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Barrier Free Design: A

Review and Critique of

th

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 p u c i ~ 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 as

sessments. Nonetheless, two fledgling themes can be ex

trapolated: tbe consistent reference to the concepts

of

a c c e s s i b i l i ~ v mobility, function

and

safety and

an

in

creased awareness among occupational therapists re-

garding the accessibility

standards

developed by the

American National Standards Institute (ANSI)

ANSI,

1971,

1980). A problem-solving model suggested by de

signersfor the 1979 revision of ANSI standards that in

corporates these

conceptual

themes is described

and

discussed.

Barbara Acheson Cooper, MHSC, Oil POT,

is ~ s i s t a n t

Professor,

~ s o c i t e Dean and

Director

of

the School

of

Occupational

Therapy and Physiotherapy, IJ 11 Health

Sciences

Centre,

McMaster University, 1200 Main Street West Hamilton, Ontar

io, Canada IBN

3Z5 She is

currently enrolled in the doctoral

program for environment behavior studies, School of Archi

tecture

and

Urban Planning, University

of

Wisconsin-Milwau

kee

Milwaukee, Wisconsin.

Uriel Cohen, DArch.

is

Associate Professor, School of Architec

ture and Urban Planning, University of Wisconsin-Milwaukee,

Milwaukee, Wisconsin.

Berry

Risteen

Hasselkus, PhI), OTK,

is

Assistant Professor,

De-

partment of Therapeutic Science and Chair, School of Occu-

pational Therapy, University of Wisconsin-Milwaukee, Milwau

kee Wisconsin.

Tbis article was Clccepted or publi catio n August 30 1990.

C

onsumers, families, and health care professionals

agree

that a physical setting that fosters inde

pendent living

is

often

the critical factor that al

lows persons

who

are frail and disabled

to

live in the

cominunity

instead of n

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 gradual

ly

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;

c o m m u n i t i e ~

are

hecoming

increasingly aware

of

the need to

provide

access to public

buildings,

services, and the neighbor

hood 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 pcrform ance of

life tasks. and a vehicle for assisting in the

development of

senso

ry, perceptual, cognitive, and motor skills and need- fulfilling intra

personal ancl interpersonal relationships. (I'. 3)

Mosey's (1986) views are supported hy

the

profes

sion

as

a

whole, as

evidenced

by

educational

curricula

that include

as a basic component the teaching of

meth

ods used

to conduct

home assessments and modifica

tions

for both architectural

and

functional

features. Fur

ther

endorsement

comes from

the American

Occupational Therapy ~ s o c i t i o n

(AOTA),

which identi

fies 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 el

derly and those

who

are physically disabled have been

identified as the two major groups requiring assistance

with environmental modification.

Barrier-free environ

ments, 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 im

proved 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

April 1991

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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 phys

ical

environment

thus becomes particularly

important.

The independent-living

thrust

defines the term environ-

ment

broadly and clearly considers

community

accessibil

ity 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

assess-

ment would

also need

to

be flexible enough

to

accommo

date diverse formats. Professional consensus regarding

the conceptualization

of

barrier-free design and assess-

ments

would provide

a consistent

method for

data collec

tion

without restricting its subsequent clinical use. An

additional benefit

would

be the provision

of

a collective,

uniform

base from which issues related

t

occupational

therapy and environmental

access

could

be

researched.

The present paper reviews and critiques the occupa

tional therapy literature

on

barrier-free design, particular

ly concerning the conceptual approach

now

used in edu

cation, research, and practice.

It

suggests a model by

Steinfeld et

al

(1979) as

one

that

might

provide the pro

fession

with an appropriate but more

comprehensive

al-

ternative to

our

present situation-specific approach and

yet allow the focus on individual function

t

be

maintained.

Lllcramrc R \ ' jew

Education and ractice

The major instructional texts in occupational therapy usu

ally 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), ad

dresses the need

for

architectural modifications

but

pro

vides

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, Kiel

hofner, Levine, and Neville (1985) to propose a

model of

four

concent ric circles.

From inner

to outer, these circles

represent the

nonhuman environment,

required func

tional tasks, roles, and culture. Second, she suggested

Kielhofner

and Burke's (1985) Model of

Human

Occupa

tion 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 evalua

tion

of

architectural features

within

the

home

and com

munity for

clients

with

physical disabilities

Although

a

sample questionnaire

is

provided,

no

overall conceptual

framework

is

suggested. The authors stressed the

impor-

tance

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 var

ious architectural zones

or

rooms.

Information

relevant to barrier-free design is some

times

buried in

texts

on other

topics.

For

example, in a

text on mental health assessments, a chapter by Hassel

kus 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 gerontol

ogy. 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 devel

oped

y

health care units and

institutions

to

meet their

own needs and vary great ly in length and breadth. Similar

organiZing constructs, however, such as safety and per

formance, arc usually used. These checklists

rerresent

an

i l

iosyncratic approach that has been

common in

occupa

tional therapy in the past. Home-safety checklists are spe

cific 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

assess-

ments are viewed by the profession primarily as situation

specific and centered

on

the home. These are often struc

tured as room-by-room checklists to be completed by the

therapist

on

site in collaboration

with

the client and fam

ily. 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

informa

tion: a consistent cluster of concepts (safety, mobility,

accessibility, and performance) and the relatively new

The American journal of

Occupational

Therapy

45



3/7

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, Occupa-

tional Therapy

in

Health Care, Occupational Therapy

in Mental Health, Occupational Therapy journal o/Re-

search, Physical/Occupational Therapy in Ceriatrics,

and Physical/Occupational Therapy in Pediatrics re

vealed that in spite of the emphasis placed by the profes

sion 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 per

spective on the issue of architectural barriers and the

problems faced by persons

with

physical disabilities.

Ac-

cessibility needs were categorized and discussed under

the headings

of

housing, education, employment, trans

portation, 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 fo

cused

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 pro

fession 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


4/7

of the modifica tions. The assessment form used

was

de

veloped 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 t

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 ther

apy research

on

barrier-free design is

in an

early phase of

development and cannot be said to demonstra te any well

defined thrusts,

Although

elderly people have been iden

tified as a target

group in

need of barrier-free design,

no

studies specific t this group were found, The home

based checklist

orientation

espoused by education and

practice is strongly evident but, again,

no common

con

ceptual

framework could be identified, As

with

the educa

tion and practice literature, conceptual trends were noted

or

could be infer red, 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 pre

sents a

primary

obstacle to further professional develop

ment,

lending

itself to idiosyncratic interpretations and

variations

of

architectural assessments that cannot be

compared, Fledgling conceptual frameworks can be ex

trapolated, the

most

distinct being the

use of

ANSI stan

dards as well as the focus

on

individual needs

as

catego

rized by a

number of different

constructs, The strongest

and most pervasive of these thrusts, the use of ANSI

standards,

is

discussed below,

wndard

The

use

of

ANSI standards

in

construction

is

currently

voluntary,

but

they have been adopted by federal agen

cies and 50 states

t

form the basis for most

of

the cur

rently 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,

The

extent of the

problem

3, Existing legislation

4. The

scope of barrier-free design problems

5, Relevant research

6. 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 par

ticular interest

t

occupational therapists. Two

sections-

the scope of barrier-free design and

human

factors re

search - 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 fo

cused

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 soluti on, whose needs

should take precedence?

RecogniZing that much of

the

literature

on

barrier

free design presented a reductionistic view, Steinfeld

et

al. (1979) proposed an ideogram called the nabler (see

Figure 1),

which

would

allow a

broader

and

simpler

con

ceptualization of disabilit y and, by

providing

a

method for

identifying

problems, facilitate design decision making,

The Enabler model represents

four

general areas

of

hu

man 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 re

search findings, then developed 13

problem

identifica

tion matrices, These matrices represent

aJl

the

movement

and functional patterns possible in the

environment

With

out 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 dis

cussed

in

some detail by Steinfeld et

al.

(1979). The

ad-

vantages include the ability

t

present the pervasive di-

The merican Journal 1 Occupational Therapy

347



5/7

DIFFICULTY INTERPRETING INFORMATION

SEVERE LOSS OF SIGHT

COMPlETE LOSS OF SIGHT

SEVERE

LOSS OF HEARING

PREVALENCE OF POOR BALANCE

INCOORDINATION

LIMITATIONS OF STAMINA

DIFFICULTY MOVING HEAD

DIFFICULTY REACHING WITH ARMS

DIFRCULTY

IN

HANDLING AND FINGERING

LOSS

OF UPPER

EXTREMITY SKILLS

J

~ : _ _ i i _ _ _ : _ ~

DIFFICULTY BENDING, KNEELING, ETC.

K

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

RELIANCE ON WALKING AIDS

L ~

INABILITY

10

USE LOWER EXTREMInES

M . ~ ~

EXTREMES OF SIZE AND WEIGHT

N

--E:

Figure

1.

The Enabler model.

Note

From

Access t 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.

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

iden

tify

that

sometimes more

practical, alternate ways

to

ac

cess and use

the

building may exist.

uman

Factors Research

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

for their

report

was found in

the human

factors (ergo

nomics) literature. This body of work explores the fit

between

human

performance

and

the

physical environ

ment. Steinfeld et

al.

were critical of the mechanistic ori

entation of this literature, but found that

it

produced a

unifying concept for barrier-free design: buildings con

ceived

of

as task environments This conceptualization

of

barrier-free design places acceSSibility into an integrated

framework of human performance and allows for the gen

eration

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 re

quirements (e.g., passing through openings [see Table

1]). Each of these

requirements

in turn has

been

subdi

vided; 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 dis

play, and (d) specific task environments On the basis

of

.

I

,

potential problem

problem

o

severe problem

r ~

impossibility

~ l i

n trances. [xi ts and OooT'flays

AB B2C

DE

FGH I

J

K

LMN

1. Extremely narrow door openin

gs

2. High thresholds

or

stairs at

entrance/exit

3. Not enough maneuvering

space

in

front of doors

4. Door

swings that

partially 0

bstruct

use

5. No

level

space in front

of

e

"try

doors

6.

Directions unclear

or poorly

marked

7.

Illogical opening procedure

8.

Great

force

needed to open d

oors

9.

Stairs

in

path

of travel to

an

emergency exit or place of r

e fuge

10. Revolving doors on turnstile

s

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

From

Access t the Built Environment:

A

Review of the Lit-

erature

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.

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.

Discussion

The

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

represent a thoughtful and

comprehensive

state-of-the

art statement on barrier-free design

and one

that is con

siderably more developed than any found in

the

occupa

tional therapy literature. Although Steinfeld et

al.

's report

is directed toward

the

design community, the ideas pre

sented embrace those identified in our review as impor

tant to occupational therapy. That

is,

they subsume the

concepts

of

safety, acceSSibility, mobility, and perform

ance and address these from the perspective

of

the

per

son

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 system

atic, exhaustive, and congruent with

the occupational-

functional orientation of our profession.

Steinfeld et al.'s (1979) conceptualization is broader

and

more

developed than

the

present occupational ther

apy site-specific

mode

of home assessment, because it

Apn l 1991 Volume 45

Number 4

48



6/7

Table

Information Needs n Designing Accessible

Environments

Task Information Needs

1. Passing

through openings

Height of openings

Width of openings

Shape of openings

Maneuvering clearances

2. Operating electronic and

Configuration of control

mechanical controls

Location

vis-a-vis

reach

Force of activation

Activation motion

Speed of activation

Relationship

to

other control

Type of feedback

3.

Moving

along route of travel

Characteristics of surface

Friction between user and surface

Length of routes

Width of path

Exposure along route (to climate)

Overall paltern of circulation

4.

NegOtiating changes

in level

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

5. Transferring from one body

Number and type of assists

posture

to

another

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)

6.

Searching

for

and

Information needs

interpreting direction-finding

Type of coding method

information

Location of display

Exposure of display

Content of information needed

Number of displays needed

Complexity of information

transmitted

Symbolic

content of information

7.

Negotiating a series of

Size

and configuration of

movements

in

a confined

clearances

space

Layout of elements in a space

Proximity of elements to each

Other

8.

Negotiating human and

Constraints

on traffIc

flow

vehicular traffic

Controls

on now

rate and

direction

Separation of human and

vehicular traffIc

9. Using flXtures,

storage, and

Height

work surfaces

Approach clearances

Configuration of fixtures

Size

10.

Avoiding hazards

in

the path

Definition of hazards thaI

should

of access

be avoided

Configuration of hazard-free zone

Size

of hazard-free zone

Guards against exposure to

hazards

Size

and configuration of warning

signals

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.

Al

though they represent very different disciplinary bases,

both the occupational

therapist

and

the designer

gather

information

on

accessibility for the same purpose: to con

struct 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 in

formation 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 multidisci

plinary 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, par

ticularly 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

unifica

tion of the present

occupational

therapy concepts relat

ing 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

profes

sion

of

occupational therapy, that is,

our

knowledge

of

specific

diseases

and disability, of

life-span

development,

and of how these various processes may influence func

tion.

Together we

can enhance and

strengthen design

decisions

and the

provision of barrier-free environments

for

elderly and disabled persons ....

Acknowledgments

Note From Access to tbe Built Envimnmenl A Review

oftbe

Literature

(p

103) by

E Steinfeld, S Schroeder,]. Duncan, R Faste, D. Chollet,

M.

We are gratefUl for the

support of

the Canadian Occupational

Bishop,

P

Wirth, and

P Cal"dell, 1979,

Washington, DC: US. Govern

Therapy Foundation

and

the

Social Sciences

and

Humanities

ment Printing

OffIce.

Research Council of Canada.

be American

journ l

of

Occupational Therapy

349



7/7

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