As part of our focus on Environment this month, we are delighted to have received a guest blog from Anava Baruch, MD of Design for Independence, housing occupational therapy specialists, offering a focus on the importance of having the right home environment post-ABI.

Children with severe brain injuries often find it difficult to adapt to get the most out of their environment. Most of us take it for granted that our pupils will automatically dilate for the amount of light around us, for example – or we stand on our toes to reach an object on a high shelf. We learn to control and manipulate objects with ease, often without realising we’re doing it.

But brain injuries that cause sensory, cognitive or physical impairments leave children restricted and inflexible. To give them a degree of independence, their environment needs to change – it needs to compensate for their lack of flexibility.

Years ago, as a young occupational therapist (OT), I worked at a convent home for children with severe brain injuries and deformities. I specialised in sensory integration and worked there as a paediatric OT. The convent had a sensory room which could be adapted to a child’s needs, in all aspects of sensory stimulation. My goal was to get the children to interact with their environment, along with me. With some, making eye contact was an incredible achievement. I quickly realised that every child was unique in the way their brain reacted to sensory stimulation. If the environment was set correctly, the child was able to concentrate, interact and, in some cases, actively control the equipment in the room. This brought them joy and brought their parents unimaginable pleasure to see their child active and responsive.

Having an MSc in ergonomics reinforced my knowledge of how unique we all are, with or without a brain injury. Children with a brain injury have a smaller, limited bag of tools and energy at their disposal. The correct tailor-made home environment should enable them to use their limited tools to make an impact on the environment around them. Having control and being able to interact to have an impact gives them quality of life.

Part M of the Building Regulations aims to provide guidelines for designing domestic environments for multiple disabled users. It tries to meet the needs of a variety of impairments with one-size-fits-all guidelines. It is usually applied when the user is unknown or the property might be used by more than one disabled person. However, when a property is designed to meet a known client with specific needs and a list of identified impairments, part M or any generic guidelines become irrelevant and lacking.

Housing OTs learn to identify the unique tools a client has and translate those into suitable layouts and interior design. The result is an environment that is made to measure – tailored to use the tools available to the child, harnessing their abilities, and understanding the ideal conditions including colours, size, amount of light and layout. This personal approach for each child enhances brain function, supports relaxation and sleep, reduces the energy required to complete tasks, increases safety and enables active participation.

Some of our clients’ injuries have resulted in visual impairment, which in itself has an impact on their use of their home environment. Enhancing natural light – as well as reducing the need for 3-D vision and depth perception when it comes to the use of staircases and access – could reduce barriers and the need for care support and supervision. Providing suitable pieces of equipment can enable independence and control.

The rule of ‘the larger the better’ room size is usually applied when designing for disabilities. This works against conserving the child’s energy (when it comes to walking with or without aids and crawling) and will have an effect on the child’s ability to fall asleep and relax. Far too often, no consideration is given to the wall colour and the level of noise, which can potentially affect their alertness level and their ability to relax or concentrate.

Designing a tailor-made environment for a child with a brain injury is vital as this enhances the child’s abilities and quality of life – and goes hand in hand with the rehabilitation process. It also has a significant impact on their care requirements and related costs.