Magazine article The Exceptional Parent

Home Modification for Independence and Success. (Accessibility)

Magazine article The Exceptional Parent

Home Modification for Independence and Success. (Accessibility)

Article excerpt

Providing the most effective environment for children with special needs can be challenging and seemingly expensive. But with sensible, creative adaptations to everyday problems, the home environment can be modified surprisingly inexpensively to promote development, independent function and success for the youngsters in our care.

Daily challenges for children with special needs include eating, dressing, hygiene, transportation, school activities and play. Within the home, difficulties with these activities are often addressed with the aid of simple environmental changes. Occupational therapists view these environmental changes in terms of modification or adaptation. Settings in which children most likely engage in activity--homes, schools, after care facilities and outdoors--are given primary attention. By applying combined knowledge, experience and creativity to home modification, occupational therapists and parents facilitate function in daily tasks while boosting self-esteem and encouraging independence.

Modifications and accessibility may be categorized into three separate groups:

* Occupational performance (function)

* Activities of daily living

* Accessibility and safety

Presented here are some common categorized concerns and modifications suggested to ease those concerns while promoting independence and success.

Occupational Performance/ Function Positioning:

The foundation for independent function is positioning. Positioning can affect the child's engagement in occupation, progress in activities and ultimately self-esteem and motivation. Both the child's body and objects in his surrounding environment may be positioned to enable performance. Activity challenges occur in the three lying positions: prone (on tummy) supine (on back) and side-lying as well as seated and standing positions. Some commercial positioning systems are complicated and require careful measurements and evaluations by therapists for proper ordering. Occasionally a simple block of wood placed under a booster seat is sufficient to provide the stability needed for erect, healthy posture ready to engage in purposeful activity.

Because every child's positioning needs are different, proper approaches to individual positioning can be challenging. If special equipment is needed, a key factor for parents and therapists to consider is flexibility for growth. Select pieces that grow with the child by deciding what position needs the most attention, (standing, seating etc.). The equipment or adaptation should be designed to allow for adjustment to meet the child's needs as he grows. Materials are a consideration as well. Positioning equipment for the home is fabricated with dense foam or wood often covered with materials such as polyurethane that do not absorb liquids, making cleaning quick and easy.

Positioning objects in the immediate environment may also facilitate a child's ability to perform developmentally appropriate tasks. For example, positioning a bath caddy in the shower for easy access to soap, shampoo and conditioner may mean independent bathing for an older, moderate to high functioning child. Sometimes a child may groom, brush teeth, dry and comb hair more effectively in a seated position rather than standing. Perhaps a bath chair on wheels easily pulled to the sink and mirror may provide the accessibility needed to perform these self-care tasks.


Imperative to function and safety is stability. A basic tenet in occupational therapy practice states mobility follows stability. Adjustments to achieve that stability, therefore, may include securing a chair, table or desk to the floor or placing a rubber mat on the seat of a chair or under schoolwork. Moderate to high functioning children achieve success attempting daily tasks when stability of tools, utensils and appliances is provided as well as stability in sitting, standing and upper extremity control. …

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