University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Environment

What's the place where you live like? Is there enough access for your wheelchair, or is it a tight squeeze? Are the things you need within reach, or are there high shelves and small closets and cabinets that are hard to get to? Does your personality show in the way your home is furnished and decorated? Your environment not only tells a lot about you, but it can even help shape what your daily life is like. Is your environment making it harder or easier for you to stay healthy?

Some people's homes are full of affordances, or features that encourage or make it easy to do important activities. You could also think of affordances as things that are useful. An example of an affordance might be having a computer with Internet access on a stand at the right height to reach comfortably, living in a building that has a laundry room, or living less than a block from a stop for a bus that has a wheelchair lift. Other people, however, may not realize that they have barriers in their own homes, that is, that the way their house is set up keeps them from getting involved in important activities. Examples of barriers include not having a phone within easy reach (like a wall phone, or not having an extension in the bedroom), not having materials around to use to relax or spend leisure time (such as magazines or books, hobby supplies, games and so on), or living in a neighborhood that doesn't have useful or fun places nearby, such as grocery stores, department stores or malls, parks and movie theatres. Creating affordances and getting rid of barriers is very important to helping people make the most of their lives. In fact, researchers have even found that having too many barriers in a person's home or neighborhood environment can "cause" disablement (that is, inability to do things that a person wants to do) and keep the person "dis-abled" by blocking them from getting involved in desired activities 1.

The way you supply your environment can make it easier to get busy in activities that you enjoy or that are necessary to do, or it can make it harder. As an example, Mitch, one of our study participants, doesn't make plans for the day because he prefers to stay in his room and watch his television or use his computer unless something special comes along, like a chance to go driving with his friends. Another study participant, Robert, lived in a board-and-care home with no personalized items except for his own wheelchair and the foam overlay on his hospital bed. Look around your home; what do you see? If you have a favorite hobby, do you have items on hand to use in your hobby? Do you have enough supplies available to use in your daily maintenance activities, ranging from personal items like soap, toothpaste and toilet paper to housecleaning products (like countertop/sink cleaner, a broom or a vacuum)? Are there things in your home that can be used for work or communication, like a phone, computer and printer? Some computers and printers can even be used to send and receive faxes; machines like this are so useful that there are often sources of funding to help you buy a computer. Find ways to let your environment support you, and help you to be active and involved!

Also take some time to look around your building, and your neighborhood. Is there convenient parking by your home, or a place where a car or van can wait while you get in and out? Are you near the places that you go to often, like shopping areas, your doctor's office, place of worship and places for meeting friends? It can be expensive and difficult to move to a new home, but sometimes it is worth it if your new home makes you much happier, and gets you closer to the places that are important for you to go to. For example, one of our study participants, Gary, was unhappy living at a skilled nursing facility because most of the residents were much older, so he spoke up for himself and was moved to a rehabilitation facility he felt more comfortable in. If moving is not an option, check out what is available where you are. Do you know where the accessible buses stop? Could you make an arrangement with a neighbor to go shopping with them? Are there classes, museums or community centers available nearby that would interest you? Ask a friend, family member or your care attendant to take time to explore your neighborhood with you, and see what you discover!

The appearance of your home can even affect your mood. For example, is your home inviting looking, with decorations in colors you enjoy and pictures or photos that are meaningful to you? Or is it kind of drab and dull, with plain walls, dusty surfaces and empty shelves? Is it messy or clean? When you look around your environment, think about how it makes you feel. If your place makes you feel happy, you've done a great job making it your special place. If you have disappointments with the place you live, think about ways you can change it to make it more pleasing. Even if you live in a home that you share, or in a group living situation, there are probably some changes that you can make that will be okay with everyone else, but will still make it more enjoyable for you. Some people enjoy house plants or a vase with fresh-cut flowers in their room, while others like to put up a corkboard decorated with photos and inspirational sayings. You can even decorate with books or CDs by arranging them in an interesting way, or making a collage out of covers. Many people like candles, but you need to be sure that lighting a candle won't set off a heat-sensing fire alarm, and that people who share your space aren't allergic to or irritated by the scent. Whatever way you choose, make your home say something about you!

In addition to having affordances and barriers, of course your environment should be accessible. Accessibility usually refers to being able to get around easily; for example, Dave, who participated in our study, lived in a house that had an elevator in it that made coming and going to his room very simple, and Judy redesigned her entire home to be accessible. But accessibility is more than just having room to move around; it also means that what is in your house is easy to use and easy to keep in good shape. For example, if you have window shades that are difficult to roll up and roll down and difficult to clean, you could say they are not "accessible." For suggestions on making your home more accessible, you can ask your doctor for a referral, or prescription to see a specialist, to have an occupational therapist check your home for specific ideas for improvement. (Sometimes rehabilitation facilities have an occupational therapist visit your home with you before your discharge to make sure you are going to be living somewhere that is accessible. 2)

Unfortunately, financial challenges that often come with serious medical situations like spinal cord injury can make it difficult for people to afford an ideal place to live. Some people deal with this by living with family or friends. For some of our study participants who lived with family, they kept some independence by staying in a converted garage, like Steve and Billy. Frank lived for a few months with his brother, but then moved to his own apartment, even though it wasn't in as nice a neighborhood, in order to keep his sense of independence.

If you do run into serious problems where you live, whether they are financial or other kinds of difficulties, start looking for a new place to live long before you have to move out, so that you will not find yourself in a bad situation. Try to let everyone know that you need help; your case worker, doctor, care attendant, family or friends might have somewhere for you to go, or be able to help you get emergency funds that will keep you in a safe environment. Even though it might be embarrassing to let people know you are having financial problems, the alternative - homelessness - is a lot worse.

Your environment tells something about you. Make sure your environment fits you, and that it supports you in getting done what you want to get done. Don't forget that the affordances and barriers in the places where you spend your time help to form your daily activities, so changing your environment can help change your pattern. It's worth exploring!

If a computer is part of your personal environment, you can also use it to find more ideas for making your surroundings more "you." First of all, for a list of many of the latest hardware and software to make a computer more "disability-friendly," there's a page on the website of the LIFE Center of the Rehabilitation Institute of Chicago about Computer Access and Adaptations. Then, check out the websites of home design, furniture and hardware stores, in whatever style you like best. Some people prefer stores like Target, K-Mart, Bed Bath and Beyond, Home Depot or OSH; others like the style of Restoration Hardware, Pottery Barn, Crate and Barrel or local specialty stores. Whatever store you like best, try typing in the store's name and then ".com;" usually that will be its home page. If that doesn't work, try using a search engine like Google or Yahoo! Search.

Another way to use your computer to help personalize your living space is to write down or download a quote that inspires you, change it into a fancy font, give it an attractive border or background, then print it out and hang it up. You might even want to look for photos or images on the Internet that you can download and print out to use as decorations; a good tool for this is the Google Image Search search engine. (Please note that Google uses a "filter" to protect people who are searching for photos from accidentally finding obscene or pornographic photos.)

For websites with information about home design and home furnishings that are accessible for people with disabilities or who use wheelchairs, a good place to start might be the National Resource Center on Supportive Housing and Home Modification, which is simply nicknamed Homemods.org. This site, based at the University of Southern California (USC), provides information and links that will help you to upgrade your home to make it more "disability-friendly."

There are also some good websites about feeling more at ease in your home space. The website of Craig Hospital in Denver, Colorado has an article called Home Alone!, which has a number of good suggestions about home safety, and Make an Emergency Fire Plan has tips for creating a plan for fire safety. And PN/Paraplegia News magazine, an online publication by the Paralyzed Veterans of America, has a page called Cabin Fever: 105°, about "Cabin Fever," that is, the sense of being upset or restless when you have been in the same indoor space for a long period of time. The article includes suggestions to keep your spirits up and engage in activities when you are "stuck" inside. Any of these articles can help you to make your home environment as comfortable and "all about you" as possible!

1 Kendall, M. B., Ungerer, G., & Dorsett, P. (2003). Bridging the gap: Transitional rehabilitation services for people with spinal cord injury. Disability and Rehabilitation, 25, (17), 1008-1015.

2 Lysack, C. L., & Neufeld, S. (2003). Occupational therapist home evaluations: Inequalities, but doing the best we can? American Journal of Occupational Therapy, 57, 369-379.