Barrier-Free Design: A

Review and Critique of

the Occupational
Therapy Perspective
Barbara Acheson Cooper, Uriel Cohen,
Betty Risreen Hasselkus
Key Words: architectural accessibility.
environmental design. literature review

This review of the occupational therapy literature on

barrier-free design identifies both a pauci~v of related
occupational therapy research on the topic and a
lack of a common conceptual base with which to
gUide the development and use of environmental assessments. Nonetheless, two fledgling themes can be extrapolated: tbe consistent reference to the concepts of
accessibili~v) mobility, function, and safety and an increased awareness among occupational therapists regarding the accessibility standards developed by the
American National Standards Institute (ANSI) (ANSI,
1971, 1980). A problem-solving model suggested by designersfor the 1979 revision of ANSI standards that incorporates these conceptual themes is described and
discussed.

Barbara Acheson Cooper, MHSC, Oil' POT, is A~sistant Professor,

Dean, and Director of the School of Occupational
Therapy and Physiotherapy, IJ 11 Health Sciences Centre,
McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada IBN 3Z5. She is currently enrolled in the doctoral
program for environment behavior studies, School of Architecture and Urban Planning, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.

A~sociate

Uriel Cohen, DArch. is Associate Professor, School of Architecture and Urban Planning, University of Wisconsin-Milwaukee,
Milwaukee, Wisconsin.
Berry Risteen Hasselkus, PhI), OTK, is Assistant Professor, Department of Therapeutic Science, and Chair, School of Occupational Therapy, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
Tbis article was Clccepted!or publication August 30, 1990.

----

onsumers, families, and health care professionals

agree that a physical setting that fosters independent living is often the critical factor that allows persons who are frail and disabled to live in the

cominunity instead of in an institution. Although thig

statement may seem self-evident, policymakers have
heen slow to acknowledge it (Liston, 1971; Shaw, 1971;
Taira, 1984). Changes made over the past 20 years in the
form of new regulatory legislation and the adoption of
more stringent bUilding standards, however, are gradually beginning to have an impact on the problem (Martin,
1987; Steinfeld et aI., 1979; Taira, 1984). Low-cost units
specially designed to accommodate the needs of specific
groups have been and are being erected; communitie~
are hecoming increasingly aware of the need to provide
access to public buildings, services, and the neighborhood at large; and heightened multidisciplinaly concern
is evident (Taira, 1984).
The occupational therapy profession has a declared
interest in barrier-free design. According to Mosey
(1986), a fundamental aspect of
the practice of occupational therapy is concern for and use of thc
nonhuman cnvironment. The nonhuman cnvironment is viewed
as an entity to be mastcred, an aid 10 facilitate the pcrformance of
life tasks. and a vehicle for assisting in the development of sensory, perceptual, cognitive, and motor skills and need-fulfilling intrapersonal ancl interpersonal relationships. (I'. 3)

Mosey's (1986) views are supported hy the profession as a whole, as evidenced by educational curricula
that include as a basic component the teaching of methods used to conduct home assessments and modifications for both architectural and functional features. Further endorsement
comes
from
the American
Occupational Therapy A~sociation (AOTA), which identifies and lists the ability to conduct home evaluations as
essential for various specialized roles (e.g., AOTA, 1981a,
1981b, 1983).
A conservative estimate of between 1.7% and 2.2% of
the population are directly affected by barrier-free design.
A more liberal view states that up to 11.6% would benefit
from the implementation of more stringent standards of
accessibility (Steinfeld et al., 1979). Persons who are elderly and those who are physically disabled have been
identified as the two major groups requiring assistance
with environmental modification. Barrier-free environments, both in the home and the wider community, are
essential to successful independent living for these at-risk
populations. Both the disabled and elderly populations
are increasing in number, primarily as a result of improved health care. This factor, the growing awareness of
the expense and negative effects of institutionalization,
and the profound desire of these persons to remain in the
community are increasing the demand for appropriate
community-based, barrier-free housing, both new and
modified. Because of their training and skills in functional
assessment and environmental adaptation, occupational

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April 1991, Votume 45, Number 4

therapists are well suited to function as facilitators for the

independent-living movement (Hasselkus & Kiernat,
1973). Thus, we can reasonably predict that the volume of
requests for our input will increase in the immediate
future.
The framework within which occupational therapy
organizes its therapeutic approach to assessing the physical environment thus becomes particularly important.
The independent-living thrust defines the term environment broadly and clearly considers community accessibility to be as important as residential accessibility for those
whom it serves. The conceptualization used in the future
by therapists, therefore, needs to be broad enough to
include all possible bUilding types and settings. It must,
however, also allow the profession's focus on individual
function to be maintained as the unit of analysis. Ideally,
this framework must be equally acceptable and useful to
all occupational therapists, regardless of their area of
practice. Given that no one clinical strategy is currently
agreed on, such a framework for environmental assessment would also need to be flexible enough to accommodate diverse formats. Professional consensus regarding
the conceptualization of barrier-free design and assessments would provide a consistent method for data collection without restricting its subsequent clinical use. An
additional benefit would be the provision of a collective,
uniform base from which issues related to occupational
therapy and environmental access could be researched.
The present paper reviews and critiques the occupational therapy literature on barrier-free design, particularly concerning the conceptual approach now used in education, research, and practice. It suggests a model by
Steinfeld et al. (1979) as one that might provide the profession with an appropriate but more comprehensive alternative to our present situation-specific approach and
yet allow the focus on individual function to be
maintained.

Lllcramrc R \'jew

Education and Practice

The major instructional texts in occupational therapy usually include sections on the topic of barrier-free design in
the sections that deal with physical disahilities or home
care. The classic general text, Willard and Spackman's
Occupational Therapy (Hopkins & Smith, 1988), addresses the need for architectural modifications but provides only brief general gUidelines for making these
changes. Additional information in chapters by Malik
(1988) and Levine (1988) discuss activities of daily living
and independent community living, respectively. Malik
(1988) listed broad areas to be considered when maklllg
home modifications, which can be restated as issues of
acceSSibility, mohility, function, and safety. Levine (1988)
stated that "the best approach for the therapist to use

cannot be precisely outlined" (p. 773). She cited cultural,

economic, and personal preference variables as barriers
to a universal approach. Nonetheless, she suggested two
ways of conceptualizing the environment for treatment
purposes. First, she built on ideas from Barris, Kielhofner, Levine, and Neville (1985) to propose a model of
four concentric circles. From inner to outer, these circles
represent the nonhuman environment, required functional tasks, roles, and culture. Second, she suggested
Kielhofner and Burke's (1985) Model of Human Occupation as a broad organizational base that could provide a
theoretical umbrella for specific treatments and theories
used in community health care.
Trombly and Versluys (1989) discussed the evaluation of architectural features within the home and community for clients with physical disabilities Although a
sample questionnaire is provided, no overall conceptual
framework is suggested. The authors stressed the importance of site visits and the inclusion of the client and
family in the assessment process, which is organized to
address function, safety, mobility, and accessibility in various architectural zones or rooms.
Information relevant to barrier-free design is sometimes buried in texts on other topics. For example, in a
text on mental health assessments, a chapter by Hasselkus and Maguire (1988), which may be a useful source of
knowledge for barrier-free design, may be missed by
therapists working in specialty areas other than gerontology. Environmental assessments such as Maguire's
(198'5) 'l'ri-Level ADL Assessment organizes and rates six
c,negories of activities of daily living by environmental
level: personal, home or sheltered, and community.
Two other sources of environmental assessments for
occupational therapy are provided by home-evaluation
and home-safety checklists. The former are often developed by health care units and institutions to meet their
own needs and vary greatly in length and breadth. Similar
organiZing constructs, however, such as safety and performance, arc usually used. These checklists rerresent an
icl iosyncratic approach that has been common in occupational therapy in the past. Home-safety checklists are specific examples of the organiZing construct of safety and,
like the home assessments, are varied and idiosyncratic
(cf. Tideiksaar, 1986)
In summary, major occupational therapy texts and
practice sources illustrate that environmental assessments are viewed by the profession primarily as situationspecific and centered on the home. These are often structured as room-by-room checklists to be completed by the
therapist on site in collaboration with the client and family. None of the checklists appear to have been tested for
reliability or validity. Although no overriding conceptual
framework can be identified, there is the suggestion that
two different approaches guide the gathering of information: a consistent cluster of concepts (safety, mobility,
accessibility, and performance) and the relatively new

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345

application of theoretical frameworks such as the Model

of Human Occupation.

journal Articles
A computer search of the major occupational therapy
journals (i.e., American journal o/Occupational Ther-

apy, Australian Journal 0/ Occupational Therapy,

Canadian Journal 0/ Occupational Therapy, Occupational Therapy in Health Care, Occupational Therapy
in Mental Health, Occupational Therapy journal o/Research, Physical/Occupational Therapy in Ceriatrics,
and Physical/Occupational Therapy in Pediatrics) revealed that in spite of the emphasis placed by the profession on the importance of barrier-free design, few articles
of relevance have been published over the past 20 years.
Those identified can be categorized as pOSition papers,
surveys, and clinical intervention strategies.
The earliest of all the articles found was a position
paper by Shaw (1971), which presented a historical perspective on the issue of architectural barriers and the
problems faced by persons with physical disabilities. Accessibility needs were categorized and discussed under
the headings of housing, education, employment, transportation, and recreation. Shaw ended with an emotional
appeal to the health care community to take up the cause
of promoting barrier-free design. A more recent paper by
Taira (1984) also presented a historical overview but focused more on the needs of older people. She Cited, as
particularly useful to occupational therapy, a series of
publications from the U.S. Department of Housing and
Urban Development (HUD). Taira commented on the
importance of considering consumer preferences and
weighed the merits of architectural modifications versus
new construction. She also issued a challenge to the profession to recognize the need to become more involved,
both as practitioners and as consultants.
Four surveys are reported in the literature. Two of
these (I<iernat, 1972; Liston, 1971) were undertaken as
occupational therapy class projects. Liston surveyed
buildings at Queen's University, Kingston, Ontario, Canada, for internal and external accessibility. Kiernat evaluated campus facilities at the University of Wisconsin in
Madison as well as some community structures. Shaw's
(1971) five categories were used to guide the data gathering of the second survey. Both grou ps of students reported that they were able to influence local attitudes and that
as a result of their surveys, a number of structural changes
were made. Data for both surveys were collected in the
traditional manner by architectural zone; results are reported in a descriptive manner.
A funded study by Martin (1987) addressed the question of ease of accessibility of public buildings by the
disabled population. Martin surveyed 13 public bUildings
of valying age for compliance with 1971 American National Standards Institute (ANSI) (ANSI, 1971) specifications.

346

Compliance was measured by the percentage of specifications met by each of the buildings on a scale developed by
Martin for the study. No building was shown to be 100%
compliant, but improved accessibility for persons in
wheelchairs, particularly in the more recently constructed
buildings, was found.
In the fourth survey, McClain and Todd (1990) rated
the accessibility of 20 grocery and convenience stores in
urban and rural settings using a scoring system based on
relevant sections of the 1982 gUidelines of the Architectural and Transportation Barriers Compliance Board. The
survey was conducted by one of the authors and it is
unclear if accessibility was judged by her or with the help
of someone using a wheelchair. It is also unclear how the
sample of stores was selected. Descriptive results indicated no overall differences between rural and urban stores
but greater acceSSibility of grocery over convenience
stores in both settings. The results of the survey were sent
to all 20 stores. A 6-month follow-up indicated that 5 of
the stores had complied further with accessibility standards. The authors concluded that occupational therapists can be effective advocates for community accessibility and thus facilitate independent liVing for clients.
An intervention study (Wittmeyer & Stolov, 1978)
tested the effectiveness of an occupational therapy visual
instructional module of common architectural obstacles
on the ability of persons with spinal cord injuries to identify specific barriers accurately. This was part of a program
to foster independent liVing skills in recently injured patients. The 1971 ANSI standards were used to develop
both the visual instructional module and a 359-item
checklist organized around the setting and the clients'
needs. Ten clients with spinal cord injuries were randomly allocated to a control or an experimental group (5
persons per group) and tested on their personal assessment of potential living accommodations at two points in
time. Instruction was provided to the experimental group
by means of the visual instructional mode prior to Time 2.
The group receiving instruction demonstrated an increased ability to choose a more functional environment,
as compared with the control group (p < .05 andp < .01
on two global measures). Sampling and methodological
issues prevent the generalization of the interesting results
of this study, but the results do indicate questions related
to intervention strategies worth investigating by occupational therapists. Unfortunately, this has apparently not
occurred.
A multidisciplinary intervention, Project Open
House, was reported by Colvin and Korn (1984). This
undertaking proVided professional input and funding for
the making of situation-specific architectural modifications in the homes of low-income, physically disabled
residents of New York City. The occupational therapist
was responsible for completing the initial client needs
assessment, for recommending the architectural
changes, and for training the client and family in the use

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April 1991, Volume 45, Numher 4

of the modifications. The assessment form used was developed with the use of AJ'JSI standards and a concern for
safety (United Cerebral Palsy of New York City, 1984). The
authors stated that evaluations of the program suPPOrt
this as a cost-effective way of improving the quality of life
for these persons and enabling them to remain in the
community, The effectiveness of the intervention itself,
however, cannot be determined from the data reported
in the article,
The present review indicates that occupational therapy research on barrier-free design is in an early phase of
development and cannot be said to demonstrate any welldefined thrusts, Although elderly people have been identified as a target group in need of barrier-free design, no
studies specific to this group were found, The homebased checklist orientation espoused by education and
practice is strongly evident but, again, no common conceptual framework could be identified, As with the education and practice literature, conceptual trends were noted
or could be inferred, Primarily, these were the use of ANSI
standards, followed by the use of clusters of constructs,
either Shaw's (1971) or those of accessibility, mobility,
safety, and function,
The lack of a clearly defined conceptual base presents a primary obstacle to further professional development, lending itself to idiosyncratic interpretations and
variations of architectural assessments that cannot be
compared, Fledgling conceptual frameworks can be extrapolated, the most distinct being the use of ANSI standards as well as the focus on individual needs as categorized by a number of different constructs, The strongest
and most pervasive of these thrusts, the use of ANSI
standards, is discussed below,

~l

Swndard

The use of ANSI standards in construction is currently

voluntary, but they have been adopted by federal agencies and 50 states to form the basis for most of the currently used gUidelines on barrier-free design (Martin,
1987; Steinfeld et aI., 1979), These standards were revised
in 1980 (AJ'JSI, 1980) with input commissioned by HUD
from the University of Syracuse in New York. Phase 1 of
the research contract, supervised by Steinfeld et al.
(1979), addressed six factors:

1. The history of the barrier-free movement

2,
3,
4.
5,
6.

The extent of the problem

Existing legislation
The scope of barrier-free design problems
Relevant research
The effects of barriers on the life-styles of persons
with disabilities and ways of mitigating these
effects.

The second phase built on these findings to focus on the

foJJowing:

1. The identification of particularly difficult design

problems and their solutions
2, Laboratory testing of design criteria
3, The collaborative development of design criteria
4, A study of the cost of erecting accessible buildings
5, An analysis of economic costs and benefits,
Six reports were published by Steinfeld et a!. (1979)
as a result of the contract (these would appear to be the
same series cited by Taira [1984]), One report is of particular interest to occupational therapists. Two sectionsthe scope of barrier-free design and human factors research - contain ideas that might provide the common
conceptual base that is needed by occupational therapy,
Ban-ier-Free Design
Most gUidelines and architectural assessments have focused on accessibility for persons in wheelchairs on the
assumption that an environment that is suitable for such
persons will be equally suitable for persons with other
disabilities, This, however, is not always the case; for
example, the installation of curb cuts, so useful to those in
wheelchairs, is hazardous for persons who are blind, For
the latter, the lack of a clear-cut boundary eliminates the
warning of the immediate presence of the street and the
dangers of traffic: supplementary cuing methods, such as
varying the texture of the pavement, are then reqUired,
Issues of this type pose a problem for the making of
environmental changes to improve accessibility in public
areas, In the absence of a universal solution, whose needs
should take precedence?
RecogniZing that much of the literature on barrierfree design presented a reductionistic view, Steinfeld et
al. (1979) proposed an ideogram called the Enabler (see
Figure 1), which would allow a broader and simpler conceptualization of disability and, by providing a method for
identifying problems, facilitate design decision making,
The Enabler model represents four general areas of human disability that should be considered in the designing
of environments: (a) mental functioning, (b) the senses,
(c) internal body regulation, and (d) motor impairment,
These subsume 15 specific areas of disability,
Steinfeld et al. (1979), using expert opinion and research findings, then developed 13 problem identification matrices, These matrices represent aJl the movement
and functional patterns possible in the environment Without being specific to area, room, or building type (see
Figure 2), Table 1 depicts an exhaustive list of movement
and functional patterns. Each matrix sets the enabler on
the abscissa and places the design factors on the ordinal.
This scheme allows problem areas to be mapped and
graded according to severity for each design concern
generated.
Advantages and limitations of this approach are discussed in some detail by Steinfeld et al. (1979). The advantages include the ability to present the pervasive di-

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347

potential problem

severe problem
impossibility

.. .. <,- -I,
~

r-~'
111~-l1i

o problem

DIFFICULTY INTERPRETING INFORMATION

SEVERE LOSS OF SIGHT

COMPlETE LOSS OF SIGHT

AB'B2C DE FGH I J K LMN

En trances. [xi ts and OooT'flays

1. Extremely narrow door openin gs

SEVERE LOSS OF HEARING

2. High thresholds or stairs at

entrance/exit

PREVALENCE OF POOR BALANCE

INCOORDINATION

3. Not enough maneuvering space in

front of doors

LIMITATIONS OF STAMINA

4. Door swings that partially

use

DIFFICULTY MOVING HEAD

DIFFICULTY REACHING WITH ARMS

0 bstruct

5. No level space in front of e "try

doors

DIFRCULTY IN HANDLING AND FINGERING

6. Directions unclear or poorly marked

LOSS OF UPPER EXTREMITY SKILLS
DIFFICULTY BENDING, KNEELING, ETC.
RELIANCE ON WALKING AIDS
INABILITY 10 USE LOWER EXTREMInES
EXTREMES OF SIZE AND WEIGHT

J --

~:__-i--i-___:_~.

7. Illogical opening procedure

K ----;,...;--..;

8. Great force needed to open doors

L---~.

M ----.~~---'
N

--E:!..........
~!::::J

9. Stairs in path of travel to an

emergency exit or place of r e fuge
10. Revolving doors on turnstile s

Figure 1. The Enabler model. Note. From Access to the

Built Environment: A Review of the Literature (p. 75) by E.
Steinfeld, S. Schroeder, J. Duncan, R. Faste, D. Chollet, M.
Bishop, P. Wirth, and P. Cardell, 1979, Washington, DC:
U.S. Government Printing Office.

Figure 2. An example of an Enabler problem matrix. Note.

From Access to the Built Environment: A Review of the Literature (p. 91) by E. Steinfeld, S. Schroeder, J. Duncan, R.
Faste, D. Chollet, M. Bishop, P. Wirth, and P. Cardell,
1979, Washington, DC: U.S. Government Printing Office.

mensions of disabilities in a manner that can be easily

understood and addressed by a multidisciplinary group.
The limitations include the inability of the matrix to identify that sometimes more practical, alternate ways to access and use the building may exist.

this, they presented a useful summary of the information

available at the time and identified the existing gaps in
each of these areas of barrier-free design. Issues such as
the influence of speed, range of motion, accuracy,
strength, and endurance on function were also discussed.

Human Factors Research

Discussion

Most of the research reviewed by Steinfeld et al. (1979)

for their report was found in the human factors (ergonomics) literature. This body of work explores the fit
between human performance and the physical environment. Steinfeld et al. were critical of the mechanistic orientation of this literature, but found that it produced a
unifying concept for barrier-free design: buildings conceived of as task environments. This conceptualization of
barrier-free design places acceSSibility into an integrated
framework of human performance and allows for the generation of a complete list of information needs for design
based on the task requirements of the inhabitants. As a
concept, access can be broken down into 10 basic requirements (e.g., passing through openings [see Table
1]). Each of these requirements in turn has been subdivided; the result is an exhaustive list of possibilities.
Steinfeld et al. (1979) reviewed and critiqued this
literature, organized by the headings of (a) functional
anthropometry, (b) biomechanics, (c) information display, and (d) specific task environments On the basis of

The reports issued for HUD by Steinfeld et al. (1979)

represent a thoughtful and comprehensive state-of-theart statement on barrier-free design and one that is considerably more developed than any found in the occupational therapy literature. Although Steinfeld et al. 's report
is directed toward the design community, the ideas presented embrace those identified in our review as important to occupational therapy. That is, they subsume the
concepts of safety, acceSSibility, mobility, and performance and address these from the perspective of the person and disability, and they allow for home assessments
and for compliance with building standards. The Enabler
model acts as a problem-solVing device that permits the
lack of ability to perform activities in task environments to
be identified and rated. This method of analysis is systematic, exhaustive, and congruent with the occupationalfunctional orientation of our profession.
Steinfeld et al.'s (1979) conceptualization is broader
and more developed than the present occupational therapy site-specific mode of home assessment, because it

348
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Apn'l 1991, Volume 45, Number 4

Table 1
Information Needs in Designing Accessible
Environments
Task
1. Passing through openings

2. Operating electronic and

mechanical controls

3. Moving along route of travel

4. NegOtiating changes in level

5. Transferring from one body

posture to another

6. Searching for and

interpreting direction-finding
information

7.

Negotiating a series of
movements in a confined
space

8. Negotiating human and

vehicular traffic

9. Using flXtures, storage, and

work surfaces
10. Avoiding hazards in the path

of access

Information Needs
Height of openings
Width of openings
Shape of openings
Maneuvering clearances
Configuration of control
Location vis-a-vis reach
Force of activation
Activation motion
Speed of activation
Relationship to other control
Type of feedback
Characteristics of surface
Friction between user and surface
Length of routes
Width of path
Exposure along route (to climate)
Overall paltern of circulation
Degree of slope for ramp incline
Configuration of stair nosing
Stair shape and size
Length of run fm incline of stairs
Location and configuration of
assistS
Configuration and size of landings
Number and type of assists
needed for transfer
Location and configuration of
assists
Strength of assists
Size and configuration of transfer
clearances
Size and configuration of built-in
elements that are transfer
points (e.g, toilet)
Information needs
Type of coding method
Location of display
Exposure of display
Content of information needed
Number of displays needed
Complexity of information
transmitted
Symbolic content of information
Size and configuration of
clearances
Layout of elements in a space
Proximity of elements to each
Other
Constraints on traffIc flow
Controls on now rate and
direction
Separation of human and
vehicular traffIc
Height
Approach clearances
Configuration of fixtures
Size
Definition of hazards thaI should
be avoided
Configuration of hazard-free zone
Size of hazard-free zone
Guards against exposure to
hazards
Size and configuration of warning
signals

Note. From Access to tbe Built Envimnmenl. A Review oftbe Literature

(p 103) by E. Steinfeld, S Schroeder,]. Duncan, R. Faste, D. Chollet, M.

Bishop, P. Wirth, and P. Cal"dell, 1979, Washington, DC: US. Government Printing OffIce.

allows both individual and group needs to be addressed

by the same model and permits homes, institutions, and
community areas to be similarly assessed. This represents
an improvement over our more limited approach. Although they represent very different disciplinary bases,
both the occupational therapist and the designer gather
information on accessibility for the same purpose: to construct an environment that is responSive to functional
needs and that facilitates performance. It is particularly
important to note that the adoption of the Enabler matrix
would permit a consistent format for data collection by
any discipline on aJl settings, persons, and disabilities.
The advantages of the establishment of such a common
data pool are obvious and enormous. For example, the
development of a large or representative database of information would allow for the generalization of findings
and the meaningful application of results from disparate
studies. Finally, Steinfeld et al.'s ideas have formed the
basis for the Jast ANSI revision and as such, serve to
include various levels of government on the multidisciplinary barrier-free design team and to proVide a gold
standard for prOViding accessible environments.

Conclusion
The profession of occupational therapy has traditionally
been concerned with accessibility and barrier-free design.
This concern has tended to be case- and home-specific. A
review of the literature indicates that both a conceptual
base and research on the topic are needed. Because the
demands for accessible environments are increasing, particularly to enable elderly and disabled persons to remain
in the community, increased occupational therapy input
will be required in the future. The literature reviewed
raises our awareness of three important issues: the need
to develop the occupational therapy base of research and
practice; the growing acceptance of ANSI standards; and
the existence of a cadre of concerned and welt-informed
designers and an architectural literature base. Steinfeld et
al.'s (1979) Enabler model may provide a viable person/
disability/function model for the extension and unification of the present occupational therapy concepts relating to barrier-free designs as well as a link to the
multidisciplinary design team In return, we can offer the
health care perspectives and skills unique to the profession of occupational therapy, that is, our knowledge of
specific diseases and disability, of life-span development,
and of how these various processes may influence function. Together we can enhance and strengthen design
decisions and the provision of barrier-free environments
for elderly and disabled persons ....

Acknowledgments
We are gratefUl for the support of the Canadian Occupational
Therapy Foundation and the Social Sciences and Humanities
Research Council of Canada.

Tbe American journal of Occupational Therapy

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349

architectural barriers. American jow77al of Occupalional

Refl:renct:s

Tberapy. 26, 10-12.

American National Standards Institute, Inc. (1971). American National Standards specifications for making buildings
and facilities accessible to, and usable by, Ihe phvsically
handicapped. New York: Author.
American National Standards Institute, Inc. (1980). Ameri-

Levine. R. E. (1988). Community home health care. In H.

Hopkins & I-I. Smith (Eds.), Willard and Spackman's occupational therapy (7th ed., pp. 756-780). New York: Lippincott.
Liston, R. (1971). Learning experience: Architectural harriers survey. Ccmadianjournal of Occupational Therapy, 38,

can National 5Landards specifications for making hUildings

71-711.

and facilities accessible to, and usable by, the physically

handicapped. New York: Author.

Maguire, G. H. (1985). Acitivites of daily living. In C. Lewis

(Ed.), Aging The health care cballenge. Philadelphia: F. A.
Davis.
Malik, M. (1988). Activities of daily living and homemaking.
In H. Hopkins & H. Smith (Eds.), Willard and Spackman's
occupational therapy Oth ed., pp. 258-271). New York:
Lippincott.
Martin, L. M. (1987). Wheelchair accessibility of public
huildings in Utica, New York. AmericanJournal ofOccupational Tberapy, 41, 217-221.
McClain, L., & Todd, C. (1990). Food store accessibility.
American journal of Occupational Therapy, 44, 487--491.
Mosey, A. C. (1986). Psychosocial components ofoccupational therapy. New York: Raven.
Shaw, J. A. (1971). Architectural barriers: A medical problem. American Journal of Occupational Therapy, 25, 13-15.
Steinfeld, E., Schroeder, S., Duncan, j., Faste, R., Chollet,
D., Bishop, M., Wirth, P., & Cardell, P. (1979). Access to tbe built
environments: A review qfthe literature. Washington, DC: U.S.
Government Printing Office.
Taira, E. D. (1984). An occupational therapist's perspective
on environmental adaptations for the disabled elderly. Occupational Therapy in Health Care, 1(4), 25-33.
Tideiksaar, R. (1986). Preventing falls: Home hazard checklists to help older patients protect themselves. Geriatrics, 41 (5),
26-28.
Trombly, C. A, & Versluys, H. P. (1989). Environmental
evaluation and community reintegration. In C. A Trombly (Ed.),
Occupational therapy for physical dysfunction (pp. 427--440).
Baltimore: Williams & Wilkins.
United Cerebral Palsy of New York City, Inc. (1984). Occu-

American Occupational Therapy Association. (1981a). The

Association - Official position paper- Occupational therapy's
role in independent or alternative living situations. American
journal of Occupational Therapy, 35, 812-814.
American Occupational Therapy Association. (1981b). The
A~sociation- Official position paper- The role of the occupational therapist in home health care. AmericanJournal ofOccupational Therapy, 35, 809-810.
American Occupational Therapy Association, Commission
on Practice. (1983). The roles and functions of occupational
therapy selvices for the severely disabled. Americanjournal of
Occupational Therapy, 37, 811-814.
Barris, R., Kielhofner, G., Levine, R., & Neville, A. (1985).
Occupation as interaction with the environment. In G. Kielhofner (Ed.), A Model of Human Occupation: Theory and
application (pp. 42-62). Baltimore: Williams & Wilkins.
Colvin, M. E., & Korn, T. L. (1984). Eliminating barriers to
the disahled. American journal qfOccupational Therapy, 38,
748-753
Hasselkus, B. R., & Kiernat,J. M. (1973). Independent living
for the elderly. American Journal of Occupational Tberapy,
27, 181-188.
Hasselkus, B. R., & Maguire, G. H. (1988). Functional assessments used with older adults. In B. Hemphill (Ed.), Mental

health assessment in occupational therapy: An integrative approach to the evaluative process. Thorofare, NJ: Slack.
Hopkins, H., & Smith, H. (1988). (Eds.). Willard and
Spackman's occupational therapy (17th ed.). New York:
Lippincott.
Kielhofner, G., & Burke, J P. (1985). Components ;mcl
determinants of human occupation. In G. Kielhofner (Ed.), A
Model of Human Occupation. Theory and applicalion (pp.
12-36). Baltimore: Williams & Wilkins.
Kiernat,

J.

M. (1972). Promoting community awareness of

pational therapy initial evaluation: Project open house.

(Availahle from United Cerebral Palsy, 105 Madison Avenue,
New York, NY 10016)
Wittmeyer, M. B., & Stolov, W. C. (1978). Educating wheelchair patients on home architectural barriers. American journal of Occupational Therapy, 32, 557-564.

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April 1991, Volume 45, Number 4