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Environmental Barriers

Chapter · January 2008

DOI: 10.1016/B978-1-4160-3205-2.10009-0

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ISBN: 978-1-416-03205-2 Author: O’Young Chapter code: 10009

10009

ENVIRONMENTAL BARRIERS:
SOLUTIONS FOR PARTICIPATION,
COLLABORATION, AND TOGETHERNESS
CHAPTER 9

Steven A. Stiens, MD, MS, Shoshana Shamberg, OTR/L, MS, Aaron

Shamberg, OTR/L, MS, and Alessandro Giustini, MD

Rehabilitation is often like surgery from the skin. . .out.

–Steven A. Stiens (1993)

s0010 1. From a rehabilitation perspective, what aspects of the environment require

evaluation and prospective treatment?
p0010 The environment is everything that surrounds and interacts with the patient, providing a unique
habitat for each person:
u0010 & The physical aspects include the object constellation and morphology as well as the energy

distribution.
u0020 & The social aspects are the responses of the living community surrounding the patient:

family, neighbors, interdisciplinary team, and any others who may have contact with the
patient.
u0030 & The political aspects dictate laws and specify characteristics of the built and community

environments as well as the rights of persons living with disablement.

p0020 Various models of the environment are described in the current literature. The World Health
Organization model divides the environment into human-made changes; support and
relationships; attitudes; services; and systems and policies. Other similar models include the
Quebec Model (1995), the Institute of Medicine (1997), and the recent Craig Hospital
Inventory of Environmental Factors (CHIEF), designed as a questionnaire.
p0030 IDEA—Center for Inclusive Design and Environmental Access: www.ap.buffalo.edu/
idea
p0040 Whiteneck G, Harrison-Felix C, Mellick D: Quantifying environmental factors: A measure of physical,
attitudinal, service, productivity, and policy barriers. Arch Phys Med Rehabil 85:1324–1335.

s0020 2. Describe the relationship between personhood and the physical environment.
p0050 Human behavior is carried out through interaction with the physical environment.
Normal human development requires in-depth perception and manipulation of the environment
as well as self-propulsion through the environment. From these interactions, one develops a
working knowledge of the environment. The capabilities acquired from these interactions define
our freedom to move about and modify the environment to our personal specifications.
These experiences of ‘‘mastery’’ are internalized as self-discovery. Mastery becomes a
behavioral pattern that is successful and is acted out in relationship to the surrounding world. It
is uniquely human to adapt to the environment, and to adapt the environment to our
specifications.
p0060 Designing a More Usable World: www.trace.wisc.edu/world
p0070 Future Home Foundation: www.thefuturehome.net
p0080 Government Disability Information and Agencies: www.disabilityinfo.gov/digov-public/public/DisplayPage. AU:11
do%fparentFolde. . .
p0090 National Resource Center on Supportive Housing and Home Modification: www.homemods.org
AU:1

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ENVIRONMENTAL BARRIERS: SOLUTIONS FOR PARTICIPATION, COLLABORATION, AND TOGETHERNESS 77

s0030 3. How does a new injury or illness affect the person–environment relationship?
p0100 Immediately after a catastrophic illness or injury, the experience of the body is radically
distorted. Body image may be altered because of new deficits in perception, sensation, motor
performance, and loss of body parts. Environmental perception may be altered as a result of
sensory deficits or neglect. This situation is compounded by the depersonalization of
hospitalization; patients are separated from the familiar, immediate environment of their clothes
and personal items and may be confined to a bed in a horizontal position. Initially,
communication as a means to share personal identity and to affect the physical environment
frequently dominates the interaction. During this vulnerable period, patients’ requests should be
encouraged and fulfilled as reassurance that patients can meet their needs in spite of new
functional limitations. Effective nursing, adaptive call lights, and access to television and
telephone provide critical personal environmental control.
p0110 A person in a new body interacting with their new environment is like an infant testing the
environment of their crib. Testing and modifying the environment through verbal and physical
interaction are crucial for beginning the problem-solving process and eliminating potential
barriers to independence. Patients carry old memories, impressions, and attitudes into their
current experience of disablement. Early ‘‘experiments’’ of environmental interaction in the new
state confirm or refute their expectations and adaptive behavior. The ongoing process of
adaptation is an operant process that is shaped in a variety of perceptual and physical
interactions, including multiple spontaneous activities, repetitions, and problem solving. In this
context, rehabilitation is a process of acquisition of functional skills, known as disability-
appropriate behaviors, and extinction of maladaptive, disability-inappropriate behaviors. The
adaptive habits need to be cued, supported, and enabled by the adapted habitat. Many of the
limitations experienced by persons with physical cognitive and sensory limitations can be
attributed to their environment.
p0120 Adaptive Environments Center (AEC): www.adaptenv.org

s0040 4. Can physical environment be divided into spaces that guide intervention from a
person-centered perspective?
p0130 Figure 9-1 depicts the spaces of the environment from a person-centered perspective:
o0010 1. Rehabilitation treatment within the immediate environment (in constant direct
contact with the person) includes specialized dressings, orthotics, prosthetics,
adaptive clothing, communication devices, adaptive or assistive technology for
toileting and feeding, and mobility devices. These aspects can be addressed in any care-
giving setting.
o0020 2. The intermediate environment (adapted specifically for inhabitants, adapted home or office)
includes designs emphasizing function, safety, and personal style.
o0030 3. The community environment (surrounds the homes) not only includes the
physical structure, but also includes people and institutions governed by a common
culture and law.
o0040 4. The political component specifies access and rights of persons with disabilities.
o0050 5. The built environment component includes public and private buildings. Many
structural changes have been implemented in accordance with the Americans with
Disabilities Act (ADA), the Rehabilitation Act (Section 504), and Fair Housing Act (FHA)
legislation.
o0060 6. Finally, the natural environment (surrounds the community-modified space) presents
access challenges that can be overcome with specialized skill acquisition, adaptive
landscaping, and terrain-specific mobility aids.
p0140 Stiens SA: Personhood disablement and mobility technology: Personal control of development. In Gray DB,
Quatrano LA, Liberman M (eds): Designing and Using Assistive Technology: The Human Perspective. AU:12
Towson, MD, Paul Brookes, 1998.

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Intermediate
environment

Immediate
environment

Community environment

Natural environment

f0010 Figure 9-1. The spaces of the environment from a person-centered perspective.

s0050 5. How can the rehabilitation team enhance patient interactions with the
environment?
p0160 Environmental spaces are a substrate for rehabilitation intervention. The goal is for the patient
to rediscover a healthy, productive interaction with the environment that allows the achievement
of life goals. Clinicians and therapists should explore patient memories of particular satisfaction,
prowess, and access in certain places. Through analysis of these interactions an intervention
plan is formulated to make stepwise changes to the patient’s environment, progressing from the
immediate environment out. The interdisciplinary team also addresses the patient’s person-
centered goals and links them to adapted tasks.

s0060 6. What assessment techniques can be used by the interdisciplinary team to target
environmental barriers and formulate solutions to maximize functional
independence?
p0170 Patient life behaviors can be elicited with retrospective sociobehavioral mapping, which is a
step-by-step review of where patients have gone, who they were with, what they were doing, as
well as their intentions for activities. Negative findings are often the most significant intervention
foci: where patients don’t go, what they are not doing. The information can be diagramed on
floor plans or community maps.
p0180 Intervention in the form of adaptive equipment often evolves as a continuum, starting with the
design of the person’s immediate environment (e.g., braces, wheelchair) and progressing to the
intermediate environment (the patient’s home). The community and natural environments are
emphasized during the latter phases of the process.

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ENVIRONMENTAL BARRIERS: SOLUTIONS FOR PARTICIPATION, COLLABORATION, AND TOGETHERNESS 79

p0190 Assessment of the home environment can include drawn floor plans, photographic/video
depictions, or home visits. Success in the home and community is achieved with passes,
predischarge home visits, and community outings. In essence, the goal is to progressively
design an environment that enhances personhood (with objectives of safety and independence)
and reflects the characteristics and goals of the patient in concert with others. Successive
approximation of the home environment is through adaptation of the hospital room and trial
living quarters as trial environments.
p0200 Giustini A: Activity and participation: New technologic possibilities to estimate and correlate them to
rehabilitation treatments. Third World Congress of the International Society of Physical and Rehabilitation
Medicine, Sao Paulo, Brazil, April 10–15 2005. Acta Fisiatrica 12(Suppl 1):S10, 2005.
p0210 Keysor J, Jette A, Haley S: Development of the home and community environment (HACE) instrument.
J Rehabil Med 37:37–44, 2005.

s0070 7. Describe four transitional environments in current use as part of community

rehabilitation units today.
p0220;o0070 1. Hospital beds and rooms on a series of units are designed for various independence levels:
intensive care, step down, telemetry, and rehabilitation unit.
o0080 2. Independent living trial apartments have real-world, generic, unmodified, and modifiable
characteristics to adapt for home simulation and to challenge the patients, caregivers, and
family to develop adaptive solutions.
o0090 3. Simulated community environments are designed for trial life scenarios without leaving the
hospital.
o0100 4. Selected community environments are for activity-specific trials.
p0230;

KEY POINTS: ENVIRONMENTAL ADAPTATIONS

o0110 1. Environmental modifications can improve activity, participation, role function, and
vocational success.

o0120 2. A functional history combined with a sketch of a home floor plan and community map is an
effective method for documenting life activity.
o0130 3. Use of retrospective sociospatial mapping and family scenario mapping can suggest
environmental changes and allow for virtual projection of the proposed impact as well as
actual outcome assessment.

s0080 8. In planning discharge to home, what other assessments are needed to help
change the patient’s immediate environment to meet personal needs?
p0240 Role changes may result from functional limitations that prevent the patient from
performing various activities or home duties. Preparation is accomplished through family
scenario mapping (i.e., verbal review of family activities to redefine tasks by interest and
aptitude). In addition, transitions can be facilitated by practice with therapy, as needed for
bathroom and kitchen activities, housekeeping, gardening, home maintenance, childcare, and
marital relations.
p0250 ADA Barrier Removal Checklist: www.usdoj.gov/crt/ada/racheck.pdf
p0260 Fange A, Iwarsson S: Changes in accessibility and usability in housing: An exploration of the housing
adaptation process. Occup Ther Int 12(1):44–59, 2005.

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s0090 9. What adaptive options should be focused on in a functional home assessment

that will enhance a patient’s activity and participation?
p0270 An occupational therapist should accompany the patient and other occupants to follow the
sequence of movements he or she would take to, and through, the home. The therapist should
consider such environmental elements as:
u0040 & Public transportation access (stops, sidewalks, safety)

u0050 & Parking (wide, covered, and level; motion-activated lighting)

u0060 & Steps (ramp, 20/1 inch length over rise; ratio, 4 degrees or 12/1 is maximum steepness)

u0070 & Entrances and doorways (level porch, flat or ramped threshold, light switch, security system)

u0080 & Telephones (cordless, multiple, headset options)

u0090 & Exterior walkways and driveway (level, lighted, rails)

u0100 & Interior stairs (gates, bilateral rails, lift options)

u0110 & Bathroom (door, commode height, grab bars, shower transfer, hand-held sprayer, controls,

drainpipe insulation)
u0120 & Kitchen (reach ability, storage, food prep, cooking sequences, clean up, and reach for dish

storage)
u0130 & Security (on-person alert system for falls, building wide with intercom, cameras, remote lock

control)
u0140 & Storage (including closets and dressers)

u0150 & Laundry facilities (front loading, reacher)

u0160 & Interior hallways (avoid loose rugs)

u0170 & Access to floors (outside walks, entrances, stair lifts, elevators)

u0180 & Living/dining room (furniture height, serving access)

u0190 & Breaker/fuse boxes (location)

u0200 & Floor surfaces (durable, nonslip)

u0210 & Environmental control units (ECUs) (location, power backups)

u0220 & Interior lighting (touch-, voice-, or ECU-activated)

u0230 & Emergency (lighting, escape pathways, fire extinguisher, smoke alarms)

p0280 Accessible Home Tour—Assistive Technology Partners: www.uchsc.edu/atp/adapted_home/adapthome.htm

Easter Seals home mods checklist and accessible home virtual tour: www.easterseals.com/site/
PageServer?pagename¼ntlc_easyaccesshousing
p0290 Fange A, Iwarsson S: Accessibility and usability in housing: Construct validity and implications for research
and practice. Disabil Rehabil 25:1316–1325, 2003.
p0300 Livable Homes Tour—Universal Design Teaching Aide: www.livablehomes.org
p0310 Ramp Building Design Guide: design.ncsu.edu/cud/pdf_files/rampbooklet296final.pdf
AU:2
10. How is accessibility defined in the community environment?
s0100

p0320In the United States the Federal Access Board does extensive accessibility research with a
variety of experts in design, architecture, medicine, and technology. Guidelines are generated for
the federal level, but state and local guidelines vary. The access board in Washington, D.C., has
extensive information, publications, and technical assistance services to address the
government regulations for compliance with such laws as ADA, the Rehabilitation Act,
Architectural Barriers Act, etc. A hard copy of accessibility guidelines can be obtained by calling
AU:3 202-272-5434.
p0330 Access Board: www.access-board.gov/ada-aba/final.htm

s0110 11. What are the rights of a tenant with disability?

p0340 The Fair Housing Act of 1988 mandates accessibility compliance and civil rights protection in
private housing. Persons with disabilities are provided equal access. The resident cannot be
denied the opportunity to modify the rented home to meet individual accessibility needs. The
cost of modification is paid by the renter. In addition, the landlord may require that the work be
done by an approved professional, and an escrow account may be established in which the
tenant must place funds for returning the residence to its original state. Modifications that are

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easily used by future renters (universal design) can be left intact. A physician’s prescription for
modifications as ‘‘medically necessary’’ permits a tax deduction for expense. Section 504 of the
Rehabilitation Act of 1973 mandates that public housing and housing subsidized with federal
funds be accessible and adaptable to meet the needs of tenants with disabilities.
p0350 Fair Housing Act Design Manual: www.huduser.org/publications/destech/fairhousing.html
p0360 Fair Housing Tool Kit: www.knowledgeplex.org/
p0370 Universal Design Accessibility article: www.mdtap.org/tt/1997.06/ttbarriers.html
AU:4
s0120 12. Discuss environmental adaptations for bathrooms.
p0380;u0240 & Multilevel or adjustable sink heights and countertops provide accessibility from standing and

seated positions.
u0250 & Plumbing should be installed toward the back wall with hot water pipes insulated and water

temperature set to prevent burns.

u0260 & Single-levered faucet handles are universal.

u0270 & Automatic faucets, hand dryers, wall-mounted electric toothbrushes, and soap/shampoo

dispensers may be installed for a person with limited hand function and upper body strength.
u0280 & Toilet height of 17–19 inches allows horizontal transfers from wheelchairs and eases standing

and sitting. However, child access with a stool and/or exclusion with lidlock may be needed
for safety.
u0290 & An ideal grab bar system is individualized for tub and toilet access that enables greatest

efficiency and safety.

u0300 & A hand-held showerhead on an adjustable-height track can be used for bathing from a seated

or standing position.
u0310 & Padded shower chairs with back support are safe and practical.

u0320 & Tub lifts, which lower a person into a tub, can be controlled by hydraulic, battery, or manual

mechanisms.
u0330 & A rubberized mat and tub strips provide a nonslip surface.

u0340 & An angled mirror and a side-mounted medicine cabinet can be used from a standing or seated

position.
u0350 & Adequate lighting is nonglare, preferably with sconces and multiple bulbs or adjustable

intensity.
u0360 & A ground fault intercept (GFI) outlet prevents electrocution from the use of electrical

appliances near a sink or other source of water.

u0370 & Contrasting the color of surfaces, especially background and foreground, enables people with

visual or cognitive impairments to see and define surfaces.

p0390 Adaptable Bathrooms Manual: www.abilitycenter.org/webtools/links/adaresources/AdaptableBath.pdf
Wheelchair Mobility Standards: www.ap.buffalo.edu/idea/Anthro/index.asp

s0130 13. Which is the most dangerous room in the house?

p0400 The bathroom. Bathroom accidents are one of the leading causes of death and disability in the
older population. Shower and tub falls rank as the third leading cause of accidental death in the
50-plus age group. More than half of all accidents could be prevented with some sort of
environmental modification.
p0410 Adaptable Bathrooms Manual: www.abilitycenter.org/webtools/links/adaresources/AdaptableBath.pdf

s0140 14. List design possibilities and features for mobility-challenged adaptations for
kitchens.
p0420 Access-friendly kitchens should have cabinets with high, deep kick plates for toe space, a U- or
L-shaped floor plan for traffic flow, an appliance and storage sequence for recipe completion to
service and clean up, and a stove in lowered countertop with side or front controls and angled
mirror overhead. For ease of mobility, a side-swinging oven door, pullout shelves, and lazy
Susans are helpful. Also, continuous countertops for sliding heavy vessels, pullout or lap cutting

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boards, shallow sinks, long, retractable sprayer hoses, task lighting, reachable fire
extinguishers, and strip outlets with on/off switches are popular innovations.

s0150 15. A single woman with mild dementia had to be discharged home. Suggest
possible environmental solutions for challenges she may face.
p0430;o0140 1. Providing environmental cues to address safety, memory, and communication deficits.
o0150 2. Personal emergency response system with medication management and training in the use
of the devices, with monitoring of her ability to learn.
o0160 3. Automatic medication management system set up weekly by a home care nurse.
o0170 4. Burglar alarm and posted fire escape plan that has been learned, practiced, and monitored
regularly.
o0180 5. Smoke alarms hot-wired with battery backup.
o0190 6. Emergency lighting in case of power failure.
o0200 7. Daily calls to monitor her ability to care for herself.
o0210 8. Meals on Wheels and use of microwave with electric hot-water pot.
o0220 9. Electric range or microwave oven. Avoiding use of a gas stove. Automatic turn-off controls
to address memory deficits.
o0230 10. Posted instructions on the step-by-step use of all appliances and their safety issues.
o0240 11. Preprogramming frequently used telephone numbers for one-button speed calling.
o0250 12. Use of a tape recorder to record daily instructions or for message taking.
o0260 13. Providing opportunities for the patient to access as many community resources as needed
to maintain her independence, health, and safety and to promote socialization (e.g., support
groups, religious associations, social service agencies, and transportation).
p0440 ADA Documents Center: www.jan.wvu.edu/links/adalinks.htm
AU:5
p0450 ADA and IT: www.adainfo.org/accessible/it/
p0460 ADA Accessibility Guidelines on Recreational Facilities: www.access-board.gov/recreation/guides/index.htm

s0160 16. What is visitability? Why is this movement important?

p0470 Visitability is a design concept for residential households that promotes the creation of communities
in which people of all abilities and disabilities, especially mobility impairments, can get into the door
and use at least one bathroom when visiting neighbors. This concept provides a bridge from the
intermediate to the surrounding community environment and fosters social interdependence
(neighbor role) and relationships that can offer natural supports for persons with disabilities.
p0480 Center for Universal Design: www.design.ncsu.edu/cud
Concrete Change/Visitability Resources: http://concretechange.home.mindspring.com
AU:6
s0170 17. What interior home and community features enhance success for persons with
visual impairments?
Interior: home
p0490;u0380 & Increase lighting and reduce glare to increase acuity.

u0390 & Contrast solid colors to define surfaces and edges.

u0400 & Post large print with raised letters or use voice output on signage and controls.

u0410 & Vary textures to define edges and boundaries.

u0420 & Illuminate switches.

u0430 & Install nonskid, matte-finish floor surfaces.

Exterior: public spaces

p0500;u0440 & Use auditory signals for crosswalks
u0450 & Record short verbal messages about opportunities or barriers in the area.
p0510 Iwamiya S, Yamauchi K, Takada M: Design specifications of audio-guidance systems for the blind in public
spaces. J Physiol Anthropol Appl Human Sci 23: 267–271, 2004.

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s0200 18. What might aid persons with hearing impairments?

p0520 Facing furniture arrangements with good lighting and wall-mounted mirrors to present faces for
interpretation. Communication technology such as telecommunications device for the deaf
(TDD) telephone, fax machine, and telephone relay system. Vibrating or light cues for clocks,
telephones, doorbells, and baby monitors.

s0210 19. What does the phrase ‘‘aging in place’’ mean?

p0530 Over the past decade, older persons have overwhelmingly reported that they would prefer to
remain in their homes as long as possible. Single-level homes with wide floor plans, or attached
separate apartments on bus lines, near shopping, and potential attendant help are most ideal.
p0540 AARP Home Modifications Guide: www.aarp.org/families/home_design/
p0550 Administration on Aging—remodeling resources: www.aoa.gov/eldfam/Housing/Home_Remodeling/
Home_Remodeling.asp
p0560 CASPAR Extended Home Living Services—home mods assessment tool: www.ecaspar.com/ec/CASPAR.pdf
p0570 Universal Home Design Guide: www.mhfa.state.mn.us/homes/Access_Remodeling.htm
AU:7
s0220 20. Describe a series of steps that might identify safety risks, functional barriers,
and an economical response to identified needs.
p0580;o0270 1. Client activities of daily living (ADLs)/home safety screening survey by direct mail or
telephone visit
o0280 2. Home environment: on-site home safety assessment in cases as defined by survey
thresholds
o0290 3. Functional and environmental assessment with individualized modification and patient
rehabilitation on program operated by specially trained occupational and physical therapists
o0300 4. Occupational and physical therapy with trial of interventions and specified planning for
modifications and installations
o0310 5. Product installation and home modification
o0320 6. Client/caregiver training to help maximize the client’s independence, wellness, and quality of
life, as well as increasing the efficiency and safety of caregiver assistance
p0590 National Organization on Disability (NOD)—Access to Worship Checklist: www.nod.org/index.cfm?
fuseaction¼page.viewPage&pageID¼1430&nodeID¼1&FeatureID¼399&redirected¼1&C
FID¼5162137&CFTOKEN¼16611784
p0600 Practical Guide to Universal Home Design: www.uiowa.edu/infotech/universalhomedesign.pdf
p0610 Removing Barriers to Health Care Guide: www.fpg.unc.edu/
ncodh/RemovingBarriers/
removingbarrierspubscfm
p0620 United Spinal Association publications: www.unitedspinal.org/pages.php?catid¼7

s0230 21. What should be considered when formulating solutions to functional and
environmental barriers to maximize independence and safety?
p0630;u0460 & Consider the goals of the client to achieve the maximum level of independence and safety for

daily activities at home to the jobsite/school environment/community.

u0470 & Consider the caregivers and others living in the home.

u0480 & Consider strengths and weakness in sensorimotor, cognitive, and psychosocial functions.

u0490 & Consider the progressive nature of the client’s illness/disability and future needs.

u0500 & Target environmental barriers along a route from parking to building entrances and

throughout the interior space, considering safety, maximum independence, and adaptability
of the environment.
u0510 & Assess the need for specialized equipment and training in its use. Internet product research is now

a very effective way to find products, evaluations of those products, and distributors.
u0520 & Prioritize all suggestions (client/caregiver in consult with the team) according to the

immediate requirements needed for functioning/caregiving, including getting in and out of the
home, training in transfers, ADLs, mobility, compensation techniques, stress management,
and safety issues according to the financial resources available to the client.

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u0530 & Provide resources for the client and caregivers of specially trained professionals, support
services, and funding options if needed.
u0540 & Provide ongoing consultation to designers, building contractors, and client during the design

and construction phase.

u0550 & Consider financial constraints and potential resources from medical insurance, community

resources, and loans/grants.

p0640 Consideration of all these factors will ensure greater levels of success in carryover of the
rehabilitation process and community integration of the person once discharged from inpatient,
intermediate care, and home-care therapy. In addition, periodically monitor progress and
challenges once environmental modifications and assistive technology are in place and in use.
Address issues of the person when functioning in his or her environment, as well as issues
of the caregiver. Adjust elements as needed to promote success, maximum safety, function, and
independence.

BIBLIOGRAPHY

1. Shamberg S: Optimizing access to home, community, and work environments. In Trombley CA, Radomski MV
(eds): Occupational Therapy for Physical Dysfunction, 5th ed. Philadelphia, Lippincott, Williams & Wilkins, 2001
AU:8 2. Shamberg S: Occupational therapy practitioner: Role in the implementation of worksite modifications. IOS
24:185–197
3. Stiens DW, Stiens SA: Environmental modifications and role functions: Redesign of a house for a family with a
paraplegic father. J Am Parapleg Soc 16:278–279
4. Wylde M, Baron-Robbins A, Clark S: Building for a Lifetime: The Design and Construction of Fully Accessible
Homes. Newtown, CT, Taunton

AU:13 RESOURCES

1. ABLEDATA (www.abledata.com): a database of information on assistive technology and rehabilitation

equipment designed to serve persons with disabilities and rehabilitation professionals. Contact Kathryn Belnap:
800-227-0216.
2. Abilities OT Services and Seminars (www.aotss.com): see www.aotss.com for a complete listing of
organizations and publications (3309 W. Strathmore Ave., Baltimore, MD 21215-3718; phone: 410-358-7269;
fax: 410-358-6454). Technical assistance, publications, and Internet and on-site training programs for medical
and design/build professionals on home modifications, job-site modifications, disability legislation compliance,
and assistive technology.
3. American Occupational Therapy Association (AOTA): www.aota.org or 800-729-2682: a list of environmental
access specialists in occupational therapy by region and technical assistance information on home
modifications and assistive technology.
4. American Society of Interior Designers (ASID): www.asid.org or 608 Massachusetts Ave., NE, Washington, DC
20002–6006; phone: 202-546-3480; fax: 202-546-3240.
5. ADAPT (advocacy for independent living): www.adapt.org
6. Adaptive Environments Center (AEC): www.adaptenv.org
7. Andrus Center: at-home modification publications and information/directory of consultants; www.homemods.
org
8. Association of Assistive Technology Act Programs: www.ataporg.org
AU:9
9. Center for Universal Design: www.design.ncsu.edu/cud
10. Delaware Assistive Technology Initiative (DATI) Fair Housing and AT Resources: www.dati.org/newsletter/
issues/2002n3/MultifamilyConstruction.html
11. Designing a More Usable World: www.trace.wisc.edu/world

AU:10 12. Easter Seals: www.easter-seals.org/resources/easy.asp or 230 W. Monroe St., Suite 1800, Chicago, IL
60606; phone: 800-221-6827; 312-726-6200; 312-726-4258 (TTY).

O’Young, 978-1-416-03205-2
ISBN: 978-1-416-03205-2 Author: O’Young Chapter code: 10009

10009

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Book: Physical Medicine and Rehabilitation Medicine
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