Environmental Adaptations

Environmental Adaptations

Key Takeaways

What are Environmental Adaptations and Assistive Technology (AT)?

  • Environmental adaptations can be structural or non-structural alterations of a home or any other setting.
  • This type of AT promotes access to an object in the home or other settings that is difficult to navigate.
  • Environmental adaptations help individuals complete everyday activities within any setting.

Common No-Tech and Low-Tech Environmental Adaptations / AT Solutions:

  • Ensure a person has access to all parts of the environment by arranging furniture to meet ADA accessibility standards.
  • Adapt items using PVC pipe, foam, and various objects from home improvement stores to improve positioning, access to, and manipulation of devices and equipment.

Who, When, and Where are Environmental Adaptations / AT Appropriate?

  • For anyone who needs an alternative access method for the environment
  • When an individual cannot run an electronic device by standard instruction due to cognitive or physical impairments
  • Environmental adaptations and controls can be appropriate in any setting to lessen or remove physical barriers

Why are Environmental Adaptations / AT Important?

  • Reduces support from caregivers
  • Lessens or removes physical barriers
  • Increases safety
  • Maintains or prolongs functional independence

Situations for Environmental Adaptations / AT:

School Environment

  • Accessing entrances and exits of the building(s)
  • Operating musical instruments
  • Accessing restroom facilities
  • Accessing computers and functions
  • Operating toys
  • Accessing food and tables in the cafeteria
  • Operating sports equipment
  • Accessing the playground
  • Operating games
  • Accessing objects and places within a classroom

Work Environment

  • Accessing entrances and exits of the building(s)
  • Accessing computers and functions
  • Placing and answering phone calls
  • Accessing restroom facilities
  • Navigating in/around the building
  • Operating appliances in the lunchroom
  • Using fax and copy machines
  • Accessing the parking lot or public transportation

 Home Environment

  • Accessing entrances and exits of the house
  • Answering the door
  • Operating appliances
  • Placing and answering calls
  • Entering and exiting rooms in the house
  • Accessing all cabinetry
  • Accessing computers and functions
  • Operating lights
  • Operating fans
  • Accessing the toilet/shower

Community

  • Accessing the parking lot or public transportation
  • Accessing entrances and exits of buildings
  • Accessing general information
  • Accessing public restrooms

Commonly Asked Questions about Environmental Adaptations / AT:

  • Q - What are structural and non-structural modifications?
    • A - Structural modifications are permanent changes to a building/structure (Ex. widening halls/doorways in a home, creating a roll-in shower in the bathroom). Non-structural modifications are temporary or minor installations or alterations of a building/structure (Ex. rearranging furniture, ramps, special door hinges that widen openings, hand held shower, magnetic door catches).
  • Q – What is the difference between environmental adaptations and AT?
    • A – Environmental AT devices are any piece of equipment, software program, or product system that improves the functional capabilities of a person. Environmental adaptations are built to address situations in one’s environment to reduce physical barriers.
  • Q – What are environmental controls?
    • A – Environmental controls are devices that enable an individual to operate electronics independently through a variety of access methods (switches, Bluetooth, smart devices) throughout one’s setting(s).
  • Q – What are access methods?
    • A – Access methods are the way in which an individual interacts with electronics and the environment. There are two primary access methods: direct selection (Ex. Eye gaze) and switches. These can be used to access a multitude of electronics, computer software/hardware, and communication devices. Switches are available in a variety of colors, shapes, sizes, and connection abilities.

 AT Solutions at ABLE Tech:

Visit ABLE Tech’s Environmental Adaptations / AT Inventory

Visit ABLE Tech's Environmental Adaptations AT/DME Reuse/Exchange Inventory

Helpful Links and PDF Resources:

Guides and Articles:

Video/Webinar/Podcast Resources:

Education

Case Studies of Individuals with Environmental Adaptions / AT Needs and Recommendations 

Case Study #1

A 3-year-old preschool student who has Dyskinetic Cerebral Palsy (CP), uses an adapted stroller as primary seating, has sudden uncontrolled upper extremity motor movements, and good head control

The student is unable to access toys within the classroom due to abrupt motor movements of the upper extremity. The student has good head control and fair lower extremity control. The teacher reports the child understands cause and effect and joint attention (shared attention is the shared focus of two individuals on an object). The student enjoys music and vibration but has difficulty with rough textures.

Possible Recommendations:

Start by identifying the student's seating and positioning throughout the day as she plays with toys. Each seating position will require different environmental control and access methods to activate toys. Select switches that are accessible by the two reliable motor movements (lower extremity range of motion and head control). Possible recommendations are push and touch switches, lever and wobble switches, or movement sensor switches.

Goals and Outcomes:

The student will activate adapted switch toys with multiple access methods in different seating positions to play in the classroom.

SETT Framework for feature-matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework
Sample Solutions:

Case Study #2

A 9-year-old student in a 4th-grade general education classroom, spinal cord injury, spasticity in the upper and lower extremities, is able to tap objects in a controlled manner with the fingers on the left hand, verbal, no cognitive deficits and uses a power wheelchair for mobility

The student gets frustrated during class with group activities due to the inability to raise his hand efficiently for question and answer sessions. The student has a one-on-one paraprofessional to assist with physical tasks. The student wants to participate in question and answer sessions independently instead of the paraprofessional raising her hand for the student.

Possible Recommendations:

The student needs a method to communicate with the teacher other than hand raising. The AT device should be as discreet as possible and reduce distractions to other students. Identifying a device with finger tapping access that also alerts would be recommended. These devices can alert by light, sound, and vibration.

Goals and Outcomes:

The student will independently activate an alerting device, in place of hand raising, to gain the teacher’s attention within the classroom to ask and answer questions.

SETT Framework for Feature-Matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework

Sample Solutions:

Case Study #3

A 15-year-old student in the 10th grade, Muscular Dystrophy, no cognitive deficits, minimal movement below the shoulders, power wheelchair for mobility, is social and participates in extracurricular activities

The student’s disease has progressed over the years now requiring a paraprofessional for physical needs and toileting. The paraprofessional sets up the student’s computer and other physical materials for each class and acts as the student scribe. Recently, the student has obtained accessible, digital textbooks (Accessible Educational Materials (AEM)) for all subjects. The student accesses the computer with a TrackerPro 2 head mouse. The student would like to decrease scribing assistance from the paraprofessional to complete writing tasks more independently.

Possible Recommendations:

The recommendation is to use dictation to convert spoken words into digital text, often referred to as speech-to-text or speech recognition. There are several types of dictation technology: built-in dictation tools, apps, computer extensions, and computer software.

Goals and Outcomes:

The student will use AT to independently dictate 75% of writing assignments in all core subjects.

SETT Framework for feature-matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework

Sample Solutions:

Funding Sources for Individuals with Environmental Adaptions / AT Needs

Employment

Case Studies of Individuals with Environmental Adaptations / AT Needs and Recommendations 

Case Study #1

A 55-year-old optometry assistant with Rheumatoid Arthritis (RA), full-time employee, numbness and tingling of the hands, mild inflammation, morning stiffness, and fatigue

The optometry assistant has begun to have difficulty writing when recording in patient charts and manual bookkeeping. The optometry assistant reports that writing in the mornings is the hardest, and the work day begins at 7:00 AM. The assistant describes stiff hands and limited movement in the hand joints for a few hours every morning.

Possible Recommendations:

The optometry assistant could trial low-tech AT with adaptive writing utensils to increase the ability to chart and bookkeep. Adaptive writing utensils use ergonomic principles to reduce strain on the fingers and wrist for comfort and ease of writing.

Goals and Outcomes:

The optometry assistant will use AT to write in charts and manually bookkeep with comfort 80% of the time.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Forms – HAAT Model
Sample Solutions:

Case Study #2

A 35-year-old adult with Down syndrome, mild cognitive deficits, verbal, poor fine motor skills, difficulty using both hands together, motivated

The employee began working at a machine shop. The job requires the adult to operate an electrical machine with small access buttons. The machine’s buttons are difficult for the individual to depress. The gentleman would like a larger button to operate the machinery.

Possible Recommendations:

The recommendation is to plug the assigned machinery into a switch interface then have push/touch switches connected that are easy and preferred by the employee.

Goals and Outcomes:

The employee will produce 10 items a day with the assigned machinery for adequate productivity with the use of the switch interface and a push/touch switch of choice.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Forms – HAAT Model
Sample Solutions: 

Case Study #3

A 60-year-old individual who works in an office, sedentary, osteoporosis, mild arthritis, herniated disc, works four, 10-hour shifts in an office cubicle

The individual has been battling back pain due to medical conditions combined with his inappropriate work station at his office. After several hours of sitting the pain level is approximately an 8 on a scale from 1 to 10. He has used all accrued sick time due to the pain associated with sitting for long periods, and would like to continue working full-time with minimal back pain.

Possible Recommendations:

The recommendation is to rearrange this employee’s office using proper ergonomics. Choose a chair that supports the natural spine curvature; adjust the chair height to rest feet flat on the floor or on a footrest. The underside of the desk should have clearance for the knees and feet. Adjust armrests so the shoulders are in a relaxed position. Place the computer monitor directly in front of the employee; the top of the screen should be at or slightly below eye level. The mouse and keyboard should be on the same surface. The wrists should be straight and biceps close to the body. Consider also alternating from standing to sitting in variables of 30 minutes using an adjustable desk.

Goals and Outcomes:

The individual will continue working full-time in his ergonomic work station using various sitting and standing positions and have minimal to no pain.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Forms – HAAT Model
Sample Solutions:

 

Community Living

Case Studies of Individuals with Environmental Adaptions / AT Needs and Recommendations 

Case Study #1

A 3-year-old with Sensory Processing Disorder (SPD), shy, pursues movement, seeks sensory input through pressure/weight, runs away in crowds

The 3-year-old displays anxiety and fear in crowds, hindering the family from public outings. The child uses the flight method to cope with anxiety and fear when in public. The child is very active and does not slow down, continuously seeking sensory input through pressure/weight such as hugs, jumping, and tumbling. The family would like for the child to begin to learn how to self-regulate when experiencing anxiety and fear.

Possible Recommendations:

The recommendation is to incorporate AT for sensory regulation to decrease anxiety and help calm and focus the child. Using weighted AT like vests, blankets, stuffed animals, and lap pads can promote a calming effect. For safety and proper usage, the weight recommendation is 10% of the child’s body weight.

Goals and Outcomes:

The 3-year-old will use AT to increase sensory regulation to self-calm 40% of the time.

See the attached HAAT Model form to see how to match the child to needed AT.

Case Study Forms – HAAT Model

Sample Solutions:

Case Study #2

A 29-year-old with focal hand dystonia, music/song writer, excessive muscle tightness, tremors, loss of muscle coordination, plays guitar as a hobby

The 29-year-old has become depressed as he is not able to play the guitar or write music as a stress outlet due to the diagnosis. The occupational therapist has discussed using alternative devices to play the guitar or write music. The gentleman would like to access a tablet or computer to use music writing and instrument software.

Possible Recommendations:

The recommendation would be to use switch interfaces, wireless switches, or eyegaze to activate the software. Switch interface is a device that connects a switch to a device for alternative control. A wireless switch consists of two parts, the transmitter and receiver. When activated the transmitter sends a signal to the receiver to control a device.

Goals and Outcomes:

The gentleman will use AT to access music writing and instrument software to create music and decrease depression.

See the attached HAAT Model form to see how to match the individual to needed AT.

Case Study Forms – HAAT Model

Sample Solutions:

Case Study #3

A 70-year-old individual with Parkinson’s, power wheelchair, full-time care, uses switches for communication

The individual has entered stage five of Parkinson’s and resides in a long-term care facility. He now uses a tilt-in-space power wheelchair. The individual uses a call button for assistance, but it keeps getting lost in the seat of the wheelchair preventing him from accessing it.

Possible Recommendations:

A mount is needed for the wheelchair to keep the call button accessible at all times. A mounting device and system allow options for access to fit one’s needs for multiple types of products such as switches, speech communication devices, and daily living items.

Goals and Outcomes:

The individual will have access to the call button on a mounting device and system while in the power wheelchair.

Case Study Forms – HAAT Model
Sample Solutions: