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Fig. 6 Treatment cubicles and «lamination room

Equipment for this department may include infrared and ultraviolet lamp*, diathermy, hot peck and electrical stimulation apparatus, ultrasonic equipment, suspension apparatus (Guthrie-Smith), electrical diagnostic apparatus» moist heat equipment, sand bags, powder boards, powder, oil or lotion, alcohol, and linen.

In many cases patients will be lying on their backs during treatments. Ceiling lighting should be indirect or semi-direct to avoid glare. Therapists making teats or examinations require shaded or nonglare spotlights.

Waiting Area Provide space for wheelchair and ambulant patients; and if there is » nursing unit, space also for a stretcher.

Place the therapist's office near the waiting area for control.

From the waiting area, lha patient should be able to go to the exercise room, hydrotherapy. or treatment cubicles with a minimum interference of activities,

Therapist's Office There should be staff office space for interviewing patients and attending to administrative duties, as well as space for files, and a desk with a dictating machine.

Partition the office so that interviews may have acoustical privacy,

Situate it near the patients entrance to the physical therapy department and design it to provide maximum supervision of activities, A patient scheduling board and writing surface are recommended. Locate them conveniently for all physical therapists

Stat* lockers and dressing rooms {separate from patients) should be near this department,

Examining Room The room should be convenient to the entrance of the physical therapy department.

Equip it with an examination table, lavatory, and apace for examination equipment.

Provide floor-to-ceiling partitions for privacy, The room may be used for special tests and measurements, or for treatment when privacy is desirable

Scales for weighing patients {including patients in wheelchairs) are sometimes provided in this room.

Exercise Aiea This area should be a flexible, clear space tor individual and group exercise activities. (See Fig, 7.)

The most frequently used items of equipment are: exercise mats (sometimes raised 24 in. off the floor for the convenience of therapists and wheetchair or crutch patients if area is of sufficient size, mats may remain in place), shoulder wheel, shoulder overhead and wall weights, shoulder ladder, steps, curbs, ramps, stall bars, parallel bars, posture mirror, stationary bicycle, counterbalanced and individual weighis, sand bags, and paraffin bath. Some of this equipment may be made by a skilled carpenter rather than purchased. Purchased equipment should be accompanied by satisfactory repair and maintenance service.

Certain equipment relationships should be maintained Place the posture mirror 4 ft from the end of the parallel bars. When mats and other movable equipment are removed, there should be sufficient space for gait training, also related to a posture mirror.

Doors to the exercise area should be wide enough to accommodate not only patients but also equipment. Double doors, each 3 ft wide, are recommended.

The layout shown suggests a minimum exercise area for a physical therapy department with one therapist and an aid. For an expansion

OUTDOOR THÉRAPY

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The exercise area may be divided by open partitions which allow for the attachment of equipment and subdividing of activities, yet which permit circulation of air and easy supervision of the total area.

An observation cubicle with one-way vision glass may sometimes be used to advantage in order that visitors wilt not interfere with patients' activities.

Reinforce the walls for installation of exercise equipment, such as stall bars.

Provide storage for equipment not in use-

Toilets should be accessible to the patients and designed for those who are confined to wheelchairs.

A wall clock in Ihe room for timing exercises is recommended.

Vinyl wall covering to a minimum height of 5 ft will protect walls and ease maintenance-

There should be adequate ventilation. Fresh air without drafts in the exercise and treatment cubicles is very important. Air conditioning of this area is highly desirable.

Windows or room exposure should be designed to provide privacy within the exercise room.

Gymnasium In larger centers or centers with inpatients, a gymnasium is recommended, it serves a variety of uses, such as individual and group exercises, recreational programs, and meetings.

The gymnasium will augment the program of the physical therapy exercise room, permitting the therapist to conduct group wheelchair and mat classes. The room should be furnished with parallel bars, wall bars, stairs, curbs, gradients, wall mirrors, etc., for individual instruction.

The room will also be used for recreational activity such as group volleyball, basketball, moving pictures, and wheelchair square dancing- A minimum clear ceiling height of 14 ft is recommended If the gymnasium meets standard space requirements, rental of its use to community athletic organizations will be facilitated- Providing a recreational program is particularly important where inpatients are involved

The gymnasium will also be used by the social group worker in the social adjustment program of some patients-

As the gymnasium is a multipurpose room, equipment and furniture within the area should be movable. Provision for its storage is essential.

As a meeting room to be used by selected groups within the community, this facility provides an excellent opportunity to acquaint the public with the problems of rehabilitation and to arouse interest in the center s program. For this purpose, the gymnasium should be easily accessible to the public.

To make maximum use of this multipurpose room, it is important that activities be controlled to avoid conflicting schedules.

Hydrothetapy The space lor hydrotherapy is frequently the most expensive area of the center; consequently, it should be planned with considerable selectivity.

Whirlpool tanks for arm, foot, hip, and leg immersion are considered inadequate by many centers serving multiple disabilities unless augmented with facilities for complete body immersion. (See Fig. 0.)

Almost all exercises and treatments can be conducted with a Hubbard tank and a wading pool and tank. Combinations of Hubbard tanks with wodtng facilities are available where space is limited.

Therapeutic pools are expensive to construct; consequently, they are usually considered only for larger centers.

AH hydrotherapy activities require linen and towel Btorage. Also provide a wringer and dryer for bathing suits and a storage space for wet and dry bathing suits ot both staff and patients.

Tank and pool areas require storage space for wheelchairs and stretchers, adequate

Whitehall Hubbard Tank Stretcher

Fig, fi Whirlpools and tank room dressing cubicles, or dressing rooms to permit maximum use ol pool, showers, and toilet facilities.

As hydrotherapy is a moderately noisy activity, it should be removed from areas requiring sound control*

Floors should he of unglazed ceramic tile with drains for spilled water and tank overflow.

As equipment is heavy when filled with water, a structure must be designed for these additional loads.

Overhead monorails with lifl mechanism are »agential for efficient use of Hubbard tanks and waders. Ceilings should be a minimum of 9 ft fi in. The location of the monorail with proper relationship to equipment is essential.

All pipes for hydrotherapy should be accessible but concealed, Waste lines should be adequate for rapid changes of water,

Ail hydrotherapy equipment should have thermostatically controlled mixing valves, Adequate pressure and an ample source of 160 1 F. water are essential.

Humidity reduction ie a major concern in planning the hydrotherapy department. Adequate air conditioning is essential for the com* fort of patients and staff.

Whirlpool» This includes equipment for ihe treatment of arms, hips, and legs. Some models are available as movable units, in which case a sink or lavatory is required in the cubicle for drainage of the unit.

Provide space for chair, table, and a stool of adjustable height.

In small centers where hydrotherapy equipment consists only of whirlpool tanks, place them near treatment cubicles and near the exercise room for easy supervision by the therapist,

Tank Room A treatment table with storage space is an essential requirement.

Allow space for wheel stretchers and provide 44-in.~wide doors. (A S6-in.-wide opening is necessary to install combination treatment and wading tank.;

Allow space for stretcher and wheelchair storage.

Showers and Dressing Rooms Directly related to the efficient use of a hydrotherapy pool is the provision of adequate dressing room facilities, Dressing facilities do not necessarily have a site relationship to the pool indicated. For example, some programs wilt require several dressing tables in order to accommodate the patients.

Hydrotherapy Pool Many variations in sits are possible.

The depih of the poof should be graduated, Variations of depth in 5-in. increments are recommended, For children the shallow end should be 2 ft deep, for adults, 3 ft. The deep end of the pool should be 5 ft.

There should be a continuous gutter around Ihe pool for the use of the palienis and for the purpose of attaching plinths.

A portion of the floor surrounding the pool may be depressed to form an observation area for the therapist.

Occupational Therapy

Occupational therapy is administered under medical supervision and performed by graduates of schools of occupational therapy approved by the Council on Medical Education and Hospitals of ihe American Medical Association,

The objectives of occupational therapists are to assist in the mental and physical restoration of the disabled person, enabling him to adjust to his disability, increase his work capacity, and to want to becoms a productive member of his community.

In addition, the occupational therapist is concerned with the training of patients in the activities of daily living.

To achieve these goals, occupational therapy utilizes, on an individual basis, remedial activities which are found in creative skills and manual arts, (See Fig. 9.)

Location Within Building Occupational therapy should bo adjacent to the physical tharapy department, since many patients will use both areas-

Locate the area so that scheduled patients may proceed directly to occupational therapy without interfering with the circulation of other departments.

As some phases of occupational therapy involve noisy activity, this area should be removed from quiet tone« in the building, or provision should be made for acoustic control.

Certain occupational therapy activities, such as those characterietic of daily living, may be conducted out of doors in favorable weather-It is recommended that, if possible, access to an outdoor area be provided

The area should be accessible to the center s physician, the social adjustment area, and the vocational counseling area. As occupational therapy involves coordination w*th the nursing unit (for dressing and toileting particularly), the occupational therapy department should be conveniently related to it-

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