Normalization Therapy and Design Rehabilitation Devices & Spaces Robin Snell Parkin Architects

1. Normalization Therapy and Design Rehabilitation Devices & Spaces Robin Snell Parkin Architects IIDEX September 2013

2. UIA/PHG Toronto 2013 architects of health care in P3’s careof architects health in P3’s • Traditional model of rehabilitation centre falls short of address the aspirations of this who use them • To better serve the motivational needs of patients and therapists we need to reconsider gymnasium-inspired designs

3. Normalization Therapy and Design Precedent Work Patricia Moore Industrial Designer, Gerontologist

4. Precedent Work • Patricia Moore • Industrial Designer, Gerontologist • Traditionalmodel of rehabilitation centre falls short of address the aspirations of those who use them • To better serve the motivational needs of patients and therapists we need to reconsider gymnasium-inspired designs

5. Precedent Work • Patricia Moore • Industrial Designer, Gerontologist • Traditionalmodel of rehabilitation centre falls short of address the aspirations of those who use them

6. Precedent Work • Patricia Moore • Industrial Designer, Gerontologist • Traditionalmodel of rehabilitation centre falls short of address the aspirations of those who use them

7. Precedent Work • Patricia Moore • Industrial Designer, Gerontologist • Patricia Moore & David Guynesdraw inspiration from everyday to create • more engaging rehabilitation experiences with: • Easy Street, Independence Square, Rehab 1-2-3, Our Town, Work Syms • Simulate real-life situations to motivate patients by helping them • connect therapy to the lifeto which they aspire to return

8. Precedent Work • Patricia Moore • Industrial Designer, Gerontologist • Evidence that motivation improves as the physiotherapy is • ‘normalized’ • better simulates real life situations, relevant to the patient

9. Precedent Work • Patricia Moore • Industrial Designer, Gerontologist • Using an empathetic research process Patricia Moore & David Guynesbuild a deeper understanding of patient’s & therapist’s values • apply the understanding to designs that are • more connected to patients aspirational needs • while still meeting their functional rehabilitation needs

10. Previous Work Adult Rehabilitation Facilities

11. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects

12. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects Size: 9,480 sm 102,000 sf Cost: $44M Opened: July 2009 Beds: 91 56 Neuromuscular, 20 Neurocognitive, 15 acquired brain injury Length of stay: 3 -4 weeks ABI: 3 months +

13. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects • Reduction in staff injury. Patient lifts in all rooms, bariatric sized patient rooms, centered water closet placement with fold down grab bars for staff assistance • Improved infection control - Hand wash sinks located at entrance to all patient care areas, built-in supply cabinets with protective clothing for isolation patients provide convenient access to supplies and encourages proper containment measures for infection control

14. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects • Restorative patient environment. Offset toe to toe bed arrangement, lowered window sills provides all patients with view to exterior from bed or wheelchair. "Memory boxes" at patient entrance doorways allowing patients to easily identify their rooms. Rooftop therapeutic garden provides patients with convenient and safe access to nature • Sustainable features include: polished concrete floors and exposed ceilings reduces finished materials. Skylights and light wells illuminate interior spaces reducing need for artificial lighting. Re-use of existing materials, brick and steel tile as interior finish elements.

15. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects Level 1 (Ground) Level 2 Level 3

16. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects outdoor rehabilitation/social spaces variable terrain integrated wheelchair spaces

17. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects steps, grade changes, surface changes, exercise/resting bars, lighting for evening use seamless transition to interior rehabilitation areas

18. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects seamless transition to larger community area for more demanding or realistic application of normalization therapy

19. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects simple clear wayfinding reduction of visual noise standing and seated client access to services

20. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects interior, safe therapy courtyard adjacent to patient interior lounge

21. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects memory-aids wayfinding devices

22. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects various exercise features integrated into pool as buoyancy is used to help with rehabilitation deeper end steps shallow end steps specialized lift ramp step portholes for adding exercise bars step step exercise bar

23. Hamilton Health Sciences Rehabilitation and Acquired Brain Injury Building Parkin Architects in association with McCallum Sather Architects

24. Recent Work Children’s Rehabilitation Facilities McMaster Children’s Hospital Ottawa Children’s Treatment Centre SickKids Children’s Hospital of Eastern Ontario AFP Projects

25. Recent Work Children’s Rehabilitation Facilities

26. Normalization Therapy Children’s Treatment Centres Parkin Architects Medically fragile, technology-dependant children Autism Spectrum Disorders Gross motor and/or fine motor deficits Behavioral or Cognitive challenges

27. Normalization Therapy Skill Acquisition and Play Parkin Architects Simulate a play area Simulate a junior kindergarten classroom Simulate the home or yard Simulate the playground

28. Normalization Therapy Skill Acquisition and Play Parkin Architects Therapeutic manipulatives Common everyday household tools Far more transferrable Real world situations, home, school, park

29. Normalization Therapy Skill Acquisition and Play Parkin Architects Balanced, sensitive, universal design approach Present challenges that help development While respecting capabilities

30. Normalization Therapy Skill Acquisition and ArtParkin Architects Fine motor skills Focused attention Creativity New projects: large therapy rooms set up as junior kindergarten classrooms sand tables, play tables, water play, reading and drama areas

31. Normalization Therapy Skill Acquisition and Music Parkin Architects New projects: therapy spaces of various sizes that simulate the home

32. Normalization Therapy Skill Acquisition and Physical PlayParkin Architects New projects: indoor therapy spaces that look like play areas climbing, balancing, movement

33. Normalization Therapy Skill Acquisition and Daily Living Parkin Architects Making cupcakes Measuring skills, hold, pour, focused attention Integration skills crucial to social development

34. Conclusion • By focusing on meeting the real world rehabilitation needs of adults and children • we can design more effective facilities that help patients achieve optimal independence sooner • at a lower cost to the healthcare system

35. References Kaplan, M.D.G. (2011) At the VA, preparing brain-injured veterans for the real world. Smart Planet. Retrieved on August 26th 2013 from http://www.smartplanet.com/blog/pure-genius/at-the-va-preparing-brain-injured-veterans-for-the-real-world/5451 McClusky, J.F. (2008) Creating engaging experiences for rehabilitation. Topics in Stroke Rehabilitation. Vol. 15 Issue 2, p80. Stafford, J. (1996) ‘Easy St.’ Therapy. Chicago Tribune. Retrieved on August 26th 2013 from http://articles.chicagotribune.com/1996-01-18/news/9601200099_1_easy-street-city-street-outpatient Bibliography Roger, S.J. (2012) Effects of a Brief Early Start Denver Model (ESDM)–Based Parent Intervention on Toddlers at Risk for Autism Spectrum Disorders: A Randomized Controlled Trial. Journal of the American Academy of Child & Adolescent Psychiatry. Vol. 51 Issue 10.p.1052-1065. Delprato, D.J. (2001) Comparisons of Discrete-Trial and Normalized Behavioral Language Intervention for Young Children with Autism. Journal of Autism and Developmental Disorders. Vol. 31, No. 3, p.315-325. Ketelaar, M. Effects of a Functional Therapy Program on Motor Abilities of Children With Cerebral Palsy. Retrieved on August 27th2013 from http://ptjournal.apta.org/

36. For more information, contact: Robin Snell, Principal, Parkin Architects snell@parkin.ca Lynne Wilson-Orr Principal, Parkin Architects lwo@parkin.ca