Home Modifications for People with Spinal Cord Injury

Original Editor - Wendy Oelofse

Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson  

Introduction

Housing accessibility for people with spinal cord injury is essential for independence, supporting health and improving occupational performance. Home modification covers a number of interventions, including assistive technologies and training in activities of daily living (ADL).

The goals of home modifications for people living with spinal cord injury include increasing "usage, safety, security and independence" and ensuring they can lead "a quality and meaningful life". However, economic barriers faced during the home modification process may prevent individuals with spinal cord injuries from purchasing much-needed equipment, supplies, and services. Therefore, to ensure an effective home modification, service providers must understand the needs of the person who lives in the home, their resources, and the supports offered by local government or private organisations.

This article provides the complimentary notes for Wendy Oelofse's Plus course, Activities of Daily Living, Self-Care, and Home Modifications for People With Spinal Cord Injury course.

Environmental Barriers

Individuals with spinal cord injuries have identified that the most common environmental barriers associated with accessibility problems are located at the entrance to the house and in the kitchen. In the entrance, the main obstacles include high thresholds and/or steps, doors not staying in the open position or closing too quickly, and a lack of handrails or a ramp. In the kitchen, the key issues are that the wall-mounted cupboards and shelves are often placed too high, the space is inadequate for manoeuvring, and controls are inaccessible.

Bathroom

Common issues include a lack of grab-bars in showers, baths, and toilets and that controls are placed in inaccessible positions.

Recommendations to improve bathroom accessibility:

Shower:

• Roll in shower
• Lever handles if limited hand function
• Temperature control valve to prevent burns
• Hand-held shower (can add a hook for a patient with tetraplegia to use independently)  

Washbasin (Sink):

• Lever handles
• Temperature control valve
• Appropriate height and size so that the wheelchair can fit underneath
• Visible mirror
• Insulated pipes under the basin so they do not burn the individual's legs when they are seated under the basin
• Angle-adjustable washbasin, extended from the wall

Toilet:

• Wall-mounted toilet armrests  
• Controls/flush accessible and can be used independently
• Adequate space to accommodate a wheelchair for transfers

External Access

Two barriers that cause accessibility problems outside the house or apartment include 1) irregular and uneven surfaces, and 2) the letterbox is difficult to reach. The most common external adaptations are:

• Ramp at the entrance
• Remote-controlled door-opening (own dwelling)
• Remote-controlled door opening (in the stairwell)

For an individual with limited upper limb strength and hand function, the following adaptations are recommended:

• Adapted key (long-handled key turner) and lever handle
• Sliding door: keep in mind that raised tracks can be difficult to cross in a wheelchair, but sliding doors can be easier to open as they do not require the individual to move their wheelchair when the door swings towards them. They can also be automated.

Other Considerations

Home adaptations with assistive technology can work wonders. Examples include: direct touch, voice operation, and switch scanning.

Resources

• A mobile application for home evaluation and DME appropriateness for space
• A global educational initiative of International Spinal Cord Society (ISCoS)
• SCIRE Community: free information about spinal cord injury research that is written in everyday language
• Social mentoring network
• Educational handouts about spinal cord injury
• Tips and tricks for an active life