Designing Houses for People with Brain Injury

Question: 

What kind of design features should be built into housing for people with moderate to severe brain injury? I work for an affordable housing developer. I would like to incorporate features that would assist specifically for impairments frequently associated with TBI.

Answer: 

It is important for the housing to be accessible for the individual with TBI, but the specific accessibility adaptations to use depend on the specific impairments of the individual.

If the individual is using a wheelchair, then typically the home should include entry-exit doorways and room doorways that are wide enough to allow the wheelchair to pass. Also, having countertop space, cabinets, and equipment at wheelchair height is important.

If the individual is ambulatory but has cognitive, perceptual, or behavioral problems, then the physical environment should be easily understandable and the sensory cues should be easy to interpret. Confusing or provocative designs should be avoided. At times, way-finding is difficult for people with TBI, so the pathways should be clear.

Posted on BrainLine January 30, 2014

Elliiot Roth

Elliot Roth, MD is the Paul B. Magnuson Professor and chairman of the Department of Physical Medicine and Rehabilitation at Northwestern University Feinberg School of Medicine, and chairman of the Department of Rehabilitation Medicine at Northwestern Memorial Hospital.

Comments

Grab bars in the bathroom: everywhere in the bathroom ; on all 3 sides of the toilet, and inside the shower and just outside the shower, and on each side of the bathroom sink. It might sound like a lot but it is necessary when balance and coordination are an issue, especially when there are wet or slippery surfaces.

My husband has cognitive issues and memory issues.  We have put lighted light switches on every electrical plate. The hot one with the lighted switch give a light source. Any that are not lit, serve a different function i.e. outlets, garbage disposal, bathroom vent. Not only does it show him which switch he needs to use, it directs you to a light source when it is dark. We installed them ourselves so only had the cost of the lighted switch. 

Does the state of Massachusetts have one of those programs?

There is an apartment complex built in Oregon for those living with brain injuries, and many of the features of these apartments could be utilized in other housing.  Open cabinets with no doors, a timer for the stove top and oven, are but a few of the ways safety was built into the apartments.

Adjustable sensory elements, limit interior echo with low pile carpet or use of larger area rugs, use black out curtains that can be opened or closed depending in the amount of natural light. Super quiet appliances to limit over stimulation. Simple design flow, nothing too busy as this can also be over stimulating. Small appliances that limit the number of steps in the process of use, maybe automated soap/softener dispenser in a one touch washing machine. Easy adjustable thermostat. The less complex the better. Some prefer removal of cupboard doors while others would be easily over stimulated by this. Additions need to be as unique as the person with the TBI and their supports.

Thank you for asking. Definitely extra sound proof and low glare windows. Noise and light are literally assaults on the TBI brain. Under cabinet lighting is a great help to me. Also no stairs. Rounded edges on counters and walls because of balance and bouncing off walls. Low noise bathroom fans. Low noise heat and A/C too.

When I purchased my latest home, I found smaller is better (wish I had gone even smaller) and an older home is something that makes me smile.  The rooms are small--and compartmentalized.  The kitchen being on its own, is better for me to NOT burn things (an important thing).  

Where my home was located was a big deal.  I am able to drive now, but sometime I may not be able to.  So I looked to be close enough to services, as well as a transit center (bus stops move-transit centers don't often move).  I chose a smaller community. I messed up with stairs... I do have them--however it is possible to change the dining room to a bedroom if needed.  

I personally believe that a tiny home community with services would be a HUGE bonus for people like me.  

We use a lot of whiteboards in each room to help with notes or directions, security system with a camera incase I'm not home and my husband isn't answering his phone. Doors and windows that also talk when open and shut We have motion sensor night lights throughout the house. Stairs aren't good for my husband we have carpet stairs and he has fell many times. Easy to use appliances if there is a such thing. Cause he can't cook or do laundry without me guiding him. Motion sensor lighting outside. Curtains that are black outs. My husband has tbi and ptsd. Hope this helps.

I know my son loves or hates textures. At the one hospital they did a wall in glass beads. He loved to touch it. For a bathroom, it may be nice to make a mural out of them somewhere, just a suggestion for sensory. Another thing was sounds... Make sure bathroom have separate fan and lighting switch. Sounds were and still can be unbearable. Toilets, make them higher and with cushion seat as sometimes it takes awhile for bowels to go. Grab bars near toilets too. Auto flush toilets if possible and sensor faucets too. Shower, we did here was the kind you could wheel into and fold down seat. Extra grab bars, lots of built in storage and both a permanent position showerhead and hand held shower attachment that is height adjustable too. Doorways, hallways, entrances everything should be easily accessible by a wheelchair. Flooring should be lowpile-tight berber- carpet or something not slippery yet easy for wheelchair to move on. Door handles should be the lever, not a knob or better yet those push button entrances if able to be installed. One story preferably, but if two then either put chair lift on steps or seriously an elevator. You honestly do not know what the future holds. Sadly we are finding this out, and my son is only four years out from his injury. I can't even get the state I am in to put a deck on so he can get in front door. Windows with the cranks vs little push in tabs to open. Keypad or keyfob to enter home vs a key to turn in a lock. Lots of security lights, locks etc. My son has PTSD and is extremely afraid now at nights. Love other's suggestions for rounded walls vs corners and on countertops too. If able, Pie in sky, adjustable countertops. That way if currently walking, and later needs to be back in wheelchair, just pull out drawer & lower counter top. (We had people at work with adjustable desks so they could stand or sit to work...base it on same principal) Solar energy, wind power and tankless hot water. Make home as energy efficient as possible because most are on very fixed incomes.

I prefer open shelves in the kitchen and bath Cupboards that close dont work for me, outa sight out of mind and i forget whats in them.

Islands with varying height in kitchen. 2 low sides allow for sitting during chopping and also wheelchair access. 2 High sides allow for stools or standing. Electric outlet in center for using appliances. Cabinets with easy access and self closing hinges might be helpful. Lights on separate dimmer switches. If you can see the lightbulb directly, it is likely going to glare. Under cabinet/shelf lighting, Tinting or shading from roof is important for large windows and sliding glass doors. Mother Nature can also be quite intense. Houses should flow with natural cues. Like a coat closet near main door, linen storage in bathrooms, easy access shelves for laundry supplies near washer and dryer, pantry near fridge, paints with metal additives in den and kitchen backsplash so magnetic organizers can be used. In house sprinkler system would be best, but fire extinguishers in kitchen at least. Minimal maintenance carpets and flooring that is level and flat but not slippery. It's worth contacting a person or company who rehabs homes for disabled persons to request a wish list too.

flooring with some give to it like cork; all doors wide enough for wheel chair or walker because while you might not need it now, you may in the future; good soundproofing throughout; easy open windows--those little slidey things to raise the storm door window are almost impossible if you don't have good finger strength, so an easy to grasp handle is much better.  smoke alarms with lighting built in and hard wired so there's never a battery to replace.  Rounded corners or bumper guards on everything.  non slip flooring in bathroom, kitchen and laundry areas are a must--too easy to not see the little bit of water and go down.  a walk in/roll in shower with grab bars and a shower head that can be stationary or hand held.  And finally, make it as energy efficient as possible as most with TBI are on very fixed incomes that do not allow for major spikes in utility costs.

Sound proofing. and motion lights that adjust to the outside lighting would be good.

I have a brain injury and have alot of trouble with glaring light. now I have lights under my counters, a light behind my tv and working on getting more lights that are behind things to lighten a room but no glare. makes all the difference in the world to me.  also if you can afford it.  having the corners of walls changed to rounded corners, i have balance problems now and the sharp edges are very bad to fall agains. rounded ones sort of slide me off a bit.  

Designing Houses for People with Brain Injury

What kind of design features should be built into housing for people with moderate to severe brain injury? I work for an affordable housing developer. I would like to incorporate features that would assist specifically for impairments frequently associated with TBI.
- every brain injured person, good for 'normals' too. All houses should be wheelchair accessible (doors, loo etc) coz my friend in UK couldn't visit me coz my home not accessible (doors/rooms) let alone loo.

It is important for the housing to be accessible for the individual with TBI, but the specific accessibility adaptations to use depend on the specific impairments of the individual.
- mine: not remembering where things are if put away, papers,must do, food must eat (not in fridge). Tiredness looking for. Need lots wall storage with easy access, shelves, cubbyholes, if door on front then small doors, small shelves, translucent = maybe too busy to look at? Colour coding, calm pattern maybe better than labels? Or poss labels at start til learn? Kitchen ergonomic, the obvious triangle fridge, cooker and sink, but plenty work-top and a table (normal height) to sit and eat at. I want kitchen can close off (smells) but BIG, invite people eat/sit in. Easy see reach micro, grill at eye level so don't hurt back/neck. Sink can wash hair in and nice tap for that/rest. Easy see hot/cold, easy adjust and swivel. Or next to/part of = dining with TV, view from table. Double sink (bowl fits if necessary, nicer than washing in too hard metal/sharp?) with drainer that drains and my/nice plastic thing to put crocks on to drain. Place put teatowels to dry, spread out - on hooks don't dry. No sharp hard edges or corners, tiny rounded. No black or dark worktop/tables: can't see things on,lose spex. Easy ventilation and privacy/dark. Good lights where need and never me make shadow into where trying do things. Lights can turn on/off from dif places and not have to go back do/have no light. Flat floor, cracks get things stuck in, but slightly softer than ceramic/tiles = resin/wood if no gaps? Colour floor not show dirt but grey rather than beige. Sparkles? Maybe distracting - no really shiny things coz looks like a hole and light shining through.

If the individual is ambulatory but has cognitive, perceptual, or behavioral problems, then the physical environment should be easily understandable and the sensory cues should be easy to interpret. Confusing or provocative designs should be avoided. At times, way-finding is difficult for people with TBI, so the pathways should be clear.

- YES! 
Would especially like more details of what is meant by 'non-provocative' details, and specific design suggestions & the reasons behind those suggestions.
- What does provocative mean? Unusual = OK if easy use. Colour is nice to help know/see and remember what's where/sections. Stands out? But not too busy/garish. Everyone will feel differently about what is though and maybe live to to experience then can change it = flexible?


closets have lights inside that turn on when you open the door.
- or not necessary if good light elsewhere? But yes maybe: but mustn't shine in my eyes, stays there too long/blinds me, makes hole in vision. Doors, drawers = all must be very easy (least effort possible) to open and not hit head on if turn round get something and forget is open.  Must be able to see at glance if front door/gate is locked. We forget to notice if have so must check/do again. Simpler than fiddly keys? Fingerprint/touch pad? Auto when x metres from house with override? In garden? Don't take handbag. Voice activated? 

any Interior rooms without windows have motion sensor lights.   
- must be set right: no walking past and set it off.
handraIls on both sides of any steps. 
- no really sharp edges/corners. Easy to see. Fewest steps possible. But I like separation of sleeping from rest. Try not to often rest in bedroom, otherwise feel always in there/sick of it. Choice of rest/sleeping? Lounge area = proper bed size = also spare room? Not have to click clack or move anything = or proper bed always out but can very easily slide to make sofa or something if need show/invite people?

safety handrails in tub shower area. 
- I hate these, useless, bang self on (don't see) and hard to clean. Prefer side bath right width to push up from with hands. And something (basin before, son used towel rail and broke it!) to steady as get out, hold.

in any space two weaker lights with independent switches are better than one bright light.  
- yes but option brighter = dimmers? Possible to simply control all from same place plus at each?

no flickering at all in any florescent lights.  
- yes.

stoves with bright burner or oven on indicators.
- and easy see know when still hot. Sometimes didn't see gas was on hob in sunshine. Easy simple see/use controls,numbers don't rub off with cleaning. EASY TO CLEAN! Width 60cms to fit all trays.
Easy access things use lot: cutlery, chop board, coffee, cereal/bowl, biscuits/cake, salt.

In my view, a house for a person with a brain injury can contain a quiet room along the lines of a quiet, single room with off-white painted walls
- YUK off white, prefer blue-grey, grey, nice lilac, some brights ok.
a desk, a chair, a light, and a spiral notebook journal with pen to write thoughts down.
- with view. Dining area [near/off kitchen?] could double as this (if able to keep clear/calm,not look busy/crammed) = look out to garden?
Separate room just this = not good for me, wouldn't use, cut off. Need office area/arty,storage, inspiration, cubby holes, shelves, computers, table. Place stick things found incl. 3D things. 

Loft (or very dry outbuilding) for suitcases, camping, surfboard, storage stuff. Tools in house? Hoover near where use most and poss for inside car. USA used to have plugs in walls so wheeled hoover then vacuum point in each room. Do computer controlled/auto hoovers work? Get right into corners? Not under shelves though = dust trap = no empty spaces skirting height under things? No breakfast bar, I stand too much (forget) and foot hurts. Better sitting with lower place do chopping (but hassle/pull out = wouldn't use). Standing at normal worktop height and look down hurts neck. No solution? Not chop anything?

Easy to do all: clean gutters, drains, u-bends, clean, find things. Help create systems. As few papers as poss, most on auto, know when must pay and get bill or auto way can truly trust. Internal doors with proper fixings/handles. Flexible windows,not just huge ones = a gale, must be able to fix ajar. Easy to clean in/out. Radiator in a cupboard = like old airing cupboard to get last damp out/store bedding/bits. Books = behind glass so don't get too dusty. Various hooks/nails in walls so choice of where put/change pictures. Sockets desk height for PCs+ and kitchen, loads sockets with switch for each. No trailing leads to trip over. Light shows when on. Help dates food/rotation. NO wood beams dark/light, flat non busy ceilings. Radiator or three can dry things in hurry. If heated towel rail must be big enough for towels not scrunched up. DRY storage in bathroom and proper sealant gaps. But towels kept outside?

Place to grow things, easy reach, plants fit climate = no water much as poss. Old well-established trees/shrubs just a cut occasionally. Beds full so little weeding. Easy compost, wormery for kitchen? Catch water rain - use to rinse hair, loo, water garden, all obvious stuff. TV in every room? Wifi TV? no cables! Phone in most rooms? Video-peephole/security, door bell can switch off? No recorded or threatening letters or phone calls! NO hassle or threats. No being pushed around or told what to do, go there, do that. Peace and security and help to build a life. Little jobs can do to regain confidence, feel achievement instead of failure. Mentor/s to encourage, push, help and check/advise. Help to make/think easy tasty meals, new recipes to make bulk/freeze. Water that tastes nice. Easy access to good food. Kindness, no fake smiles or condescending, no fake looks of 'concern'. 

Solid wood storecupboard for baking foods, tins. No rubbish strips peeling off yuk melamine or door fixings falling off. Doors not so big, easy handles don't get fingers stuck in. Not black inside = very light/white or light grey/sealed wood? No loud wood grain yuk or plastic wood. On Mac: instant traduction of french to english/vice versa. Smart phone that's not flat,nice to hold and folds. Black test on white buttons, big enough screen,easy insert symbols, caps and numbers punctuation. Old version Quark/open source make documents = easy learn/use/output. Little as poss dust-catchers and twiddly bits except where nice design,not sharp. Desktop Mac aswell as laptop. Sep (or very safe) from internet as always had before. Simple instructions create and how UPLOAD/service websites with no/few/easy updates ever necessary.

Bed that's soft enough (like had) but cool bedroom or summer would get too hot? Space round mattress to not hit hands+ on bedside/rad. Slats for double silly (useless) if alone sleep in middle and the join slats is in centre and no spring - derr. If mattress good then no need spring in slats? Can't put mattress topper coz fitted sheets = no more room in. Easy to see sheets really fit mattress size and sizes duvet covers really fit, easy read. Easy read useless when systems trying to explain are complicated. Bath right length so don't sink, rest feet on end? Thermostat run bath, like cars = my settings/others, easy to see when they've changed it. Not chrome that rusts, less shiny. Easy way clean calcaire/it doesn't stick kettle, loo+.

Place for friends stay sep from me, privacy both, and can rest/sleep day without them having to creep around - kitchen,loo/shower/TV/relax. Place for motorbike and S&P paid design/sort one for me bit like old XT. Boats to beaches with landing stage so easy if tired/hurts to walk/carry stuff and wheelchairs.Place keep clothes other season and know what's where for in-between seasons. Fresh air without draughts/gale/bugs,no ants/bugs in bedroom. No gutters that clink rain. Simple clear diagrams/instructions/access to plumbing, electrics and all systems. That enough for now? But can't ever know if something works til use it, try. Sick of trying adapt to rubbish. But even if wrong easier to put up with than move stuff.

Would especially like more details of what is meant by 'non-provocative' details, and specific design suggestions & the reasons behind those suggestions.

closets have lights inside that turn on when you open the door.  any Interior rooms without windows have motion sensor lights.   handraIls on both sides of any steps. safety handrails in tub shower area. in any space two weaker lights with independent switches are better than one bright light.  no flickering at all in any florescent lights.  stoves with bright burner or oven on indicators.

In my view, a house for a person with a brain injury can contain a quiet room along the lines of a quiet, single room with off-white painted walls, a desk, a chair, a light, and a spiral notebook journal with pen to write thoughts down.

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