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  1. Identify the roles and responsibilities of the physical therapist in examination of the physical environment.

  2. Understand the importance of environmental accessibility in optimizing patient function.

  3. Identify common home, workplace, and community environmental barriers that affect patient function.

  4. Identify the tests and measures, tools used for gathering data, and data generated during examination of environmental, home, and work barriers.

  5. Describe examination instruments used to measure environmental impact on patient function.

  6. Identify strategies to improve patient function through environmental modifications.

  7. Describe the scope of adaptive equipment and assistive technology options available for individuals with activity limitations and disability.

  8. Recognize the importance of an examination of the environment within the context of a comprehensive plan of care.

A variety of both built and natural objects comprise the physical environment in which an individual functions. Built objects refer to buildings and structures created by humans; natural objects include other humans, as well as geographical objects such as vegetation, mountains, rivers, uneven terrain, and so forth.1 The environment encompasses a substantial range of components that affect human function and includes the individual's home, neighborhood, community, and method(s) of transportation, in addition to the individual's educational, workplace, entertainment, commercial, and natural settings.2

Environmental barriers are defined as physical impediments that prevent individuals from functioning optimally in their surroundings and include safety hazards, access problems, and home or workplace design difficulties.3 Accessibility is the degree to which an environment affords use of its resources with respect to an individual's level of function. Accessible design typically refers to structures that meet prescribed standards for accessibility. In the United States, these standards are available from the American National Standards Institute,4 the Fair Housing Amendments Act of 1988, and the Uniform Federal Accessibility Standards (UFAS). Requirements for public and commercial buildings are regulated by the guidelines of the Americans with Disabilities Act (ADA) Standards for Accessible Design.5


Universal design (UD) refers to "the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design."6, p. 1 This design concept emphasizes social inclusion by creating products and environments that are usable by a wide range of individuals of different ages, stature, sizes, and abilities, and it addresses the changing needs of human beings across the life span. Other terms associated with this design concept include inclusive design, design-for-all, accessible design, barrier-free design, life span design, aging-in-place design, and sustainable and trans-generational design. Joines suggests that "although the individual's capabilities do not change as a result of the design, his/her abilities do. By redefining problems, changing environments, and selecting different products, the quality of life of the individual may be enhanced."7, p. 155

Universal design has been identified as an outgrowth of the disability rights movement in the 1960s, ...

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