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 key to maintaining their independence, supporting health and improving 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 ensuring they can lead a quality of life in society.However, economic barriers the person faces during the home modification process may prevent them from 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 lives in the home, their resources, and 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 the 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's wall-mounted cupboards and shelves are often placed high, the space is inadequate for manoeuvring, and controls are inaccessible.

Bathroom

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

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 a hook for a 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 the 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 the house or apartment include irregular and uneven surfaces, and 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 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

Home adaptations with assistive technology can help wonders. It includes 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