BY CHARLES M. SCHWAB, AIA, UDCP, CAPS, CGP
“By involving your child or youth in your home rental or access:able bed and bath design, you may feel you have more control and you and your child may both become what I call mobility empowered.”
If you are a parent of a child with mobility needs, you may find yourself consistently problem-solving access and design matters within your own home. Have you and your child ever thought that those solutions were so awesome and such great ideas that there might be lasting value in them, and that they should be shared with others? I’m guessing you have, and that many of those creations are brilliant adaptive solutions that make your home more what I call access:able for everyone, not just you and your child with mobility needs.
You may have also noticed and experienced firsthand, that when you worked or produced home design solutions with your child, you both gained much more than a better way to do things and more usable spaces. You may have experienced that you bonded, learned from each other and developed a deeper love and happiness. You may, and still do, feel that with the struggles, time and costs, you still wouldn’t have it any other way. Of course that is what good parents do, so this is nothing new. Parents are a child’s first teacher, nurse and friend.
The ideas I hope to share here probably reaffirm what you already know: designing the environment for access, within your own home or rental, when under your control and participation, has numerous positive benefits and impacts on child development, problem-solving skills, self-reliance, self-dependency, satisfaction and a host of other good things. It’s common knowledge that the home environment contributes to health one way or another. In a great article titled: Children with Disabilities: Opportunities in the Home Environment by four therapist professionals, the following is quoted:
“Some of the skills and behaviors that are building blocks of self-determination include expressing preferences, participating in decision making, displaying engagement and persistence, and exercising increased appropriate control over the environment. Whether young children are typically developed or not, they need to engage with friends and family, make choices and decisions, control and regulate their surroundings and develop self-efficacy.”
Self-efficacy is the ability to dream and believe you will be able to achieve that dream or goal. Self-reliance is ability to achieve it on your own, and self-determination, the ability to do it when and where you want to. Autonomy or independence can be the end result of all of the above.
A good place to start are two areas where you both spend a lot of time: the bedroom and bathroom. By involving your child or youth in your home rental or access:able bed and bath design, you may feel you have more control, and you and your child may both become what I call mobility empowered. In the case of injury, you and your son or daughter will be taking an active role in their recovery or rehabilitation within the home. In the case of chronic mobility impairment, these design tools learned during the process will stay with him or her throughout their lifetime. They will move from home to home and have the tools necessary to create an access:able home for their lifetime.
Access:able Bedrooms for mobility empowerment!
There are numerous planning and detail considerations that will help your son or daughter become mobility empowered in their own bedroom. The bedroom location within the home, bed location in the room, best bed type and size, window placement, accessible furniture, space for parent and helper are a few of the considerations that address mobility needs.
Healthy materials and site aesthetics of the views, natural light, interior colors, artificial lighting and even play or study areas, can all be designed with your son’s and/or daughter’s participation.
For recovery, the bedroom can become a place for work, solace, healing and rest. With proper planning, it can be a good example of home healthcare design. When this is achieved, significant time can be saved going to medical appointments. The loading of mobility aids, transfers and the like all take time. Mobility needs must be considered in design and are fundamental to successful home healthcare.
Bedroom planning list
Every daily activity is an opportunity to involve your youngster in the process. Measure your child’s physical characteristics and aid needs, mobility aids and space for parent or helper. Work from big picture planning to smaller details. Then consider the following:
• A full bathroom flowing directly from the bedroom eliminates abrupt right angle corners that are difficult to maneuver around.
• Adequate space adjacent the bedside, for the lift or mobility aid, needs to be provided. Transfer space and use for one or more helpers may also be required.
• Adequate storage for mobility devices is paramount for a clutter-free environment. This can be a challenge and, in some instances, an entire room is dedicated to storage.
• Closets need to be designed for autonomy and usability so the youngster can learn to dress him or herself at the same time and appropriate age as able bodied children.
• An access:able route, or pathway, needs to be provided through the room in order to operate the windows, reach all controls and access all of the room functions.
• Thoughtful layering with task, ambient, decorative and accent lighting are helpful when performing daily activities, such as transferring and dressing, and also for restful sleep.
• Ask your child to participate in color and material selection. Colors have meaning and can make a psychological impact.
• Homework will happen at study spaces that they help design and therefore work best for them.
• A family disaster and fire evacuation plan should be prepared and practiced. Children with mobility needs can be at a disadvantage during such events.
• Inform your local authorities when your youngster, or anyone else, uses a wheelchair or other mobility aid within the household.
The bathroom is perhaps the hardest working space in the home. Adaptable mobility aids, fixtures and products that specifically address your youngster’s needs are essential to safe and efficient functioning. A bathroom designed for interdependent use when necessary and independent use when possible will make these tasks easier. Once again, work from big picture planning to the details. Then consider the following:
Bathroom planning list
• In bathrooms with a fixed, predetermined room size, as in a rental unit, extra usable space can be created through use of adaptable fixtures and portable assistive technologies.
• In a new home or addition, more than one bathroom will be appreciated by the entire family. The child or youth with mobility needs may need additional time.
• When several kids are using the bathroom, designing for each kid’s space and uses is a fun and colorful strategy to keep peace in the home and bathroom.
• The value of water play for parent-child bonding and learning, for children up to age nine, can be significant. Retaining the bathtub and using a tub or wall lift is an option.
• A hand held, adaptable shower head will be one of the most useful bathroom tools and will be used for a lifetime. These can be multi-functioning and hung at flexible locations.
• Temperature and water pressure controls are critical for safety and functionality, especially for those with paralysis who may not feel temperature extremes. Sudden movements can be dangerous.
• In a new or remodeled bathroom, when space for a parent or helper is needed, a larger roll-in shower is possible. It can also provide the opportunity for a 360 degree wheelchair turn.
• A wet-room application is when the entire room or area is waterproofed or “tanked,” making the whole area a usable shower hygiene space.
• For an individual with sufficient upper body strength that can independently pull him or herself out of a wheelchair, a transfer shower may be the best bathing option.
• Toilets that allow transfer or assistance from both sides are most adaptable for the parents and multiple caregivers. People may prefer flexibility from either side.
• Bathroom sinks that are adjustable up and down will be the most adaptable for a growing child. Grooming is a learning lifetime activity; space for the parent should also be provided.
• Open space under the sink may need to be provided for seated use if the youngster uses a wheelchair.
• During recovery after injury, there needs to be adequate space on a countertop for medical supplies and aids. The Spinal Cord Injury association (SCI) recommends one side has a deeper counter section allowing for medical supplies, meds or assistive aids.
• A single lever faucet control is more easily reached with either hand when located in the center. A motion sensor faucet self-activates and conserves water.
• Parents and children who share more time in the bathroom might consider water saving games. Water play as a learning tool, can also be a step towards self-determination and self-efficacy.
Importance of design for hygiene and clothing changes
Space for changing is often overlooked but critically important if a youngster is to learn how to be independent outside the house in the public world. Interdependence now can nurture independence later. Appropriate space needs to be provided when moving and transferring to and from the area and table, or vertical change station, just as it does for other activities of daily living. There are both horizontal and vertical methods for changing.
Changing can have significant impacts on psychological and emotional development of your child. For kids over age three, don’t call them diapers. Underwear briefs are space-age technology and can hold up to 60 ounces these days! Design and product selection are paramount to health, safety and success of change stations that are best integrated into the bedroom and bathroom design. Addressing this challenge head-on can have big impacts on the health of the child and family. Here are a few of dozens of suggestions that I wish I could share here:
• During design, think big picture first. It is preferable that your youngster is not rolled through the public portions of the house, and changing in front of siblings should not be permitted.
• Vertical changing stations placed specifically adjacent a toilet can actually increase rehabilitation and help build leg strength when this is possible.
• Child dress skills for the appropriate ages are easily learned and the child is encouraged to dress him/herself just as other kids the same age. Steps toward autonomy begin with children learning how to dress and care for themselves as best they can.
I hope you have found this helpful and have the fun opportunity to learn and design with your child for lifetime happiness and health benefits. Learn how and learn more at www.ChildAccessBedandBath.com or www.AccessibleHealthHome.com
ABOUT THE AUTHOR:
Charles M. Schwab, AIA, UDCP, CAPS, CGP. Access: Able and Universal Design Specialist.
IMAGE: SQUARING THE CIRCLE: you may have noticed that when you worked on home design solutions with your child, you bonded, learned from each other and developed a deeper love and happiness.