Physical rehabilitation center by Caitlyn Kelly

Physical Rehabilitation Center

Caitlyn Kelly

This book is dedicated to... Those I love, who never let a negative prognosis keep them from fighting back.

table of contents Section 1- introduction Section 2- historiography section 3- case studies section 4- ergonomics section 5- topical explorations section 6- existing site & context section 7- program configuration section 8- code, regulations & standards section 9- executive summary section 10- bibliography

1 7 21 67 85 105 121 133 147 151

introduction

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Approximately 54 million people in the US have some type of disability, with physical, sensory, mental, and self-care effects ranging from mild to severe (UHealth). This research is dedicated to understanding and creating a better life for those that struggle daily.

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Many rehabilitation centers throughout the nation separate their patients and join them within age groups. The goal of this project is to bridge the gap created by different generations; this connection between patients varying in age and social status influences the rehabilitation process. Rehabilitation centers pride themselves on the traditional team approach with members that include doctors, non-physician health professionals, the patient and their family or caregivers. This team should continue to extend to the long list of patients going through similar issues within the facility. Throughout this process there will be research of healthcare projects from local Philadelphia design firms and the steps they follow when creating their projects. After research online I had found “Healthcare Design Magazine”, this source has proved to be filled with extremely valuable information on important parts of designing within the healthcare field.

As an interior designer the main contribution to healthcare design is finding the most functional layout for optimal contact to all of the patients and the rest of the staff. Designers must consider the need for “flexibility and/ or using modular systems to make adapting to change easier” (Healthcare form, meets healthcare function). With the constant need to adapt to the patient’s needs, designers must

learn to standardize the patient’s rooms yet create a unique environment that doesn’t bring negativity to its occupants. Sustainability in healthcare design is at times harder to achieve than in other areas. Martha Jefferson Hospital in Charlottesville,VA is slowly integrating sustainable features into their facility. They started with selecting low consumption plumbing fixtures that would be as undisruptive to the patients as possible. Sauk Prairie Memorial Hospital & Clinics in Prairie du Sac, Wisconsin is another example of a healthcare center that is transitioning into a more sustainable design. Sauk Prairie “incorporates native plants to help the campus blend in with the surrounding rural landscape, reduce landscape maintenance costs, and improve storm water quality” (Designing for sustainable healthcare facility maintenance). The overall goal of this project is to not only take previous healthcare facilities sustainable features into consideration but to additionally integrate more sustainable features in the entire center.

Figure 1.

The main users of all rehabilitation centers vary widely. The main users are the doctors, administrative staff, maintenance and the families of the patients as well as the patients involved in the treatments. The facilities need to have a clear separation between the administrative spaces and the spaces where patients and doctors interact. However, even with this enforced separation there needs to be common areas where the doctors and nurses have direct, close access to the patients in case of unforeseen circumstances. With this separation yet closeness needed for special planning, designers need to think of the best, most functional design for all users.

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“It is well documented that ethnic/racial minorities are disproportionately affected by many health care conditions that impact their health in comparison to their white counterparts. Many reasons are cited for these disparities, including socioeconomic status, health behaviors of the minority groups, access to health care, environmental factors, and direct and indirect manifestations of discrimination” (Disparities in Health and Health Care).

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With the large range of age groups occupying common areas in a rehabilitation hospital, designers must consider the differences in design taste from a teenager, to a woman in her eighties. Healthcare design is often looked down upon with their dull colors and overall depressing design. As healthcare design integrates into the new millennium, the designers are slowly transitioning with the times, designing spaces that are comfortable for all age groups, while allowing there to be spaces that would be separated amongst the ages.

“Universal Design is a concept that, when applied to environments, ensures that facilities, products, and services are usable by all people” (Universal Design for Healthcare Facilities). As universal design becomes more well-known, the idea of not applying it seems wrong. Universal design is even more important when it comes to healthcare environments due to the extreme range in patients entering the facilities. The American with Disabilites Act’s “parameters greatly affect the design, construction, and operation of buildings and facilities as well as the products that go into them” (Universal Design for Healthcare Facilities). Rehabilitation centers are very clearly meant to help patients through physical therapy to regain the body functions they have lost due to many different types of causes. With this end goal in mind, rehabilitation centers must be one hundred percent ADA accessible because the doctors in the facility never know what they will have to handle in their daily work day.

Figure 2.

Images Cited

Fig 1. Pained Body. Digital Image. N.p., n.d. Web, < http://www.bestfayettevillechiropractor.com/> Fig 2.Physical Therapy Patients. Digital Image. N.p, n.d. Web, < http://uchealth.com/women/programs-specialties/womens-services/pelvic-floor-physical-therapy/ >

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Works Cited

Baldwin, D. “Disparities in Health and Healthcare: Focusing Efforts to Eliminate Unequal Burdens.” Online Journal of Issues in Nursing 1st ser. 8.1 (2003): n. pag. Online Journal of Issues. Web. Levin, Debra. “Healthcare Form Meets Healthcare Function.” Healthcare Design Magazine. N.p., 10 July 2015. Web. “Statistics of Disability- Physical Medicine and Rehabilitaiton.” University of Miami Health System. N.p., n.d. Web. Tendler, Matthew D. “Designing For Sustainable Healthcare Facility Maintenance.” Healthcare Design Magazine. N.p., 13 Aug. 2013. Web.

historiography 2.0

2.0 The history of strokes Hippocrates, the man who is considered to be the father of medicine, first recognized what a stroke is known to be today over 2,400 years ago. When first discovered between 460 B.C and 370 B.C., the term stroke was not used; it was referred to as the Greek word “apoplexy” which when translated means “struck down by violence”. Hippocrates

sudden collapse, a loss of consciousness and paralysis described apoplexy to be a

(Demarin V. Et.). A apoplexy was often referred to as a “brain attack” to reference the fact that it is caused by a lack of blood supply to the brain (John Hopkins Medicine). At the beginning of its discovery, the only known treatment was simply to feed and care for the patient until the attack ran its course.

It wasn’t until the mid 1600s that Jacob Wepfer found that patients who died from apoplexy had bleeding in the brain (John Hopkins Medicine). Thomas Willis, another influential man in the medical field, focused his experiments on the further understanding of strokes and brain trauma (Thompson). Fast forward to the 21st century when physicians commonly describe a stroke to be the occurrence of a vessel in the brain rupturing, or causing blockage with a blood clot. Treatment is much simpler in modern times, by either opening the blockage or treating the rupture.

2.0

Figure 1.

2.0 The history of brain traumas The existence of brain trauma dates as far back to the Neolithic period, also known as the late Stone Age. This was confirmed after the discovery of remains that proved to be from successful brain operations. These remains were found in France, suspected to be from 7,000 B.C. It is said that preIncan civilizations practiced brain surgery as early as 2,000 B.C. In Prarcas, Peru there was archeologic evidence found that indicates brain surgery, this was used extensively, with a success rate found that proved patients were restored back to health.

The church had a ban on the study of anatomy; however many of the churchmen were outstanding physicians and surgeons of their time. Treatment for brain injuries were often times limited to kings, priests and the nobility. The treatment used for brain injuries â&#x20AC;&#x153;were also used for mental illnesses, epilepsy, headaches, organic diseases, neuropathy treatment, osteomyelitis and head injuriesâ&#x20AC;? (Siegfried).

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Figure 2.

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Currently in America there are 1.7 million traumatic brain injuries every year.

These injuries can range from open and closed brain traumas. Open injuries are when the skull has been fractured, resulting from falls or other accidents when the head comes into direct contact with hard surfaces. On the other hand, a closed injury is more serious due to the possibility of brain swelling and the formation of dangerous clots inside the skull. Both of these types of injuries can cause paralysis, loss of consciousness or in some cases, death (Brain Injury Overview). When a person is in a collision the skull doesnâ&#x20AC;&#x2122;t in all cases have to be involved in a head on collision for a traumatic brain injury to occur, often the sheer force of the accident can cause the brain to collide against the inside of the skull.

Over half of all reported traumatic brain injuries are the result of an automobile accident. -Car Accident TBI

Figure 3.

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Common injuries usually seen after accidents are bruising, tearing and swelling of the brain. When there are large amounts of force in an accident, the brain is often being moved both backwards and forwards in the skull, causing inevitable bruising. Tearing in the brain is also caused by force in a collision, when this occurs the victim is at serious risk of impairment of their bodily function. Swelling is commonly seen as a natural healing process the body puts itself through, when it comes to the brain this is not seen as a good thing. In the limited space of a personâ&#x20AC;&#x2122;s skull there is no extra room for the brain to migrate, this is deadly and can be the cause of severe impairment of many body functions.

2.0 The history of Physicial Rehabilitation Before physical therapy was a common practice of treatment, physicians in Europe between the 1500s-1700s used exercise, massage, heat, cold temperatures, water and electricity as treatment for patients. This dates back originally to Greek culture with the influence of Hippocrates, the father of Western medicine. In the 1800s, muscle re-education was introduced to physicians for better understanding of orthopedic diseases and injuries. In 1916 the polio epidemic hit the United States with force, causing an even greater need for muscle testing and muscle re-education to restore function to the victims of polio.

With World War I beginning in 1917, the US Army took notice to the extreme need of physical rehabilitation for soldiers who had been injured in battle. The special unit of the Army Medical Department, known as the Division of Special Hospitals and Physical Reconstruction, had developed 15 reconstruction aide programs in order to respond to the need of medical workers with an expertise in rehabilitation (Network/Synergy Group). With this new awareness, the profession of physical therapy, as it later was named, had been born. Physical therapists continued to evolve and develop, primarily due to injuries sustained by soldiers during wars, and advances in medicine that kept these soldiers from dying war injuries (News Foundation for Physical Therapy).

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You are not here merely to make a living. You are here in order to enable the world to live more amply, with greater vision, with a finer spirit or hope and achievment. You are here to enrich the world, and you impoverish yourself if you forget the errand. -Woodrow Wilson Figure 4.

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The first physical therapists had studied and graduated from Reed College and Walter Reed Hospital, they had begun their careers under the occupational name of â&#x20AC;&#x153;reconstruction aidesâ&#x20AC;?. The students attended the college studying in a variety of other academic areas, with additional training to learn physical therapy services. In the 1920s, the partnership of physical therapists in both medical and surgical communities grew, gaining public recognition and validation for the up and coming profession. As

1946 approached, congress had adopted the Hill Burton Act.

This act was passed in order to have hospitals built across the country, increasing the public access to health care facilities. With this increase in hospitals, there was also an increase in demand for physical therapists. Shortly after, in the 1950s, physical therapists continued to gain independence, autonomy and professionalism with their field. With this respect constantly growing for physical therapists, congress mandated the first national examination to assess the competency of the professionals in order to practice medicine in 1954 (Network/ Synergy Group). In 1959, there were state regulations existing in 45 states.

Todays physical therapy profession boasts confident, accomplished, professional practioners on the cutting edge of health care, and it consistently ranks as one of the nations most desirable careers -The History of Physical Therapy During the 1960s, physical therapy practices in the neuromuscular area had expanded with the development of techniques for adults with strokes, cerebral palsy, and other disorders of the central nervous system (Network/Synergy Group). With the profession only growing, the late 60s called for an addition of outpatient therapy in the medicare program. As the 21st century progresses, there is further development of the scientific basis concerning the services of physical therapists; this causes for the creation of entry level education standards to meet the demands of todayâ&#x20AC;&#x2122;s health care system.

Figure 5.

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Images Cited

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Fig. 1. Hippocrates. Digital Image. N.p., n.d. Web. < https://www.emaze.com/@ALLFZIOC/Hippocrates> Fig. 2. Brain Surgery. Digital Image. N.p., n.d. Web. < http://www.bible.ca/tracks/peru-tomb-art.htm> Fig. 3. Stephens, Lee. “Accident”, Digital Image. 2008. Fig. 4. War and Prosthetics. Digital Image. N.p., n.d. Web. < http://www.collectorsweekly.com/articles/war-and-prosthetics/> Fig. 5. Physiotherapy. Digital Image. N.p., n.d. Web. < http://amkphysio.blogspot.com/2012/11/history-of-physiotherapy-if-one-goes.html>

Works Cited

Al., Demarin V. Et. “Stroke: A Historical Overview and Contemporary Management.” REVIEW ARTICLE UDC 19.2 (2011): 16-17. Web. “Brain Injury Overview.” Find Law. N.p., n.d. Web. “Car Accident TBI.” TraumaticBrainInjurycom. N.p., n.d. Web. “History of Stroke.” John Hopkins Medicine. N.p., n.d. Web. “News from the Foundation for Physical Therapy.” Physical Therapy 95.3 (2015): 1-5. Jones and Bartlett Publishers. Web. Siegfried, Juliette. “History of Brain Surgery.” BrainSurgerycom. N.p., n.d. Web. “Stroke Treatments.” American Heart Association. American Heart Association, 5 May 2013. Web. “The History of Physical Therapy.” Network/Synergy Group, n.d. Web. Thompson, Jesse E., MD. “The Evolution of Surgery for the Treatment and Prevention of Stroke.” American Heart Association Journals. American Heart Association, 25 Jan. 1996. Web.

case studies 3.0

3.1

good shepherd rehabilitation: the history Reverend John Raker, a Lutheran minister, had a deep desire to build a home for the needy. He continued to speak out about his goals and received donations from others who shared his vision. This continued effort became the tradition of charity and care that would be known as the Good Shepherd Home, located in Allentown, Pennsylvania beginning on February 21, 1908 to the present day. Shortly after its founding, Reverend John Raker printed the first edition of Good Shepherdâ&#x20AC;&#x2122;s official magazine, Sweet Charity. This magazine was intended to spread the spirituality Raker wished for the organization to have.

The first accredited nursing home in the Lehigh Valley opened in 1924, founded by Good Shepherd. Continuing to expand their services; Good Shepherd opened a dispensary unit in 1938, with a part time in house physician on staff.

Good Shepherds founder, Reverend John Raker served as superintendent until his death in 1941. Within 33 years of service, Raker led Good Shepherd into the leading position as a provider of care to individuals with disabilities, orphaned children and senior citizens. By the year 1967, Good Shepherd opened its first rehabilitation hospital in Allentown, Pennsylvania. The hospital unit was one of the countryâ&#x20AC;&#x2122;s first inpatient facilities. Beginning with a mere 22 bed facility, the hospital offered integrated rehabilitation care to individuals with orthopedics or neurological issues and injuries (Good Shepherd Rehabilitation History).

3.1

The Lord is my Shepherd, I shall not want. Even though I walk through the shadow of the valley of death, I will fear no evil, for you are with me. -Psalm 23 Figure 1.

3.1 good shepherd rehabilitation: the present Currently the facility is located within the main city region of Allentown. Though the being located within the city elements makes it difficult to accommodate the need for a fully operating rehabilitation hospital, Good Shepherd maintains its reputation being a world-class rehabilitation network providing comprehensive inpatient and outpatient services (Good Shepherd). Good Shepherd is currently owned and operated by a non-profit organization, with over 37 locations as of date. The main rehabilitation building is composed of five floors with a variety of assigned occupants. The first floor is where the general hospital services are located.

Administration quarter and mailing centers are housed on the second floor, making sure to separate yet have easy connection to the exam rooms. Atop of the third floor, the cafeteria, meeting rooms and pharmacy are all located. The educational rooms for the patients, their families and the employees of Good Shepherd are located where they can have common meeting areas to discuss treatment and post-surgery requirements. Lastly the fifth floor is where the chapel resides. With Good Shepherd being founded amongst a very religious background, the need for a deep connection to faith and spirituality is important to maintain within the facilities.

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Figure 2.

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Figure 3.

“We do not turn people away, here at Good Shepherd we serve anybody who walks through those doors”(Joann Frey, Good Shepherd Allentown). Throughout the many locations Good Shepherd has, they pride themselves on the large variety of people that receive treatment at their facilities. There are no specific age groups intended to go through rehabilitation, so Good Shepherd does not limit the age groups allowed to enter into the treatment regime. “Each year, more than 45,000 people come to Good Shepherd to receive specialized treatments for stroke, orthopedics, brain injury, spinal cord injury, pediatrics, amputation and more” (Good Shepherd Rehabilitation Network). Over 800 employees make up the staff of the Allentown facility; ranging from physical therapists, occupational therapists, and nurses, to administration staff, receptionists, and cleaning personnel. The building that stores the main rehabilitation treatments has received limited upgrades within the last couple of years. The main attention has been put to the Health and Technology building. While travelling from building to building, one can’t help but take notice to the extreme differences in not only general appearance of the décor, but basic upkeep within the facilities as well. When talking with employees that work in all of the buildings, the one thing mentioned unanimously was the need for more space. Patient rooms contain two people in each, while this does not necessarily hurt the treatment patients receive; the need for more private areas for the patients to spend time with their families is something preferred over having to a share a room with another patient receiving a whole different rehab regime.

“The patients rooms work for the purpose they are meant to serve, but if we had a chance to enlarge them that would be great! We could always use more space, but at Good Shepherd, we make due with the space provided”(Joann Frey, Good Shepherd Allentown).Throughout the rehabilitation hospital they have room for 75 beds to accommodate patients. There are then 99 beds in the longterm care unit, this building is separated from all of the others for patients to live without a set departure because it is not safe for them to live to far from the hospital without general care, however their health is at the level that they do not need to receive medical attention daily. There are also 35 beds in the specialty care unit, as well as an additional 18 beds in the pediatric unit. In total, Good Shepherd is able to accommodate close 230 patients within their facilities.

3.1

design concept and style 3.1

The patients rooms are nothing unique compared to a traditional medical center. The rooms throughout, not just patient headquarters, are lit with traditional fluorescent lighting as well as occasional natural lighting wherever they can afford the space. Material choices for the hospital are chosen for their ability to be cleaned from any unforeseen mess. Many of the fabrics a bystander would see in Good Shepherd are chosen from health care specialized fabrics. The facility at Good Shepherd in Allentown is one of the oldest centers created by the company. The furniture and finishes throughout the rehab hospital building show the age in the program created. Even though their equipment is up to date and modern in many ways, the appearance of the hospital when walking through the front doors

takes you back a decade in healthcare design. Throughout the tour of the facility, the employees had mentioned the need to create a bright, warm and welcoming space for the patients to proceed with their signified treatment. Good Shepherd truly does need to revamp their interiors, taking note from healthcare design of the current time which is constantly changing for the better and in turn, affecting the patients in a positive way. Designers have transitioned their healthcare designs from â&#x20AC;&#x153;overall sterile-feeling (often bright white) environments to more homelike, comfortable, and hospitable spaces. Designers are now more diligent about making sure that operational efficiency and practical matters like maintenance, arenâ&#x20AC;&#x2122;t compromised for the sake of styleâ&#x20AC;? (K. Zeit, Healthcare Design).

Throughout the facility there are many signs explaining what rooms are where so as to not get lost. “Our facility is large with many different corridors leading to all of the different rooms we at a hospital need, it’s easy to get lost, even if you work here.

Figure 4.

But we try to keep maps and labels everywhere to avoid that problem” (Joann Frey, Good Shepherd Allentown). Outside between the buildings on their campus, there are maps explaining the purpose of each building and what specialties are treated in each.

Figure 5.

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Although the needs for ADA compliant buildings are becoming more widespread, hospitals enforce the design guidelines. This need is even more important within a rehabilitation hospital where the employees never know what type of patient will soon arrive. “Within our facility we have ADA everything. Not a single part of our hospital does not accommodate to the disabled patients we serve” (Joann Frey, Good Shepherd Allentown).

Adult Therapy Zones

“We treat everyone who comes through our doors with

dignity, respect, supportiveness and

care”(

Good Shepherd: Our Mission and Vision). The environment of the rehab facility is filled with warm and friendly employees that are attentive to the patients throughout. With the state of the art healthcare services Good Shepherd has to offer, not one patient goes unseen.

Figure 8.

Adolescent Therapy Zones

Figure 7.

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Figure 9.

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Images Cited

Fig 1. Founder, John Raker. Digital Image. N.p., n.d. Web, < https://plus.google.com/111632551269888773039/posts> Fig 2. Good Shepherd Map. Digital Image. N.p., n.d. Web, < http://www.goodshepherdrehab.org/node/3855/good-shepherd-plaza-main-campus-physical-therapy-allentown/good-shepherd-plaza-campus-map> Fig 3. Good Shepherd. Digital Image. N.p., n.d. Web. <http://www.vwmin.org/specialty-hospital-good-shepherd-rehab.html> Fig 4. Kelly, Caitlyn. “Map”, Digital Image, 2015. Fig 5. Kelly, Caitlyn. “Hospital Directory Signage”, Digital Image, 2015. Fig 6. Kelly, Caitlyn. “Healing Garden”, Digital Image, 2015. Fig 7. Kelly, Caitlyn. “Adolescent Therapy”, Digital Image, 2015. Fig 8. Kelly, Caitlyn. “Adult Therapy”, Digital Image, 2015. Fig 9. Stephens, Sheryl. “Rehab”, Digital Image. 2008.

Works Cited

“Good Shepherd History.” Good Shepherd Rehabilitation. N.p., n.d. Web. “Our Mission and Vision.” Good Shepherd Rehabilitation. N.p., n.d. Web. “Psalm 23 ESV.” Bible Hub. N.p., n.d. Web. Zeit, Kristin D. “The Evolution Of Healthcare Design Interiors.” Healthcare Design. Healthcare Design Magazine, 24 Apr. 2015. Web.

NovaCare Rehabilitation 3.2 Select Medical, founded by Rocco and Robert Ortenzio â&#x20AC;&#x153;began as a regional provider of outpatient physical rehabilitationâ&#x20AC;? (NovaCare Rehabilitation: History). Their company continued to grow with their services when they bought out NovaCare Physical Rehabilitation in 1999. Once they added on this center they became a diverse health care company known nationwide. There are multiple locations along the east coast, the location chosen for this case study is located on Broad Street in Philadelphia., PA.

With many locations, the services provided vary per location, some offer all or a select few of the following services: Physical Therapy Athletic Training Sports Performance Work Conditioning Occupational Health Services Functional Capacity Evaluations Work Strategies Program Aquatic Therapy Occupational Hand Therapy

3.2

This rehabilitation center is a one level outpatient facility with 12 people at a maximum working at all times. With the general large scale size of the building; as expected, there are many other programs stored amongst the different levels. The location along a busy street in Philadelphia allows for access to many local universities, as well as general bystanders traveling through the city. There is one main entrance that is intended for patients right off of Broad Street, with two other main doorways used for emergency exits as well as employee access.

A nationally prominent, locally driven provider of outpatient physical rehabilitation. 3.2

Figure 2.

Figure 1.

spatial planning 3.2

Upon entering the facility you immediately arrive at the reception station with 2 employee offices as well as an open employee lounge behind the desk. There is a half wall splitting the building separating the waiting area and employee spaces from the physical therapy area. Along the perimeter of the therapy space they have open exam beds that serve a dual purpose for both therapy treatments injury evaluations.

Figure 3.

With the limited space the facility has, their additional exercise machines are placed in the corners of the rooms as well as the spaces in between doors and circulation paths. Directly across the entrance to the therapy unit, youâ&#x20AC;&#x2122;re faced with the two private evaluation rooms. Other than these secluded rooms, the therapy treatments are all completed in the open area.

Figure 4.

Figure 3 shows the general planning of the single floor facility.

Figure 5 highlights the private patient evaluation rooms. These rooms are the only secluded areas for patients.

Figure 4 illustrates the main circulation path that the patients are be guided along as they travel throughout their therapy treatments.

Figure 6 shows the private therapists offices where they handle personal and company phone calls as well as meeting with the other employees and patients that come into the facility.

Figure 5.

Figure 6.

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Figure 7 & 8 are images of the exam beds and a select area of exercise equipment that the patients use for their treatment.

3.2 Figure 7.

Figure 8.

Figure 9 illustrates the different areas where there are exercise machines for the variety of therapies provided at NovaCare.

Figure 9.

Design Concept & Style The colors throughout the facility are rather neutral with inexpensive materials used on the floor and upholstery. When walking through the main therapy spaces, scratches and scuff marks are noticeable on the walls from general wear and tear from the exercise equipment. The upholstery used on the exam beds and the waiting room seating are different shades of blue vinyl, making it easy to clean.

Aside from the equipment generally needed in a physical therapy space there was no additional dĂŠcor to alter the feel of the environment.

3.2

The lighting was also ver y traditional fluorescent lighting, creating a ver y even and bright glow in all spaces.

Figure 10.

3.2

Images Cited

Fig 1. Kelly, Caitlyn. “Exterior”, Digital Image, 2015. Fig 2. NovaCare Site Plan. Digital Image. N.p, n.d. Web. < https://www.google.com/maps/place/NovaCare++Spring+Garden/@39.9620351,-75.1612079,15z/data=!4m2!3m1!1s0x0:0xb70c66907b763feb?sa=X&ved=0CIQBEPwSMAtqFQoTCOimvsH9j8gCFYFWHgodEGULvg> Fig 3. Kelly, Caitlyn. “General Floor Plan”, Digital Diagram, 2015. Fig 4. Kelly, Caitlyn. “Patient Circulation”, Digital Diagram, 2015. Fig 5. Kelly, Caitlyn. “Patient Evaluation Rooms”, Digital Diagram, 2015. Fig 6. Kelly, Caitlyn. “Private Therapist Offices”, Digital Diagram, 2015. Fig 7. Kelly, Caitlyn. “Exam Beds”, Digital Image, 2015. Fig 8. Kelly, Caitlyn. “Exercise Equipment”, Digital Image, 2015. Fig 9. Kelly, Caitlyn. “Exercise Equipment”, Digital Diagram, 2015. Fig 10. NovaCare Logo. Digital Image. N.p, n.d. Web. < https://en.wikipedia.org/wiki/NovaCare_Rehabilitation>

Works Cited

“NovaCare Rehabilitation History.” NovaCare Rehabilitation. N.p., n.d. Web.

SPAULDING HOSPITAL 3.3 Spaulding hospital is a rehabilitation center located in Boston, Massachusetts on land that was previously known to be Bostonâ&#x20AC;&#x2122;s Naval Yard. The 378,367 square foot building was completed in 2013, designed by Perkins & Will. The rehabilitation center is considered to be the â&#x20AC;&#x153;hospital of the futureâ&#x20AC;?, creating a new gathering place for the community and patients alike. With its placement so close to the Boston Harbor Walk, the intention of the first floor was to integrate closely to the exterior elements , taking advantage of this beautiful community feature. There is a trail that runs along the waterfront outside of the hospital, allowing for therapeutic exercises to be performed on different natural landscaped surfaces, rather than keeping the patients therapy treatments indoors at all times.

Figure 1.

With the existing site conditions once housing the Boston Naval Yard, the architects from Perkins & Will drew inspiration from this fact in their designs and material choices. They had chosen to use materials for the facade that were to mimic the military battleships and aircraft carriers that were previously located on the site during the 20th century.

3.3

The structure appears to be smaller than what it actually is, with two different sections appearing to be separated, creating the illusion of a smaller scale than intended. These separate portions hold different programs within the interior. The largest of the two is comprised of 8 stories, soley dedicated to patient rooms. The next section is a great deal smaller, only made of 3 stories, hosting the therapeutic gymnasium and pool for the variety of therapies Spaulding Hospital provides. Spaulding Hospital received LEED Gold certification for the design and sustainability throughout. Another honor bestowed upon this hospital was being accredited by the commision on accreditation of rehabilitaion facilities (U.S News Health).

3.3

Figure 2.

3.3 exterior design concept The design of the building has no evident rear end, allowing interesting views from all sides. The different portions of the building are made of a variety of materials, creating a slightly different buidling from each angle a bystander would be standing at. There is a vegetated roof atop of the building, allowing for proper stormwater runoff. This also reduces the cooling loads and heat island effects. Due to the rising sea levels and the location being so close to the shore, the hospital was built so that the main floor is one foot above ground level. The HVAC equipment was placed on the roof in order

Figure 3.

building program 3.3 Outpatient Services Pool for Aquatherapy Two large gymnasiums Activities of daily living suite Transitional patient apartment Satellite gyms embedded on two inpatient floors

Figure 4.

Figure 5.

3.3

interior design concept Perkins & Will researched each component of healthcare design and the needs of patients with different handicaps so that the hospital would be capable of addressing the needs of the widest range of people. Customized elements were designed to make for a better operated hospital, the customized pieces are : Entry at street level Reception desk is low and rounded Patient rooms have: Custom cabinetry Automated shades Patient lifts Private bathrooms Private refrigerators Sleeping accomodations for family members Wireless connection for patients and guests

Figure 6.

3.3 Level 1. Site Plan Figure 7.

Level 3 Figure 8.

Level 1 Figure 9.

Level 5 Figure 10.

3.3

customized features Architectural glass artist Paul Housberg designed and installed a unique glass wall for the hospital that connects the main lobby to the mezzanine. The concept of the art work was “to evoke the peaceful movement of water, inspired by the hospital’s location on the Charlestown waterfront” (DeCagna, Urban Glass). Housberg’s installation is appropriately titled “Water Walk”, creating a sense of depth in a usually cramped corner. As he would state, “water traditionally plays a role in healing or is associated with healing”, hopes for this installation peice are to create a similar feeling from water, a calming and uplifting experience for the people of Spaulding Hospital to partake in.

Figure 11.

3.3

Figure 12.

Figure 13.

3.3

sustainable features Sustainable design was a key element in the design process. There is an abundance of natural light throughout the hospital because of the glass curtain walls, with this lighting the interior feels more open and inviting for the patients, visitors and employees.

The building contains large amounts of operable windows that allow for natural ventilation, this is an element that will remain operational if the mechanical system becomes interrupted. The operable windows are located in the gymnasiums, multi purpose rooms and educational rooms. There are many terraces placed throughout the hospital that allow for therapeutic services for the patients, staff and families.

Figure 14.

3.3 Section Figure 16.

Exloded Axon Figure 15.

Figure 17.

3.3

Figure 18.

â&#x20AC;&#x153;For far too long, rehabilitative care was an afterthought to many, relegated to the basements of hospitals and of the site. This hospital makes a bold statement that a new era of rehabilitative medicine is hereby bringing together scientific innovation and patient centered design that puts this institution on par with the major centers of healing in the worldâ&#x20AC;? -David Storto, President,

Figure 19.

Figure 21.

Figure 20.

Figure 22.

3.3

Images Cited

Fig 1, 7-10, 15-16. Perkins & Will, Digital Diagrams, 2013. Fig 2-6, 14, 17-19,21. Steinkamp Photography, Digital Images. N.p, n.d. Web. < http://www.archdaily.com/443408/spaulding-hospita-perkins-will> Fig 11, 20.Materials & Methods, Digital Image. N.p, n.d. Web. < http://www.materials-methods.com/work/spaulding/> Fig 12. Glass Project, Digital Image. N.p, n.d. Web. < http://www.glassproject.com/spaulding-rehab/> Fig 13. Urban Glass, Digital Image. N.p, n.d. Web. < https://www.urbanglass.org/glass/detail/paul-housberg-references-water-in-new-architectural-glass-installation> Fig 22. Grassl, Anton. Esto, Digital Image. N.p, n.d. Web. < http://www.bizjournals.com/boston/blog/bioflash/2014/04/one-yearafter-marathon-bombs-spaulding-settles.html>

Works Cited

DeCagna, Gina. “Paul Housberg References Water in New Architectural Glass Installation.” Urban Glass. N.p., 8 Aug. 2013. Web “Spaulding Hospital / Perkins+Will” 01 Nov 2013. ArchDaily. “Spaulding Rehabilitation Hospital.” US News. U.S.News & World Report, n.d. Web.

rehabilitation centre groot klimmendaal

3.4

Rehabilitation Centre Groot Klimmendaal is a 150,694 square foot rehabilitation center located in the Netherlands, designed by the architect Koen van Velsen in 2011. The design was not completed soley by the architect, there was a large amount of collaboration with the local intended users of the building to find what worked best for them. The rehabilitation center received many awards: • 2010 Building of the year, awarded by the Dutch Association of Architects. • 2010 Hedy dÁncona Award, selected for excellent healthcare architecture • 2010 Arnhem Heuvelink • 2010 Dutch Design Award • 2011 Mies van der Rohe Award Finalist

Figure 1.

The building is built within the trees, which in turn welcomes the forest into the interior spaces. The “surrounding nature has a strong visual and tangible presence everywhere in the building” (Velsen, ArchDaily). With exterior surfaces being a golden brown anodized aluminum facade, it appears to blend in with its natural surroundings.

3.4

The structure gradually extends outwards when travelling to the top and then cantilevers out towards the surroundig terrain. The exterior full height glazing following the central interior spaces, allows for a seamless continuity throughout. Koen van Velsen’s design concept for this space was to create an environment that doesn’t have sole focus on being simply a health center; the larger goal was to create a structure with a large connection to not only the exterior elements and surroundings, but the community as well. The overall structure radiates

self confidence

and self control, in not only the design but the intended program as a whole.

3.4

Figure 3. Site Plan

Figure 2.

interior design concept

3.4

Koen van Velsen designed the interior with the intention to create a positive and stimulating environment that increases the well-being of patients and allows for a beneficial effect during their rehabilitation process (ArchDaily). The interior programs are primarily separated by floors. Below are the offices, above are the clinical areas, and the roof has a Ronald McDonald House. The height of the entrance is doubled, designed to facilitate the special elements the building needs to hold. The special elements include: • Sports facility • Fitness • Swimming pool • Restaurant • Theatre

The patients, family members, and community all use these facilities on a regular basis.

Figure 4.

The walls and ceiling are painted striking, yet subtle colors with many different natural lighting features to contrast these bright artificial colors. With these elements the space becomes a welcoming and open environment as soon as you enter. The design allows for a natural habitat meant for healthcare as well as other activities.

3.4

The building, both exterior and interior, is composed with many voids, creating a push and pull conceptual design There are light wells that create a spatial connection between the different floors. With these features, the center has natural daylight in spaces that most wouldnâ&#x20AC;&#x2122;t have seen.

Figure 5.

Throughout the building there are a large amount of sustainable materials being used that require little to no maintenance and allows the rehablitation center to have a long lifespan.

3.4

Figure 6. Basement

Figure 7. Ground Level

Figure 8. First Level

Figure 9. Second Level

Figure 10. Third Level

Figure 11. Fourth Level

Main features on each level:

3.4

• Basement Level- Offices • Ground Level- Theatre, Swimming Pool and Gymnasium • First Level-Fitness Center • Second Level- Smaller Gymnasiums and Patio • Third Level- Patient Rooms and Living Rooms • Fourth Level- Ronald McDonald House Figure 12. Roof Level

3.4

Figure 13. Analysis Drawings

Within Groot Klimmendaal there stands a shallow timber staircase that runs the full interior height of the building. This staircase not only allows for a direct route between the floors, but also allows for a large variety of alternative routes to travel throughout the spaces. The building was custom made to allow for the healthcare program entailed, however if the program were to ever change, the center would be able to adapt.

Figure 14. Longitudinal Sections

3.4

Koen van Velsen designed a space that comes together with both complexity and simplicity with a focus on

details.

physical, practical and social

Figure 15. Cross Sections

Figure 16.

3.4 Figure 17.

Figure 18.

â&#x20AC;&#x153;Rehabilitation Centre Groot Klimmendaal is designed with transparency, continuity, layering, diversity, the play of light and shadow and the experience of nature. These pieces are all ingredients of the stimulating environment the rehabilitation center provides.â&#x20AC;? -Koen van Velsen

Images Cited

Fig 1-2,4-5. Rob t’Hart Photography, Digital Images. N.p, n.d. Web.< http://www.archdaily.com/126290/rehabilitation-centre-groot-klimmendaal-koen-van-velsen> Fig 3, 6-15.Koen van Velsen, Digital Diagrams. N.p, n.d. Web. < http://www.archdaily.com/126290/rehabilitation-centre-groot-klimmendaal-koen-van-velsen> Fig 16.Groot Klimmendaal, Digital Image. N.p,n.d. Web.< http://www.dearchitect.nl/projecten/2010/09/Arnhem+Koen+van+Velsen+Revalidatiecentrum+Groot+Klimmendaal/galerijen/interieur.html?picIndex=1&picName=klimmendaal014.JPG> Fig 17-18. Groot Klimmendaal, Digital Images. N.p,n.d. Web. < http://inhabitat.com/gorgeous-glass-clad-groot-klimmendaal-rehabilitation-centre-sits-tucked-amongst-the-trees/>

3.4

Works Cited

“Rehabilitation Centre Groot Klimmendaal / Koen van Velsen” 08 Apr 2011. ArchDaily.

Ergonomics 4.0

Ergonomics-Healthcare facilities

4.0

The factors that cause human variations are gender, age, ethnicity and race. Healthcare facilities do not treat one kind of patient, enforcing the need to create an easily accessible environment. The environment consists of three defined zones, often

â&#x20AC;&#x153;neighborhood within the hospital cityâ&#x20AC;?: public, semi-public, and private. looked at as a

Public spaces would include: lobbies, front of the house food service, retail shops, waiting and reception areas, chapel, libraries, resource centers, education and training rooms. The waiting areas are specifically designed to accommodate both interaction among patients and family members as well as separation and privacy. The seating throughout these common areas should not only incorporate typical hospitality style lounge seating,

but also sections with bariatric seats. These bariatric seating portions are typically a width of 32-42 in and 18-19 in high. Out of all of the lobby seats, ten percent of the seats should be bariatric seats.

Figure 1.

The semi-public spaces are listed as the corridors that lead to the patient areas and family rooms. All corridors must be free of obstructions, allowing access to the mandatory handrails for ADA purposes. Lastly the private areas consist of the rooms that limit access solely to the administration, staff, patients and family members. These private areas are commonly placed closely with one another in order to increase operational efficiency. Typically there will be a need for large, open spaces that allow for a variety of physical activities and exercises that the nurses organize for the patients. There are also smaller, private rooms needed for individual treatment and therapy.

Figure 2.

Exam rooms must include a guest chair that is lightweight, making it easy to move around. It is best to be made from metal, which is easier to manage for the cleanliness factor. These chairs should often also be bariatric (34 in wide), with this feature it is able to accommodate both a parent and a child when confined to a smaller space.

Figure 3.

4.0

Security

4.0

Security within a hospital is closely monitored by all who work within the facility. It is encouraged that staff members or hospital volunteers lead a patient and/or visitor to their intended destination. This is due to the fact that some areas require a key card upon entry, also because of the often confusing maze of hallways. The hospital is divided into sections to limit the chance of fire and smoke spread in an emergency situation. In this case, hospital personnel would activate the “defend

place” or “horizontal evacuation” methods.

With this method, patients are not entirely evacuated from the building; they are moved to a smoke free area in close proximity to their rooms.

Figure 4.

Figure 5.

wayfinding A healthcare facility and its staff have one common

the need to reach their final destination as quickly and efficiently as possible. With clear goal in mind for their patients,

4.0

signage that is user friendly, the spaces become easier to navigate and the goal is achieved. Wayfinding should be a seamless feature that connects itself throughout the whole building. By using the simple aspect of color and art, it sets the spaces apart and creates a â&#x20AC;&#x153;landmarkâ&#x20AC;? of sorts for each location. Using large directional signage that is a permanent feature allowing for a changeable message to be displayed is a clear and influential piece for the visitor to find their way. Large sized and easy to read type fonts are desirable, especially in areas where elderly patients are more prevalent.

Figure 6.

Figure 7.

materials and finishes

4.0

All finishes chosen in healthcare should be durable

High pressure laminates with a decorative aspect are often chosen because of its durability and cleanliness after sanitization. Alongside these laminates, appliances are to be stainless steel.

Flooring materials should be seamless, with a smooth threshold along transitions to minimize the risk of falls. The flooring chosen should be able to have proper drainage to reduce slippage.

Textiles are to be made from solution dyed fibers; these are antibacterial, stain resistant and contain a moisture barrier. With a ten percent bleach solution, textiles will meet healthcare ratings. â&#x20AC;&#x153;Write offâ&#x20AC;? proprieties are being introduced for vinyl and polyurethane upholstery, this allows for pen and ink markings to be able to be scrubbed off of the textile.

and easy to maintain. Epoxy paint is often used in areas that are medication preparation areas due to its ability to be scrubbed free of messes.

Ceiling finishes should be either plaster or gypsum board.

Figure 8.

Figure 9.

4.0

Figure 10.

Figure 12.

Figure 11.

Figure 13.

patient rooms- toilet room

4.0

In order to plan for successfully planned patient rooms, the location of the toilet is a top priority, most patient room layouts are designed around the restroom. These doors should be a minimum

Entry doors to the rooms should be a minimum of

Figure 14.

Figure 15.

of 32 in, and to be located near the entrance of patient rooms. Toilets are typically either wall hung or floor mounted, with a bedpan washer often nearby. All patients are permitted access to a toilet room with a single toilet and sink; these spaces are to be shared by no more than two patient rooms. If two patients share a room, there should be cubicle curtains to provide visual privacy for patients and their families.

48 in wide, with a door swing extending outwards.

All exit doors should be equipped with double acting hardware, allowing for emergency access to patient rooms. Additional doors within the room are encouraged to be folding or sliding doors that provide a large opening; this approach takes up less floor space.

patient rooms- configuration Patient rooms have very specific points that need to be made in order for them to be accessible and appropriate for all patients expected to enter. All rooms must not only be accessible, but easy to maintain, and spacious enough to contain high tech life support and monitoring equipment. The patient specific areas should be equipped with the basic amenities: patient chair, visitor chair, television set, wardrobe, drawers for clothing and personal items, and a countertop for miscellaneous items.

The construction of the patientâ&#x20AC;&#x2122;s bed needs to include a headboard with a nurse call button, reading light, room light switch, television control, electrical outlets and/or central monitoring capabilities. These features will be built into the headboard unit that is either built into the wall as a partition or a prefabricated unit. All headboards and footboards throughout the facility are meant to be interchangeable throughout all rooms.

Figure 16.

Figure 17.

4.0

There are three major patient room layouts often used, these include

nested.

4.0

inboard, outboard, and

Inboard rooms are located near the corridor walls, outboard rooms are located next to the exterior walls and nested rooms are located between both a inboard and outboard room.

Figure 19.

Figure 18.

Figure 20.

4.0

Figure 21.

patient rooms- furniture

4.0

The primary concern for furniture selection of healthcare facilities is the comfort for the patient and the ability to clean well. Bedside cabinets have drawer inserts with molded plastic that assists in the cleaning process. Patient seating is designed and chosen to reinforce the need for patients to get out of bed and strive to recover from their trauma. Chairs with a mesh seat and back can relieve stress points and increase circulation throughout the patientâ&#x20AC;&#x2122;s body. If seats

Figure 22.

were to have a waterfall front edge, patients would have a decrease in pressure targeted at the back of their knees. Another wise choice for seating are chairs that require a slight rocking motion, this forces the patients to partake in small amounts of exercise without alleviating themselves. Swing away or drop chairs are often chosen because they allow for simple access for patients that need to transfer to and from their wheelchairs. Lastly lift chairs are incorporated in patient rooms, these help users rise from a sitting position and then the final transfer to their bed.

Figure 23.

4.0

Figure 24.

Figure 25.

4.0

Lighting When natural light is not available, lighting fixtures are chosen to mimic daylight or incandescent light. With high amounts of natural light available in common spaces, there are beautiful light patterns exposed throughout the day. With the proper lighting, spaces can become warmer and create an overall more enjoyable experience compared to the effect of cool, fluorescent lighting fixtures.

Figure 26.

However, sun glare is still a concern in patient rooms. Harsh sun glare on fixtures could be a hindrance for bother the patient and hospital staff.

The use of natural light in patient rooms should be controlled, allowing the patients to obtain privacy if they so desire. All artificial lighting fixtures should be able to be adjusted by the patients or staff to their preference.

Figure 27.

Acoustics Mechanical equipment often creates undesirable sound throughout a building; within healthcare design the equipment should be as isolated as possible to manage this sound distribution from getting too aggressive throughout the building.

Figure 28.

4.0

Staff lounges, patient waiting rooms and dressing rooms should be insulated or separated from other common rooms to prevent excessive sound. Carpeting, solid doors and insulated walls and ceiling contribute to the noise reduction demanded in healthcare design; with these elements patient spaces become both peaceful and private. Partitions between patient spaces should have a sound transmission class of 45. Spaces within a healthcare facility designated for infants should have a noise control that never exceeds 50 decibels.

Figure 29.

Images Cited

4.0

Fig 1,2,17-20, 24, 25. Binggeli, Corky, Pat Greichen, and Maryrose McGowan. Interior Graphic Standards. Hoboken: John Wiley & Sons, 2011. Print. Fig 3. Bariatric Chair. Digital Image. N.p, n.d. Web <http://nflinc.com/onlineshop/molti-bariatric-chair> Fig 4. Fire Exit. Digital Image. N.p, n.d. Web <http://www.clipartbest.com/fire-sign> Fig 5. Security. Digital Image. N.p, n.d. Web <http://www4.columbian.com/news/2013/jan/28/community-steps-up-for-uninsured-diabetic-dad/> Fig 6. Wayfinding. Digital Image. N.p, n.d. Web <http://www.coroflot.com/lbrown_design/wayfinding-and-environmental-graphics> Fig 7. Directory Signage. Digital Image. N.p, n.d. Web <http://www.studiofuerte.com/en/portfolio/hospital/> Fig 8. Flooring. Digital Image. N.p, n.d. Web <http://linoleumblago.blogspot.com/2015/05/tarkett-linoleum-xf-flooring.html> Fig 9. Ceiling Elements. Digital Image. N.p, n.d. Web <http://pinnacleceilings.com/portfolio/el-camino-hospital/> Fig 10. Durable Materials. Digital Image. N.p, n.d. Web < http://info.furnitureconcepts.com/blog-0/topic/contract-furniture-fabric-making-it-last> Fig 11. Stainless Steel. Digital Image. N.p, n.d. Web <http://www.stainlessaquatics.com/?attachment_id=2313> Fig 12. Laminate. Digital Image. N.p, n.d. Web < http://www.saxonmfg.com/portfolio-view/laminate-doors/> Fig 13. Flooring. Digital Image. N.p, n.d. Web <http://pulse.seattlechildrens.org/top-ten-features-building-hope-cancer-inpatientunit/> Fig 14. ADA Toilet. Digital Image. N.p, n.d. Web < http://www.bashihq.com/2015/05/24/bathroom-stall-size/> Fig 15. Room Layout. Digital Image. N.p, n.d. Web <http://www.nytimes.com/interactive/2014/08/21/arts/design/a-model-roombecomes-real.html> Fig 16. . Room Orientation. Digital Image. N.p, n.d. Web <http://www.lhbcorp.com/project/duluth-childrens-hospital/> Fig 21. Hospital Organization. Digital Image. N.p, n.d. Web <http://www10.aeccafe.com/blogs/arch-showcase/2014/03/09/navalhospital-at-camp-pendleton-earns-two-agc-alliant-build-america-awards/> Fig 22. Natural Lighting. Digital Image. N.p, n.d. Web <http://www.steelcase.com/discover/information/health/> Fig 23. Guest & Physician Seating. Digital Image. N.p, n.d. Web <http://www.coroflot.com/KellyRoach/CHILDRENS-HOSPITAL> Fig 26. Patient Lighting. Digital Image. N.p, n.d. Web <https://www.pinterest.com/explore/hospital-room/> Fig 27. Natural Lighting Control. Digital Image. N.p, n.d. Web <http://origin.www.futureoflight.philips.com/post/78427988064/5great-things-led-lights-do-that-arent-just> Fig 28. Acoustical Ceiling. Digital Image. N.p, n.d. Web <http://www.healthcaredesignmagazine.com/article/crystal-ball-lookingfuture-patient-room-design> Fig 29. Partition Elements. Digital Image. N.p, n.d. Web <http://www.3-form.com/ready_to_go/partitions/get_inspired/>

topical explorations 5.0

5.1

patient motivation in rehabilitation Motivation from a healthcare physician and the patient themselves is an important role in physical rehabilitation. “Successful rehabilitation is strongly influenced by patient expectancies and the expectations of the significant people in the patient’s environment” (Barry 65). There is a proper time in the rehabilitation process where the specialists allow the patients and their families to go through a grieving period; this consists of the final realization that their life is to drastically change due to a disability now encountered. It has been said that the official rehabilitation process should start prior to the end date of the grieving period. “The rehabilitation team provides hope; while they cannot guarantee over-optimistic outcomes to the patient, they can challenge the patient’s and his families imaginations with plans to help the patient compensate for his disability and cope with his new situation” (Barry 65).

The relationships the patients have with their friends and family, as well as the doctors that treat them alter their progress. Family and friends are the people there to support the patient throughout the treatments, whereas the doctor is there to motivate them through exercises as well as keeping them on their day to day regime. If the patient has respect for the doctor they are more likely to follow the guidelines set for them in order to progress in treatment. In order for the patient to reach the level where they follow instructions from the professionals, they often travel along a five stage behavioral change. These steps are as follows: 1. Not thinking about change, 2. Unsure about change, 3. Ready to change, 4. Actively making the change, 5. Sustaining the behavior change.

5.1

Figure 1.

5.1

The external pressures that bear down on a patient are another aspect that affects the rehabilitation progress of an individual. Families inevitably put pressure on each other, rather this pressure is something that helps or harms a patient’s rehabilitation is up to their interpretation. It all depends on the way the patient takes this pressure, and how they apply it to their treatment. “These outside pressures in some instances are probably helpful by stimulating the patients fear, discomfort, hope and expectancies, and in this way, serve to further the patient’s rehabilitation” (Barry, 66).

Figure 2.

5.1 Figure 4.

Figure 3.

External pressures are not always family influences on a patient; it could also be described as financial struggles. These pressures are all things that should make the patient want to change and continue to progress with treatment, they are aspects in an individualâ&#x20AC;&#x2122;s life that pushes them to not settle with a negative prognosis. Studies have shown â&#x20AC;&#x153;that as little as one or two brief motivational interview sessions, either as a standalone intervention or in conjunction with other forms of treatment, can successfully motivate troubled patients to stay with the program and eventually change their behaviorâ&#x20AC;? (Scales/Miller, 166).

5.1 Figure 5.

The availability of opportunities for treatment, re-training and other rehabilitation treatments are additional aspects that affect the motivation on a patient. â&#x20AC;&#x153;The availability of opportunities or resources for rehabilitation alone is not a sufficiently motivating force, but it is certainly an important consideration in trying to predict rehabilitation outcomesâ&#x20AC;? (Barry, 66). State-federal programs are considered a valuable resource for rehabilitation, if these programs didnâ&#x20AC;&#x2122;t exist, there would be many people left without treatment, forced to continue their daily lives in pain and in need of treatment.

Figure 6.

Images Cited

Fig 1. Patient/Doctor Meeting, Digital Image. N.p, n.d. Web.< http://www.chiroeco.com/magzine/getting-results-in-practice-the-importance-of-patient-involvement/> Fig 2. Family/Patient Interaction, Digital Image. N.p, n.d. Web. < http://www.coronaregional.com/patients-and-visitors> Fig 3. Worried Patient, Digital Image. N.p,n.d. Web.< http://www.african-sweetheart.com/2015/01/the-weeks-message-when-youthink-about.html > Fig 4. Patient Dealing with Bills, Digital Image. N.p,n.d. Web. <http://www.billing-services.com/patient_billing_services.html> Fig 5. Relaxed Woman, Digital Image. N.p,n.d. Web. <https://treatments4depression.wordpress.com/2015/07/13/bmc-psychologyfull-text-a-metacognitive-perspective-on-mindfulness-an-bmc-blogs-network/> Fig 6. Patient Rehabilitation, Digital Image. N.p,n.d. Web. <http://www.rehabalternatives.com/the-best-paying-health-care-careers/>

5.1

Works Cited

Barry, John R., Ph.D. “Patient Motivation for Rehabilitation.” (n.d.): n. pag. University of Florida, College of Health Related Professions. Web. Maclean, Niall. “A Critical Review of the Concept of Patient Motivation in the Literature on Physical Rehabilitation.” Social Science & Medicine (2000): 495-506. Department of Public Health, Guy’s King’s and St. Thomas’ School of Medicine, Capital House. Web. Scales, Robert, Ph.D., and Joseph H. Miller. “Motivational Techniques for Improving Compliance with an Exercise Program: Skills for Primary Care Clinicians.” (n.d.): n. pag. Department of Human Performance & Development, University of New Mexico. Web.

5.2

color theory Monotonous environments with of lack of color variation can cause sensory deprivation (Korpacz 268). In order for the brain to function properly it needs to be exposed to a changing environment, this in turn causes physical stimulation. Without this stimulation, a person’s healing process is in jeopardy. White was once considered the proper color choice for healthcare, expressing a sense of cleanliness. As years passed, white has become undesirable; creating a clinical experience. Patients wish to see a more homelike interior, similar to that of a hotel. There is a greater use of balanced color, harmonic color combinations and moderate value contrasts in areas where patients are located long-term. Value contrasts don’t pass into high levels because it quickly becomes tiring to the eyes.

If a facility has outdated coloring with general wear throughout, patients feel there is a lack of attention throughout. This causes for concern, negatively impacting their positive health care image. Color is used to “accentuate the positive and ensure confidence by communicating the image of competency, expediency and personal care” (Korpacz 268). A continuous color scheme throughout a healthcare facility helps connect all the spaces together. All though there should be some range in color selection to pay homage to the most important spaces. “Color contrasts can be used to articulate form and eliminate optical illusions” (Korpacz 272). Areas designated for the elderly should have more contrasting saturated colors to simplify visual issues for the aging eye.

5.2 Spaces â&#x20AC;&#x153;where extensive physical movement is required, bright and bold colors are suggested to convey a sense of energyâ&#x20AC;? (Functional Color & Design). The color red increases the heart and respiration rate, creating an overall energizing environment. This color is appealing in rooms where patients will be performing physical therapy treatments or at the end of long hallways, encouraging the continuing movement through the corridor. Strong color contrasts are recommended for therapy spaces as well to add visual interest to the space. There needs to be a balancing act when trying to create a space with high contrast for therapy treatments. The patientâ&#x20AC;&#x2122;s need to focus during their activities so the design cannot be too attention grabbing, taking their mind away from the task at hand. Figure 1.

Orange is the color most commonly used in

Figure 2.

healthcare because of its cheerful and emotional effect on the patient. Peach, apricot, pumpkin and spice are all tones of orange used in healthcare, positively accentuating the skin tone which is a quality most appreciated in a hospital setting, motivating patients to get better because they feel better. This color should be applied with caution, using it in areas that will encourage patients rather than be detrimental to their recovery process. For example, orange should not be painted in exam rooms; the color can be misleading for a patientâ&#x20AC;&#x2122;s true skin tone, leaving the doctor to possibly misdiagnose a person.

Figure 3.

Figure 4.

5.2

Yellow is a color used in moderation as a stimulator

in healthcare, creating the sense of cheeriness. â&#x20AC;&#x153;Too much reflected yellow can make skin tone appear jaundiced and can induce vomiting in a patient that is already nauseated from treatmentâ&#x20AC;? (Korpacz 270). Due to these effects, yellow should be used sparingly because often the negatives outweigh the positive outcomes in healthcare design.

5.2

Figure 6.

Figure 5.

Figure 7.

Cool colors are less of a stimulator for patients versus warm colors. These colors are often used in rooms where patients experience anxiety.

Green is considered emotionally calming, at times

5.2

considered a sedative in terms of the nervous system.

Blue is the most calming of the cool colors,

used in areas for respite. Even though this color can be calming, it can also have negative effects on patients. Blue has a connection with cold temperature, making patients believe the room to be colder than what it is.

Figure 9.

Violet is a color most uncommonly used in

healthcare even though some people believe it to be a healing color. This color allows for a wide range of color compositions due to its flexibility of use.

Figure 8.

Figure 10.

Images Cited

Fig 1. Red Room Wayfinding, Digital Image. N.p, n.d. Web.< http://ifgroup.org/cms-website/workspace/images/projects/ slides/468-slide-7197.jpg > Fig 2. Physical Therapy Color Scheme, Digital Image N.p, n.d. Web. < http://www.functionalcolor.com/healthcare/room-by-room/ exam-and-treatment/physical-therapy/> Fig 3. Orange Ceiling Feature, Digital Image. N.p,n.d. Web.< http://www.cgsociety.org/cgsarchive/newgallerycrits/ g52/225152/225152_1298649398_large.jpg > Fig 4. Orange Color Scheme, Digital Image. N.p,n.d. Web. <http://wallpaperswa.com/thumbnails/detail/20120712/pattern%20orange%20squares%201400x1050%20wallpaper_wallpaperswa.com_88.jpg> Fig 5. Yellow Door Openings, Digital Image. N.p,n.d. Web. <http://www.desiretoinspire.net/blog/2013/11/27/you-wont-believewhat-this-is.html> Fig 6. Yellow Color Scheme, Digital Image. N.p,n.d. Web. <http://www.dezeen.com/interiors/health-interiors/> Fig 7. Mother Baby Center, Digital Image. N.p,n.d. Web. <http://www.kurtjohnsonphotography.com/category/blog/> Fig 8. Purple Wall Feature, Digital Image. N.p,n.d. Web. <http://www.df-photographe.com/architectural-interiors/> Fig 9. Upstate Medical Hospital, Digital Image. N.p,n.d. Web. < http://www.iida.org/content.cfm/2015-healthcare-interior-design-competition-image-gallery > Fig 10. Blue Glass Corridor, Digital Image. N.p,n.d. Web. <http://www.worldarchitecturenews.com/index.php?fuseaction=wanappln.showprojectbigimages&img=2&pro_id=17912>

5.2

Works Cited

Kopacz, Jeanne. “Three Dimensional Applications.” Color in Three-dimensional Design. New York: McGraw-Hill, 2004. 267-72. Print. Kovacs Silvis, Jennifer. “Healing Hues: Choosing Paint Colors for Healthcare.” Healthcare Design. N.p., 11 May 2012. Web. “Physical Therapy.” Functional Color Design. N.p., n.d. Web.

5.3 human behavior

Studies show that general encounters within healthcare environments evoke fear, anxiety, stress and uncertainty. Throughout their stay in a hospital, patients often feel vulnerable, being alone in their room. These feels transition into a sense of depersonalization, where the patients feel as if they don’t have control over their bodies, being kept at the doctor’s mercy. “Research in the domains of environmental psychology and healthcare design supports the notion that the healthcare environment affects the health and well-being of patients” (Tanja-Dijkstra, 44).

Figure 1.

5.3 Figure 2.

Figure 3.

Figure 4.

Patient rooms were originally designed with a focus on the functionality for healthcare faculty. This design concept has gradually changed over time; the rooms are now being designed to be psychologically supportive for the patients themselves. The physical environment of a healthcare setting “can make a difference in how quickly the patient recovers from or adapts to specific acute and chronic conditions” (TanjaDijkstra, 44). Lighting conditions can affect a patient’s length of stay and treatment progression. When a patient is exposed to music before surgery, they are surrounded with a sense of peace. Entering surgery while being calm decreases the chance of postoperative pain as well as the pain they may originally have felt during the surgery.

5.3

100

Healthcare design struggles trying to find the appropriate balance between creating a space that is functional for the professionals, yet comfortable for the occupants. “Creating a homelike environment with many decorations, soft lights, and nice furniture could give patients a positive feeling, but at the same time it might make the work of the medical team more difficult” (TanjaDijkstra, 44). However, if the room’s décor were to be reversed, creating function for the faculty, the patients may feel uncomfortable in their own room.

Figure 6.

Figure 5.

Figure 7.

Figure 8.

5.3

In patient rooms, patients are often surrounded by large amounts of wires that are connected to the variety of different machines needed in a hospital room. “This arrangement can seriously compromise patient safety when cables are inadvertently disconnected or infusion lines can snap off” (TanjaDijkstra, 45). Studies have shown that placing wires out of site leads to reduced feelings of stress in patients. The headwalls behind a patient’s bed are now being designed so to reduce clutter and minimize the visibility of medical equipment.

Figure 9.

When medical equipment is placed out of sight patients should feel less stress and be in a more positive mood. On the other hand, the visibility of medical equipment often evokes of sense of calm for the patients and trust in the medical professionals.

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Images Cited

Fig 1. Hospital Room, Digital Image. N.p, n.d. Web.< https://coreproductsco.com/> Fig 2. Patient Bed Digital Image. N.p, n.d. Web. < http://wnpr.org/post/eastern-hospitals-agree-prospect-deal#stream/0> Fig 3. Patient Room, Digital Image. N.p,n.d. Web.< http://insharepics.info/imhg-hospital-room-with-patient-and-family.htm> Fig 4. Patient listening to Music, Digital Image. N.p,n.d. Web. <http://www.123rf.com/photo_25303741_portrait-of-young-male-dialysis-patient-holding-glass-of-crushed-ice-during-renal-dialysis-at-hospit.htmll> Fig 5. Confortable Patient Room1, Digital Image. N.p,n.d. Web. < http://www.willowwalkhomes.com/7650-beautiful-looking-of-modern-hospital-design-room/ > Fig 6. Confortable Patient Room2, Digital Image. N.p,n.d. Web. <http://pulse.seattlechildrens.org/top-ten-features-building-hopecancer-inpatient-unit/ Fig 7. Confortable Patient Room3, Digital Image. N.p,n.d. Web. < http://www.kahlerslater.com/expertise/healthcare/san-juan-regional-medical-center> Fig 8. Bed with Wires, Digital Image. N.p, n.d. Web. < http://www.kahlerslater.com/expertise/healthcare/aurora-st-lukes-medical-center> Fig 9. Patient in Bed. Digital Image. N.p, n.d. Web. < http://giz-img.blogspot.com/2014/03/melatonin-post-7.html >

Works Cited

Dohr, Joy Hook., and Margaret Portillo. <i>Design Thinking for Interiors: Inquiry, Experience, Impact</i>. Hoboken, NJ: John Wiley &amp; Sons, 2011. Print. Tanja-Dijkstra, Karin, PhD. “The Impact of Bedside Technology on Patient’s Well-Being.” Health Environments Research & Design Journal 5.1 (2011): 43-51. Department of Public Health, Guy’s King’s and St. Thomas’ School of Medicine, Capital House. Web.

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delaware county, pennsylvania Delaware County is the oldest settled section of Pennsylvania established in 1643 by Governor Johan Printz; built upon over 184 miles, and divided into 49 municipalities. The population of Delaware County tripled during the 1680â&#x20AC;&#x2122;s under William Pennâ&#x20AC;&#x2122;s rule. Roads that were developed back then, Route 252, 452, Springfield Road and Lansdowne Road, are still well known and used to this day. The county became connected in a new way by 1907 through the use of trolley cars. Easy access was established to travel to West Chester, Sharon Hill, Ardmore and Media. After the First World War the community saw large increases in residential development.

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Figure 1.

â&#x20AC;&#x153;Rich in ... culture, history and commerceâ&#x20AC;?

Figure 2.

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Delaware County, Pennsylvania has a population of

558, 979 people. This population consists of: 405,233 Caucasians 110,260 African Americans 26,277 Asians 874 American Indians 145 Native Hawaiianâ&#x20AC;&#x2122;s

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The entire community is made up of 222,902 housing units, out of this total only 208,700 buildings are currently occupied. 6.4% of these housing units are vacant as of 2010. The average household has an income of $64,041 yearly, 28% of families are surviving off a single earner and 12% of families are surviving with no one bringing in an income. For those whom are working in this community, they generally work 38 hours a week, making $26.16 hourly. 10% off Delaware Counties members are selfemployed, with men bringing in $57,373 yearly and women earning $44,746 yearly.

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The people in Delaware County travel in a variety of different methods: 75% drive alone 10% use public transportation 7% carpool with others 5% walk The average commute time is about 28 minutes to travel outside of the county. Delaware County accumulates 43 inches of rain per year and 16 inches of snowfall.

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The residents see 204 sunny days yearly, with an average high of 87 degrees. The lowest temperature they generally see is 25 degrees in January.

Figure 3.

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Figure 4.

haverford Township, Pennsylvania Haverford Township has a population of

48,491 people. This population consists of: 44,245 Caucasians 1,293 African Americans 2,048 Asians 43 American Indians 2 Native Hawaiianâ&#x20AC;&#x2122;s

Figure 5.

Haverford Township is a unincorporated community with a small town suburban feel; taking its visitors away from the hectic life of Center City Philadelphia, a mere 10 miles away. With its larger, wide spread land, homes and businesses have room to breathe; not having to stack on top of one another. The township is most known for Haverford College and being the home to one of the oldest country clubs in Pennsylvania, Merion Cricket Club. Haverford is located directly on the Main Line, which is historically known for its wealth. This is evident when traveling along the heavily used roads and viewing the properties. As of August 2009, the average home was estimated to cost $849,000. Many of these expensive residents sat along College Ave, and had large amounts of land to seclude themselves from the neighboring houses. The homes were all older, more traditional in style compared to the newly developed homes popping up all over the country.

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zoning map

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Figure 6.

Figure 7.

Figure 8.

Figure 9.

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The Haverford Community and Recreation Center is located off of Parkview Drive, a short distance away from two different housing complexes built within the Haverford Reserve. Athertyn is a condominium housing unit constructed from steel and concrete, offering spacious upscale homes that allows homeowners to be freed from many of the responsibilities and expenses that come with larger homes (Athertyn Condominiums). Directly across the street from these condominiums are the Carriage homes. These houses form a village of European style exteriors that allow the residents to live within elegance and luxury (Carriage Homes, Haverford Reserve).

Figure 10.

The red indicates the area Athertyn Condominiums resides and the blue area is where Carriage homes are built. The lower end of the map highlighted yellow is the location of Haverford Commmunity Center. Figure 11 is a street view of Athertyn Condominiums.

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Figure 11.

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Figure 12.

The community center is within three miles of Bryn Mawr Hospital, with other more specialized healthcare units surrounding it. Highlighted red are the most local healthcare facilities to the intended site.

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Haverford Reserve, the grounds of the former Haverford State Hospital, was purchased by the township from the state in 2001. At that time, Haverford Township took measures to preserve and protect the 125 acres of open space. Situated in the Darby Creek Watershed, there are over five miles of trails meandering through the hills and valleys (Haverford Township Parks and Recreation Department). Signs are placed near the trail entrances indicating the 13 different paths able to travel and the lengths in which a person would hike when choosing which trail. These paths allow visitors to enjoy the natural elements that surround the site.

Figure 14.

Figure 15.

6.0

After traveling through the private residences, the community center appears, framed by two baseball fields and an abundance of open land. Beyond the trees Interstate 476 stands, causing loud traffic noise to interrupt the tranquility the environment portrays. The landscape blocking the traffic views improves the noise, and the bothersome the view would inevitably create, but it is not able to cut off the background noise in its entirety.

Figure 16.

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Figure 17.

Images Cited

Fig 1. Delaware County, Digital Image. N.p, n.d. Web.< http://www.delawarecountyhistory.com/images/TheOfficeoftheDelawareCountyRepublican.jpg> Fig 2. Delaware County Map, Digital Image. N.p, n.d. Web. < http://www.delawarecountyhistory.com/images/EarlySettlementsofDelawareCountyPa.1862.jpg\> Fig 3. Media Train Station, Digital Image. N.p,n.d. Web.< http://insharepics.info/imhg-hospital-room-with-patient-and-family.htm> Fig 4,10,12-13. Caitlyn Kelly, Site Anaylsis Diagrams, Digital Diagrams. N.p,n.d. 2015. Fig 5,7-8, 11,14-16. Caitlyn Kelly, Digital Images. N.p,n.d. 2015. Fig 6. Zoning Map, Digital Image. N.p,n.d. Web. < http://www.haverfordtownship.org/topic/index.php?topicid=55&structureid=4> Fig 9. Haverford Train Station, Digital Image. N.p,n.d. web. < https://thenatureofdelawarecounty.files.wordpress.com/2013/12/ thornbury-train-station.jpg> Fig 17. Haverford Community Center, Digital Image. N.p,n.d. Web. < http://www.haverfordtownship.org/department/division. php?structureid=93>

6.0

Works Cited

“Carriage Homes.” Haverford Reserve | Main Line Homes. N.p., n.d. Web. “Delaware County, PA Economy Data.” Town Charts. N.p., n.d. Web. “Delaware County, Pennsylvania. Climate.” Sperling’s Best Places. N.p., n.d. Web. “The History of Delaware County.” Delaware County Historical Society. N.p., n.d. Web. “Welcome To Athertyn!” Athertyn. N.p., n.d. Web. “2010 Decennial Census Data.” Delaware County Planning Department GIS & Information Services. N.p., n.d. Web.

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Program documentation 7.0

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Figure 1.

Figure 2.

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Figure 3.

Figure 4.

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Reception & Waiting

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Offices Children Playroom

Exercise Area

Treatment Rooms Utility Rooms

Storage

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Images Cited

Fig 1. Extremity Whirlpool, Digital Image. N.p, n.d. Web.< https://www.flickr.com/photos/53959864@N07/4993524953 > Fig 2. Exercise Area, Digital Image. N.p, n.d. Web. < http://www.healthcaredesignmagazine.com/article/photo-tour-pain-and-rehabilitative-consultants-medical-group-outpatient-clinic > Fig 3. Haverford Community Center, Digital Image. N.p,n.d. Web.< http://www.kimmel-bogrette.com/portfolio/port-rec-28-1. html> Fig 4. Parallel Bars, Digital Image. N.p,n.d. Web. < https://blog.chocchildrens.org/benefits-physical-therapy/ >

7.0

Works Cited

â&#x20AC;&#x153;Physical Therapy.â&#x20AC;? DoD Space Planning Criteria 390 (2015): 8-15. 7 Aug. 2015. Web.

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Haverford Township Community Recreation Center 9000 Parkview Drive Haverford, PA 19083

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The township of Haverford, Pennsylvania opened the doors of the $7.5 million recreation center in 2012 after an extensive design process from architecture firm Kimmel-Bogrette. “Located on the township-owned portion of Haverford Reserve, the 35,000-squarefoot, two-story Community Center features a fullsize gymnasium, walking track, multi-use rooms, environmental education lab and health and wellness area with treadmills, elliptical machines, exercise bikes and strength equipment, as well as beautiful views of the adjacent nature preserve” (Puglionesi, Delco Times). The buildings overall design concept was

inspired by the forested ravines along the nearby Darby Creek. “Timber “tree columns” dramatically support the atrium roof in the front and back and are complemented by timber “kicker” supports framing the clerestory windows lining the top of the building” (Kimmel-Bogrette). These timber columns are highlighted red in the plan drawing in Figure 8.

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Figure 1.

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Figure 2.

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Figure 3.

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Figure 4.

Haverford Community center has many green features throughout the building, both interior and exterior, as well as the land surrounding it. The parking lot consisted of the minimal space required to meet the zoning laws in order to encourage visitors to car pool, saving the environment from gas pollution. There are a collection of bioswales and stormwater basins that improve the quality and quantity of stormwater runoff. The roof was constructed as a â&#x20AC;&#x153;white roofâ&#x20AC;? to efficiently reflect solar heat and use this energy throughout the facility. In addition to the white roof, the community center has 40 on site wells that capture heat for HVAC use. Lighting is managed through the large amounts of windows along the exterior, allowing for an abundance of natural light to enter into the activity spaces. See Figure 7 to view the solid versus void along the exterior elevation. Architects, Kimmel-Bogrette, design with a common factor among all of their projects, this is the integration between interior and exterior spaces. The use of large, open windows and exterior patio spaces help bring the outdoors in and vice versa. Figure 9 highlights the exterior terraces that are used as both classroom areas and patio dining space. The community center has two major forms in floor plan, the largest, the most effective form is where the gymnasium currently sits, lastly is the smaller form that allows for activities on both floors, serving as classrooms and utility areas. These forms are shown in Figure 10.

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Figure 5.

Figure 6.

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8.0 Figure 7.

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Figure 8.

Figure 9.

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Figure 10.

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Project Data: Project Name: Haverford Rehabilitation Center Address: 9000 Parkview Dr. Haverford, PA Date of Completion: 2012 Number of Stories: 2 Total Gross Sq/Ft: 35,000 Applicable Building Code Information: Zoning Ordinance: Special Residential Development Fire Code: 2010 Philadelphia Fire Code Building Code & Date: 2012 Energy Code: International Energy Code General Building Requirements: Sprinklered: Protected Dead End Limit: 50’-0” Minimum Corridor Width: 72 inches Number of Exits: 2 per story Exit Access Travel Distance: 250 feet Use Group Classification: I-2: Institutional Group B: Business Group

142

Maximum Load Occupancy: I-2: 10,500 Sq/Ft Sleeping Areas Gross Sq/Ft: 5,250 SF/Occupant: 120 Number of Occupants: 44 Patient Treatment Areas Gross Sq/Ft: 5,250 SF/Occupant: 240 Number of Occupants: 22 B: 10,500 Sq/Ft Exercise Areas Gross Sq/Ft: 7,000 SF/Occupant: 50 Number of Occupants: 140 Offices Gross Sq/Ft: 3,500 SF/Occupant: 100 Number of Occupants: 35

Total Amount of Occupants: 241

Sanitation: I-2: Institutional Group Hospital Care Recipient 44 Water Closets, 1 per Room 44 Lavatories, 1 per Room 44 Showers, 1 per Room 1 Drinking Fountain Minimum 1 Service Sink Minimum Employees 1 Water Closet Minimum 2 Lavatories Minimum 1 Drinking Fountain Minimum Visitors 1 Water Closet Minimum 1 Lavatory Minimum 1 Drinking Fountain Minimum

Fire Protection Requirements: Fire Exit Enclosures: 2 Hours Shafts and Elevator Hoistways: 2 Hours Tenant Space Separations: 2 Hours Smoke Barriers: 30 Minutes Corridor Fire-Resistance Rating: n/a Incidental Use Areas: Storage Rooms over 100 Sq/Ft 1 hour or provide automatic fire-extinguishing system I-2 Waste and Linen Collection 1 Hour

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B: Business Group 4 Water Closets Minimum 4 Lavatories Minimum 2 Drinking Fountains Minimum 1 Service Sink Minimum

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Figure 11.

Images Cited

Fig 1 & 11. Caitlyn Kelly. Haverford Community & Recreation Center, Digital Image. N.p, n.d. Web. Fig 2-4. Kimmel-Bogrette, Haverford Community & Recreation Center, Digital Drawings. N.p, n.d. Web. Fig 5 & 6. Haverford Community & Recreation Center, Digital Image. N.p,n.d. Web.< http://www.kimmel-bogrette.com/portfolio/ port-rec-28-1.html> Fig 7-10. Caitlyn Kelly. Haverford Community & Recreation Center, Digital Diagrams. N.p,n.d. web.

8.0

Works Cited

“Architecture + Site, Haverford Community & Recreation Center.” Kimmel-Bogrette. N.p., n.d. Web. Puglionesi, Lois. “Haverford Community Center Officially Opens.” Delaware County Daily Times News. N.p., 18 June 2012. Web.

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Executive summary 9.0

147

Physical therapy has been a common healthcare practice since World War II; treating soldiers who came home from war in need of physical rehabilitation after suffering severe injuries. Since the early 1920â&#x20AC;&#x2122;s the need for rehabilitation has only increased, allowing physical therapists to treat people in all forms. Throughout the research put into this book, many unique aspects of healthcare design have come into focus. A healthcare space has to be treated differently when designing in order to create a functional and practical environment for the physicians as well as the patient and their families.

9.0

Often more times than not, healthcare environments feel sterile and unwelcoming; I would like to change this feeling of dread when attending physical therapy. The environment in which the patient is treated in directly affects their motivation to get better; therefore the activity spaces should enforce positive feelings in order to see positive results. When taking these findings and implementing them into a special and experiential design, I intend to breach the distance between the elderly and the younger generations through physical therapy treatments.

Figure 1.

I would like to extend a very special thank you to those who guided me through the writing of the book:

148

Lisa Phillips, Philadelphia University Joann Frey, Good Shepherd Rehabilitation Leah Brown, Array Architects

Figure 2.

Images Cited

Fig 1. Motivational Quote, Digital Image. N.p, n.d. Web. < https://www.pinterest.com/pin/315603886361088775/ > Fig 2. Physical Therapy, Digital Image. N.p, n.d. Web. < http://www.dynamiccorept.com/>

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Bibliography

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“2010 Decennial Census Data.” Delaware County Planning Department GIS & Information Services. N.p., n.d. Web. Al., Demarin V. Et. “Stroke: A Historical Overview and Contemporary Management.” REVIEW ARTICLE UDC 19.2 (2011): 16-17. Web. “Architecture + Site, Haverford Community & Recreation Center.” Kimmel-Bogrette. N.p., n.d. Web. Baldwin, D. “Disparities in Health and Healthcare: Focusing Efforts to Eliminate Unequal Burdens.” Onl line Journal of Issues in Nursing 1st ser. 8.1 (2003): n. pag. Online Journal of Issues. Web. Barry, John R., Ph.D. “Patient Motivation for Rehabilitation.” (n.d.): n. pag. University of Florida, College of Health Related Professions. Web. Binggeli, Corky, Pat Greichen, and Maryrose McGowan. Interior Graphic Standards. Hoboken: John Wiley & Sons, 2011. Print. “Brain Injury Overview.” Find Law. N.p., n.d. Web. “Car Accident TBI.” TraumaticBrainInjurycom. N.p., n.d. Web. “Carriage Homes.” Haverford Reserve | Main Line Homes. N.p., n.d. Web. DeCagna, Gina. “Paul Housberg References Water in New Architectural Glass Installation.” Urban Glass. N.p., 8 Aug. 2013. Web “Delaware County, PA Economy Data.” Town Charts. N.p., n.d. Web. “Delaware County, Pennsylvania. Climate.” Sperling’s Best Places. N.p., n.d. Web. Dohr, Joy Hook., and Margaret Portillo. <i>Design Thinking for Interiors: Inquiry, Experience, Impact</ i>. Hoboken, NJ: John Wiley &amp; Sons, 2011. Print. “Good Shepherd History.” Good Shepherd Rehabilitation. N.p., n.d. Web. “History of Stroke.” John Hopkins Medicine. N.p., n.d. Web. Kopacz, Jeanne. “Three Dimensional Applications.” Color in Three-dimensional Design. New York: Mc Graw-Hill, 2004. 267-72. Print. Kovacs Silvis, Jennifer. “Healing Hues: Choosing Paint Colors for Healthcare.” Healthcare Design. N.p., 11 May 2012. Web. Levin, Debra. “Healthcare Form Meets Healthcare Function.” Healthcare Design Magazine. N.p., 10 July 2015. Web. Maclean, Niall. “A Critical Review of the Concept of Patient Motivation in the Literature on Physical Re habilitation.” Social Science & Medicine (2000): 495-506. Department of Public Health, Guy’s King’s and St. Thomas’ School of Medicine, Capital House. Web. “News from the Foundation for Physical Therapy.” Physical Therapy 95.3 (2015): 1-5. Jones and Bartlett Publishers. Web. “NovaCare Rehabilitation History.” NovaCare Rehabilitation. N.p., n.d. Web Nussbaumer, Linda L. Human Factors in the Built Environment. New York: Bloomsbury, 2014. Print.

“Our Mission and Vision.” Good Shepherd Rehabilitation. N.p., n.d. Web. “Physical Therapy.” DoD Space Planning Criteria 390 (2015): 8-15. 7 Aug. 2015. Web. “Physical Therapy.” Functional Color Design. N.p., n.d. Web. “Psalm 23 ESV.” Bible Hub. N.p., n.d. Web. Puglionesi, Lois. “Haverford Community Center Officially Opens.” Delaware County Daily Times News. N.p., 18 June 2012. Web. “Rehabilitation Centre Groot Klimmendaal / Koen van Velsen” 08 Apr 2011. ArchDaily. Scales, Robert, Ph.D., and Joseph H. Miller. “Motivational Techniques for Improving Compliance with an Exercise Program: Skills for Primary Care Clinicians.” (n.d.): n. pag. Department of Human Performance & Development, University of New Mexico. Web. Siegfried, Juliette. “History of Brain Surgery.” BrainSurgerycom. N.p., n.d. Web. “Spaulding Hospital / Perkins+Will” 01 Nov 2013. ArchDaily. “Spaulding Rehabilitation Hospital.” US News. U.S.News & World Report, n.d. Web. “Statistics of Disability- Physical Medicine and Rehabilitaiton.” University of Miami Health System. N.p., n.d. Web. “Stroke Treatments.” American Heart Association. American Heart Association, 5 May 2013. Web. Tanja-Dijkstra, Karin, PhD. “The Impact of Bedside Technology on Patient’s Well-Being.” Health Environ ments Research & Design Journal 5.1 (2011): 43-51. Department of Public Health, Guy’s King’s and St. Thomas’ School of Medicine, Capital House. Web. Tendler, Matthew D. “Designing For Sustainable Healthcare Facility Maintenance.” Healthcare Design Magazine. N.p., 13 Aug. 2013. Web. “The History of Delaware County.” Delaware County Historical Society. N.p., n.d. Web. “The History of Physical Therapy.” Network/Synergy Group, n.d. Web. Thompson, Jesse E., MD. “The Evolution of Surgery for the Treatment and Prevention of Stroke.” Ameri can Heart Association Journals. American Heart Association, 25 Jan. 1996. Web. “Welcome To Athertyn!” Athertyn. N.p., n.d. Web. Zeit, Kristin D. “The Evolution Of Healthcare Design Interiors.” Healthcare Design. Healthcare Design Magazine, 24 Apr. 2015. Web.

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images cited Section 1

Section 2

Fig. 1. Hippocrates. Digital Image. N.p., n.d. Web. < https://www.emaze.com/@ALLFZIOC/Hippocrates> Fig. 2. Brain Surgery. Digital Image. N.p., n.d. Web. < http://www.bible.ca/tracks/peru-tomb-art.htm> Fig. 3. Stephens, Lee. “Accident”, Digital Image. 2008. Fig. 4. War and Prosthetics. Digital Image. N.p., n.d. Web. < http://www.collectorsweekly.com/articles/ war-and-prosthetics/> Fig. 5. Physiotherapy. Digital Image. N.p., n.d. Web. < http://amkphysio.blogspot.com/2012/11/history-of-physiotherapy-if-one-goes.html>

Section 3.1

10.0

Fig 1. Founder, John Raker. Digital Image. N.p., n.d. Web, < https://plus.google.com/111632551269888773039/ posts> Fig 2. Good Shepherd Map. Digital Image. N.p., n.d. Web, < http://www.goodshepherdrehab.org/node/3855/ good-shepherd-plaza-main-campus-physical-therapy-allentown/good-shepherd-plaza-campus-map> Fig 3. Good Shepherd. Digital Image. N.p., n.d. Web. <http://www.vwmin.org/specialty-hospital-good-shepherd-rehab.html> Fig 4. Kelly, Caitlyn. “Map”, Digital Image, 2015. Fig 5. Kelly, Caitlyn. “Hospital Directory Signage”, Digital Image, 2015. Fig 6. Kelly, Caitlyn. “Healing Garden”, Digital Image, 2015. Fig 7. Kelly, Caitlyn. “Adolescent Therapy”, Digital Image, 2015. Fig 8. Kelly, Caitlyn. “Adult Therapy”, Digital Image, 2015. Fig 9. Stephens, Sheryl. “Rehab”, Digital Image. 2008.

Section 3.2

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Section 3.3

Fig 1, 7-10, 15-16. Perkins & Will, Digital Diagrams, 2013. Fig 2-6, 14, 17-19,21. Steinkamp Photography, Digital Images. N.p, n.d. Web. < http://www.archdaily.com/443408/ spaulding-hospita-perkins-will> Fig 11, 20.Materials & Methods, Digital Image. N.p, n.d. Web. < http://www.materials-methods.com/work/spaulding/> Fig 12. Glass Project, Digital Image. N.p, n.d. Web. < http://www.glassproject.com/spaulding-rehab/> Fig 13. Urban Glass, Digital Image. N.p, n.d. Web. < https://www.urbanglass.org/glass/detail/paul-housberg-references-water-in-new-architectural-glass-installation> Fig 22. Grassl, Anton. Esto, Digital Image. N.p, n.d. Web. < http://www.bizjournals.com/boston/blog/bioflash/2014/04/one-year-after-marathon-bombs-spaulding-settles.html>

Section 3.4

Fig 1-2,4-5. Rob tâ&#x20AC;&#x2122;Hart Photography, Digital Images. N.p, n.d. Web.< http://www.archdaily.com/126290/rehabilitation-centre-groot-klimmendaal-koen-van-velsen> Fig 3, 6-15.Koen van Velsen, Digital Diagrams. N.p, n.d. Web. < http://www.archdaily.com/126290/rehabilitation-centre-groot-klimmendaal-koen-van-velsen> Fig 16.Groot Klimmendaal, Digital Image. N.p,n.d. Web.< http://www.dearchitect.nl/projecten/2010/09/Arnhem+Koen+van+Velsen+Revalidatiecentrum+Groot+Klimmendaal/galerijen/interieur.html?picIndex=1&picName=klimmendaal014.JPG> Fig 17-18. Groot Klimmendaal, Digital Images. N.p,n.d. Web. < http://inhabitat.com/gorgeous-glass-clad-grootklimmendaal-rehabilitation-centre-sits-tucked-amongst-the-trees/>

Section 4

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Fig 16. . Room Orientation. Digital Image. N.p, n.d. Web <http://www.lhbcorp.com/project/duluth-childrens-hospital/> Fig 21. Hospital Organization. Digital Image. N.p, n.d. Web <http://www10.aeccafe.com/blogs/arch-showcase/2014/03/09/naval-hospital-at-camp-pendleton-earns-two-agc-alliant-build-america-awards/> Fig 22. Natural Lighting. Digital Image. N.p, n.d. Web <http://www.steelcase.com/discover/information/health/> Fig 23. Guest & Physician Seating. Digital Image. N.p, n.d. Web <http://www.coroflot.com/KellyRoach/CHILDRENS-HOSPITAL> Fig 26. Patient Lighting. Digital Image. N.p, n.d. Web <https://www.pinterest.com/explore/hospital-room/> Fig 27. Natural Lighting Control. Digital Image. N.p, n.d. Web <http://origin.www.futureoflight.philips.com/ post/78427988064/5-great-things-led-lights-do-that-arent-just> Fig 28. Acoustical Ceiling. Digital Image. N.p, n.d. Web <http://www.healthcaredesignmagazine.com/article/crystal-ball-looking-future-patient-room-design> Fig 29. Partition Elements. Digital Image. N.p, n.d. Web <http://www.3-form.com/ready_to_go/partitions/get_inspired/>

Section 5.1

10.0

Fig 1. Patient/Doctor Meeting, Digital Image. N.p, n.d. Web.< http://www.chiroeco.com/magzine/getting-results-in-practice-the-importance-of-patient-involvement/> Fig 2. Family/Patient Interaction, Digital Image. N.p, n.d. Web. < http://www.coronaregional.com/patients-and-visitors> Fig 3. Worried Patient, Digital Image. N.p,n.d. Web.< http://www.african-sweetheart.com/2015/01/the-weeks-message-when-you-think-about.html > Fig 4. Patient Dealing with Bills, Digital Image. N.p,n.d. Web. <http://www.billing-services.com/patient_billing_services.html> Fig 5. Relaxed Woman, Digital Image. N.p,n.d. Web. <https://treatments4depression.wordpress.com/2015/07/13/ bmc-psychology-full-text-a-metacognitive-perspective-on-mindfulness-an-bmc-blogs-network/> Fig 6. Patient Rehabilitation, Digital Image. N.p,n.d. Web. <http://www.rehabalternatives.com/the-best-payinghealth-care-careers/>

Section 5.2

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Fig 8. Purple Wall Feature, Digital Image. N.p,n.d. Web. <http://www.df-photographe.com/architectural-interiors/>Fig 9. Upstate Medical Hospital, Digital Image. N.p,n.d. Web. < http://www.iida.org/content.cfm/2015-healthcare-interior-design-competition-image-gallery > Fig 10. Blue Glass Corridor, Digital Image. N.p,n.d. Web. <http://www.worldarchitecturenews.com/index.php?fuseaction=wanappln.showprojectbigimages&img=2&pro_id=17912>

Section 5.3

Fig 1. Hospital Room, Digital Image. N.p, n.d. Web.< https://coreproductsco.com/> Fig 2. Patient Bed Digital Image. N.p, n.d. Web. < http://wnpr.org/post/eastern-hospitals-agree-prospect-deal#stream/0> Fig 3. Patient Room, Digital Image. N.p,n.d. Web.< http://insharepics.info/imhg-hospital-room-with-patient-and-family.htm> Fig 4. Patient listening to Music, Digital Image. N.p,n.d. Web. <http://www.123rf.com/photo_25303741_portrait-ofyoung-male-dialysis-patient-holding-glass-of-crushed-ice-during-renal-dialysis-at-hospit.htmll> Fig 5. Confortable Patient Room1, Digital Image. N.p,n.d. Web. < http://www.willowwalkhomes.com/7650-beautiful-looking-of-modern-hospital-design-room/ > Fig 6. Confortable Patient Room2, Digital Image. N.p,n.d. Web. <http://pulse.seattlechildrens.org/top-ten-features-building-hope-cancer-inpatient-unit/ aurora-st-lukes-medical-center> Fig 7. Confortable Patient Room3, Digital Image. N.p,n.d. Web. < http://www.kahlerslater.com/expertise/healthcare/san-juan-regional-medical-center> Fig 8. Bed with Wires, Digital Image. N.p, n.d. Web. < http://www.kahlerslater.com/expertise/healthcare/ Fig 9. Patient in Bed. Digital Image. N.p, n.d. Web. < http://giz-img.blogspot.com/2014/03/melatonin-post-7.html >

10.0

Section 6

Fig 1. Delaware County, Digital Image. N.p, n.d. Web.< http://www.delawarecountyhistory.com/images/TheOfficeoftheDelawareCountyRepublican.jpg> Fig 2. Delaware County Map, Digital Image. N.p, n.d. Web. < http://www.delawarecountyhistory.com/images/ EarlySettlementsofDelawareCountyPa.1862.jpg\> Fig 3. Media Train Station, Digital Image. N.p,n.d. Web.< http://insharepics.info/imhg-hospital-room-with-patient-and-family.htm> Fig 4,10,12-13. Caitlyn Kelly, Site Anaylsis Diagrams, Digital Diagrams. N.p,n.d. 2015. Fig 5,7-8, 11,14-16. Caitlyn Kelly, Digital Images. N.p,n.d. 2015. Fig 6. Zoning Map, Digital Image. N.p,n.d. Web. < http://www.haverfordtownship.org/topic/index.php?topicid=55&structureid=4> Fig 9. Haverford Train Station, Digital Image. N.p,n.d. web. < https://thenatureofdelawarecounty.files.wordpress. com/2013/12/thornbury-train-station.jpg> Fig 17. Haverford Community Center, Digital Image. N.p,n.d. Web. < http://www.haverfordtownship.org/department/division.php?structureid=93>

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Section 7

Fig 1. Extremity Whirlpool, Digital Image. N.p, n.d. Web.< https://www.flickr.com/photos/53959864@ N07/4993524953 > Fig 2. Exercise Area, Digital Image. N.p, n.d. Web. < http://www.healthcaredesignmagazine.com/article/photo-tour-pain-and-rehabilitative-consultants-medical-group-outpatient-clinic > Fig 3. Haverford Community Center, Digital Image. N.p,n.d. Web.< http://www.kimmel-bogrette.com/portfolio/ port-rec-28-1.html> Fig 4. Parallel Bars, Digital Image. N.p,n.d. Web. < https://blog.chocchildrens.org/benefits-physical-therapy/ >

Section 8

Fig 1 & 11. Caitlyn Kelly. Haverford Community & Recreation Center, Digital Image. N.p, n.d. Web. Fig 2-4. Kimmel-Bogrette, Haverford Community & Recreation Center, Digital Drawings. N.p, n.d. Web. Fig 5 & 6. Haverford Community & Recreation Center, Digital Image. N.p,n.d. Web.< http://www.kimmel-bogrette. com/portfolio/port-rec-28-1.html> Fig 7-10. Caitlyn Kelly. Haverford Community & Recreation Center, Digital Diagrams. N.p,n.d. web.

Section 9

Fig 1. Motivational Quote, Digital Image. N.p, n.d. Web. < https://www.pinterest.com/pin/315603886361088775/ > Fig 2. Physical Therapy, Digital Image. N.p, n.d. Web. < http://www.dynamiccorept.com/>

10.0

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Caitlyn kelly capstone research & programming fall 2015 caitlynjanekelly@gmail.com behance.net/caitlynjkelly