The second phase built on these findings to focus on the cussed in some detail by Steinfeld et al. (1979). The ad-
foJJowing: vantages include the ability to present the pervasive di-

The American Journal 01 Occupational Therapy 347
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.. .. <,- -I,
~
DIFFICULTY INTERPRETING INFORMATION

SEVERE LOSS OF SIGHT

o

potential problem
o problem
severe problem
impossibility
r-~'
111~-l1i
COMPlETE LOSS OF SIGHT En trances. [xi ts and OooT'flays AB'B2C DE FGH I J K LMN

SEVERE LOSS OF HEARING 1. Extremely narrow door openin gs

PREVALENCE OF POOR BALANCE 2. High thresholds or stairs at
entrance/exit
INCOORDINATION
3. Not enough maneuvering space in
front of doors
LIMITATIONS OF STAMINA
4. Door swings that partially 0 bstruct
DIFFICULTY MOVING HEAD use
DIFFICULTY REACHING WITH ARMS 5. No level space in front of e "try
doors
DIFRCULTY IN HANDLING AND FINGERING
6. Directions unclear or poorly marked
LOSS OF UPPER EXTREMITY SKILLS J -- ~:__-i--i-___:_~.
7. Illogical opening procedure
DIFFICULTY BENDING, KNEELING, ETC. K ----;,...;--..;
8. Great force needed to open doors
RELIANCE ON WALKING AIDS L---~. 9. Stairs in path of travel to an
emergency exit or place of r e fuge
INABILITY 10 USE LOWER EXTREMInES M ----.~~---'
10. Revolving doors on turnstile s
EXTREMES OF SIZE AND WEIGHT N --E:!..........
~!::::J

Figure 1. The Enabler model. Note. From Access to the Figure 2. An example of an Enabler problem matrix. Note.
Built Environment: A Review of the Literature (p. 75) by E. From Access to the Built Environment: A Review of the Lit-
Steinfeld, S. Schroeder, J. Duncan, R. Faste, D. Chollet, M. erature (p. 91) by E. Steinfeld, S. Schroeder, J. Duncan, R.
Bishop, P. Wirth, and P. Cardell, 1979, Washington, DC: Faste, D. Chollet, M. Bishop, P. Wirth, and P. Cardell,
U.S. Government Printing Office. 1979, Washington, DC: U.S. Government Printing Office.

mensions of disabilities in a manner that can be easily this, they presented a useful summary of the information
understood and addressed by a multidisciplinary group. available at the time and identified the existing gaps in
The limitations include the inability of the matrix to iden- each of these areas of barrier-free design. Issues such as
tify that sometimes more practical, alternate ways to ac- the influence of speed, range of motion, accuracy,
cess and use the building may exist. strength, and endurance on function were also discussed.

Human Factors Research Discussion
Most of the research reviewed by Steinfeld et al. (1979) The reports issued for HUD by Steinfeld et al. (1979)
for their report was found in the human factors (ergo- represent a thoughtful and comprehensive state-of-the-
nomics) literature. This body of work explores the fit art statement on barrier-free design and one that is con-
between human performance and the physical environ- siderably more developed than any found in the occupa-
ment. Steinfeld et al. were critical of the mechanistic ori- tional therapy literature. Although Steinfeld et al. 's report
entation of this literature, but found that it produced a is directed toward the design community, the ideas pre-
unifying concept for barrier-free design: buildings con- sented embrace those identified in our review as impor-
ceived of as task environments. This conceptualization of tant to occupational therapy. That is, they subsume the
barrier-free design places acceSSibility into an integrated concepts of safety, acceSSibility, mobility, and perform-
framework of human performance and allows for the gen- ance and address these from the perspective of the per-
eration of a complete list of information needs for design son and disability, and they allow for home assessments
based on the task requirements of the inhabitants. As a and for compliance with building standards. The Enabler
concept, access can be broken down into 10 basic re- model acts as a problem-solVing device that permits the
quirements (e.g., passing through openings [see Table lack of ability to perform activities in task environments to
1]). Each of these requirements in turn has been subdi- be identified and rated. This method of analysis is system-
vided; the result is an exhaustive list of possibilities. atic, exhaustive, and congruent with the occupational-
Steinfeld et al. (1979) reviewed and critiqued this functional orientation of our profession.
literature, organized by the headings of (a) functional Steinfeld et al.'s (1979) conceptualization is broader
anthropometry, (b) biomechanics, (c) information dis- and more developed than the present occupational ther-
play, and (d) specific task environments On the basis of apy site-specific mode of home assessment, because it

348 Apn'l 1991, Volume 45, Number 4
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Table 1 allows both individual and group needs to be addressed
Information Needs in Designing Accessible
by the same model and permits homes, institutions, and
Environments
community areas to be similarly assessed. This represents
Task Information Needs
an improvement over our more limited approach. Al-
1. Passing through openings Height of openings though they represent very different disciplinary bases,
Width of openings
Shape of openings both the occupational therapist and the designer gather
Maneuvering clearances information on accessibility for the same purpose: to con-
2. Operating electronic and Configuration of control struct an environment that is responSive to functional
mechanical controls Location vis-a-vis reach
Force of activation needs and that facilitates performance. It is particularly
Activation motion important to note that the adoption of the Enabler matrix
Speed of activation would permit a consistent format for data collection by
Relationship to other control
Type of feedback any discipline on aJl settings, persons, and disabilities.
3. Moving along route of travel Characteristics of surface The advantages of the establishment of such a common
Friction between user and surface data pool are obvious and enormous. For example, the
Length of routes
Width of path development of a large or representative database of in-
Exposure along route (to climate) formation would allow for the generalization of findings
Overall paltern of circulation and the meaningful application of results from disparate
4. NegOtiating changes in level Degree of slope for ramp incline
Configuration of stair nosing studies. Finally, Steinfeld et al.'s ideas have formed the
Stair shape and size basis for the Jast ANSI revision and as such, serve to
Length of run fm incline of stairs include various levels of government on the multidisci-
Location and configuration of
assistS plinary barrier-free design team and to proVide a gold
Configuration and size of landings standard for prOViding accessible environments.
5. Transferring from one body Number and type of assists
posture to another needed for transfer
Location and configuration of Conclusion
assists
Strength of assists The profession of occupational therapy has traditionally
Size and configuration of transfer
clearances been concerned with accessibility and barrier-free design.
Size and configuration of built-in This concern has tended to be case- and home-specific. A
elements that are transfer review of the literature indicates that both a conceptual
points (e.g, toilet)
6. Searching for and Information needs base and research on the topic are needed. Because the
interpreting direction-finding Type of coding method demands for accessible environments are increasing, par-
information Location of display ticularly to enable elderly and disabled persons to remain
Exposure of display
Content of information needed in the community, increased occupational therapy input
Number of displays needed will be required in the future. The literature reviewed
Complexity of information raises our awareness of three important issues: the need
transmitted
Symbolic content of information to develop the occupational therapy base of research and
7. Negotiating a series of Size and configuration of practice; the growing acceptance of ANSI standards; and
movements in a confined clearances the existence of a cadre of concerned and welt-informed
space Layout of elements in a space
Proximity of elements to each designers and an architectural literature base. Steinfeld et
Other al.'s (1979) Enabler model may provide a viable person/
8. Negotiating human and Constraints on traffIc flow disability/function model for the extension and unifica-
vehicular traffic Controls on now rate and
direction tion of the present occupational therapy concepts relat-
Separation of human and ing to barrier-free designs as well as a link to the
vehicular traffIc multidisciplinary design team In return, we can offer the
9. Using flXtures, storage, and Height
work surfaces Approach clearances health care perspectives and skills unique to the profes-
Configuration of fixtures sion of occupational therapy, that is, our knowledge of
Size specific diseases and disability, of life-span development,
10. Avoiding hazards in the path Definition of hazards thaI should
of access be avoided and of how these various processes may influence func-
Configuration of hazard-free zone tion. Together we can enhance and strengthen design
Size of hazard-free zone decisions and the provision of barrier-free environments
Guards against exposure to
hazards for elderly and disabled persons ....
Size and configuration of warning
signals Acknowledgments
Note. From Access to tbe Built Envimnmenl.· A Review oftbe Literature
(p 103) by E. Steinfeld, S Schroeder,]. Duncan, R. Faste, D. Chollet, M. We are gratefUl for the support of the Canadian Occupational
Bishop, P. Wirth, and P. Cal"dell, 1979, Washington, DC: US. Govern- Therapy Foundation and the Social Sciences and Humanities
ment Printing OffIce. Research Council of Canada.

Tbe American journal of Occupational Therapy 349
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Refl:renct:s architectural barriers. American jow77al of Occupalional
Tberapy. 26, 10-12.
American National Standards Institute, Inc. (1971). Ameri- Levine. R. E. (1988). Community home health care. In H.
can National Standards specifications for making buildings Hopkins & I-I. Smith (Eds.), Willard and Spackman's occupa-
and facilities accessible to, and usable by, Ihe phvsically tional therapy (7th ed., pp. 756-780). New York: Lippincott.
handicapped. New York: Author. Liston, R. (1971). Learning experience: Architectural har-
American National Standards Institute, Inc. (1980). Ameri- riers survey. Ccmadianjournal of Occupational Therapy, 38,
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