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Designing for Spinal Cord Injury

April 1, 2006
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Adding this form of specialized care requires major environmental modification by Scott Speser, RA, LEED
BY SCOTT SPESER, RA, LEED Designing for spinal cord injury
For the facility wanting to manage more of these cases, some environmental reminders
Imagine that you are no longer able to move your arms and legs, and everyday tasks have become major hurdles. Individuals who have sustained spinal cord injuries face many challenges, including such medical issues as pressure wounds and infection, loss of bowel and bladder control, and requiring ventilator-aided breathing. They may also experience low self-esteem, depression, poor body image, and tension in their personal relationships and work environments.

Spinal cord injury (SCI) can result in either paraplegia (the loss of nerve control from the waist down) or quadriplegia (the loss of nerve control from the neck or shoulders down). Paraplegia accounts for about 40% of all spinal cord injuries and quadriplegia 30%. Many patients are without upper torso control, arm and hand control, and intrinsic hand articulation.

It is estimated that between 250,000 and 400,000 individuals in the United States live with SCIs. An additional 11,000 injuries occur each year, which translates to approximately 30 injuries per day. Most of these injuries are caused by traumatic events, such as auto accidents, while some are caused by chronic healthcare issues, such as infections of the spinal nerve cells. Sixty percent of SCI patients are under the age of 30, with most being men.

Figure 1.

Designing for SCIs
The quality of life for people with a spinal cord injury can be dramatically improved with facility design that addresses their needs. SCI patients often experience long hospital or nursing home stays, and a properly designed physical environment can positively affect patient outcomes by reducing patient stress, facilitating increased independence, and ensuring patient dignity.

Mobility and accessibility are primary concerns for people with SCIs. Manufacturers continue to develop products that address mobility and accessibility constraints. An example is flooring that meets ease of roll-ability testing standards.

Other technology promotes additional independence, such as remote control devices to adjust artificial lighting levels, window treatments that admit or filter natural daylight, and individual thermostats to control room temperature. Sip-and-puff technology-a straw-like pneumatic switch that allows the use of one's breath to perform mouse clicks-has been developed to aid individuals with quadriplegia. The signals generated from sip-and-puff are also used in conjunction with wireless transmitters that interface with various devices to control the patient environment.

Space allocation for an SCI unit should be defined early in the planning process, since it is generally much larger than that allocated for many other programs. Space allocation within facilities should meet or exceed design guidelines set forth in ADAAG (ADA Accessibility Guidelines for Buildings and Facilities) and UFAS (Uniform Federal Accessibility Standards)(figure 1). Patients confined to wheelchairs or stretchers require additional space to maneuver. Adequate clearances for corridors and doorways must be maintained. Automatic doors should also be considered.

Wall protection should be employed to reduce damage caused by wheelchairs, stretchers, and carts. A crash rail located 8" above the floor is beneficial, as well as one located at chair rail height. This upper bumper guard may be combined with a handrail to provide additional assistance to patients traveling along corridors. In areas that experience only cart traffic, the upper rail may be eliminated. Solid sheet products installed between the upper and lower crash rails can protect this area from dents and marks caused by rolling equipment and wheelchairs.

Figure 2.
Photo: Cannon Design

Making It Feel Like Home
When designing for SCI facilities, the development of a homelike environment should be the primary goal, in view of the long stays involved (figure 2). Materials and finishes that suggest a residential environment may be appropriate, but care should be taken that all components are hospital-grade and easy to maintain to ensure cleanliness and durability. Materials with antimicrobial properties are ideal because patients with spinal cord injuries are at higher risk for developing infections. The introduction of color, texture, light, sound, and smell are additional tools that may be used in the design of the SCI unit. For example, a color palette that includes warm and soothing colors has been shown to have a calming effect on patients and contribute to successful patient outcomes.

Although staff supervision is important, bedrooms must be designed to provide privacy and dignity by shielding the patient from direct view into the room. Space requirements in the bedroom for wheelchair battery charging must be considered, in addition to adequate storage space for personal possessions. Casework should be designed to meet anthropometric standards as outlined in ADAAG, UFAS, and VA guidelines to provide patients with a high level of accessibility. Outside views and adequate lighting are extremely important (figure 3), as glare is a particular consideration for patients confined to stretchers, and exterior views may be the only connection some SCI patients have with the outside environment. The color of lighting should also be considered; for visual comfort, warm white light sources are preferable to cool white ones.