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Archive for September, 2012

Getting together with friends is one of the many joys of life. Whether going out for lunch, drives in the country, shopping or just sharing a cup of coffee together, friends make it better. But when friends all decide to meet at a home that is not wheelchair accessible, someone like me in a wheelchair could feel left out.

If your personality happens to be like mine, I don’t feel left out or targeted when I’m not able to get into people’s homes. A home is intended to be personal, and represent the style and taste of the owners. There may be tiered landscaping, stairs, multiple floors, etc. And if you are fortunate to live in an older home, there will be many corners with narrow hallways and doors. I certainly do not expect friends to cater to me being in a wheelchair, and redesign their dream home for an occasional visit from me.

Someone asked me if I could write a post offering some practical and inexpensive ideas to make a home accessible for company in wheelchairs. I know that many news homes are now built meeting ADA standards for accessibility which is a great thing for disabled people looking for a home purchase. But, what if you are like me and want to live in the old style homes with many nooks and crannies, narrow steep stairs and natural landscaping?

I have a friend in Maine that lives in a traditional New England farm that was built in 1790. Even if I did nothing more than sit in the driveway and stare at the beautiful architecture, I would be content. I had been in her home before my injury and she was determined that I would get in again. But with granite block steps and narrow doors, it looked a little daunting. But where there is a will, there is a way. So with Wendy and I working together (Wendy doing the work), we are able to get into her kitchen and visit there. I’m not able to go into the rest of her beautiful home because of the narrow doors, but, I would not have her change a thing. It would seem like desecration of a piece of history to me.

Now, all of this being said, there are some simple things that can be done to a home to make it “wheelchair friendly” that will not destroy your home. Let’s start with getting into a home that has steps. The easiest and least expensive method here would be to own a portable metal ramp. This type of ramp is something you can just keep in storage until you need it. I have one and they work great. If we are going over to someone’s home, we pack it up and bring it with us. It just unfolds and lies on top of the steps forming a ramp. Then with just a little assistance if needed, voila, you are inside the home.

Inside of your home the first thing to consider is placement of furniture. Try to have the approach to doorways a straight shot without needing to make sharp turns. This will make even the more narrow doorways possible to get through. If you have doorframes separating rooms in your home, but without the actual door, you can have a carpenter redo the door jams which can give a couple more inches to any door. If there is a door that is used, like for a bathroom or bedroom, there are specially designed hinges known as pocket pivot hinges. These allow the door to swing completely out of the door frame affording more space. Another option here is to install a pocket door. A carpenter can fix this up fairly quickly and without great expense. We have a couple of these in our home in Maine, an older home, and they work great.

The last room I would consider would be the bathroom. Most bathrooms have a vanity style sink that is difficult for people in wheelchairs because of the cabinet. One solution would be to redesign the vanity so there is no cabinet beneath the sink. Another option, depending on how your bathroom is designed, would be to install a wall mounted sink. This is what we have at our cabin in Maine which works perfect for me. Also remember to move the mirror low enough so that a person sitting in front of the sink can see into the mirror. You can sit in a regular chair to test the heights. One last thing would be to install an accessible shower. The market is flooded with many types, designs and price ranges. These can be great for anyone, not just people in wheelchairs.

Well those are the basics that I would consider. The best thing that you can do to make your home accessible, is to make your disabled friends feel welcome. If I know you are sincerely glad to have me visit, then little things that are not accessible in the home will not matter at all. Besides, you will be the one repainting scraped door jams when I leave, not me.  Smile.

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When I was a kid I heard the expression, “Can’t you sit still? You must have ants in your pants!” I heard that expression a lot, especially from my parents. It may have been in church, school, the grocery store or the car, but some part of me was always moving. I smile when watching my youngest daughter sit anywhere because she does exactly what I use to do. Whether bouncing her knee or ankle, or tapping her toes, some part of her is always moving.

But prior to my injury, I did have control over my muscle movements if I chose to. After my injury the term “spastic” took on a whole new meaning for me.

People with spinal cord injuries will have muscle spasticity ranging from mild to severe. My spasticity is very mild and doesn’t create many problems for me. Mine usually occurs when lying down. For instance, I am lying in bed typing this blog on my laptop, and my legs will occasionally jump, or spasm.

There are many forms of spasticity. “Extensor spasms” are when the legs straighten out and become rigid. I was in college with a man that would experience extensor spasms so severely in his back and legs that he had to be strapped into his wheelchair because his spasms would literally through him to the floor. There are also “Flexor spasms” which act just the opposite, pulling the legs upward toward the chest into the fetal position. Then there are “Clonus spasms” which are repetitive jumping of muscles. These often occur in the ankles which will cause repeated bouncing of your feet on the wheelchair foot rest.

According to doctors, there are both beneficial and detrimental effects to spasticity. On the detrimental side of the scale, spasms can interfere with quality of life by throwing off balance, working against transfers, disrupting sleep and contributing to pain. There are some beneficial aspects to spasticity also such as maintaining muscle mass, stimulating blood flow and lessening the inevitability of Osteoporosis.

Since I know many people in wheelchairs, I see all types of spasticity and all levels of severity. Relating to the spasms that I have, I consider them mostly to be a nuisance. For instance, if I am pushing my wheelchair over rough terrain, my legs will often start to spasm bouncing my feet off my footrest. So I have to stop, pull my feet back up, and then continue on again. There are straps of course that would keep my feet in place, but I look at that as just one more hindrance to deal with every time I want to transfer into or out of my wheelchair.

There are many treatments for spasticity. Doctors usually start with the noninvasive procedures such as medications or stretching exercises. Speaking for myself, I try to incorporate stretching exercises into my daily routine, as a means to control spasms. For one thing I look at exercise as the most beneficial method without any negative side effects. Depending on how severe a person’s spasticity is, stretching may or may not help. The one thing to remember about stretching, for it to be the most effective, is that it needs to be done almost as a yoga exercise in length of time, and become a consistent part of your daily routine.

Medications given are usually the type to lessen pain–the less pain, the less spasticity a person will experience. Any medications should be discussed thoroughly with your doctor to learn about all possible side effects. I have chronic back pain which may or may not be the result of muscle spasms. I have tried numerous medications to lessen my pain: however, in my thinking, the minimal reduction in pain I receive is not worth the side effects.

There are also more invasive treatments available such as an “intrathecal catheter and pump device” which is implanted under the skin. These pumps contain pain medication that directly targets nerve cells in the spinal cord and can be administered in smaller doses with less severe side effects. Of course this would mean more surgery, ongoing maintenance and even pump replacement about every five years.

There are also procedures called nerve blocks and trigger point injections. Believe it or not, Botox injections may also help reduce spasms and pain by paralyzing the muscle. I know people that have had nerve blocks done with some good success for muscle spasms and pain. In my case, because of the way I was put back together, nerve blocks are out of the question.

So when it comes to spasticity that a person experiences, yes there are many options to help lessen them. I say go for the therapeutic stretching exercises and only use meds or surgery as a last resort. But once again, the choice is yours.

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After my spinal cord injury I quickly realized many physical aspects about me had already changed, or would soon be changing: for instance, a sneeze. I don’t exactly remember at what point after my injury I had my first sneeze, but when I did sneeze, we all got a good chuckle out it. You have probably noticed that everyone sneezes quite differently. I have heard and seen people sneezing that would bring a smile to the sternest of faces. http://www.youtube.com/watch?v=uHO-jVr2io0&feature=youtu.be  I used to have, what I thought, was a very “manly” sneeze. But my first sneeze after my injury sounded like a little kitten had sneezed!

My level of injury is T8 complete. The doctor explained to me that my diaphragm would no longer work at full capacity because of my paralysis. So the “little” things in life that I once took for granted, like sneezing and coughing, was now greatly diminished in force. The sneezing is humorous, like the video shows, but the coughing aspect can become a very dangerous concern for people with paralysis. While in the hospital, and later in therapy, I was given a handheld breathing apparatus to use. It was actually “breathing therapy” for my lungs and diaphragm. I did not like using it, but, I was informed how critical it was for me to improve my breathing. I still didn’t fully grasp how much of a decrease in my breathing capacity I had because of my injury. Then I attempted to do the most simplest of task–blow up a balloon. I couldn’t even get it started. So I faithfully started doing my breathing exercises.

A simple cold can quickly turn into something much worse, like bronchitis or pneumonia, because I can no longer cough with enough force to remove fluid from my lungs. Individuals that are quads have even a greater risk of health complications. Everyone knows the importance of staying healthy and avoiding situations that spread germs.

Here are some good tips from the Center for Disease Control (CDC) on flu prevention.

Take everyday preventive actions to stop the spread of germs.

  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid touching your eyes, nose and mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
  • While sick, limit contact with others as much as possible to keep from infecting them.

One of the things that the CDC, and the VA by the way, recommends is to get a flu vaccination. They are readily available everywhere and the cost is minimal. Some places also offer free flu shots. Of course the decision to get a flu shot is completely up to you. I personally get one each year and a pneumonia shot every 10 years. You can check out the CDC website for complete information to see if getting a flu shot is a good thing for you to consider. http://www.cdc.gov/

So remember that the flu is nothing to sneeze at (sorry for the poor humor). So as we go into another flu season, take appropriate actions in your life to avoid influenza or something worse.

www.Rickhuntress.org

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Welcome to the part of our home that acts as my “man-cave.” Of course it is rather difficult to have a man-cave with a wife and two daughters. So while I try to hibernate at times, my “girls” are running in and out, fashion questions asked and answered, blow dryers running and makeup being applied. But I do have my own space here in the bedroom where I read, write, play my xbox 360 or watch TV.

When we remodeled this end of our home, we intentionally made the master bedroom and bath extra large so that I could easily get around, but also so I would have a space to be alone when I needed to. Looking down the hall from the foyer you will see it is a straight shot into the master bedroom. If you were to take a right hand turn just before going into the master bedroom you would go down another hall to our daughter’s bedrooms and bath. The only modification that we did in their area was to widen the bathroom door to a 36 inch door. This made the bathroom accessible for me and any company we might have that are in wheelchairs as well.

The home had four bedrooms originally, but during the remodeling process we combined two of the bedrooms into one large master bedroom. By doing that we were able to add a walk-in closet for Wendy and make a large master bath. The bedroom has hardwood floors, a drop leaf desk for me, a wall mounted TV, book cases and remote controlled everything. Furniture near the bed was selected for space and also a place to hide all of my stuff that I need. One thing about being in a wheelchair is that I feel overwhelmed with “stuff.” So we wanted a bedroom that would accommodate that necessity of my life but also offer me a place to keep it out of the way. Another change we made was the height of the clothes rod in my closet. We had it installed at my level rather than the industry standard for most people. Just a simple change like that can make life a lot easier for someone in a wheelchair.

The original master bath had a 28 inch door, a small sink, toilet and shower stall. It was one of those bathrooms that you had to leave just to change your mind. The new master bath has a 36 inch door opening (minus the door) and is now 8 X 16 feet. There is a double vanity with large mirrors so that I can see in them. I have been in many bathrooms where the mirror over the sink is placed so that a person in a wheelchair cannot use it. The vanity has a cutout under my sink so that I can pull right up to it with plenty of leg room. There is also a 5 foot turn radius in front of the commode which complies with VA and ADA standards. There is plenty of shelf space for supplies, and a 5 X 5 foot roll-in shower which is my pride and joy of our entire remodeling project. I am able to take care of all my bathroom needs without any difficulty of getting around. Then when finished in the bathroom, I just roll to our bed to get dressed.

As I mentioned before, remodeling can be expensive. Each person will have to choose what he/she considers to be the most important area to spend money on. In our case we spent most of ours on the bedroom and bathroom. It gives me complete independence to get ready in the mornings and also a space to call my own.

Well now you have had the complete tour through our accessible home. We often have people who will come over for design ideas to incorporate into their home. So if you are ever in the area and want a tour, just let me know. Or feel free to email and ask questions. I can always send more pictures and offer some advice that may save you some headaches in your own accessibility designs.

www.rickhuntress.org

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One thing to consider, when purchasing or remodeling a home for accessibility, is the size of the rooms. Our home was not being lived in when we first saw it on the market, so we had an excellent opportunity for me to roll around the empty rooms and get a good concept of floor space.

Since the home was built in 1970, one thing that was an immediate concern was the size of the bathrooms. There were three bathrooms in the home and I was not able to get into any of them. The picture you see on the right was a combined laundry room/bathroom that is off our kitchen. There is also a pantry cupboard in the room and a door to exit into the garage.

It was obvious that this room was impractical for me, and the half bath (where you now see the washer and dryer), was about the size of a phone booth with a 28 inch wide door. Wendy did not like the idea of three toilets to clean in the house anyway, so we decided to remodel this room. When we remodeled, we eliminated the half bath and moved the washer and dryer to that side of the room.  We also replaced the 32 inch door going into the garage with a 36 inch door. We have no other furniture in the room, which makes for a very spacious laundry room with a large pantry cupboard.

Moving to the other side of the kitchen there is a doorway that leads into our den. This door is only a 32 inch door, but since I can fit through it fine, we decided to leave it as is because there are built-in bookshelves surrounding the door in the den. We have a lot of books and did not want to give up bookshelf space if at all possible. Once again we have hard wood floors in the den, but you will see from the picture that we added an area rug. When choosing the rug we made sure it was durable and not very thick. Pushing wheelchairs on carpeting or thick rugs is not an easy thing to do.

The two pictures of our den with the fireplace in view were taken from the doorway leading into the foyer. A couple of things to point out here: the fireplace and the computer desk. The fireplace is equipped with gas logs that are remote controlled. The remote makes it very easy for me to ignite the logs and is a great safety feature for anyone. The older style gas logs had to be started from inside the fireplace which was difficult for me to do. I would much prefer a fireplace with natural wood to burn, but, unfortunately, that is not the most practical thing for me any longer.

Finding a computer desk that is wheelchair accessible will probably send you on many shopping excursions. The typical design of computer desks is to put the keyboard on a tray that pulls out from beneath the surface of the desk. That does make good sense but rarely allows enough height distance to roll a wheelchair up under. My knees hit the keyboard tray, and that is as far as I go. So what we did was purchase a library table large enough to set our desktop computer and accessories on. This allows me plenty of leg room, and I am able to reach everything that I need when sitting there.

The last thing to mention in our den is the TV. Thanks to the new style of flat screen TV’s, we mounted ours on the wall which freed up a lot of floor space. A large entertainment center can be very nice if you have a room large enough to handle it and still leave plenty of room for maneuvering a wheelchair around in. Floor to ceiling bookshelves are great because I keep my books on the lower shelves and Wendy uses the upper shelves. We also have multiple other bookcases spread throughout the house with easy access.

One last thing to point out in a den is placement of furniture. Most dens will have sofas and chairs surrounding a large coffee table for entertaining, or placed around the TV for optimal viewing. In our case you will notice that the center of the room is obstacle free. We have three beanbag chairs to crash on when someone watches TV. Then they can be easily tossed into the corner to get them out of the way. Not the most aesthetically pleasing look for most people, but it definitely keeps open space for wheelchairs.

And for my next post, we will travel into the bedrooms and two bathrooms.

Remember to check out www.rickhuntress.org for book ordering details.

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I had planned on leaving my kitchen today and moving on to the next couple of rooms. However, since I was asked several good questions concerning kitchen remodeling I decided to park here for another post.

The kitchen is a critical room in every home, accessible or otherwise, since a lot of time is spent in the kitchen. As you read in my last post, we did not make any accessible modifications in our kitchen. I tease my wife that her favorite thing to make for dinner is reservations. And yes I must also admit that I do not put in a lot of KP duty. I can cook quite well when I want to, I just don’t want to an awful lot. But putting aside our preferences, I have been in some accessible kitchens that are truly amazing.

One thing to consider of course in the kitchen is what type of appliances to choose. You may be under the impression that all appliances are created equal. That is definitely not the case. If you are in a wheelchair, or mobility impaired in any way, you need to select appliances that offer as much independence as possible. Starting with the refrigerator, there are many designs available on the market. From a personal preference, I like the style where the freezer section is located on the bottom, rather than the top or a side door. The top makes it impractical to reach, and the side door is very narrow and limited in space. The freezer on the bottom offers accessibility to the entire space. The refrigerator above, with shelves that slide out, puts the most used items at eye level to a wheelchair user.

I would also recommend a range top separate from your oven. You can have this designed with doors that open in the front of the stove top, or with empty space beneath, so that you can roll your wheelchair up to the stove for easy use. Also make sure that the burner knobs are designed to be at the front of the stove top rather than the back or along the side. This is a must for a safety feature so you do not have to reach over hot burners. You can also have an electrician wire the controls for the range hood to be placed on the front of the counter for easy use. This allows you to use the hood light and fan without reaching over a hot stove top. Something else to consider here is to have the stove top lower than the rest of your counter space for easy use of all burners.

Placement of a separate oven should be where it is most practical to take things out of the oven and placed easily on counter tops with hot mats. Once again, always focus on safety. Having the oven built lower in your cabinets is another safety feature to prevent burns and for ease of use.

The sink should also be lower than the rest of the counter space. Here again you can have doors in front that open to leg room beneath for your wheelchair to roll up under. This is much more practical than sitting sideways to the sink to do dishes. Shelves can be installed on the inside of the doors for cleaning products. Having your dishwasher next to your sink is also very practical. Consider which side of the sink you prefer when installing one. The electrician can also rewire the garbage disposal and sink light switches to the front of the counter for easy use.

One last quick thing to consider is how to make your top cabinets functional for you. There are accessible pull down shelves on the market today that allows a person in a wheelchair to utilize upper storage space, and keeps fewer items on the
counter tops.

You can check out this web site for universal designs at http://www.pbs.org/hometime/house/udesign.htm It has all of the key components to consider for an accessible kitchen.

Also check the short Youtube video I have included. http://www.youtube.com/watch?feature=player_embedded&v=qAzqUdJNrbY

This video discusses more than just kitchens, but there is an excellent segment on barrier free kitchen design about half way into the video.

Yes the kitchen is important, but if you have not already guessed, it can also be expensive. Determine what you really want in a kitchen and how much your budget will allow. A kitchen “fit for a king” may look nice in magazines, but only if you plan on spending countless hours of cooking or love to entertain.

If you come visit us…you may just get pizza and a bean bag chair.

www.rickhuntress.org

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One trend in homes that is popular at the present time is known as “Minimalism.” I suppose that people subscribe to this for various reasons, but for someone in a wheelchair, it is very practical and functional.

Minimalism is just a fancy way of saying less is best. I’m sure that many of you have been in homes that in order to get through, you have to follow a trail around furniture, coffee tables, entertainment centers, room dividers, etc. For an able bodied person there is nothing wrong with a home set up like that. But for someone in a wheelchair, at least the way I think, I do not want to live in an obstacle course.

Starting at our front door, I enter our foyer that has one piece of furniture in it. You will also find hardwood floors throughout the house instead of wall-to-wall carpeting which is difficult to push a wheelchair on. To the left is a large archway going into what would normally be a formal sitting room. Ours is used as a music room, allowing room for my piano, and plenty of open space to roll a wheelchair around. To the right of the foyer is a four foot wide hall leading to the bedrooms and bathrooms. Straight ahead is a 32 inch doorway which leads into the family room. I would recommend a 36 inch door whenever possible, but since I fit through it fine, we left it as is when remodeling.

If I go through the music room there is another large archway opening up into our dining room. The dining room is our most crowded room in the house due to the size of the room and of course the dining room table in the middle of the room. But even here I have free access to go through the dining room and into the kitchen. I also have plenty of room to get to my assigned seat at the table where there is no chair to worry about moving.

Once in our kitchen you will find the only piece of furniture, except for a small decorative stand in the corner, is our kitchen table. Make sure when purchasing a dining room/kitchen table, you measure the necessary height for you and your wheelchair to sit at. Due to design features, many tables are not functional for people in wheelchairs. The rest of the kitchen is open floor space for me to maneuver around in. The kitchen can be a very critical piece in remodeling your home depending on your desire of what you wish to do in the kitchen. If you are a gourmet chef and love to cook than our kitchen would be completely impractical for you. There are many attractive and functional kitchen features on the market today, such as cut-out spaces under sinks and range tops, pull down shelving storage in upper cabinets and lowered counter space for food preparation. Once again, design your kitchen for what works best for your goals. The only change we made in our kitchen was the flooring. We removed the linoleum and put in ceramic tile. Note of caution here. If ceramic tile is something that you would consider, choose wisely. We wanted something light in the kitchen, but the light colored grout has caused problems. The light colored grout shows dirt easily and stains very quickly. So if you do choose a light colored ceramic flooring, make sure you get the grout sealed very well to help keep it clean.

If you were to open cupboard doors in most kitchens, you would find similar placement of the most commonly used items. The placement of those items will usually be eye level with someone that is standing up. If you are able bodied and open the cupboards in our kitchen, you will find all of the most commonly used items knee level. As strange as that may sound, it saves me having to always ask for assistance to get something I need. The kitchen is one room that can rapidly eat up your remodeling funds if you are not careful. So do what is necessary to make it functional for you, but don’t get caught up in the hundreds of gimmicks that are on the market today.

Even if minimalism is not for you, your home needs to be practical. That may sound like everyone compromising for me because I’m in a wheelchair. But Wendy and I both agreed that the more we could do for my personal independence, would ultimately result in much less work for everyone else. So in our case…less is best.

www.rickhuntress.org

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