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Integrating Daily Activities into Rehabilitation Therapy

By Lynne Wilson Orr, Principal, Parkin Architects Limited

I had a conversation a couple of days ago with one of the other Parkin Principals about rehabilitation facilities. He described how thirty years ago, he was tasked with figuring out how to move a 1980 Ford Fairlane inside an existing traditional rehab facility, remove the gas tank and engine and support it on a platform, in order to provide patients the opportunity to relearn how to get into a car as part of their rehabilitation. He had recently revisited the same facility only to discover that the car was long gone and the patient profile had changed from young men who had become paraplegics as a result of car accidents to elderly people who had suffered strokes or lost limbs to diabetes. This is an over-generalization of the change but it reminded me that whom we rehabilitate has changed as much as how we rehabilitate.

Many of us have had to attend physiotherapy sessions over the years for sports injuries or for other less glamorous reasons. These are typically held in a gymnasium-type facility outfitted with arm ergometers, exercise bikes, treadmills, overhead grids, etc. where we learn new ways to move to repair our musculature. It has never been a lot of fun but we do the exercises and the injury heals. But what has frustrated me has been the physiotherapist’s inability to help me and others learn how to prevent re-injuring myself during my daily activities. I don’t translate the movements developed in an exercise at the physiotherapist’s office into how I move when picking up a suitcase from an airport baggage carousel or getting into a car or climbing up exposed stairs in work boots on a construction site.

This disconnect between physiotherapy and daily activities was brought home to me one day while working with a client organization that provides rehabilitation therapy and treatment for children with a wide variety of  severe physical disabilities. She said, “Wouldn’t it be wonderful if we could make cupcakes with the children and have a birthday party. Our kids never get invited to regular birthday parties.” The room went absolutely silent as all the therapists and the designers absorbed her comments. Another physiotherapist looked around and said, “Why can’t we use climbing walls to teach children gross motor skills? It would be a lot more fun than traditional equipment.” An Autism specialist said, “We can use the handholds to teach shape and colour discrimination while helping the children improve their hand/eye coordination.”  The room absolutely exploded with ideas on how to make physical therapy fun, how to make the children feel like normal kids and how much benefit there could be if we normalized the therapy process.

So, instead of a car in a gym to re-teach driving skills to twenty-something paraplegics, we have incorporated a simulated school bus to help children learn how to safely get on and off the bus; there is a room designed to recreate a school junior kindergarten room so children can learn how to behave in a regular classroom and of course, there is a two storey climbing wall right at the entrance to the facility. It says, “ Come in, we believe you can do anything you set your mind to with our help and let’s have some fun”. We believe that architecture and design need to reflect real life needs and when they do, they can transcend Project Specific Output Specifications (PSOS) documents, building codes, program requirements and cost estimates to become something very special.

Cupcakes will be baked on Tuesdays and the giggles will be music to our ears.

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