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Disability and its Effects are not Always Obvious

Special Reports

Eddie Lamptey, Expert Witness on Disability Accommodation for Cowan Architects, argues that we must not define people by their abilities or disabilities but rather help them to normalise their lives through sophisticated adaptations in their living environment.

Some people don’t realise that impairments such as migraines, dyslexia, asthma and back pain can count as a disability. Certainly, under the rather dry definition of the Equality Act 2010 this is the case if the adverse effect of these conditions on the individual is substantial and long-term. The key thing is not the impairment but its effect.

As an Expert Witness for accommodation I have to look beyond what is in front of my eyes and use empathy and understanding to really see the ramifications of in individual’s disability. I know of a man in his late 50s who was left a paraplegic after a road traffic accident. All the experts, such as the Occupational Therapist, the Accommodation Expert and the Carer, where making recommendations for therapy rooms and facilities until the psychologist spoke out. “This is total nonsense! What this man needs is a large, insulated garage with lots of space and room for a sofa or two so that he can have all his mates round to natter and tinker with cars. That’s what he needs”.

Of course, the psychiatrist was right. Or part-right as making the most of the man’s living space has to go beyond a garage, but he had addressed the nub of it by getting inside the soul of the man and this is an important part of our remit.

As far as accommodating disability in the strict housing sense, we have Part M of the Building Regulations to guide us; a tick box exercise that any builder can follow. BUT to really provide a solution that’s helpful, a housing expert must really look below the surface with an informed eye. Even someone who considers themselves articulate on the subject might be surprised at the extent that their view of disability short-serves them. From the mother with a pushchair trying to get through a doorway at one end of the spectrum to the immobile tetraplegic totally at the mercy of a carer at the other, and everything in between, ‘normal’ levels of accessibility is compromised.

The idea of what’s ‘normal’ is central to the debate. Going back to the Equality Act 2010, it says that “disability has a long-term adverse effect on a person’s ability to carry out normal day-to-day activities”. This means activities that people do on a regular or daily basis, such as reading, writing, using the telephone, having a conversation and travelling by public transport. One might not think that the loss of hearing would have an impact at home, but loss of balance often goes hand in hand with defects to the hearing and the need for a single level dwelling may become necessary to avoid the hazards of staircases.

As specialists in adapting living spaces to meet the individual needs of a client or in acting as Expert Witnesses in High Court Cases, Cowan Architects often finds solutions that are far from obvious that need us to ‘get under the skin’ of the syndrome or disability in question. Indeed, every client carries and handles their individual disability differently. We always want to design a home that doesn’t shout out ‘disability’ if we can avoid it.

Accommodation also needs to be future-proofed with a design that can provide life-time flexibility incorporating aspects such as knock-out walls to allow for the future installation of hoist systems, sufficient storage for equipment such as wheelchairs and generous rooms and circulation to allow for easy use by wheelchairs. If this is done well, the interior shouts ‘contemporary’ instead of ‘disabled’.

It is also important to involve the user in the design where possible such as wheelchair accessible gardens, colour schemes and finishes.

To appreciate the breadth and depth of understanding needed in each case, it may be worth looking at some of environments and disabilities that require specialist accommodation needs.

Brain Injury

At any one time about 1,000,000 people in the UK are living with the results of a head injury and the effects may be devastating. Stroke can induce similar effects. Bones can mend and scars can heal but a brain injury stays with you for life and impacts on everything you think, feel and do, affecting not only the injured person, but also family, friends and work colleagues. The problems that arise do not always depend on the severity of the injury. People with an apparently minor injury may experience difficulties with memory, concentration, communication, problem solving, mood and personality changes, as well as fatigue and intolerance to their environment. People with more severe injuries may, in addition, experience complex physical and sensory difficulties.

For younger people, it’s better to have separate spaces for separate function, even if they’re smaller so that the child knows that this room is for sleeping, this one is for play and this one is for therapy. For older patients, a quiet room is also important as temper thresholds are lower and personal space becomes more important - for everybody.

Attention to clever design should be given externally as well as internally. The importance of outdoor space, such as gardens, cannot be over-estimated as its sensory stimulation has important therapy effects, being good for wellbeing and rehabilitation. Mobility

The rise in diabetes, sepsis and other conditions can lead to severe limitations in mobility from limb loss where wheelchair use becomes commonplace with 7,000 new cases annually from diabetes in the UK alone.

Key elements to consider are the kitchens, bathrooms, circulation and access areas (particularly for wheelchairs), specific equipment, environmental controls, materials and finishes. Living areas such as the kitchen, dining area and toilets need to be designed with helpful features such as lower components, rise and fall worktops, quick-cool hobs, robust knockproof finishes and moveable components.

In the garden, ramping, non-slip surfaces, wide paths with pointing on the diagonal for smoother, more comfortable rides in the for wheelchairs and raised beds for easier interaction, can all make a positive difference. If the garden is visible from the bedroom and living areas, its benefits will be felt inside as well as out.

Those needing a secure environment can also enjoy outside space too with the use of circular routes which run in and out of a courtyard with benches for ‘stop and stare’ time.

Military

Any member of the Armed Forces is at risk of sustaining a variety of serious injuries both during training and in the field including brain injury, chest injury, spinal injury, loss of sight, single or multiple loss of limbs, burns /scalds and cold injury. Non Freezing Cold Injury (NFCI), or sometimes known as “Trench Foot” or Cold Weather Injury, can occur to feet and hands and is the most common form of military injury suffered on military exercise in the UK. The residual effects of the injury can last for many months and in the worst cases be permanent leading to increased sensitivity to cold and changes in temperature. This might be mitigated by added insulation around the home to minimize temperature fluctuations. Using sophisticated techniques to improve the property’s insulation levels, such as Passivhaus Technology, may help in such situations.

Post Traumatic Stress

It’s not just physical disability that needs to be accommodated as there are plenty of design techniques that can help combat the mental stresses of life such as PTSD. Such individuals are over-sensitised and they react very differently to visual, environmental and noise stimuli, particularly those in the military. Living areas that are open-plan with limited textures, colour palettes and ‘hidden’ areas will provide a more calming influence as will elements of sound attenuation to lessen loud noises. Sensory outdoor spaces with water features and fragrant plants are also calming.

Birth Trauma

Problems during and around childbirth can lead to the baby’s brain being starved of oxygen resulting in both physical and mental disability. Cerebral Palsy is the name given to a group of lifelong conditions that affect movement and co-ordination, largely as a result of such a problem and occurs in 2.1 per 1,000 live births. The symptoms are not usually obvious in the first two or three years of a child’s life and their severity can vary significantly. Some people only have minor problems while others may be severely disabled so that extensive adaptations to the family home are needed or the relocation to a more suitable home.

We’ve worked with a family whose son has dystonic quadriplegic cerebral palsy and they needed to find a property that could be suitably adapted to provide for their son’s current and future needs, while also accommodating the separate needs of their other son and two young daughters. Our aim was to design living spaces that integrated the child with the family and maintain the family unit to everyone’s benefit.

A large new kitchen now acts as the family hub with a garden room connecting the old and the new with easy wheelchair access and space where the son can easily mix with the rest of the family without restriction. This opens out onto decking that uses slip-resistant boarding, with a long-lasting surface for disabled and abled-bodied persons alike. #

Loss of Vision

A total or partial loss of sight can lead to all manner of complications in the home but there are a number of adaptations that help the adjustment. As an example, we were approached by a family with a visually impaired son to undertake remedial, redecoration and external works on a three-storey Victorian property to create a more suitable environment for him. A scheme of re-decoration using contrasting surfaces and colours, while minimising trip hazards and sharp corners, was implemented. The outside was also completely re-designed to provide a safe, trip-free environment including different textured surfaces and contrasting colours surfaces to help orientation. Rubber matting was also used to prevent the grass area from becoming muddy in the winter months while also providing a soft surface when the ground became hard both in the summer or winter. The pathways were also laid using a permeable, resin-bound surfacing to provide a non-slip overlay that allowed water to drain through, preventing any build-up of ice in the winter. The provision of off-road carparking bays mitigated traffic problems.

Disability comes in many forms but help should be enabling and not defining. Understanding its effect on an individual and the application of clever solutions goes a long way to supporting and empowering those facing greater challenges than some of us to live the ‘normal’ life that everyone deserves.

Eddie Lamptey

Eddie Lamptey has more than 15 years’ general practice experience and has worked with a number of world-renowned architects (including Sir Norman Foster) both in the UK and Scandinavia.

His work for inclusive design has covered the design of Canary Wharf tube station, which was part of the wider Jubilee Line extension. More recently Eddie has been involved with the delivery of concept ideas for improving environments for people with Huntington’s disease at the Royal Hospital for Neuro-disability in Putney.