Home Modifications for People with Spinal Cord Injury

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Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson  

Introduction

Housing accessibility for people with spinal cord injury are key to maintain their independence, support health and improve occupational performance. Home modification in addition to assistive technologies and training in activities of daily living (ADL) is part of home adaptation interventions.

The goals of home modifications for people living with spinal cord injury include increasing "usage, safety, security and independence", and to ensures they can lead a quality of life in society.However economic barriers the person faces during home modification process may prevent them form purchasing needed equipment, supplies, and services. Therefore the planning stage of an effective home modification requires a good understanding of the needs of the person who live in the home, their resources, as well as the support system offered by a local government or private organisations.

This article supplies complimentary notes to the ADL, Self-Care, and Home Modifications for People With Spinal Cord Injury course.

Environmental Barriers

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

Bathroom

Lack of grab-bar at shower, bath, and toilet are a recurrent problem along with controls placed in inaccessible position.

The following are recommendations for bathroom accessibility:

Shower:

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

Washbasin (Sink):

• Lever handles
• Temperature control valve
• Appropriate height and size so that wheelchair can fit underneath,
• Visible mirror
• Insulated pipes under basin so it does not burn legs when 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 generating accessibility problems outside of the house or apartment include irregular and uneven surface, and the letterbox is difficult to reach. The most common external adaptations are:

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

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

• Limited hand function: 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 if limited UL strength but it can be easier to open as it does not require one to move the wheelchair when the door swings towards you and it can be automated

• Other considerations Other considerations: Hard flooring vs carpets Remove loose rugs Light switches – level and can it be operated Home automation – can help wonders

• • Environmental control units: Direct touch, voice operation, switch scanning

Resources

• A global educational initiative of International Spinal Cord Society (ISCoS)
• https://scireproject.com/ (SCIRE Professional)
• 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