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Environmental Mastery
chapter 16
36
Other
Post-Graduate
06/19/2014

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Term
Context
Definition
includes cultural, personal, temporal and virtual
Beyond the physical and social environment
conditions surrounding the client
Term
ADA
Definition
civil rights law
accessible environment
policies on public service, employment and public accommodations
Term
Omnibus Budget Reconciliation Act (OBRA)
Definition
restraints cannot be used without proper justification and documentation
Term
IDEA
Definition
children with disabilities are in least restrictive environment
Term
Environmental Evaluation
Definition
Identify and Prioritize needs, goals, desires, problem areas
establish abilities
assess functional use of devices
Identify device's availability, safety and cost
Determine device's location/frequency of use
Determine funding before showing client
Term
client factors and contextual factors of environmental evaluation
Definition
sensory skills, visual-perceptual processing skills, musculoskeletal skills, neuromuscular skills, cognitive skills, psychosocial skills

Contextual include physical considerations and sociocultural considerations
Term
Home Evaluation General Consideration
Definition
type of dwelling
Protection from weather
Driveway
Level
Entrance and accessibility
Stairs
Railings
Door sills
Width of elevator, doorways, hallways,
Opening of doorways
Door handles
Obstructions
Pets
Carpeting
Electrical Cords
Seating
Light Switches
Telephones
Smoke Detectors
Space heaters
Emergency call system/exit plan
Term
Railings
Definition
Interior railing 1 1/2" from wall
Exterior - waist high or 34-38"
Railing - 1 1/2 to 2 " in diamerity
Term
Doorways
Definition
Minimum 32"
Optimal 36"
Term
Hallways
Definition
Minimum 36"
Term
Opening of doors
Definition
18" using walkers
26" using wheelchairs
Term
Home Eval - Bedroom
Definition
Bed height, size, etc
Accessibility to bed
Clothes accessible
Room for commode
Term
Home Eval - Bathroom
Definition
Number of
Location
Width of doorway
Type of bathing ability
Grab bars, etc. availability to add
Height of tub, sink, toilet
Throw rug
hand held shower,
anti-scald
Term
Home Eval - Kitchen
Definition
Meal prep devices
Countertop
Direction of opening for items
Accessibility of food, pts, etc
Fire extinguisher
Anti scald
Term
Falls Evaluation - Intrinsic Factors
Definition
Sensory changes:
vision
Vestibular
Age related changes
Pathological state
Medications
Delirium/dementia
Anxiety/depression
History of
Fear of
Term
Falls Evaluation - Extrinsic Factors
Definition
Floor
Toys
Pets
Carpets
Furniture
Stairs
Footware
Poor lighting
Poor threshold
Extension cords
Transfer techniques
A/E
No grab bars
Soap issues
Toilet seat hight
Wet floor
Low bcabinets
Movable chairs
Height of bed,
Closets
Wires and Clutter
Chairs too high
Term
Prevention of Falls
Definition
Determine Functional problems
Take away risk factors
Improve functional mobility through tx. and interventions
Provide Sensory compensation strategies
Modify ADLs
Adapt and Modify activities
Teach energy conservation techniques
Communicate w/ family and caregiver
Modify environment to reduce falls
Provide safety guidelines to follow
Provide psychological support and specific interventions
Term
When a fall happens
Definition
Check for:
Fall injury
Head injury
Spinal Cord injury
Dissiness that may have preceded fall
Provide reassurance
Provide first aid
Call emergency
don't life pt.
Solicit witness
document incident
Refer to fall prevention program
Term
Average w/c measurements
Definition
width 24 - 26 " rim to rim
length 42 - 43 "
Term
Turning measurements for s/c
Definition
Clearance space of 60" x 60"
Term
Maximum countertop height
Definition
31"
Term
Parking Spaces
Definition
4' aisle
Term
Pathways and walkways
Definition
48" wide
Term
Ramps
Definition
minimum of 36" wide
non skid surface
ratio of slope to rise 1:12
(for every 1" rise 12" of ramp needed)
Term
Railings
Definition
29" - 36" high (32" is average)
Term
curbs on ramps

landings on ramps
Definition
4" high

if ramp is too long requires a landing
Term
Height for side reaching

w/ counter
Definition
48" high without obstruction

46" w/counter
Term
90 degree turns on ramp
Definition
minimum of 4' x 4' on landing
Term
180 degree turn on ramp
Definition
minimum of 4' x 8' on landing
Term
in front of a door off of a ramp
Definition
5' x 5' platform
12" before the door to allow door swing
Term
w/c assessment
Definition
sensory issues
neuromuscular issues
musculoskeletal
cognition
psychosocial
Personal assessment
Contextual assessments
W/C characteristics needed
Developmental Considerations
Cultural and Social and Contextural considerations
Term
Wheelchair components
Definition
Armrests - wraparound spacesaver saves wheelchair 1" space
Legrests - elevating - edema
Footplates
Tires
Casters - solid core best - locks avail.
Frame - fixed - sports &older
Weight
Flexibility
Anti-tippers
seatbelts
harnesses
arm trough, lap board
head supports
brake extensions
hillholder
Term
W/C Measurements
Definition
Measure width across hips and add 2"
for bariatric - measure at forward edge of seated position
Depth - posterior portion to popliteal fossa (back of knee) and subtract 2 inches
back height - based on ability, posture, needs, etc. - take measurement from seat surface (including cushion) to either: under scapula by 1-2" - mid scapula - or top of shoulder
Seat height - knees and ankles should be positioned at 90 degrees, footrests 2" clearnace from floor
standard - 19.5
hemi-height 17.5
super low 14.5
Armrest height - measure under elbow to cushioned seating (shoulders in neutral and elbows at 90 degrees)
Term
Bariatric considerations
Definition
hard tires, adjustable backrest, reclining wheelchair, power application
Term
Wheelchair mobility training
Definition
Assess Cognition
Posture
Pressure relief
Purpose
Time schedule & weight shifts
propulsion
Safety
Manipulate parts
Maneuver
Negotiate
Maintenance
Developmental considerations
Independence
Term
Goals of seating and positioning
Definition
provide stability control and comfort
Promote Proximal Stability
Decrease the risk of muscle contracture, deformity, decubiti
Increase sitting tolerance and enrgy level
Increase function
Allow for pressure distribution and support
Allow for proper positioning and correct alignment of trunk and extremities
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