Ali Karabulut - Spinal Cord Injury (SCI) Pages

 

HOME SAFETY AND MODIFICATIONS

     In most cases, your house, apartment, condominium, or townhouse will need to be modified to be fully accessible and continue to be your home. Since the modifications are best made while you are in rehabilitation, it is advisable to get started on them as soon as possible. Making changes is not always as complex as it may appear. Simply selecting a certain product or installing a new device is sometimes all that is needed to enable you to live safely and with the greatest amount of independence. Following are features of the various areas of your living space that are well suited to people with a SCI.
 

BATHROOMS

Showers and Bath Tubs

     If you can transfer yourself out of your wheelchair, then your existing bathroom may only need to be modified with a shower chair, grab bars, a shower wand, a tub lift, or a shower bench. Grab bars should be installed on three sides of the shower, non-skid strips should be applied to the bottom of the shower or tub, and adequate space is needed for transfer to the shower bench. To facilitate transfer to the bathtub, benches, bathtub seats, portable seats, built-in seats, and hydraulic seats can be used.

     If you cannot transfer yourself out of your wheelchair, then a wheelchair shower needs to be installed so you can wheel yourself directly into the shower, or have an attendant wheel you in. There are three types of showers for people in a wheelchair: (1) roll-in; (2) transfer with fixed bench; and (3) roll-in with removable bench. Preformed, fiberglass, wheelchair shower units can be purchased and installed.

Water Controls and Valves

  • A single-handed control, with a lever that controls the temperature of the water and adjusts the flow, and a clear width between the handles and the wall, OR,
  • Remote control and electric valves, if needed - Shut-off valves that are easy to use and accessible; pressure balance and thermostatic valves, at the point of the water supply, for safety
  • Water temperatures between 110 and 120 degrees Fahrenheit, at the point of water supply, for a 105 degree delivery temperature
  • Insulated hot water feed and draining pipes to prevent scalding

Counters and Sinks

  • 27 inch deep counter tops for sinks that are securely bracketed so wheelchair can move under the sink, OR
  • 27 inch deep counter tops to the left or right of the sink so wheelchair can move next to the sink and there is workspace for self-help devices and personal hygiene products

Towel Racks, Soap Dishes, Mirrors, and Floors

  • Towel racks, soap dishes, and shelves no more than 40 inches from the floor; a recessed shelf in the shower for soap, shampoo, etc. is useful
  • Mirrors positioned so the bottom edge is 36 inches from the floor; full length mirrors should be installed wherever possible for the convenience of other family members.
  • Bathroom floors should be hard and should not become slippery when wet

Toilets

  • Toilets raised 20 inches for people in wheelchairs, OR
  • A standard-height toilet with a raised toilet seat and a cutout in the front and back to allow an individual or attendant access for digital stimulation and hygiene purposes
  • Specially designed seats with attached arms, if needed.
  • Sufficient area around the toilet to permit wheelchair transfer
  • Grab bars at a height to maximize the person's ability
  • Easily operated flushing device and easily reached toilet paper

KITCHENS

Layout, Counters, and Cabinets

  • Unobstructed space around the refrigerator, stove, sink, and table for the wheelchair; an L- or U-shaped design is efficient and requires the least turning
  • Smooth, non-skid floor surface
  • Counter height of 30 - 33 inches with undercounter clearance; a standard 36 inch counter can be modified with a pullout shelf at 30 inches.
  • High recessed base under the cabinets to accommodate wheelchair footrests
  • Cabinet door pulls, pullout boards, and drawers that have built-in stops and are easy to use
  • Portable shelf units on casters and/or narrow pullout shelves for single-row storage for more accessible storage

Sinks and Refrigerators

  • Sinks that are no deeper than 6 inches, have drainage at the rear, allow for knee space underneath; underside sink surface and pipes are insulated; adjustable-height sinks are available.
  • Insulated swivel arm faucet, capable of swing over the adjacent countertop; spray attachment, instant hot water sink attachment, a sink garbage disposal, and trash compactor are recommended
  • For persons with limited reach, levers to control water flow can be placed below the counter rim to one side of the bowl.
  • A two-door, side-by-side, self-defrosting, refrigerator-freezer is recommended; if a one-door refrigerator is available, the freezer should be at the bottom for the wheelchair user, or, at the top for an ambulatory person with a disability

Ovens and Cook-tops

  • A built-in oven, with a side-hung door that opens away from the light source, no knee space below, and oven shelves with non-tip stops that pull out easily
  • A pullout board under the oven for transferring and preparing food
  • Burners in a single row at the rear section of the cook-top (so the front section can be used to prepare food) and flush with adjacent surfaces to for easy sliding of pots and pans
  • Controls located at the front section of the cook-top, as well as a lip along the front edge or a slot with a drain pan below to minimize the dangers of spillage.
  • Switch for range hood vent positioned within easy reach

BEDROOMS

  • Convenient access to bath and toilet rooms
  • Adequate space around the bed for wheelchair access and movement; bed height should be level with wheelchair seat height; firm mattress for dressing and transfers; a light switch, telephone, clock, etc. easily accessible at the bed
  • Convenient storage next to the bed for braces, prostheses, and/or clothing
  • Furniture on casters; drawers, with stops, that can be opened with one hand; bottom shelves 18 inches from the floor
  • Shelving units with narrow shelves for single-row storage can be used
  • Do not use heating pads or electric blankets

DOORWAYS AND DOORS  

  • Minimum clear width for doorways of 32 inches for wheelchair passage; clear width of narrow doorways can be increased by 1 ½ to 2 inches with offset or fold-back hinges, be removing the door, or installing a pocket door which slides into the wall when not in use
  • A 5 foot, level space inside and outside each doorway, especially near the top of a staircase; doors should open outwards, especially in small rooms, such as bathrooms.
  • Side-hung doors are suitable for people with limited arm and hand usage; remote control doors for other individuals - doors to consider: pocket-sliding, sliding, folding, automatic, remote controlled, equipped with opening and closing devices, pneumatically assisted doors, and pulley-operated openers and closers
  • Kick plates for protection from wheelchair footrests; 7 ½ inch high bottom frame of glass doors; mat wells for doormats to provide level surfaces
  • Handles, pulls, latches, locks, etc. with shapes that are easy to grasp with one hand and do not require tight grasping, pinching, or twisting of the wrist to operate; lever, push type, and U-shaped handles are available that slip over existing round doorknobs; auxiliary handles or rails can be installed that align with the door and are used to open the door
  • A clearance of 2 inches between the handle and the door; handles placed between 3 feet and 3 feet, 3 inches from the floor
  • Thresholds that are no higher than ¾ inch; wooden thresholds that are beveled on each side, or weather stripping, act as a mini-ramp.

FLOORS, HALLWAYS, AND WALLS

  • Hard surface floors -- such as wood, vinyl, tile, or tightly woven carpeting installed tight to the floor - with a flat, non-skid surface; joints of a tile floor provide a measure of friction and patterns can be selected that mask scuff marks from wheelchair tires
  • 4 feet wide hallways, wherever possible; if narrow hallways must be used, then doors should be widened to allow easy access to and egress from adjoining rooms; turning room at the beginning and end of a hallway
  • Evaluate the routes from the street curb, driveway, or garage, into and through the home and remove structures that impede free wheelchair movement
  • Walls of a materials that is easy to clean and maintain, with clear plastic edging or metal plaster bead at corners, and clear plastic shields in hard wear areas, such as above the sink and where wheelchair footrests touch the walls for protection; insulation inside the walls to reduce heat and air conditioning expenses

WINDOWS, STORAGE, LAUNDRY, AND COUNTERS

  • Windows that open outward and are easy to operate; horizontal sliding windows are recommended -- casement windows, which are difficult to operate and require a free area in front of them are not recommended; inaccessible windows can be power operated
  • A full wall of narrowly constructed shelves for single-row storage, without a counter(s), offers the most accessible storage; if a counter is present, shelves above the counter are, for the most part, inaccessible
  • Hanging rods in closets can be lowered, or, a second, lower rod can be installed
  • Modular storage systems configured to specific requirements and/or power units which raise and lower and/or rotate shelves and racks can be installed
  • Where a counter or writing surface is required, one 30- to 33-inch high counter or tabletop is recommended
  • Laundry facilities require sufficiently wide doorways, space for maneuvering, and appliances that are front-loading, easily operated, and have front-mounted controls

MECHANICAL AND ACCESSIBILITY ISSUES

LIGHT SWITCHES AND LIGHTING

Light Switches and Lighting

  • Light switches placed at a height between 3 feet and 3 feet 6 inches; if adjacent to a door, light switch positioned horizontal to the door handle for easy in locating it; two-way light switches at staircases and hallways; no more than 2 switches per light plate
  • For persons with limited hand or finger mobility, rocker action switches, light switch extenders, wireless remote control switches, cord switches, dimmer switches, timer switches, and/or pull chains are recommended
  • Wall-bracket lighting, placed within easy reach, is convenient, accessible for light bulb changing, and stable when securely fastened to the wall
  • Table lamps with wide bases for maximum stability, pull chains, or pressure-sensitive switches
  • Fuses and circuit-breakers within easy reach
  • Power strips of switches and outlets, alongside the bed to control lights, TV, stereo, radio, etc., and in the kitchen to control these items and appliances

HEATING/AIR CONDITIONING AND CENTRAL VACUUM CLEANING SYSTEM

  • Thermostatic controls positioned at a level for easy reading and operation
  • Space heating may be required in bedrooms and bathrooms
  • Air conditioning is required for people with impaired lung function or breathing problems and for most quadriplegics
  • Ceiling-mounted circulating fans provide more even heat, circulate the air, and reduce expense of heating and air-conditioning
  • A central vacuum system, with hoses and attachments plugged into special outlets built into the walls in each room, is useful

SAFETY AND MAILBOXES

  • In the event of fire, there should be an emergency evacuation plan, a fireproof area and a shielded balcony or deck for evacuation purposes, fire detectors, fire extinguishers, smoke alarms, and emergency numbers on all phones
  • If mechanical lifts are used for primary access, a ramp at the opposite end of the home should be used for secondary access
  • A large slot letterplate in the door, with a letter basket inside the door; an outdoor shelf for newspapers and packages; and/or a drive-up mailbox positioned to allow access from the vehicle

RAMPS

  • Ramps are the most reasonable means of access to and from a home.
  • Ramps vary widely and therefore the person's ability to navigate through a ramp, as well as the incline, location, convenience, style, and materials should be considered before a ramp is built or purchased. All ramps should be at least 36 inches wide.
  • For curb-height obstacles and small steps, several manufacturers offer a variety of wheelchair ramps, made of aluminum or fiberglass, for temporary, semi-permanent, and permanent applications
  • For longer, steeper ramps, ramps may need to be designed and constructed out of concrete or wood. The maximum incline recommended for wheelchair users is 1:12, i.e. for each inch in height, the ramp must extend 12 inches;
  • For strong wheelchair users and for those who must be pushed or have a motorized chair, the ramp can be less gentle, i.e. for each in height, it can extend 5 inches
  • For unusually strong wheelchair users, for extra-powerful motorized chairs, and if the person is lightweight but the pusher is strong, for each inch in height, the ramp can extend 7 inches · For exterior ramps in climates where ice and snow are common, the incline should be more gradual, i.e. 1:20
  • On a long ramp of any slope or on a steep ramp, level rest platforms are necessary at 10 foot intervals for both ascent and descent and to turn the wheelchair; continuous handrails should be installed on each side of the ramp and extend beyond the slope at the top and bottom of the ramp; and ramps should have curbs on both sides to help brake a wheelchair in an emergency
  • There should be at least 5 feet of straight clearance at the bottom of a ramp
  • Non-skid surfaces are essential and possible with concrete ramps; expanded metal ramps provide traction but are poor for heeled shoes; wood should be treated against rot and have no more than ½ inch between planks; ramps should be protected against the weather and kept free of ice and snow

LIFTS AND HOISTS

  • Individual lifts and hoists are used where ramps cannot be placed and/or to transfer people from bed to the wheelchair, bath tub, toilet, exercise mat, etc. and back to the wheelchair and/or the bed; some require assistance, but some can be operated independently; types include manual hydraulic, electrically powered, and portable
  • Mechanical lifts are used in homes where there are stairs but no space for ramps; types include vertical and inclined platform lifts, which can be installed with walls for gates for safety and which should have easy to use and conveniently located controls
  • Vertical lifts are placed at the bottom of stairs and the upper landing may be need to be extended to meet them
  • Inclined platform lifts are mounted on walls or stairs or on tracks along the stairs

ELEVATORS AND TRANSPORTATION

  • Residential elevators are available with special car sizes to accommodate wheelchairs and can be installed in a corner or closet that is accessible to all floors of the home based on local building codes
  • A standard vehicle with hand controls is suitable for some individuals
  • Wheelchair vans and taxis, as well as custom-built vans, are useful for individuals who require assistance or who transport themselves using a power wheelchair or cart; these van should be parked in a covered area, such as a garage, with direct access to the home
  • Be careful of car heaters; always wear shoes, seat belts, and shoulder restraints; and avoid resting bare skin on a hot surface

 
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