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LEARNING OBJECTIVES
Identify the role of the physical therapist in examination of the physical environment.
Understand the importance of environmental accessibility in optimizing patient function.
Identify common home, work life, and community environmental factors that affect patient function.
Describe strategies used to examine environmental impact on patient function.
Identify the general categories of tests and measures, tools used for gathering data, and data used in documenting examination of environmental factors.
Identify strategies to improve patient function through environmental modifications.
Describe the scope of adaptive equipment and assistive technology available for individuals with disability.
Recognize the importance of an examination of the environment within the context of a comprehensive rehabilitation plan of care.
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Addressing the environment in which an individual will live and function is crucial to a comprehensive physical therapy plan of care (POC), especially for those recovering from accident or illness or transitioning from rehabilitation facilities. A well-developed POC that allows a wheelchair user to freely access their home and achieve independence in all activities of daily living (ADLs) will fall short if the home's entrance is obstructed by stairs or if a bathroom is inaccessible. As a patient progresses through rehabilitation, the living environment should be carefully considered, as returning to a familiar home and community is a high priority for most patients. This is particularly true for older adults who function best in familiar surroundings and may be attached to a home setting that holds memories of important family events experienced over a lifetime.
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Disability or disease places new emotional, care-giving, and financial demands on the family. While adjusting to these demands, the unexpected challenge of addressing needed costly modifications to a beloved home is often overwhelming. The physical therapist is part of an interdisciplinary team that advocates for the patient and family by providing education, counseling, environmental analysis, and training to aid in the successful transition to the discharge setting. Physical therapists have expertise in examining and determining the impact a patient's health condition, bodily structure and function restrictions, activity and participation constraints, and personal and environmental variables will have on the ability to return to or maintain functional independence in the home, community, school, and workplace. As such, a thorough rehabilitation POC will also address examination of community accessibility, reliable transportation options, and workplace, school, or higher education settings.
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This chapter addresses how the surrounding physical environment affects functional independence for patients impacted by injury, illness, or disease. It presents strategies to examine the home, workplace, and community physical settings; reviews current guidelines for public building and transportation access; and makes recommendations for environmental modifications to increase accessibility and reduce hospital readmission risk.
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The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) recognizes disability and functioning as an outcome of the dynamic interaction between health conditions ...