By Lynne Wilson Orr, Principal, Parkin Architects Limited
As the general population is aging and the numbers of those over 65 is increasing, we are seeing more people requiring rehabilitation following traumatic healthcare events. At the other end of the spectrum, however, there is a cohort of children who need rehabilitation therapy in order to enhance their capacities to live well. Both groups can benefit from receiving rehabilitation therapy in their home communities and new research is identifying that a change in strategy in how therapy is provided and the physical environment that it is provided in can influence the success of the outcome.
Normalization of Therapy
A new approach, ‘normalization of therapy’, suggests that if therapy is offered in an environment that reflects the ‘real’ world, it is better assimilated by the person, young or old, and the long term prognosis are more positive. New architectural solutions are now being presented, which explore how Evidence-Based Design can contribute to earlier discharge and more effective treatments.
Children’s Rehabilitation Therapy
Children requiring rehabilitation therapy form a small and consistent percentage of the general population. Many are medically fragile, technology-dependent kids, but others require less intensive interventions.
There are an increasing number of children with Autism Spectrum disorders and these children also benefit from rehabilitation therapy. Many of these children have associated gross motor and/or fine motor deficits in addition to behavioural or cognitive challenges.
Normalization of therapy is a new approach that simulates a junior kindergarten classroom or play area to teach children the skills that they need to be successful and happy. A child’s fine motor skills can be improved through using therapeutic manipulatives, but can be better improved through using common, everyday household tools. The lessons are then more transferrable to real world situations at the local playground, at home or in public.
For example, learning to make cup cakes for a birthday party involves measuring skills, fine motor skills to hold and pour ingredients and requires focused attention, all of which can be both challenging and rewarding for children.
For many of these children, invitations to birthday parties are few and far between. A trip to the playground is a huge challenge. Those using walkers are often tired by the time they make the trip from home to the playground so if the ‘accessible’ playground then requires them to make their way up a ramp to find play elements they won’t be able to make the effort. For other kids, the challenge is playing in an area with other children in a way that doesn’t lead to tears and arguments.
Ontario Rehabilitation Facilities Incorporating Normalized Therapy
The new ErinoakKids Centre for Treatment and Development facilities located in Brampton, Mississauga and Oakville are being designed to meet the needs of these children in a new kind of environment. Large therapy rooms will be set up as junior kindergarten rooms with sand tables, water play, and reading and drama areas so that children can master new skills in an environment very similar to the one they are preparing to enter in the community. Indoor therapy spaces will have equipment that looks like play equipment as it is much more fun to climb up stairs to reach a slide than it is to climb back down again.
The Hamilton Regional Rehabilitation Centre was completed three years ago and includes both centralized and on-unit therapy areas as well as extensive outdoor therapy areas that incorporate a variety of types of walking and wheeling surfaces, varying grades of ramps, different types of outdoor seating and other real world challenges for rehabilitation patients.
The new centre is a consolidation of rehabilitation programs from multiple sites in the Hamilton Region and includes a specialized Acquired Brain Injury facility in addition to Neuromuscular Rehabilitation and Neurocognitive Rehabilitation through both outpatient and inpatient programs. Recent changes in rehabilitation programs in Ontario mean that inpatients are being returned to their homes much earlier in their recovery path and extensive and intensive outpatient therapy programs have developed to support this early discharge.
By focusing on meeting the real world rehabilitation needs of adults and children, we can design more effective facilities that help patients achieve optimal independence sooner and at a lower cost to the healthcare system.