Episode #44: Invisible Universal Design
Video of Adaptive Dog Leash:
Examples of Cup Holder and Modified Reacher:
YouTube: Shower Curtain Modification
[00:00:00] Sarah: You’re Listening to Good Fit Poor Fit. A podcast that explores the interaction between people, design, and activity. Good Fit Poor Fit is part of The Universal Design Project, a nonprofit organization with a vision for every community across the USA to have a surplus of homes and opportunities for social participation that are universally and financially accessible.
[00:00:23] Learn more at universaldesign.org.
[00:00:28] Rachel: Welcome to another episode of Good Fit Poor Fit. If you recognized a different voice citing that intro, then you’d be correct! This is Rachel Melvin– We’ve met in a few podcasts– I’m an OT student who’s interning with the Universal Design Project for the fall semester. Today, I’m here with Sarah and we’re going to discuss a concept that I’m coining as “learned creativity” in another episode of our Candid Conversation series.
[00:00:55] Learned creativity is the only option left when you’ve exhausted all other options. So much of our world is built without accessibility in mind, and our homes are no exception. With all the activities we do in our homes it is almost inevitable to find yourself in a poor fit situation, but this doesn’t have to be a negative! These opportunities allow room to get creative and to make a good fit when there is no available or maybe even affordable option.
[00:01:23] Sarah: Exactly! Learned creativity is really as simple as making something on your own to meet a need when there isn’t a product option out on the market. This reminds me of a family I met when I was once doing a home evaluation. The gentlemen only had one walker at his house and he needed it upstairs and downstairs. So what did he do? He created a little pulley system in which he was able to hook his walker on some ropes at the bottom of the steps, walk up the steps using the handrails, and pull his walker from the first floor once he reached the second.
[00:01:58] I love stories like this. And honestly, this type of creativity is in the wheelhouse of occupational therapists. We’re constantly trying to think outside the box to help get people, to use their spaces with more independence, even if it means trying to create something different or spur on some ideas for new product creations in the mass market, like the magnetic zipper we talked about in episode #44, Invisible Design. And of course, people who live with a disability and their caregivers are great at this learned creativity too. They are constantly faced with a world that is not welcoming to their needs and trying to work around things to make things a better fit.
[00:02:38] So, of course, our knowledgeable design advisors helped share their experiences for this episode. They get candid regarding some of the creative options that they have made, or they had someone design for them, to make their tasks easier within their homes. Their learned creativity really helped us understand how a poor fit home impacts their daily activities.
[00:02:58] Rachel: That’s right! I imagine that the process of trialing different options to figure out what works can be frustrating. We recognize that there are different ways people perform their daily tasks. That’s why the Universal Design Project aims to make our designs as flexible as possible. The home environment is only one piece in the puzzle, so it’s not going to be able to provide support 100%. But if the design is flexible, it gives people the ability to add in additional products to complete their occupation successfully. When living in a home that may be a poor fit, it’s possible that people try out several options to safely and independently complete their occupations. A lot of thought and application gets put into figuring out what works.
[00:03:42] I think it’s important to note that even though the examples of creativity in this podcast are wonderful, we can’t help, but think about the time, effort, and headaches that could be saved if things were designed well from the start. So with all that said, let’s chat about some of the examples of learned creativity shared by our design advisors.
[00:04:03] Sarah: Okay, I’ll go first because Scott and I have done some trial and error regarding products in our time. My husband actually was with some OT students in brainstorming how to create a leash for him to walk a dog. When he was using a manual chair, walking a dog was really difficult because when you’re using a wheelchair, you need to have both hands available to push the chair.
[00:04:26] So the typical way people hold a leash is in one hand. And if you hold a leash in one hand, that would only give you the availability to push a wheelchair with one hand, which doesn’t work very well. He also doesn’t have grip strength. So it was like he was kind of trying to hold onto the leash with his wrist.
[00:04:45] Another thing we thought about was maybe we could tie the leash onto the side or the front of his chair. But then he was afraid that the dog would pull his chair to one side, making it difficult to keep himself in control. So the creative OT students actually bought a bunch of different products and configured them in a way that could work well for him. We took two pieces of fabric and hooked it onto the back of his chair because he didn’t want anything attached to his body because he was afraid the dog would pull him forward.
[00:05:15] We attached two pieces of pretty hefty loops onto the back of his chair. And then in front of him, we attach those two pieces of fabric to a carabiner to hold them together. Then we bought a leash. That was one of the ones you can actually wrap around your body to be hands-free when running and used that loop that’s typically for the body as a way to slip the leash over the dog’s head because my husband couldn’t operate those traditional metal fasteners of a leash to put on a collar.
[00:05:44] Then we hooked the traditional metal part of that leash to the carabiner. So after all of that, the dog was actually able to walk without the leash hitting my husband’s knees. And he was able to slide the leash over the dog’s neck to make it easier to walk the dog.
[00:05:59] So the dog wasn’t pulling him in one direction or another. This sounds a little complicated. I actually have a YouTube video in the show notes for you to look at. So we didn’t make anything new but made something new with other materials. If that makes sense. So it worked really well.
[00:06:15] Rachel: It sounds like quite a lot of thought was put into making that leash so Scott could walk the dog in a way that was most efficient and comfortable for him. This really highlights the benefit of working with OTs. We’re able to look at things from multiple angles through what the profession refers to as activity analysis.
[00:06:33] In your example, Sarah, the activity analysis was completed by breaking down the task of walking a dog into very specific increments. This opens up the opportunity to address issues like how long the leash should be, where to situate the leash, how to attach the leash, and other details as well. But you get the picture.
[00:06:52] Another design advisor, Chris, also mentioned that he had a chance to collaborate with the class of OT students as well.
[00:07:00] Chris: Two devices that I have that were designed jointly with an OT class. This one that allows me to carry a closed cup on my crutch. Basically, a bicycle bottle holder that’s been modified to use on my crutch. And the other device that I have is this modified grabber that has this blue tongue attached to it. That allows me to get cereal boxes or a can or whatever off an upper shelf in our pantry. The nice thing about it is this supports the bottom of the cereal box nicely. So in case you lose a grip or whatever, you don’t have to grip so hard to keep from spilling the cereal onto the floor.
[00:07:39] Rachel: I love hearing all of these examples and the collaboration with OTs students!
[00:07:43] Sarah: Yes. These situations are really great practice for OT students to meet people with disabilities and help problem-solve ways they can be independent, especially when there isn’t something that fully works well out on the mass market.
[00:07:56] Teaching these skills in the classroom gives students more confidence to be creative and think outside the box when it’s time for them to work with real patients on their fieldwork and when they are professionals.
[00:08:07] Rachel: I agree. This concept is actually very similar to a prompt given to me and my classmates for an assistive technology course. We connected to people in the community who have a disability and collaborated with them on creating something that would be of use to them. I think the idea was for new fabrication, but it turns out that all of my classmates ended up taking an item and reconfiguring it in a way that worked best.
[00:08:31] Actually this turned out to be the most common approach to learned creativity rather than inventing something completely new, most solutions proved to be the modification or adaptation of pre-existing products. Much like what we see with homes, it sounded like our design advisors were close to finding a good fit, but had to put in a little extra effort to make sure it was just right for them and their needs.
[00:08:55] Design advisor and OT, Larissa shared her experiences as it directly relates to the needs of her clients.
[00:09:02] Larissa: Invented created something like from thin air because I not that creative, but I have made some adjustments or adaptations to make things easier for patients. I just was creative on how to address the patient’s needs.
[00:09:16] Rachel: I think that totally works! It also suggests that there are already a lot of available products and devices out there that address the need for accessibility. But it’s important to be curious. So we have to ask ourselves, why do these products exist in the first place?
[00:09:31] Well, because the world we live in is not built to be very accessible. Leaving people with no choice, but to intervene with products after the design has already been implemented. Design advisor, Mike said, quote, “I have worked on a variety of solutions for people with significant functional mobility and functional reach impairments. It really depends on the individual in question and how their environment is not accommodating them in that particular case. It’s more of an inclusive design specified to one person than a universal design intended for a wider audience.” Unquote.
[00:10:06] I loved this and it reminded me so much of how OTs approach their intervention, which is very person- or client-centered approach. Yet, we know that universal design is for all persons.
[00:10:18] Sarah: So you make a really good point here about the difference between products that can be considered accessible for one person and their needs versus something that might be considered universal. Most often people’s needs are so unique that accessible things need to be made or developed for them to do tasks independently, but not all the time is that same creative contraption useful for others. We aren’t saying that these accessible products are bad by any means, but they will be able to be used even better in spaces that are designed with universal design in mind. Oftentimes it’s even creating an accessible product to look normal and not medical, which can be a goal as well.
[00:11:00] Chau, one of our design advisors, mentioned that they have used soft conductive fabrics to easily mount big switches or buttons so clients can activate and use communication devices and computer games. This is more of an accessible feature for those that use them. But the look and feel of these devices can easily blend into the surroundings and not stick out to be viewed as specialized. After all, most people want something that looks appealing.
[00:11:26] Lindsey is another design advisor and shared with us a unique way in which she helped move her daughter with disabilities. They created a simple hammock harness to make it easier to carry and lift her. We actually considered a blanket with handles when my daughter was born to make it easier for my husband to pick her up when she was young. We also found that wearing her in a carrier was actually easy for my husband. I did a lot of baby-wearing with my daughter when she was young, but the concept of carrying a child either in front or in back of your body is not a new one. It sounds like Lindsey was able to craft this hammock just for how it would work for their daughter. Thankfully, keeping a child safely strapped to your body or moving them from place to place is a fairly common task to look for inspiration.
[00:12:15] Rachel: These are great examples to showcase the definitions of accessible and universal. Let’s be clear: Though the terms accessible and universal serve a similar purpose, they are not the same. Despite universal design being a thing since the 1980s, there’s still widespread confusion about it today, which we believe is largely due to people, not fully understanding the depth of what it means. And because they sometimes get used interchangeably, people can get lost in what they really mean.
[00:12:45] So in short, “accessible” often is for one person and their needs, and “universal design” is looking at everyone’s needs and seeing how a lot of different people can use or even access the same information.
[00:12:58] Sarah: That’s right. Some of that confusion between these two terms has made it difficult for universal design to gain traction in various settings. And why figuring out how to design things for everyone can become tricky. Honestly, one of the hardest spaces to get the design right for everyone in the home is in the bathroom. We had many of our design advisors reply to our ask for help with this episode, with examples from the bathroom that they figured out how to get creative in either increasing their comfort or independence.
[00:13:29] Larissa is an OT and one of our design advisors, and she shared some quick creative fixes that she did with some of her clients.
[00:13:36] Larissa: I have this one lady who had a stroke and she was having a hard time using the bedside commode. She had one side that was very impaired and her affected side, like really hurt to just by touching the bedside commode.
[00:13:49] So I put some pool noodles on the bedside commode. So it would be a little more plush and not hurt her. For another lady, she was having a hard time with the soap. The soap kept running away from her. So I just put together a little like soap on a string so that she would always have access.
[00:14:08] Sarah: One of the things that I like here is that she’s finding simple solutions to fix a problem. Soap on a rope is such a great idea. I’ve also seen people put a bar of soap in a pair of pantyhose and tie it onto a bar or part of the shower chair. So if the soap drops, they could actually grab the pantyhose and still have access to soap.
[00:14:29] Another design advisor mentioned that they ended up modifying a shower chair from its original form to make the width right for the shower and then added more cushioning and a smoother seat to make it easier on the skin. I have to agree that most typical shower chairs out there aren’t that comfortable. They are made of a hard plastic and are really difficult to sit on, especially if you’re concerned about getting a sore when they’re sitting too long in one place without proper cushioning.
[00:14:57] Ruchika also mentioned that the swing of the shower door in her parents’ bathroom wasn’t ideal. Instead of an expensive shower renovation to change out the shower completely, she just changed the swing of the door a quick and easy fix to make things more functional.
[00:15:13] Controlling water for the shower and tub is always a problem. In fact, we’re working on a design in-house, and this is one of the biggest things we’re trying to solve. When you have showers that don’t have a small curb, then you have to figure out how to keep the water inside. In addition, many people are dealing with tubs in their home and the easiest option for those is a tub bench. This is a pro because it allows someone to sit on the side of the bench on the outside and lift their legs into the tub while seated. So much safer than stepping over the side of the tub. However, because the bench sits inside and outside of the tub, a shower curtain can’t fully sit in the tub, which causes water to come out.
[00:15:56] Janna shared a great trick for helping out with that. She says, “I buy clear plastic shower liners for my patients and cut slits in the bottom. So they fit around extended tub benches to prevent water from splashing out of the tub into the floor. This idea came from working with my client in a personal care home. She wanted to use the bench. Her daughter bought her because of her knee pain and range of motion limitations she was having when getting into the tub but didn’t want to get water on the floor, which would have increased her risk for a fall.”
[00:16:30] Janna knew there had to be a solution and so she turned to Google! I’m actually gonna share a YouTube video in the show notes that details the process step-by-step. Janna is hopeful that you will find some help in this. Her client was very pleased and grateful.
[00:16:47] Rachel: Bathrooms really are a sore spot in a lot of American homes. Most tend to be a really tight space and offer little to no support in terms of accessibility. Design advisor and OT student, Makia, shared a very interesting approach. She learned through an interview with an individual with a spinal cord injury. She said, quote, “His bathroom was not wheelchair accessible. So he and his wife created a lift system on their back porch using car straps to lift him into their hot tub for bathing. Luckily, they had a home health OT who checked it over to make sure that it was going to be safe for the individual, but it was able to mimic a Hoyer lift.” Unquote.
[00:17:28] This just about blew my mind! I don’t know if I would have ever thought about bathing in a hot tub. Though, younger Rachel probably begged to do this during family vacations. This unconventional idea may not be for everyone, but it worked for this family.
[00:17:45] Sarah: Right? What a creative way to get clean. I also had a patient who would book a room at a hotel every once in a while, and it wasn’t for a getaway. It was basically to get a shower because the bathroom that they used in their house was upstairs and he couldn’t get upstairs. I’ve heard of others getting a gym membership because there was a shower there at the gym they could use. It’s crazy the things that people have to do just to get themselves clean when their home isn’t designed well. Rachel, I am loving all the examples of learned creativity here, but before we finish up, do you have anything else you’d like to add?
[00:18:23] Rachel: Yeah! I actually wanted to end our podcast today with an awesome solution that design advisor, Maria, and her husband came up with for the exterior landing of their home. Maria shared that she felt frustrated holding all of her stuff and trying to lock and unlock their main entry door. So she asked her husband to make two shelves near the door to set her things down. She added that it was a simple fix that she uses just about every day and apparently her delivery folks love it too. I just love how Maria and her husband were able to come up with something that turned out to be helpful. Not only for them, but people visiting their home. Sarah, what do you think?
[00:19:03] Sarah: I think this is a perfect example of universal design and it’s flexible in use for so many things. I’ve even heard of people putting their back on it while they search for their keys. It’s just really great.
[00:19:15] Rachel: I agree, Sarah. Thanks for tuning in for another episode. And of course, I want to extend a big thank you to our team of design advisors for contributing to this episode. This was my first time interacting with this group and I’m so appreciative of all the great feedback so we could provide this podcast. By sharing these examples of learned creativity we’re able to gain some more perspective into the sometimes inaccessible world we live in and maybe some inspiration to address that issue. I hope you all leave this podcast, feeling creative and empowered, and ready to take on the week ahead. Thanks again and take care!
[00:19:55] Thanks for listening to Good Fit Poor Fit. I’m your host Sarah Pruett, Program Director and Occupational Therapist at The Universal Design Project. Learn more about our work at universaldesign.org, and find more episodes and links to subscribe at goodfitpoorfit.com If you have questions or topics you’d like to discuss, email us at [email protected][00:20:22] Thanks for fitting us into your day!