Impairment & Rehabilitation/Translating ‘Impairment’ into the Design Brief

1. Impairment & Rehabilitation
Dr Jan Gawronski
Consultant in Rehabilitation Medicine
London Spinal Cord Injury Centre
RNOH

2. Rehabilitation
Survival
Health
Activity & Participation

3. 1945 & you sustain a SCI
Chances of survival to 1 year
• 50:50
• 30:70
• <5%

4. Sir Ludwig Guttmann
• ‘To rescue these men &
women from the human
scrapheap and to return most
of them.. to the community as
useful & respected citizens’

5. SCI: Life expectancy now
• 85% • ~70%

6. KG 19 yr female
• C6 complete spinal cord injury diving into a
shallow swimming pool

7. What did we do?
• Intensive care • Physician
• Theatres • Social worker
• Urology
• Spinal surgery • Dietician
• Nursing • SCI community nurse
• Physiotherapy • Carer training
• Occupational Therapy • Lifelong follow up
• Psychology/ Psychiatry

8. Rehabilitation- attention to detail
• Skin • Pain
• Breathing • Home
• Bladder • Family
• Bowel • Employer
• Sexual dysfunction • Travel
• Psychology • Sport
• Modulating aberrant • Communication
reflexes

11. Rehabilitation
Survival
Health
Activity & Participation

12. International Classification of Functioning,
Disability & Health
• WHO 2001
• Framework for measuring health and disability at both individual and
population levels
• Puts the notions of ‘health’ and ‘disability’ in a new light
• Acknowledges that every human being can experience a decrement
in health and thereby experience some degree of disability
• ‘mainstreams’ the experience of disability and recognises it as a
universal human experience
• Includes Contextual Factors, in which environmental factors are
listed, ICF allows recording of the impact of the environment on the
person's functioning

13. International Classification of Functioning,
Disability & Health
• WHO 2001
• Section ‘e’ environmental factors
• e515 Architecture and construction services
• e520 Open space planning services
• e525 Housing services
• Body function & structure; Activity & participation; Environment

14. • http://www.who.int/classifications/icf/en/
• http://apps.who.int/classifications/icfbrowser/
Thank you for listening

15. Stephanie Williamson
PFI PROJECT
Translating ‘Impairment’ into the
Design Brief

16. A Unique Healthcare Organisation
• 124 beds including:
– Children & Young Peoples Centre with 37
beds
– London Spinal Cord Injury Centre with 38
beds
– Specialist Adult Acute Wards with 49 beds
Complex physical, mental and emotional impairment
Families and carers
Unique equipment needs

17. Translating the Dream
• Creating presence and
establishing the tone
• Focus on restoration &
rehabilitation
• Supporting the patient pathway
• Importance of outside space
• A ‘show case’ for the
rehabilitation environment

18. The Trust provides a critical mass of world class clinicians, a
strong focus on restoration and rehabilitation and a service that
can care for the patient from cradle to grave. The hospital does
as much ‘medicine’ as it does ‘surgery’ and provides a psycho-
social cradle of care for the patient and their family / carers.
The focus on holistic
rehabilitation must be
reflected in the design
solution with a real sense
of empowerment for
patients and visitors,
spaces that provide respite
from clinical areas, a
design that encourages a
dynamic rehabilitation, not
passive, but calm and
uplifting.

19. Quality of the Patient Experience
•Encourage patients, carers, families and staff to develop relationships which will
enable patients to feel safe and independent, carers to feel supported and staff
to feel motivated and valued.
•Promote social interaction between all users of the building and enable patients
to have somewhere to go/something to do either on their own or in the company
of others.
•Provide different ambiances, e.g. diversionary, calming, welcoming, inspiring,
fun and provide views and access to gardens, courtyards and the surrounding
landscaping.
•Support people of all abilities; the abled and disabled, independent, partially
dependant and dependant, people with sensory impairments, mental health
problems and people with chronic conditions typical of a growing elderly
population
Two key areas

20. Main Entrance Facilities
It cannot just be aesthetically pleasing on the eye but must provide opportunity
for distraction, relaxation and respite.
It should draw people in so that it becomes a focal point rather than a place to
traverse.
From the moment of entering the space the visitor should understand the nature
of the organisation, including our work with children and spinal cord injury and
major disability.
This means the design must respond to the needs of patients; enhancing
freedom of movement, being truly inclusive and evoking a spirit of joy and
community.
Designers should draw on experience from elsewhere, looking for healthcare
facilities that have created a ‘wheel-based’ approach to movement design and
effective and flexible use of public space so that it can become a place to meet,
be entertained or watch the world pass by.

21. Patient Environment
“Patient Rooms: A Changing
Scene of Healing: The hospital
is still the place where patients
and their families, caregivers,
and administrators come
together for the common
purpose of restoring a patient to
good health. The issues each of
these parties face all come into
sharp focus in the patient room.
It is there that the delivery of
care is undergoing more change
than at any other point in
history.” Herman Miller
Healthcare Research

22. The Ward Model
•The Children’s Centre could be seen as a ‘home from home’ at the same
time as being a place that supports rehabilitation through play, education
and social development
•The adult acute beds are more like a ‘hotel’ providing healthcare –
functional and efficient whilst being welcoming
•The SCIC could be viewed as a ‘conference hotel’ building on the hotel
model above with an emphasis on development and progression and the
spaces in which patients and staff ‘conference’

23. Orthopaedics
Stepping away from the surgical hegemony
The future will be one of multidisciplinary integration, which gives direct
benefit to patients, puts the Trust at the forefront of innovative thinking
about hospital process design and brings basic science and translational
research right into the clinical setting.
The future will integrate clinicians, academics and patients in a system
which has rehabilitation as its core organisational principle, not surgery.