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  1. Identify the role 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, work life, and community environmental factors that affect patient function.

  4. Describe strategies used to examine environmental impact on patient function.

  5. Identify the general categories of tests and measures, tools used for gathering data, and data used in documenting examination of environmental factors.

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

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

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


For individuals undergoing rehabilitation, addressing the environment in which he or she will live and function is an essential component of physical therapy intervention. A well-developed plan of care (POC) that achieves independence in all activities of daily living (ADL) for a full-time wheelchair user will fall short if entrance to the home is precluded by stairs or if the bathroom is inaccessible. As such, the patient’s planned living environment warrants early and consistent consideration during the course of rehabilitation. For most patients, returning home and to a familiar community is a high priority. This is particularly true for elders who function better in familiar surroundings and have strong bonds to a cherished home associated with a lifetime of important events.

Disability or disease places new emotional, care-related, and financial demands on the family. While adjusting to these demands, the unexpected challenge of addressing needed modifications to a beloved home is often overwhelming. A critical role for the physical therapist in this area is that of advocate for the patient and family by providing the needed education, counsel, environmental analysis, and recommendations to assist with successful transition to the discharge setting. With collaborative input from other disciplines (e.g., occupational therapy, speech-language pathology) and knowledge of environmental barriers and their potential solution, availability of community resources, and needed assistive and/or adaptive equipment, as well as information about the patient’s functional capabilities, cultural background, characteristics of the home environment, and financial resources, the physical therapist is in a unique position to guide the patient and family in optimizing accessibility. For most patients, the environmental examination extends beyond the home to the community and the availability of appropriate transportation; for others, it will include examination of the workplace, school, or higher education setting.

This chapter considers key environmental design concepts and common barriers impacting access. It addresses strategies to examine various aspects of the physical environment including the home, workplace, and community. Also included are approaches to modifying the environment to improve accessibility as well as legislation stipulating access requirements for public buildings and transportation.


A variety of both built and natural objects comprise the physical ...

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