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Physical Environment & Dimensional Extremes

Issues Related to the Physical Environment

Survivors with functional limitations related to dimensional extremes are especially affected by the physical environment.  People of short stature may have difficulty reaching materials or supplies if placed on higher shelves.  People who are obese may have difficulty rising from seating that sink too low.  These barriers are not only disabling, but can create an awkward environment for the people you serve.

Examples of Problems

  • A support group meets in a living room style space with an assortment of couches and armchairs that have arrived through various donations. They all have a similar problem – they sink too low and have arms that are little help in lifting and pushing off from. An obese survivor only fits on a couch and cannot rise independently from it. Others in the group help pull her up but is risky for the helpers, painful for the woman and makes for an awkward social situation.
  • A woman of short stature in a shelter is unable to reach anything easily in the kitchen. She has signed on to help with cooking but is eye level with the stove top.

Suggested Solutions

  • Create capacity to meet the needs of obese survivors. Have at least one large rated ergonomic chair that will work for someone 300+ pounds. There are a range of resources. See Large-Rated Chairs This link will open a new browser window..
  • Short stature is a low incidence condition. You may never serve a survivor of short stature.  Making changes beyond minimal accessibility to universal design will greatly benefit survivors of short stature, but there will still be issues that may need to be addressed. Be prepared to know where to go for solutions if specialty products are needed.

Short Stature

  • Many people of short stature experience significant pain and many are vulnerable to fractures from minor falls or bumps. Minimizing risk of falls and safety getting in and out of bathing facilities, toileting and bed are important areas to plan with the survivor to minimize risks.
  • Little People of America’s website includes a valuable listing of adaptive products which vary from inexpensive extensions for light switches to custom stepstools.
    Dwarfism Resources This link will open a new browser window.
  • There is a kit for little people marketed to the hotel industry that may make sense for a coalition to have available.
    Direct Access Resources This link will open a new browser window.

Obesity

  • Making a welcoming environment for obese survivors in SA/DV environments requires awareness and sensitivity to a range of issues that can make a positive difference in her experience and sense of acceptance and compassion.
  • Meeting the needs of obese survivors will include acquiring some specialized equipment for SA providers. A extra large blood pressure cuff is necessary as is a large speculum. Adjustable height examination tables are recommended that are rated at least 300 pounds but 600 pounds is preferable.
  • Many obese people are warm all the time and find ordinary temperatures too hot for comfort. Room level controls for heating and cooling will help in bedrooms and fans will provide some individual comfort in public spaces.
  • Given the national epidemic of obesity, there is a growing awareness in the health and service sectors of needing to learn how to serve this population with competence and care.
  • The following chart is adapted from an article directed at primary care physicians.

Tips for Improving Your Office Space for Obese Patients

 

Parking & office entry
  • Close parking for people with special needs.
  • Ramps and handrails at entrances.
  • Adequately sized doors and hallways
Waiting room
  • Adequate number of large chairs with armrests or regular chairs without armrests; sufficient height to facilitate rising.
  • Magazines that feature healthy lifestyles and positive images of larger people. Patient-education materials that are friendly to obese patients and address relevant health issues.
Rest rooms
  • Adequate size and number of rest rooms.
  • High, easy-rise toilets.
  • Adequate space surrounding toilets.
  • Handrails next to toilets.
  • Personal hygiene materials (such as moist towelettes) to facilitate cleansing.
Triage rooms
  • Scale with wide base; equipped to weigh patients > 300 pounds. Scale located in private area.
  • Large blood pressure cuffs.
Exam rooms
  • Large examination tables; low enough to allow easy access (hydraulic lift tables are ideal); wider base to facilitate getting onto the table.
  • Large specula for female exams.
  • Extra large gowns, preferably cloth
Check-out office
  • Comfortable and available seating, as in waiting room.
  • Adequate space for mobility.

1 Syed M. Ahmed, MD, MPH, DrPH, Jeanne Parr Lemkau, PhD, and Sandra Lee Birt, Toward Sensitive Treatment of Obese Patients, http://www.aafp.org/fpm/20020100/25towa.html#4