FLEX Vanderbilt Medical Complex

+ SPORTS MEDICINE & PHYSICAL THERAPY + Brenna Murphy + Marissa Wilson + Courtney Gilbert I.D. 421_ Fall Semester 2013

Marissa Wilson Brenna Murphy Courtney Gilbert 11

+Table of Contents

RESEARCH COMPONENTS: 4 + Research Strategies 6 + Key Words & Literature 13 + Evidence-Based Goals & Objectives 19 + Universal Design Principles 21 + Precedent Analysis 27 + Individual Research Strategies

28 + Observation

41 + Interview

47 + Concept Development

PROGRAMMING COMPONENTS: 53 + Theories of Care 63 + Proposed Goals and Objectives 69 + Client and User Analysis 79 + Site Analysis 89 + Spatial Needs 105 + Diagrammatic Analysis 117 + Code Issues 139 + Design Considerations 145 + Schematic Phase 160 + Literary Resources

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+ RESEARCH STRATEGIES

1. KEY WORDS & 2. EVIDENCE- BASED 3. EXISTING LITERATURE

- Find relevant articles - Annotated Bibliography

- Create a list of key words and define to better understand sports medicine

GOALS & OBJECTIVES

- Identify areas related to evidencebased design in healthcare environments

- Research relevent design solutions found in current literature

PRECEDENT ANALYSIS

- Research found clinic-based design and note concept of space

- Visit and conduct research of the UK sports medicine clinic

4. OBSERVATIONS - Casual observation: View daily operations in sports medicine clinic & begin to understand how it functions

- Systematic observation: Designate key spatial areas of interest & prepare observation assumptions. View users in spaces

5. INTERVIEW

- Expert interview: Utilize broad questions to gain an understanding about satisfaction of their environment

- Client-based interview: Discuss overall clinic experience with patient to see if the firms initial assumptions are apparent to client

6. CONCEPT

DEVELOPMENT

- Through the use of the strategies, the firm will synthesize research to develop ways to improve patient experience in future clinic

- Six sentence structure that then forms project statement

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+ KEY WORDS & LITERATURE Exploring concepts, themes, and ideas to further dive into the world of sports medicine and to develop individual research methods.

Athletic training- The course of practice and exercise and diet undertaken by an athlete.

Acute Tramatic Injury- In sports, these injuries usually involve a single blow from a single application of force, like getting a cross-body block in football.

Biomechanics: (related to sports)- Mechanical laws of sports relating to movement or structure of living organisms.

Clinic- a place or hospital department where outpatients are given medical treatment or advice.

Community- Based Exercise Programs- Have the potential

to increase physical activity participation among older adults by reducing barriers, increasing access, and providing social support and supervision.

Community Based Strength Training Programs- includes

balance and flexibility exercises through leadership training of both laypersons or “peers� and health and fitness professionals.

Evidence-based Design- Decision making process based on evidence that has been analyzed from research, observations, mapping out goals and objectives, hypothesizing outcomes and innovating them into a successful design.

Flexibility: The range of motion possible around specific joints.

The ability to move muscles and joint through their full range of motion. Flexibility in clinic design is crucial to create a space that will be able to work with the human body.

Musculoskeletal injury: Injury or disorder of

muscles, tendons, ligaments, joints, nerves, and blood vessels, or soft tissue.

Orthopedic injury- Associated with skeletal

system and associated with muscles, joints, and ligaments.

Range of motion: The extent to which a joint

can be extended and flexed in a normal way.

Doctors use this to evaluate joint injuries and can improve strength through physical therapy.

Rehabilitation: Restoration to health or to normal life by training and therapy after imprisonment, addiction, illness, or injury.

Sports science- Studies the application of

scientific principles and techniques with the goal of improving sports performance.

Strength training- The use of resistance in

combination with muscles to build strength and endurance. There are many different methods to this training.

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ANNOTATED BIBLIOGRAPHY (LITERATURE) Brawley, S., Fairbanks, K., Nguyen, W., Blivin, S., & Frantz, E. (2012). Sports Medicine

Training Room Clinic Model for the Military. Military Medicine, 177(2), 135-138.

The Marine Corps Base Camp Lejeune shows success in the Sports Medicine and Reconditioning Team (SMART) clinic. Through their findings, the team creates a clinic where more patients are can be seen and the coordination of care between providers increases.

California Pacific Orthopaedics and Sports Medicine; local bay area orthopaedic clinic

expands its operations in marin county to cater to a growing need for sports

medicine care in the area. (2012). Biotech Week, 148.

The center has the top orthopaedic doctors and cutting-edge technology to effectively treat and diagnose patients. The Marin clinic has a partnership with a physical therapy treatment center to provide rehabilitation.

Chen, A. (2005). Good joints. Interior Design, 76(2), 132-132,134,136. Retrieved from http://ezproxy.uky.edu/login?url=http://search.proquest.com/docview/23495523 6?accountid=11836.

Aime Gross Architects understands the value and importance of designing spaces in clinical environments as showcased in the new office of Duke Chiropractic Center for Alternative Sports Medicine, New York. Chen describes how eco friendly products, low-VOC paint, and a well designed floor plan can help aid a patients healing process and promote a cleaner way of living. Gross also recognizes the need to maintain visual interest throughout the space by utilizing a mix of colors, textures, and various materials.

Daykin, N; Byrne, E; Soteriou, T; O’Connor S. (2008). The impact of Art, Design and

Environment in Mental Healthcare: A systematic Review of the Literature. The

Journal of the Royal Society for the Promotion of Health. 128(2). 85-94.

Art positively affects a person while in a space through physiological, psychological, clinical and behavioral effects. It can speed the recovery process and relieves stress of the person in the space.

Derman, W. (2011). Guidelines for the composition of the travelling medical kit for

Sports Medicine professionals. International SportMed Journal, 12(3), 125-132.

Derman provides a guideline for the contents of a sports medicine kit for use in the medical coverage of sports events. The kit’s composition must be based on knowledge of Sports Medicine, in addition to “aviation, space medicine, environmental, travel medicine, and wilderness medicine experiences.”

Guiney, Anne. (2003) Let’s Get Physical. Interior Design, 74(2), 88.

Physical therapist James Fowler believes that posture and the way that the foot hits the ground plays a key role in the health of joints and connections. When designing his private practice, Fowler’s approach was to create a clinic that did not look like a clinic in the traditional sense. Glass cubicles framed with bronze provided privacy in the otherwise open floor plan.

Hackett, S. L. (2008). Improving administrative operations for better client service

and appointment keeping in a medical/behavioral services clinic. (Order No.

1463557, University of North Texas). ProQuest Dissertations and Theses, , 64-n/a.

Retrieved from http://ezproxy.uky.edu/login?url=http://search.proquest.com/docvie

w/304539433?accountid=11836. (304539433).

Hackett recognizes that appointment no-shows are a large problem in the field of healthcare and that both the appointment intake and the scheduling process are good areas for improvement. The clinic was able to see an increased number of appointments kept and a decreased appointment lag time through better training of employees and a more strategic approach to scheduling.

Haskell, W.L., I.-M. Lee, R. R. Pate, K.E. Powell, S. N. Blair, B. A. Franklin, C. A. Macera,

G. W. Heath, P.D. Thompson,. (2007). Physical Activity and Public Health: Updated

Recommendation for Adults from the American College of Sports Medicine and

the American Heart Association. Special Communications, 39(8), 1423-1434.

Adults ages 18-65 need to be physically active for at least 30 minutes everyday.

Performing physical activity has numerous benefits and can reduce diseases.

Jones, M. L. (2004). High school principals’ satisfaction with clinic and hospital-based

outreach athletic training services. (Order No. 3147920, The University of

Southern Mississippi). ProQuest Dissertations and Theses, , 90-90 p. Retrieved

from http://ezproxy.uky.edu/login?url=http://search.proquest.com/docview/305127

151?accountid=11836. (305127151).

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Jones identifies the level of satisfaction of high school principals with clinic and hospital based outreach athletic training services. Both principals and athletic trainers showed high levels of satisfaction with the program thus showing the benefit of high school students participating in this program.

Layne, J. E. (2007). Dissemination of and adherence to a community-based strength

training program for older adults. (Order No. 3283085, Tufts University).

ProQuest Dissertations and Theses, , 139. Retrieved from http://ezproxy.uky.

edu/login?url=http://search.proquest.com/docview/304800026?accountid=11836.

(304800026).

In this dissertation, Layne atempts to describe that community-based exercise programs have the ability to increase physical activity among older adults. The developed model shows how age is not a factor in educating classmates; peers can assist as well.

Community-based exercise programs helps to educate older adults as well as give positive feedback on lifestyle.

Perkins, O. (2001, Aug 15). Roll with it: Adaptive sports clinic puts disabled athletes on

wheels. Colorado Springs Independent.

This sports medicine clinic provides services for disabled athletes that range from peer counseling to recreational sports activities to rebuild strength. Peer counseling is emphasized to encourage initiative and positive attitudes toward recovery.

Rich, Valerie J, PhD, ATC, CSCS, WEMT-B. (2009) . Clinical Instructors’ and Athletic

Training Students’ Perceptions of Teachable Moments in an AthleticTraining

Clinical Education Setting. Journal of Athletic Training. 44(3), 294-303.

Clinical instructors need to help athletic training students through teachable moments.

This consists of having an area for training and teaching students while working with certain patients for demonstration and learning.

Shoemaker, L. K., RN, MSN, DHA, NEA-BC; Kazley, A. S., PhD; White, A., PhD. (2010).

Making the Case for Evidence-Based Design in Healthcare: A Descriptive Case

Study of Organizational Decision Making. HERD: Health Environments Research

& Design Journal. 4(1). 56-88.

Organizational decision-making process is used in the selection of making evidence based design concepts. Learning innovations in healthcare design, the criteria used to make decisions and listening to the input from the staff is the process that needs to be understood.

Sun, B. (2011). Simulation modeling and analysis of a multi-resource medical clinic.

(Order No. 1504999, University of Louisville). ProQuest Dissertations and Theses,

, 97. Retrieved from http://ezproxy.uky.edu/login?url=http://search.proquest.com/

docview/913000119?accountid=11836. (913000119).

In this dissertation, Sun highlights the progress made at the Healthy for Life clinic sponsored by the University of Louisville to decrease the number of overweight children. The goals of the thesis were to increase the use of staff in an effective manner and decreasing the waiting time of patients.

Tamarin, N. (2008). Zimmer gunsul frasca architects: University of oregon athletic

medicine center, eugene. Interior Design, 79(15), 50-51. Retrieved from http://

ezproxy.uky.edu/login?url=http://search.proquest.com/docview/55475767?accoun

tid=11836
Sport and spa mix at Zimmer Gunst Frasca’s athletic medical center

for the University of Oregon.

Tamarin showcases the sports imagery filled design for the University of Oregon Athletic Medicine Center by Zimmer Gunsul Frasca Architects. Student athletes utilize the 15,000-square-foot center that reflects the athletic traditions, athletes, famous coaches, and staff who have changed the campus culture at the University of Oregon.

Ulrich, R. S, PhD; Zimring, C., PhD; Zhu, X., BArch, PhD; MS, Jennifer, MS; Seo, Hyun

Bo, MArch; Choi, Young-Seon, MArch; Quan, Xiaobo, PhD; Joseph, Anjali, PhD.

(2008). A Review of the Research Literature on Evidence-based Healthcare

Design. HERD: Health Environments Research & Design Journal. 1(3). 61-125.

Patient safety, outcomes and staff outcomes while in the space need to be analyzed.

Having effective ventilation systems, good acoustic design, nature and lighting, better ergonomic design, acuity-adaptable rooms, improved floor layouts and work settings are key in heath care design.

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+EVIDENCE-BASED GOALS & OBJECTIVES Identifying and defining considerations that will impact the clinic’s environment of care.

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PATIENT SATISFACTION

Environmental Variables That Impact Patient Satisfaction

Art

Research showed that patients respond positively to artwork that is realistic and related to nature. In the study, patients showed an affinity towards representational artwork, which differed from the more original, abstract choices of the design students.

Limitations of this study are the ages of surveyed patients, which ranged from 50-65 years old.

Nanda, U., Eisen, S., and Baladandayuthapani, V. (2008). Undertaking an Art Survey

to Compare Patient Versus Student Art Preferences. Environment and Behavior,

40(2), 269-301.

Evidence- Based Art

A total of 380 inpatients were interviewed via telephone shortly after discharge and asked questions about six environmental sources of satisfaction and dissatisfaction inside the patient room and outside the patient room. The study found that hospital interior design features were the most common room features, and the second most common hospital features, mentioned by participants in the study (over other environmental elements such as architectural features, ambient environment, social features, remodeling/ construction, or parking). Only maintenance outside the patient room received a higher score than interior design. The only comments made in reference to the decoration were about the artwork. The inclusion of art programs in healthcare facilities has the ability “to create a more uplifting environment�.

Hathorn, K, and Nanda, U. (2008). A Guide to Evidence-based Art. A Position Paper for

The Center for Health Design’s Environmental Standards Council. http://www.

healthdesign.org/chd/research/guide-evidence-based-art.

Patient and Family Perspectives and Preferences Relating to Healthcare Facilities

Focus groups were conducted at three different healthcare settings (acute, ambulatory, and long-term) and five different facilities in various cities to conduct this study.

Researchers identified that access from the parking lot to the building, a floor plan that facilitates navigation, visibility and accessibility to nature, ADA compliancy, and a comfortable waiting area for family were among concepts that clinic guest responded positively to.

Stern, A., MacRae, S., Gerteis, S., Harrison, T., Fowler, E., Edgman-Levitan, S., Walker,

J., and Ruga, W. (2003). Understanding the Consumer Perspective to Improve

Design Quality. Journal of Architectural and Planning Research, 20(1), 16-28.

Presence of Nature

This study conducted by Brad Davis examined how the inclusion of a rooftop garden at a Tennessee medical impacted the rehabilitation process for patients. Davis improved on past research by choosing to focus on the emotional and physical effects that gardens have on patients. While the research notes that it is important to view nature through windows, the physical experience of actually being within nature can be therapeutic. It was observed that the garden quickly became a place for meetings, casual walks, and community involvement because it was considered a “reprieve” from the hospital atmosphere. Research was conducted through interviews, patient surveys, and behavioral observations. Limitations include the small sample-size and the preexisting preference for nature that many patients expressed prior to the study.

Davis, B. (2011). Rooftop Hospital Gardens for Physical Therapy: A Post-Occupancy

Evaluation. Health Environments Research and Design Journal, 4(3), 14-43.

Privacy and Acoustic Properties of Materials

The study examined how recycled fabric composites can be used to absorb sound and control acoustics in interior spaces. Due to the porous properties of recycled fabric composites, high-frequency sound waves were easily absorbed. Researchers noted that increasing the thickness of the fabric resulted in sound absorption performance of medium-and-low-frequency sound waves to be slightly lower. Acoustics are important to consider in healthcare clinics to ensure client privacy as doctors and administrative secretaries openly discuss personal information in the facility. The authors did not identify any limitations.

Lou, C., Lin, J., and Su, K. (2005). Recycling Polyester and Polypropylene Nonwoven

Selvages to Produce Functional Sound Absorption Composites. Textile Research

Journal, 75(5), 390-394.

Waiting room Design

The dissertation researched to discover if “layout, seating and elements of positive distraction in the pain center waiting room related to the patients experience of pain and distress?” Through the use of a mixed- method approach, researchers were able to study 39 participants discovered that design can help to improve a patient’s body by improving surroundings. More studies on this subject are currently being conducted to help explore more possibilities and connections between design and healing properties.

Draper, H. (2012). Pain center waiting room design: An exploration of the relationship

between pain, comfort and positive distraction. (Order No. 1508585, Arizona

State University). ProQuest Dissertations and Theses, , 113. Retrieved from http://

ezproxy.uky.edu/login?url=http://search.proquest.com/docview/1011000826?accou ntid=11836.

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Wall Color Preferences

Park completed this study to take a look at how color is perceived at pediatric clinics and its affect on the health of a child. There were no significant differences between the colors selected by healthy children and patients, however, healthy children showed a stronger preference for yellow. All test subjects showed an affinity towards blue or green. White was the least favored colored for all children. The research method consisted of a pilot study of 63 children of various ethnicities and a main study of 153 children. The experiment was conducted by creating multiple models of different colors that simulate a patient’s room.

Park, J. (2009). Color Perception in Pediatric Patient Room Design: Healthy Children vs.

Pediatric Patients. Health Environments Research and Design Journal, 2(3), 6-28

Wayfinding

Researchers examined the difficulty of a first-time patient attempting to navigate through a health clinic. In a study, subjects were 62 percent more likely to report feeling “totally lost� in a plan that is symmetrically designed. Results from research showed that symmetrical plans, while perceived as boring, are also confusing due to their repetitive and monotonous nature. Suggestions for establishing distinctions include color coding, using various lighting techniques, and signage (which had a 52.2 percent success rate). Building maps placed at the entrance and throughout the building are beneficial to first-time visitors. Windows are also helpful additions because patients can identify landmarks that are outside the building to help them find their way to their destination.

Baskaya, A., Wilson, C., and Ozcan, Y. (2004). Wayfinding in an Unfamiliar Environment:

Different Spatial Settings of Two Polyclinics. Environment and Behavior, 36(6).

PATIENT FALLS

Environmental Variables that Impact Patient Falls

Safety Precautions for the Elderly

Researcher Mary Tinetti began her study by initially identifying that over one-third of elderly people will fall at least once a year. Injuries sustained from these falls can inhibit movement and the ability to perform daily activities. Some precautions that can be taken to prevent falls of elderly patients are the inclusion of handrails and non-slip flooring materials, along with sitting down with the elderly to discuss safety measures.

Tinetti also identified that including adjustable beds in clinic rooms has the ability to reduce blood pressure by keeping the head elevated. Older patients have a higher possibility of experiencing a fall during the month following hospital charge and during severe illness. The research method used by Tinetti consisted of reviewing 57 studies that focused on falls and taking precaution for elderly people.

Tinetti, M. (2003). Preventing Falls in Elderly Persons. The New England Journal of

Medicine, 348(1), 42-47.

Restrictions of Limb Movement

Various methods of modeling and rendering were used during this study to examine body movements of an injured person. Researchers believe that with this understanding there will be improvements in the physical therapy profession. Limb injuries result in restricted body movement, so it is important to consider ergonomics.

The research method used was mathematically based on kinematics, a branch of mechanics, to create the body renderings and to determine barriers. The experiment was limited to finger, wrist, and shoulder movements.

Abdel-Malek, K., Yang, J., Brand, R., and Tanbour, E. (2004). Towards Understanding the

Workplace of Human Limbs. Ergonomics, 47(13), 1386-1405.

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THERAPEUTIC ENVIRONMENTS Key Factors that Enhance Staff Satisfaction, Improve Patient Outcomes Reduction or Elimination of Environmental Stressors:

Environmental stressors can be removed or reduced from the patient experience through the inclusion of soothing artwork, adequate personal space in public areas such as lobbies, and visual and acoustical privacy. Designers should be very aware of the sensitivity of the patient’s senses when evaluating the acoustical properties of materials, lighting options, air quality, and the colors used in the space, as these are traits that have influence over comfort and stress levels. Stress of patients is also linked to unclear wayfinding. Landmarks and signage are great techniques to direct users of the space throughout the facility.

Presence of Positive Distractions:

Despite the negative connotations of the term, some distractions can be beneficial to include in healthcare design. Access to nature, soft music, and some pets can be considered positive distractions. Providing areas that allow for short walks are also nice to include so visitors can relax and collect their thoughts. Whenever patients are exposed to nature, whether through a window or through physical contact, studies show notable declines in stress levels.

Enable Social Support:

It is important to include support areas for friends and family of the patient. There is a wide range of time spent by these people as they wait for their loved one to be seen.

Designers can cater to their needs by including furniture that is comfortable for sitting and sleeping and an Internet and phone connection. Seating arrangements should be sociopetal and encourage conversation and interaction. Since many family members and friends also accompany the patient to attend the medical appointment with them, designers should provide seating and accommodations for them in the examination room.

Give a Sense of Control:

Patients should have control over certain environmental settings so they can customize their experience to suit their individual needs and wants. Features that the patients should have some level of control over include privacy, lighting brightness, and radio and television channels and volume. Patients should also have the power to select their meal from the menu when it is time to eat and should be provided with storage options so they can become settled into their new temporary space.

Staff Benefits Received from: - - - - - - -

Noise reduction Same-handed patient rooms Access to daylight Providing offstage areas for respite Proximity to other staff Use of technology Decentralized observation, supplies, and charting

Smith, R, and Watkins, N. (2010). Therapeutic Environments Forum. AIA Academy of

Architecture for Health. http://www.wbdg.org/resources/therapeutic.php.

+ UNIVERSAL DESIGN PRINCIPLES: 1. Equitable Use The design is useful and marketable to people with diverse abilities.

- Provide the same means of use for

all users: identical whenever possible; equivalent when not.

- Avoid segregating or stigmatizing any users.

- Make provisions for privacy, security and safety equally available to all users.

- Make design appealing to all users.

2. Flexibility in Use The design accommodates a wide range of individual preferences and abilities.

- Provide choice in methods of use.

4. Preceptible Information The design communicaticates nescessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities.

- Use different modes (pictoral, verbal,

tactile) for redundant presentation of essential information.

- Maximize “legibility” of essential information.

- Differentiate elemtns in ways that can be described (ex: make it easy to give instructions or directions).

- Provide compatibility with a variety of techniques or devices used by people with sensory limitations

5. Tolerance for Error The design minimizes hazards and the adverse consequences of accidental or unintended actions.

- Arrange elements to minimize hazards

and errors: most used elements, most

accessible; hazardous elements

eliminated, isolated or shielded.

- Provide warnings of hazards and errors.

- Provide fail safe features.

- Discourage unconcious action in tasks

that require vigilance.

- Accomodate right - or - left handed acccess and use.

- Facilitate the user’s accuracy and precision.

The design can be used efficiently and - Provide adaptability to the user’s comfortably and with a minimum of fatigue. pace.

- Allow user to maintain a neutral body

position.

- Use reasonable operating forces.

- Minimize repetitive actions.

Use of the design is easy to understand,

- Minimize sustained physical effort. regardless of the user’s experience, knowledge, language skills, or current concentration level.

- Eliminate unnecessary complexity.

6. Low Physical Effort

3. Simple and Intuative Use

7. Size & Space for Approach & Use

- Be consistent with user expectations Appropriate size and space is provided for and intuition. approach, reach, manipulation and use - Accommodate a wide range of regardless of user’s body size, posture or literacy and language skills. mobility.

- Provide effective prompting and

- Provide a clear line of sight to important feedback during and after task

elements for any seated or standing user. completion.

- Make reach to all components comfort

able for any seated or standing user.

- Accomodate variations in hand and grip size.

- Provide adequate space for the use of

assistive devices or personal assistance.

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+PRECEDENT ANALYSIS Studying current clinic facilities to highlight important design aspects that could influence future design.

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//REHABILITATION CENTRE: Groot Klimmendaal Location: Arnhem, Netherlands | 2011 Firm: Architectenbureau Koen Van Velsen BV

Users:

Patients

Family Members

Members of the Community.

Features:

Landscape and nature provide a soothing atmosphere for patients. Continuous connection between interior and exterior.

The Building Composition 1st level- Offices 2nd level- Clinical areas 3rd level- Ronald McDonald House Double height ground floor Swimming pool

Sports facility Fitness Restaurant

//THE DESIGN CONCEPT: Groot Klimmendaal “The care concept is based on the idea that a positive and stimulative environment increases the well-being of patients and has a beneficial effect on their revalidation process. The design ambition was not to create a center with the appearances of a health building as part of its surroundings and the community.”

Its has an open welcoming environment to allow for many activities to occur in it’s natural habitat for care. The architect wanted to collaborate the building with its users. He did this through designing a shallow timber staircase that runs through the full height of the building.

This encourages interaction for the users to see what is available on every floor to invite them into the spaces.

The designer uses a combination of large and small voids to give a spatial connection of the buildings interior with the outside.

Daylight shines through these voids into the space along with artificial lighting.

The building was built to be sustainable through the material choices that were chosen for the finishes, ceilings, façade cladding and through many other features, including the thermal storage – heat and cold.

(Mechanical and electrical installations).

The overall idea for the building was to use the complex features of nature’s environment by integrating transparency, continuity, layering, diversity and light and shadow with the design.

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//UNIVERSITY OF KENTUCKY Sports Medicine & Physical Therapy Clinic Location: 601 Perimeter Drive, Suite 200 I Lexington, KY 40517

Users: Patients, Family Members,

Sports Medicine Doctors, Physicians, Nurses, Techs., Athletic Trainers, and Administrative Staff.

Features: Windows surrounding the

building allow for light to enter every space.

The Building Composition 1st level- Sports Physical Therapy Clinic Weight Training Clinic Table Exercise Equipment

Open Gym Floor

Private Patient Rooms

Tech. Desk/ Waiting Area Administrative Offices Restroom

2nd level- Sports Medicine Clinic

Tech. Desk/ Waiting Area

Private Patient Rooms

Physician Computer Room Administrative Offices Breakroom

//DESIGN CONSIDERATIONS The University of Kentucky HealthCare Sports Medicine Clinic is located directly above the UK Physical Therapy Clinic.

Windows surround the entire building, which creates a positive healing atmosphere for patients and medical employees. Although the spaces are not heavily designed there is a concept of health and wellness throughout the building. Sports related artwork is hung to allow for patients of look at interesting images. In the physical therapy clinic, framed sports jerseys are located in the private patient room to add interest.

In the sports medicine clinic, patients are greeted by a waiting area and tech. desk.

Private patients rooms are located around a U shaped hallway to the right of the waiting area. All patients are seen in private rooms as to give patients maximum privacy.

To the left of the clinic, changing areas lead to the X-Ray room to give patients a place to store personal items. Past the X-Ray room, administrative, athletic trainer, and a physician offices are located to help run the facility. The sports medicine clinic has a stagnate feel and flexibility of spaces is not prohibited due to the design of the space.

The physical therapy clinic is a much more open and active space. The open floor plan in the gym room allows for trainers to help patients strengthen and heal their bodies through a variety of methods.

Some private patient areas allow for therapists and patients to have a private session depending on the injury or course of treatment. The location of the clinic allows easier access for patients who might have difficulties entering the space.

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+INDIVIDUAL RESEARCH STRATEGIES: Observation Examining a sports medicine clinic through casual and systematic observations to understand the successes, failures, and daily operations of the facility.

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CASUAL OBSERVATION Date: Friday, September 13, 2013 Time: 2:00 pm- 4:00 pm Location: University of Kentucky HealthCare Sports Medicine/Physical Therapy Clinic Firm members present: B. Murphy, M. Wilson, and C. Gilbert.

- Is the waiting room designed in an efficient manner to easily allow patients to sit?

- What is available to patients who might have difficulty walking?

- Is the check in process efficient?

Goals: View daily operations in clinic and begin to understand how users in the space interact as well as gain an understanding of how the space functions.

Purpose: To look throughout the space to ask questions regarding perceived potential issues.

- Does this space compromise patient privacy?

- Is the current storage system working to help the clinic?

- Do windows in private patient rooms help patients heal faster/doctors enjoy their day more?

UNIVERSITY OF KENTUCKY HEALTHCARE SPORTS MEDICINE & PHYSICAL THERAPY CLINIC

- Is the current filing system one that improves or hinders productivity?

- Why are paper files used?

- Do doctors utilize this space?

- How do they use it?

In groups or one at a time?

- Is it possible that patient privacy could be compromised by utilizing this space?

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SYSTEMATIC OBSERVATION Date: Wednesday, September 18, 2013 Time: 3:00 pm- 4:30 pm Location: University of Kentucky HealthCare Sports Medicine/Physical Therapy Clinic Firm members present: B. Murphy, M. Wilson, and C. Gilbert.

Goals: Designate key spatial areas of interest and prepare observation assumptions. View users in the clinic space.

Purpose: Develop a greater understanding of how the clinic functions. As a result, be able to utilize found information for future clinic adjacencies.

INITIAL PRESUMPTIONS BEFORE OBSERVATION Waiting Area

- Patients would not understand the proper check in procedures.

- Tech desk would become crowded with patients attempting to check in.

- Patients would be unable to locate restrooms and would ask for assistance.

- Patients would spread out through waiting area and would not sit next to one

another.

Private Patient Rooms and Hallway

- Doctor workstation areas would get crowded and cause pathway issues.

- Patients would be confused about check out process and where to go.

- Patients with wheelchairs or other equipment would have a hard time travelling

through doors and through hallways.

- Patients would interpret doors leading to computer room and tech. desk as an

exit.

- Layout of space would cause excess walking for employees.

X-Ray Waiting Room

- Many patients will need to receive an x-ray, as well as use the dressing rooms.

- Employees that work in the x-ray room will not travel frequently to the

administration room, and vice versa.

- Phone room employee will travel between her desk and the administration room

often to receive private records and exchange information with the other

workers that handle private information of patients.

- Doors will be closed and employees would speak in lower voices to protect the

privacy of patients.

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PRIVATE PATIENT ROOMS & HALLWAY Location: University of Kentucky HealthCare Sports Medicine/Physical Therapy Clinic

DOCTOR + RESIDENT OBSERVATIONS - Hallway creates a ‘U’ with private patient rooms

- 2 corner rooms are designated for casts - 4 doctors are stationed on one side, 3 on other - They only work with patients on their sides - Workstations for doctors to collaborate on each side of ‘U’

- Computer, phone, schedules, supplies

- Doctors gather at these areas to communicate about their patients. Discussing

private issues dealing with patient injuries.

- Look at info on computers, check off schedules, make phone calls, record patient info.

ISSUES - Need to be more private because they are discussing private patient issues.

- Crowds the hallway causing circulation problems - Patients have to say “excuse me” and go around/through them while they are talking - X ray screens are in hallway cause crowding of pathway SOLUTIONS - Have a central core area for the doctors to collaborate in that is close to the patient rooms but allows for just enough privacy - Having scattered private cores doctors can go to discuss patient issues - Creating wider hallways that allow for more than 2 people to pass through - Having a core for computer screens and x ray screens so patients and doctors can look and discuss them while being out of the way of the path of travel - Having x ray and computer screens in each patient room

PATIENT OBSERVATIONS - Many of the patients were limping on one leg. One man had just gotten his cast off and could barely walk; no one helped him while he was wobbling his way down the hall holding onto the wall for support.

- New patients had to ask which way to exit ISSUES - New patients were confused when leaving room after exam was over.

One patient tried to exit through a doorway that was leading to the computer room.

- Patients had to excuse themselves around the doctors that were congregating out in the hall to get by.

SOLUTIONS - Having signage or installation so patients can recognize where they are.

- Limiting open doorways so it doesn’t confuse patients with the exit doorways.

- Have a wider hallway.

- Give doctors area to collaborate somewhere else besides in the open hall to eliminate traffic issues.

- Make equipment available for those who have trouble walking or someone to assist them.

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TECHNICIANS OBSERVATIONS - Manage patients coming in - Deal with setting up new patients - Insurance issues - Computers - Charts/files organize in wheel buckets - Copy/print behind them ISSUES - Not an organized flow – too much going on - Check in process interrupts their job - Have to deal with Charts - Multitasking - Had back turned to patients when organizing charts SOLUTIONS - Creating a space that has areas designated for each task

- Printing, copying, charts, talking to patients

- Creating barriers to hide clutter from patients

- Having more storage

- Having a recognizable check in area and process

- Technological devices for check in – ipads?

- Have proper signage or an installation that makes area noticeable to patients

that this is where they first go when entering the space

- Having at least one or two people sitting at the check in desk to help patients - Patient chart filing system that is hidden from patient’s eyes or having them electronically on the computer - Separate areas for check- out and for techs working behind desk, but have these areas be adjacent

PATIENT COORDINATOR OBSERVATIONS - Walked around a lot to bring patients back and to check patients out, gives therapy slip etc.

ISSUES - Had to walk all over the clinic to get patients from waiting room and bring them back and also to check them out - Too much travelling for one person - Because only one person was doing this, the process took longer causing patients to wait SOLUTIONS - Hire more staff members to fulfill this position - Have check out in patient rooms rather than hallway and having to go back and forth - Develop a separate area where patients go to check out with staff there to finish check out process

5

ADMINISTRATIVE ASSISTANT OBSERVATIONS - Walked around throughout the day and worked in the storage room - Moved constantly - Dealth with the organizations of the clinic ISSUES - Storage room was visible to patients.

- Storage room is in middle of hallway causing confusion and traffic.

- Standing in hallway – causing a traffic block SOLUTIONS - Create area designated for storage that is hidden from patient views. Maybe inside central core for doctors, or in an area that blocks views from patients to see the clutter - Develop an area for emergency supplies that is close to patient rooms but is smaller and only used when necessary - Have an area for patient coordinator and assistant to hang out at so they are out of the way of the pathway traffic

RESIDENTS- COMPUTER ROOM OBSERVATIONS - Sit at X-Ray computers - Stay in this space for the majority of the day - Utilize teamwork in the space ISSUES - Patients can see into this room while in hallway - May cause distraction to doctors inside who work on the computers because they are in-between the front desk and patient hallway/rooms - Very unorganized area with different storage units and computers - Mixed-use room - Need updated technology SOLUTIONS - Design a specific area for storage and for the computer equipment

- Have this be part of the central core for doctors and adjacent to techs.

- Separate storage from computers - Utilize updated equipment

35 6

WAITING ROOM & TECHNICIAN DESK Location: University of Kentucky HealthCare Sports Medicine/Physical Therapy Clinic

OBSERVATIONS - Windows help to illuminate the space and make the waiting room more open - Coffee table has no coffee or refreshments on it because it is in the middle of the day - Patients do not sit close together. They are spread out through the space.

- No music is playing - T.V. is not on - Door to X-Ray hallway is located in the waiting room - Patient coordinators and administrative staff walk constantly across clinic to perform different tasks - Technician desk is where many patients congregate - After seeing the doctor, patients go back to the tech. desk to ask if they can leave (even when they have a next appointment slip) - Patients have difficulties:

- Checking in

- Locating the restrooms/water fountain even though there are signs in the

waiting room

- Knowing where to go when their name is called ISSUES - Patients do not see the “check in desk” and walk straight towards the techs for assistance in checking in. This issue slows down the entire check in process and creates patient buildup in the center of the waiting room - Patients walk up and down hallway looking for restrooms and have to go ask technician desk where the restroom is - Patient coordinators and administrative staff waste time walking and run into patients - Some patients have a difficulty moving through the waiting room after seeing the doctor SOLUTIONS - Design a desk with two separate stations for check in and registration - Place registration desk on an angle so patient build up does not block waiting room - Develop more intentional adjacencies so clinic staff does not have to travel as far - Give technicians easy access to waiting room to better assist patients - Place X-Ray room closer to private patient rooms so traffic does not have to travel through waiting area - Focus on patient satisfaction in waiting area (entertainment and ambiance while promoting health and wellness) - Allow for restrooms and water fountain to be seen from waiting room - Create wider pathway in center of waiting room - Place receptionist’s office closer to tech. desk/clinic manager to better relay messages and to improve communication

37

X-RAY & WAITING ROOM Location: University of Kentucky HealthCare Sports Medicine/Physical Therapy Clinic

OBSERVATIONS - Fluorescent lighting - Very wide doors for accessibility - Neutral color scheme with navy blue accents

- Pale yellow and beige floor tiles and paint on walls

- Navy blue accent tiles

- Blue upholstery w/ geometrical shapes

- Black and white sports related photography - Slip resistant floor tiles - Only one patient needed an x-ray during our visit and she did not use the locker - Administration room employees and x-ray room employees crossing paths while travelling across the hallway - The phone room employee only left her office once ISSUES - X-ray room employee had to travel across hallway and through the administration room just to retrieve a water bottle - A lot of noise coming from the administration room in the form of voices and machinery - Frequent traffic between the administration room and the x-ray room - Dressing/ locker rooms were not used during observation SOLUTIONS - Place the break room in a central area - Place the administration room right next door to the x-ray room, or place both rooms in a larger space that is shared, but divided with a thin wall or panel.

- Provide soundproof walls and materials for areas that require sharing of private information - Since the x-ray waiting room was not utilized much, eliminate it and just designate an area in the main waiting room for patients that need an x-ray.

- After consolidating the main waiting room and the x-ray waiting room, place the dressing/locker rooms directly adjacent to the main waiting room.

39

+ INDIVIDUAL RESEARCH STRATEGIES: Interview

Developing insights into the sports medicine field by viewing the world through they eyes of people who utilize the facilities the most.

41

EXPERT INTERVIEW (CLINIC MANAGER) September 13, 2013. 3:00 p.m.

DEMOGRAPHICS Age: 50 Gender: Female Ethnicity: Caucasian

PSYCHOGRAPHICS Active in the field: 20+ years Job Title: Athletic Trainer

UK HealthCare Sports Medicine Clinic Manager Diet: Healthy lifestyle.

UK HEALTHCARE SPORTS MEDICINE CLINIC 1..What are your thoughts about this clinic? Is there a sense of community within the staff?

2. Describe your staff team.

3. What is the check in process like for patients?

4. What is the waiting room like on a daily basis? Does it ever get too full?

5. Describe the process of the staff when a patient gets called?

6. Are all of the patient rooms private?

7. What is the age range of patients you see?

8. What is the check out process like?

9. How effective is technology in your space right now?

10. How would you improve the current clinic?

OVERALL EXPERIENCE 1. Do you feel that the staff has adequate room for the tasks and functions they have to perform?

2. What are your thoughts of having the physical therapy clinic on the first floor and the sports medicine clinic on the second?

3. Are there any improvements you would like to make to create a more enjoyable space and an overall better experience while at work?

“Almost everyone always passes the ‘sign in’ table and goes straight to the administrative desks. No matter how many times we move the sign, people do not see it!”

“Windows are important. Going from our old building to this building with windows drastically changed everyone’s behavior to be more positive and it improved our overall “Have more accessible areas for older people, a lot of our doors are not for the handicapped and it is a big issue.”

“Sometimes the hallways do get a little crowded especially when patients and a doctor are looking at x-rays on the screens out in the hallway.”

“Having more technological advances would be ideal. We do not have it in our budget right now, but a lot of clinics are moving towards using technology in the check in process and most have client files on a computer system.”

ANALYSIS Interviewing the clinic manager allowed us to get an understanding of how the space works and how it does not work. She was very aware of what does not function very well in the space. One of the major issues they have is the check in process. They were given this space so they had to work with what they had. There is a random ‘sign in’ table that patients almost always walk right past, and instead go to the three technicians behind the desk disrupting their work. Another issue she mentioned is that the waiting room can get crowded which usually happens early in the mornings.

One main concern she discussed was the space is not handicap accessible. Another issue the clinic was working on was transferring all

of the charts onto the computer. Right now, the files take up a lot of space cluttered the office. One of the positive aspects of their office she mentioned is having windows. She said this has greatly impacted the staff’s behavior making them more positive and happy to be at work. This has overall created a sense of community for them; she said they are like a family. Based from this, we can see how she primarily focused on the negative areas of their space and understood what did not work. From there, we can begin to think of why and how these areas are an issue and investigate further through observations and conducting more research.

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CLIENT-BASED INTERVIEW (PATIENT) September 19, 2013. 7:00 p.m.

DEMOGRAPHICS Age: 22 Gender: Female Ethnicity: Caucasian New or returning patient: Returning Occupation in medical/nutrition field (Y/N): No Equipment needed throughout injury: Multiple knee braces, crutches, wheelchair

PSYCHOGRAPHICS Injury: Knee (ACL Reconstruction, Medial Meniscus repair) Sports related injury (Y/N): No. Not sure what caused initial injury. Second, reoccurring injury was from jumping 5in. off the ground. 3rd surgery was bone reconstruction due to failed surgery. Finally, 4th surgery was reconstruction and final repair.

Workout habits: Restricted due to injuries Diet: Healthy, fruits, vegetables, balanced meals.

UK HEALTHCARE SPORTS MEDICINE CLINIC 1. What kind of experience did you have when you first came into the clinic?

2. Describe the your experience with the staff and doctors.

3. What is the check in process in the clinic?

4. Describe the waiting room and how you feel in it.

5. On average, how long do you wait in the waiting room?

6. Describe what happens when your name is called to go and meet with a doctor.

7. Describe your thoughts on the private patient room.

8. After being taken to the room, how long does it take for the doctor to arrive?

9. Describe your experience with your doctors, nurses, athletic trainers or residences.

10. Describe the check-out process. Is it convenient for you? Easy to understand?

UK HEALTHCARE PHYSICAL THERAPY CLINIC 1. Describe the staff.

2. What is the check in process in the physical therapy clinic?

3. What is your experience and comments on the waiting room?

4. On average, how long to do wait in the waiting room?

5. Describe what happens when your name is called to go and meet with a doctor.

6. Describe your thoughts on the private patient room.

7. After being taken into the private physical therapy room, how long does it take for the physical therapist to arrive?

8. Describe your experience with the physical therapy open gym.

9. Describe the check-out process. Is it convenient for you? Easy to understand?

OVERALL EXPERIENCE 1. Do you feel that you can travel through the space well without assistance from staff?

2. What are your thoughts on having the physical therapy clinic on the first floor and the sports medicine clinic on the second?

3. Were your expectations of the clinic achieved or do you feel unsatisfied?

4. What improvements would you make to either of the clinics to make your experience more enjoyable?

“I think a major issue would definitely be the fact that you can hear the doctor saying one thing to the resident outside your door because the room is not sound proof, but he said something completely different to you when he is in the room. This might be an issue with only my doctor, but you can hear all conversations in the hallway.”

“Personally, I think the process isn’t that productive. Putting a slip of paper in a box and waiting to get called allows for other people to get seen before you that arrived after you. It is also confusing for new patients.”

“Many rooms are available for private areas. There can be congestion on the open tables sometimes, but that is just when the clinic is crowded with a lot of patients. Sometimes the front desk can be crowded because of people trying to pay or schedule appointments.”

“Maximum, I have waited for up to two hours. Time management isn’t their strong suit. It is very difficult to wait for that long of a time and I find myself dreading attending my check-ups.”

ANALYSIS The patient interview revealed that patients notice when there are issues in the functioning or layout of the space. Major issues that are apparent is that patient privacy is not protected due to the poor acoustical properties in the space and the check-in process that can be found in the waiting room is not efficient. The patient also noted that the time spent in the waiting room is too long and ultimately has a negative effect on the patient’s ability to

heal. Moving forward in the design, more attention will need to taken into the planning of adjacencies in the space. Compressing patient travel time and eliminating unnecessary steps in the operational aspect of the clinic will help to eliminate any discomforts patients might feel. Improving patient satisfaction in the space will allow for patients to feel more comfortable and to be able to heal more quickly.

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+ CONCEPT DEVELOPMENT Clarifying the deepest structure of the goals and research topic.

47 47

PROJECT STATEMENT

Located in Nashville, Tennessee, the design for this sports medicine and physical

therapy clinic is influenced by evidence-based design principles. The overall objective is to improve the lives of those that visit Flex Vanderbilt Medical Complex through an examination of health and evaluation of what it truly means to be a community. The sports medicine clinic will occupy the entire second floor (14,970 square feet) of the seven-story new construction medical complex. A branded entryway with a clear circulation path built around the three distinctive athletic, arts and healing, and childcare zones, with retail and dining options placed as connectors to maintain continuity, will occur on the first level. By offering diverse amenities targeted to various age groups, the goal of Flex Vanderbilt is to inspire guests to take greater interest in their physical and mental health.

Initial research showed that a disconnection is often present between the needs of

patients and what the built environment provides. Flex will resolve this issue by placing emphasis on universal design principles, which will enable all patients to explore the space without being restricted by a physical or unseen handicap. Highlighting patients abilities, rather than their disabilities is a goal Flex strongly wishes to achieve. Careful consideration will go into arranging adjacencies and using the square footage to its full capacity. Other design objectives include maximizing privacy of both the guests and staff, incorporating up-to-date technology, bringing nature’s elements inside and the promotion of health education. By achieving these goals and valuing the clinic’s relationship with both the Gulch and Vanderbilt University communities, Flex Medical Complex will solidify their commitment to healing and overall well-being that will not only enhance, but accelerate, the recovery process.

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HISTORICAL ASSESSMENT OF SPORTS MEDICINE [28]

[30]

[29]

[28]

[29]

[18/19]

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+THEORIES OF CARE Developing an understanding of where sports medicine has been in the past and learning how to proprel into the future.

53 53

CURRENT TRENDS

Trends & Concerns for Sports Medicine Physicians

1. Concussion Management

- Concussions can have long-lasting implications that can harm athletes while they are on the field and in their life after they have retired as well.

- Research is being done on the biochemistry of head injuries and high impact sports are developing protocols for concussion management and prevention.

- Professional teams and leagues are now relying more on physicians and medical

providers to make decisions about when athletes can return to play. The athletes

can’t return until they are cleared by the team physician, and most physicians are conservative with their judgments.

Design Opportunity: Provide spaces in the sports medicine clinic for MRI scans of injured/recovering patients and create a space where physicians can research their findings.

2. ACL Injuries

- Athletes of all ages and in all sports are at a high risk for anterior cruciate ligament (ACL) injuries and technology is becoming more a more advanced to help researchers understand this injury.

- Surgeons, specifically, are looking at anatomic ways to reconstruct the ACL with less invasive procedures.

- The new procedures use grafts that stretch from where the initial ligament starts to where it ends to more closely mimic natural anatomy.

Design Opportunity: Technology is beginning to understand that mimicking the flexibility of the human body will yield better results with injured patients. Flexibility throughout the space will help to repeat the current trends in research.

3. Playing Surface

- The surface on which players practice and play on can have a large impact on injuries.

- Research is discovering that synthetic turf (while is it more durable and has a low (upkeep) can predispose athletes to knee, ankle, and leg injuries.

- More studies could reveal a more controlled environment in the future.

- Developing new shoes to help defeat athlete injury are in the works to help battle turf related injuries.

Design Opportunity: The realization of turf injuries have created a market for a retail spaces that could promote specialized shoes for various sports. This space would go above any beyond a shoe retailer and combine sports medicine studies into their designs.

4. Injury Prevention

- A newer field in sports medicine has been emerging over the past couple of years and it focuses on the prevention of injuries in athletes.

- “We look for potential injuries as well as asymmetries between the two sides of the body. We have been looking at hundreds of athletes over the past several years to see if there is a correlation of different scores and asymmetries with injuries over time.” – Dr. Karas.

- This system of testing is currently very expensive, but in the future it could be priced reasonably to help students better learn how to protect their bodies.

Design Opportunity: Include a space where this type of advanced technology can be practiced. Creating a large gym space will allow for researchers to have the space to have students run so they can track their movements with a computer.

5. Recovery Process

- The goal of the recovery process is to have athletes return to the field to play at the same level, or higher, than they were before.

- Injury evaluations now include ultrasound technology that gives surgeons the

opportunity to see a ruptured tendon or gap alignment in real time.

[26]

OUTPATIENT CLINIC DESIGN TRENDS “Almost all hospitals already include some outpatient diagnostic and treatment spaces.

Many outpatient construction projects are responses to hospitals’ increased outpatient workloads. Existing outpatient facilities within hospitals are expanded, overhauled, and updated. Such a renovation can serve a number of important functions in addition to that of giving the hospital a new outpatient focus. It may create improved circulation patterns or it may replace obsolete clinical areas with state-of-the-art services for use by inpatients as well as outpatients. Light-filled lobbies can give a friendly new face to hospitals that had been dour and intimidating—a new image that is very valuable in today’s competitive climate.” [37]

-Increased outpatient health care is a result of :

Less expensive to build and operate than a hospital More effective use of space Fire code requirements are less demanding Mechanical and electrical systems can be of a simpler scale Less staff are required

Clinic Layout

- Promote staff efficiency by shortening the travel distance between heavily utilized spaces.

- Design with support spaces in key locations so they can be shared by adjacent

functions. Multiple users utilizing one space will help to increase efficiency.

- Group or combine functional areas with similar system requirements.

- Emphasis on careful programming to ensure that all spaces are crucial to the clinic.

Flexibility and Expandability

- Follow modular concepts of space planning and layout.

- Plan with future expansion in mind.

- Establish standard room sizes so spaces can move as the clinic grows.

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Cleanliness and Sanitation

- Durable finishes - Antimicrobial surfaces - Proper detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joints.

- Appropriate placement of housekeeping spaces.

- O&M practices

Easy Visibility

- Easy to find from the road through good directional signage.

- Easy to enter through a well- identified entrance, and a clear route for parking.

Accessibility

- Comply with the minimum requirements of the Americans with Disabilities Act (ADA) Therapeutic Environment - Using familiar materials with varied colors and textures.

- Views of landscapes - Nature scene of nature view is unavailable - Ample natural light - Quiet areas for mediation/ spiritual renewal

Aesthetics -

Artwork Bright and open public spaces.

Homelike and intimate scale in patient rooms and offices.

Attention to detail, proportions, color, and scale.

Security and Safety

- Promoting patient dignity and privacy by visual screening within exam rooms and sound insulation between exam and consultation rooms and other spaces.

[37]

Top 20 Worldwide Fitness Trends for 2012 1. Educated, certified and experienced fitness professionals 2. Strength training 3. Fitness programs for older adults 4. Exercise and weight loss 5. Children and obesity 6. Personal training 7. Core training 8. Group personal training 9. ZUMBA and other dance workouts* 10. Functional fitness 11. Yoga 12. Comprehensive health promotion programming at the worksite 13. Boot camp 14. Outdoor activities* 15. Reaching new markets 16. Spinning (indoor cycling) 17. Sport-specific training 18. Worker incentive programs 19. Wellness coaching 20. Physician referrals [38]

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Fitness Facility Design Trends for 2013 1. The use of large open space in fitness facility design.

2. Lots of windows to allow natural light into the activity spaces. Studies show that natural light plays a major role in overall body rhythm and energy is not produced from movement and exercise alone.

3. Natural lighting combined with crisp, clean design help to create an inviting fitness center. Incorporating earth tones and water features add to a serene and appealing atmosphere.

4. Interesting punches of color and accents on walls, flooring, equipment and décor contribute to energy levels and work together to inspire the workout.

[39]

Gensler’s Design Forcast 2013 Workplace Trends 1. “It’s the Economy”- mobility is reducing and real estate is changing to fit the changing work environment.

2. “Millennial Influence”- an increased interest in self-direction and self-expression. Community spaces (or makeshift ones) are in high demand with young professionals.

3. “Supporting Focus Work”- focus work is needed, but in conjunction with an open and collaborative work setting.

Health and Wellness Trends 1. “Focused on Staying Well”- proactively maintaining health (not just treating illness) is the new idea surrounding healthcare and wellness.

2. “Redesigned for Wellness”- increased focus on patient experience and communities are giving a new value to recreational open space.

3. “Accessible Healthcare”- offering neighborhood clinics as well as an increased integration of technology.

[40] http://www.gensler.com/uploads/documents/Gensler_Design_ Forecast_01_04_2013.pdf

CLINIC OVERVIEW: WHAT IS SPORTS MEDICINE & PHYSICAL THERAPY? SPORTS MEDICINE:

According to the Medical dictionary, “sports medicine is the branch of medicine concerned with injuries sustained in athletics, including their prevention, diagnosis, and treatment.” More than 1 million people in the United States are treated for sports injuries which are usually caused by inadequate warm-up exercises.

These injuries involve:

Muscle sprains, strains and tears

Shin splints

Runner’s knee

Pulled hamstrings

Achilles tendonitis

Ankle pain

Arch Sprain

Charley horse

Tennis elbow

Baseball finger Dislocations

Muscle cramps Burstitis Myofascitis Costochondritis Hernia http://medical-dictionary.thefreedictionary.com/sports+medicine

Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier.

PHYSICAL THERAPY:

1. “Treatment by physical means.”

2. “The health profession concerned with the promotion of health, the prevention of

disability, and the evaluation and rehabilitation of patients disabled by pain, disease, or injury, and with treatment by physical therapeutic measures as opposed to medical, surgical, or radiologic measures.”

“Physical therapy is the profession practiced by licensed physical therapists. According to guidelines published by the American Physical Therapy Association, physical therapy should be defined as the examination, treatment, and instruction of persons in order to detect, assess, prevent, correct, alleviate, and limit physical disability and bodily malfunction. The practice of physical therapy includes the administration, interpretation, and evaluation of tests and measurements of bodily functions and structures and the planning, administration, evaluation, and modification of treatment and instruction, including the use of physical measures, activities, and devices, for preventive and therapeutic purposes. Additionally, it provides consultative, educational, and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction, movement dysfunction, and pain.” http://medical-dictionary.thefreedictionary.com/physical+therapy

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OVERVIEW OF CLINIC TYPE - Sports Medicine is a specialty subfield of orthopedic medicine, a profession that

diagnoses and treats musculoskeletal problems.

- Field of medicine that focuses on improving how the body functions, recovering from an injury, and teaching ways to help prevent future injuries. [42] - One of the fastest growing sections of health care. [42] Provide treatments for: knee, leg, back, shoulder, hand injuries, joint pain, stiffness are a few disorders treated. Sprains, strains, dislocations, ligament injuries, minor fractures and avulsions, apophysitis, tendinitis, overuse injuries, cartilage injuries,

exercise- induced asthma, concussions, nutrition and supplement issues, diabetes, eating disorders, stress fractures, heat illness, and unique conditions for athletes with special needs. [43/44] - Goals of Sports Medicine: recover, improve, prevent, and perform. [43] - Doctors that practice sports medicine have an additional background education in sports- and work- related injuries.

- It is common for physicians to work long, irregular hours, and about fifty percent of doctors are currently clocking in over 50 hours per week (Sports Medicine Physicians).

- Along with diagnosing musculoskeletal injuries, a normal workday also usually

consists of interpreting results from x-rays and laboratory tests, as well as providing education and counseling for injury prevention.

- Other tasks completed by sports medicine doctors include supervision of the patient’s rehabilitation process, prescribing medication for treatment, and conduction of

research that is related to sports-related injuries.

- According the Bureau of Labor Statistics, forty-one percent of doctors work in private- for-profit facilities and twenty-five percent are self-employed.

- The average length of one session is around an hour for the initial check-up, and

can vary following the first appointment. Frequency varies depending on the injury sustained.

[22/23]

Sports Medicine Physicians - A physician with specialized training who promotes lifelong fitness and wellness, and encourages prevention of illness and injury.

- Leader of the sports medicine team, which also includes specialty physicians and

surgeons, athletic trainers, physical therapists, coaches, athletes, and other personnel.

-Experience sports medicine physicians with a primary specialty in Family Practice,

Internal Medicine, Emergency Medicine, Pediatrics, or Physical Medicine and

Rehabilitation.

- Specialize in musculoskeletal problems, which include:

-- Acute injuries (such as ankle sprains, muscle strains, knee & shoulder injuries,

and fractures)

-- Overuse injuries (such as tendonitis, stress fractures) - Trained in the non-musculoskeletal aspects of sports medicine:

-- Mild traumatic brain injury and other head injuries

-- Athletes with chronic or acute illness

-- Nutrition, supplements, ergogenic aids and performance issues

-- Exercise prescription for patients who want to increase their fitness

-- Injury prevention

--“Return to play� decisions in the sick or injured athlete

-- Strength training and conditioning

-- Healthy lifestyle promotion [41]

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+ PROPOSED GOALS & OBJECTIVES Clarifying the ideals that will help to unite The Gulch and influence the community through fitness and a healthy lifestyle.

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PROPOSAL FOR ENTRY LEVEL

“A universal and holistic approach to a healthy lifestyle. Breathing life into the community.�

Lungs: Part of the respiratory system. Each lung fills up with air after each breath allowing oxygen in our bodies to enable growth and energy for our cells.

Brain: Part of the nervous system. The brain stem is what keeps a person breathing. It is in charge of all functions of the body and is our need to stay alive.

Heart: Part of the circulatory system. It pumps blood throughout the body providing oxygen that was breathed in through the lungs.

TRAINING FACILITY: lungs

(With coordinating retail option)

CONNECTION TO BUILDING

Focus on health and promotes physical activity.

COMMUNITY OUTREACH

Welcomes the community to exercise and offer neighborhood group fitness classes.

ACTIVITIES

Running, walking, washing, stretching, lifting, toning, spinning, jumping, strengthening, throwing, climbing

NEED FOR FACILITY

In the Gulch area there is a significant lack of workout facilities that allow for patrons to exercise that their own leisure. Many of the current businesses only offer small, personalized workout programs where a large sense of community is not offered.

ARTS & HEALING FACILITY: brain (With coordinating retail option)

CONNECTION TO BUILDING

Utilize alternative healing methods through the arts to educate users of the space in a “non-competitive” atmosphere as well as promote health and wellness.

COMMUNITY OUTREACH

Attract users who are interested in the arts. Generate a community space for artists/art appreciation.

ACTIVITIES

Relaxing, viewing, learning, reading, enjoying, socializing, listening, thinking, creating

NEED FOR FACILITY

In the surrounding area of Nashville there are no spaces to promote a healthy lifestyle in alternative methods. This space has the potential to introduce a variety of users to the practices of balanced living.

CHILDREN’S EDUCATIONAL FACILITY: heart (With coordinating retail option)

CONNECTION TO BUILDING

Offer daycare services for the community and employees. Provide after school program for children along with summer camps to emphasize healthy learning and wellness.

COMMUNITY OUTREACH

Provide a safe learning environment for children.

ACTIVITIES

Playing, learning, running, laughing, enjoying, participating, educating, babysitting, developing, teaching, socializing NEED FOR FACILITY Daycare spaces are available in Nashville, but they are only available for younger children. In the surrounding area, there is a need for a safe space for children to play after school. This space has an opportunity to begin to plant the seed of healthy living within a child and that seed has the potential to spread throughout the community. 65 [36]

PROJECT GOALS AND OBJECTIVES Goal: Privacy Performance Requirements: The facility should be equipped with visible and acoustical privacy to enable patient comfort during examinations and physical therapy sessions while also protecting patient confidentiality.

Concept 1: The design of the space will include private examination rooms to create an environment for patients to feel comfortable revealing personal information to doctors and not feel self-conscious about their injury or their body.

Concept 2: Sound-absorbing materials will be used in areas where personal and private conversations will occur to protect personal information of patients.

Concept 3: A touchdown area will be included exclusively for doctors to discuss patient medical issues in an environment that is secluded from public areas including the lobby and open hallways.

Goal: Comfort Performance Requirements: The design should cater to the medical needs and healing process of the clinic patients because most will be experiencing a physical disability.

Concept 1: Integrate technology into the registration and check-in stage so patients with a hand, wrist, or arm injury can still easily complete the process without needing to write as well as incorporating more technological advances throughout the whole space.

Concept 2: The layout of the patient exam rooms will be thoughtfully arranged so that patients who have injured their leg, foot, or hip will not need to travel far to reach their destination.

Concept 3: Bariatric design features will be included to accommodate larger guests.

Goal: Circulation Performance Requirements: The design should facilitate movement throughout the clinic by including clear sightlines, wayfinding strategies, and following ADA guidelines that will easily be understood and accommodate sports medicine patients.

Concept 1: The design of the first floor will be divided into three distinctive sections for an athletic training facility, a childcare education facility, and an arts and healing facility to create landmarks for easy navigation.

Concept 2: There will be no visible obstructions and very clear signage so that users of the spaces have a clear view of where they are travelling.

Concept 3: The design will include wide hallways so patients using crutches, walkers, and wheelchairs can easily move throughout the clinic without causing traffic jams.

How the goals and objectives were acheived through the final design: + Privacy: Discussion of Patient’s Medical Issues

+ Private patient rooms for exams, changing & P.T. sessions + Doctor touchdown areas to discuss patients medical issues

+ Private offices for physicians and staff

+ Comfort: Highlighting Ability rather than Disability

+ + + + + +

Technology: Check-in/out Presence of nature Providing privacy options Bariatric furniture Eliminating travel distance Providing assistive equipment

+ Circulation: Providing easy Wayfinding Strategies for Patients of all Ages

+ Wide hallways to avoid traffic issues + Identifiable Landmarks such as elevator, stairs and atrium + Pathways provided with branded signage and wayfinding features

67

6

+ CLIENT & USER ANALYSIS Gaining a clear understanding of the user groups who will be interacting in the space to better design for their needs.

69 69

INTERDISCIPLINARY TEAM MEMBERS Vanderbilt University- Client

Contact: Nicolas S. Zeppos, chancellor

Vanderbilt Healthcare- Client

Vanderbilt Sports Medicine staff- Consultants

Contact: Andrew Gregory, M.D., FAAP, FACSM

Contact: Warren Dunn, M.D., M.P.H.

Vanderbilt Sports Medicine patients- Consultants

Vanderbilt Orthopaedics- Client

Contact: Kurt Spindler, M.D., Head Team Physician

Gresham, Smith and Partners- Architecture and Engineering

Contact: Patricia West, Senior VP Healthcare department

IKON Construction, Inc.- Contractors

Todd Morrow, senior construction manager

University of Kentucky Orthopaedic Healthcare- Sports Medicine

Contact: Sherri McNew, Director of Athletic Training Services

Contact: Sara-Elizabeth Bush, Patient University of Kentucky Professor

Contact: Lindsey Guinther

Contact: Sabrina Mason Nutrition Healthcare firm- Consultants Renae Mantooth, designer Jennifer Seymour, designer Bella Yunker, designer

PATIENT AND VISITORS Vanderbilt University students, faculty,& staff The Gulch community of young urban upper class natives Those who are near the area and want to live a healthy lifestyle

Overview: - Residents of The Gulch and surrounding Nashville neighborhoods.

- Interested in the idea of community and how space can help facilitate the growth of a healthy community.

- Has the desire to become a member at a fitness gym.

- Has the desire to utilize childcare services.

- Has the desire to develop mind through art education.

- Any age range.

- Individual who is interested in heath/wellness and the continuation of a healthy

lifestyle.

- Individual who is in the process of healing from an injury.

- In need or an X-Ray or MRI. - Student who is involved with an athletic trainer.

- Interested in the idea of community and how space can help facilitate the growth of a community.

Community of Nashville

Metro Population: 1,647,200 Major Industries: Tourism, Health care, Education Gross Metro Product: $82.8 B Median Household Income: $52,424 Median Home Price: $159,600

Unemployment: 6.5% Job Growth (2012): 3.9% Cost of Living: 1.4% above nat’l avg College Attainment: 30.6% Net Migration (2012): 15,330

Education

High School Attainment: 87.4% College Attainment: 30.6% Graduate Degrees: 10.4%

http://www.forbes.com/places/tn/nashville/

71

PATIENTS & VISITORS FROM THE GULCH Gulch Demographics Population:

Male: 6,168 Female: 5,266 Total: 11,431

Median age: 34.8 years old Occupational employment:

White collar: 81.15% Blue collar: 18.85%

Household info:

Family households: 2,125

Non-family households: 3,708

Households with children: 1,151

Households without children: 4,681

Average person per household: 1.78

Total households: 5,833

Household income:

Median Median Median Median Median Median Median

income income income income income income income

under 25: $15,192 25-34: $28,228 35-44: $31,957 45-54: $36,557 55-64: $34,054 65-74: $26,842 over 75: $18,771

Marital status:

Never married: 4,622 Married: 1,356 Separated: 1,195 Widowed: 629 Divorced: 1,281

Education statistics

No high school: 170 Some high school: 854 Some college: 1,583 Associate degree: 240 Bachelor’s degree: 1,359 Graduate degree: 1,069

http://www.point2homes.com/US/Neighborhood/TN/Nashville/The-Gulch-Demographics. html http://www.nashvillegulch.com/index.php/dining

PATIENTS & VISITORS FROM VANDERBILT UNIVERSITY Vanderbilt Demographics Size:

330 acres 234 buildings 18.2 million square feet University: 5.8 million square feet, 32% Medical: 10.2 million square feet, 56% Real estate: 2.2 million square feet, 12%

Total Enrollment (Fall 2013):

Undergraduate: 6,835 Graduate & Professional: 5,950 Total: 12,795

Admission Rates (Fall 2013):

First-year applicants: 31,099 Admits: 3,963 Admit rate: 12.7% Enrolled First-Year Students: 1,613

Gender and Ethnicity Breakdown (All Undergraduates, Fall 2013)

Female: 50% Male: 50% American Indian or Alaska Native: 0.4% Asian or Hawaiian/ Pacific Islander: 8.5% Black/ African American: 8.0% Hispanic (of any race): 7.9% Two of more races: 4.9% Total minority enrollment: 29.6% International: 5.9%

Enrollment by Region (All Undergraduates, Fall 2013)

South: 35% Midwest: 19% Middle States: 17% Southwest: 9% West: 8% New England: 6% International: 6%

http://admissions.vanderbilt.edu/profile/#enrollmentfall2012 http://www.vanderbilt.edu/info/facts/ 73

Enrollment by Region (All Undergraduates, Fall 2013):

College of Arts and Science: 4,197 School of Engineering: 1,350 Peabody College of Education & Human Development: 1,780 Blair School of Music: 193

Academics

Undergraduate colleges and schools: 4 Graduate and professional schools: 6 Total full-time faculty (excluding Medical School and School of Nursing): 1,041 Student-to-faculty ratio: 8:1 Female faculty: 28% Minority faculty: 15% Faculty with Terminal Degrees: 97% Undergrad classes w/ fewer than 50 students: 91% Undergrad classes w/ fewer than 30 students: 78%

Employment (2013): Staff: Full-time: 20,160 Part-time: 764

University Central: Full-time: 4,014 Part-time: 188

Medical Center: Full-time: 16,146 Part-time: 576 Faculty: Full-time: 3,672 Part-time: 430

Campus Life

Percent of students living on campus: 83% Student organizations: 510+ First-year student retention rate: 97%

Housing

First year residence halls: 10 All residence halls and apartments: 29

Commodore Athletics

Varsity teams: 10 women’s, 6 men’s Women’s teams: Basketball, Bowling, Cross Country, Golf, Lacrosse, Soccer, Swimming, Tennis, Track and Field, Men’s teams, Baseball, Basketball, Cross Country, Football, Golf, Tennis

NCAA championships: 1 Club sports: 41 Intramural sports: 40+ School colors: Black and gold Mascot: The Commodore

Life After Vanderbilt

Students graduating in four years: 87% Students graduating in six years: 93% Number of living alumni: 120,000+ Number of alumni chapters worldwide: 41

Where is the Vanderbilt Class of 2013?

Employed: 55% Graduate or professional school: 31% (of this group, 72% admitted to first choice school) Other (e.g.: undecided, volunteering, traveling, etc.): 13%

Research Information (2013):

Total research expenditures: $571.3 million

Sponsored research and project awards: $616.1 million

Medical center: $471.6 million

University: $144.5 million

NIH funding: $339.8 million

Hospitals and Clinics (2013):

Licensed hospital beds: 1,019 Discharges: 57,768 Impatient days: 307,292 Ambulatory visits: 1,833,337 Emergency visits: 119,225 Total cost of charity care, community benefits, and other unrecovered costs: $843.6 million

75

STAFF TEAM MEMBERS Sports Medicine Staff

Entry Level Staff:

Physicians Medical doctor Doctor of Osteopathy Podiatrist Nurse X-Ray Technician MRI Technician Physicians Assistant Physical Therapist Athletic Trainer Kinesiotherapist Massage Therapist Exercise Physiologist Biomechanist Nutritionist/Dietetics Sport Psychologist Coaches Strength and Conditioning Specialist Social Worker Front Desk Technician Receptionist Clinic Manager Patient Coordinator

Open Gym:

Sports Medicine Staff General Characteristics Work 50 + hours a week High responsibility High physical activity High decision making Low repetitiveness High level of competition Medium level time pressure High critical thinking and problem solving High technology design and control High verbal skills High levels of math and science High levels of leadership (5)

Receptionist Manager

Athletic Trainers

Personal Trainers Assistants

Yoga Classroom: Manager

Educated Instructors Assistants

Art Classroom:

Manager

Art Teachers

Children’s Education:

Certified Caretakers

Program Director

Activity Coordinator

Educated Instructors Nutritionist Nurse Receptionist

Dining: Manager Cooks Cashiers Servers

Retail: Manager

Sales associates Cashiers

Stock room employees

Cleaning Staff:

Maitenance Janitors

Custodial Workers Security

77

+ SITE ANALYSIS Studying the context of Nasvhille to understand the needs of the area at every level of organization.

81 79

THE GULCH “... WHOSE NAME COMES FROM A TOPOGRAPHICAL DEPRESSION THROUGH WHICH TRAINS HAVE CHUGGED SINCE THE 1880S — WAS ONCE A RUN-DOWN INDUSTRIAL AREA DOTTED WITH ABANDONED WAREHOUSES.” [12] HISTORY - The story of the Gulch begins with the history of the railroad in Nashville.

- In the 1850s the Gulch was a fissure in the face of Nashville that helped to define the western edge of town.

- Five railroad lines entered the city in 1861 and Nashville became a transportation hub during the Civil War. - In 1896, the Gulch was filled with more than three- dozen tracks and a massive round house.

- For the next five decades the Gulch was the place where commuters and travelers arrived and soldiers departed for the war during the World Wars.

- In 1956, the railroads discontinued the commuter service and passenger rail ended completely by 1979. Commercial transport shifts to the highways and air. [13]

TIME FOR A CHANGE - The initial concepts were to “plop office buildings on top, elevate the train shed on piers and create a “festival marketplace” beneath, put a new library within, and make the Gulch a park.” None of these ideas became a reality.

- Union Station was renovated into a hotel in the 1980s and Cummins Station became an office and retail space in the 1990s, but the Gulch still continued to be stagnant.

- Steve Turner helped to create the Nashville Urban Venture with investors and developers to help to change the lackluster Gulch. Their vision was not to try to make the Gulch match the rest of Nashville, but to create a new urban neighborhood. [12/13]

TODAY - “Self-consciously modern and contemporary.”

- This is Nashville’s “cutting edge district that pushes the design envelope to the limits of basic good urban design.”

- Structures are mid-rise, mixed-use, and are open and welcoming to the public on the first floor to generate a sense of community.

- Major intersection is where Eleventh and Twelfth Avenues intersect. This vibrant area of the Gulch is geared towards the residents living in the area rather than tourists. [13] - Old renovated warehouses renovated into residential, office and upscale restaurants with vibrant nightlife.

- Features:Chic settings, eclectic settings, live music, urban fashion, high-end fashions and authentic. [13]

Initial drawings of the Gulch development/ neighborhood planning. [13]

SITE ANALYSIS OF NASHVILLE

STAR Physical Therapy “specializing in spine therapy, manual therapy, and industrial rehabilitation.” [17]

Nashville Sporting Goods Team Sports “providing Nashville with all of its sports equipment needs.” [16]

1000 Hawkins Street Nashville, TN 37203 Vanderbilt Sports Medicine “treats all kinds of patients, not just athletes. Specialize in knee and shoulder injuries.” [15]

Youth Life Learning Center “faith-based, intensive afterschool academic centers for children growing up in inner city neighborhoods.” [14]

LEGEND Sports Medicine

Sporting Retail

The Gulch

Orthopedic

Childcare

Vanderbilt Campus

Physical Therapy

Site

81

SITE ANALYSIS OF THE GULCH

Takes 2 Fitness Professional trainging and fitness studios.

LEGEND

Broadways Gym “Our clubs classes, training sessions and equipment variety offer an array of exercise programs to keep you active and your workouts fun and exciting.” [17]

Exercise Facility

Childcare

The Gulch

Retail

The Site

Proposed Gulch Expansion

Dining

goPerformance & Fitness “...provide a personalized fitness club for beginners, fitness enthusiasts, and athletes with an emphasis on introducing new and innovative forms of exercise.” [16]

The Chrome Bar Intensive dance exercise class with a modern twist.

CrossFIT Forte Forging Elite Fitness. “independently owned strengthening and conditioning gym or ‘box.’”

[10]

Julia’s Body SHOP Bootcamp style exercises.

Observations - The Gulch is a fully developed neighborhood filled with all of the amenities that could make a resident feel at home.

- Another incredibly populated area in downtown Nashville is Broadway.

- The retail/dining options surrounding the site are very limited.

- Two four star restaurants are the only dining options to the site within

walking distance.

- Workout facilities/gyms in The Gulch are focused towards personal bodybuilding, intensive training, and individualized fitness plans.

- The majority of these centers are small and utilize unusual methods of

exercise.

- These centers market to individuals who are serous about improving their

health and seeing drastic results.

Design Implications - Moving forward in the design process, it is imperative to recognize the lacking retail and dining spaces available for future users of the sports medicine clinic to utilize.

- In order for The Gulch to expand and grow, the programming of the new clinic should cater to the current needs of the community and to the users, families, staff, and visitors of the clinic.

- Create more opportunities to attract users to the area through a new clinic, opportunities for shopping, and dining.

- By including a community centered gym in the first floor of the clinic users will have increased opportunities to build relationships with those utilizing the space.

83

SITE CONTEXT

LEGEND Site

Sidewalk

Current entrance to site

Parking

Bike Lane

Proposed entrance to entry level

Proposed green space

Tree

Traffic pattern

Clinic

Bus Stop

SUN PATH ANALYSIS Legend Path of the Sun Sunrise Position of the Sun at 10:00 am Sunset

January 1st at 10:00 am Main Entrance Placement

May 1st at 10:00 am

The location of the sunrise in Nashville in relation to the context of the site helps to give justification for the placement of the main entrace to the entry level of the space. Designing large windows on the eastern portion of the building will allow visitors, patients, and staff to see the sunrise when the clinic opens in the morning. Daylight throughout the space will be a critical element to conveying health and wellness to the users of the space.

September 1st at 10:00 am [25]

85

LINE OF SIGHT ANALYSIS

3

2 1

Legend Current view from city to the site Extended view once 7 story building is constructed Views out that extend

Views out with end point

SITE VIEWS

1

2

3 Site Visit= October 6, 2013

87

+ SPATIAL NEEDS Researching the requirements of a sports medicine facility to better plan for the spatial needs of the users.

91 89

// CLINIC SPATIAL NEEDS PRIMARY AREAS:

QUANTITY:

SF/UNIT:

NSF:

P.T. Open Gym:

1

50-65 sqft

1,000 2,000 sqft

Waiting room: - add 60 NSF per every bariatric exam room

1

120 min. + 60 sqft

380 sqft

Kiosk, Patient Check- in:

1

30 sqft

60 sqft

Receptionist

1

150 sqft

150 sqft

Waiting Restroom:

2

65 sqft

130 sqft

Patient Education room:

1

120 sqft

120 sqft

Cast room:

1

180 sqft

180 sqft

Exam room - standard and bariatric:

8

120 sqft

960 sqft

I.T. for X-Ray/MRI:

1

150 sqft

X-Ray room:

1

450sqft

450 sqft

MRI room:

1

450 sqft

450 sqft

Doctor Touchdown

2

120 sqft

240 swft

150 sqft

6

// CLINIC EQUIPMENT SPATIAL NEEDS PRIMARY AREAS: P.T. Open Gym:

EQUIPMENT: Cycling Bike Treadmill Bench Press Stair Stepper Parallel Bars Balance boards - various sizes Balance discs (vestibular) Dyna board Combination board Rocker board Exercise balls Dumb bells

Kiosk, Patient check-in Waiting Restroom

NSF:

2 2 1 1 1 6 6 6 6 6 6 20 10

(49” x 26”) 50-65 sqft (77” x 35”) Per heavy (5’ x 5.5’) machine (5’ x 2’) (8’ x4’) (15”– 36”) (19.5” x 16”) (14” - 23.6”) (24” diameter) (20” diameter) (18” – 43”) (1 – 10 lbs) (.5 – 20 lbs)

Patient chairs: Standard Bariatric Stools End tables

11 8 3 2

(20” (30” (24” (21”

x 18.5”) x 24”) diam.) x 21”)

380 sqft

Reception Desk Desk chair

1 3

(72” x 29.5”) (20” x 18.5”)

240 sqft

ADA Toilet ADA Sink Grab bars

2 2 2

(31.5” x 20”) (17” min. D) (42” min)

130 sqft

Cuff weights Waiting room:

QTY AVE. SIZE:

91

// CLINIC EQUIPMENT SPATIAL NEEDS PRIMARY AREAS:

EQUIPMENT:

QTY.

SIZE:

Patient Education room:

Chairs Table Computer Projection Screen

4 1 1 1

(18” x 18”) (36”- 44”) on table on wall

Exam room/Cast room Standard & Bariatric

Treatment table Storage Cabinet Unit Chair Stool

1 1-2 2 1

(77” x 23”) (7’ x4’) (24” x 18” e.)

(29.5” x 28”)

I.T. for X-Ray/MRI

Computers Desk Desk chairs

3 2 2

on desk/wall (4’ x 2’) (20” x 20”)

X-Ray room MRI room

X-Ray machine MRI machine

1 1

(7’ x 2’) (15’ x 6’)

Doctor Touchdown

Desks Chairs Computers

2 2 2

(4’ x2’) (18” x 18”) on desk/wall

NSF:

// CLINIC EQUIPMENT SPATIAL NEEDS SUPPORT AREAS:

EQUIPMENT:

QTY.

SIZE:

NSF:

Refreshment table (waiting room):

Table with cabinets Upper cabinets Fridge

1 1 1

(18” x 24” e.)

(18” x 18” e.) (mini)

120 sqft

Changing room:

Chairs Lockers

4 12

(20” x 20”) ( 1’ x 18”)

150

Equipment Storage:

Shelves

3

(2’ deep)

120 sqft

Laundry room:

Washer Dryer

2 2

(27” x 30”) (27” x 30”)

150 sqft

sqft

93

// CLINIC SPATIAL NEEDS SUPPORT AREAS:

QUANTITY:

SF/UNIT:

NSF:

Refreshment table (waiting room):

1

30 sqft

30 sqft

Changing room:

2

75 sqft

150 sqft

Lockers

1

1.2 sqft

10 sqft

Equipment Storage:

1

120 sqft

120 sqft

Laundry room:

1

150 sqft

150 sqft

// CLINIC SPATIAL NEEDS STAFF/ADMINISTRATIVE AREAS:

QUANTITY:

SF/UNIT:

NSF:

Clinical Manager Office:

1

140 sqft

140 sqft

Private Offices: Physicians

10 3

120 sqft

380sqft

1

180 sqft

180 sqft

Administration

2

120 sqft

240 sqft

Computer/copier space:

2

120 sqft

240 sqft

Storage for Office Supplies:

1

60 sqft

60 sqft

Admin. Collaoration:

1

120 sqft

120 sqft

Touchdown space for DR.

2

120 sqft

240 sqft

Conference/classroom:

1

120 sqft

240 sqft

Lounge/break room:

1

180 sqft

180 sqft

Storage for files

1

120 sqft

120 sqft

Staff Restroom:

2

65 sqft

130 sqft

Athletic Trainers

95

// CLINIC EQUIPMENT SPATIAL NEEDS STAFF/ADMIN. AREAS:

EQUIPMENT:

QTY. AVE. SIZE: NSF:

Clinical Manager Office/ Private Offices: Physicians

Athletic Trainers Administration

Desk Desk chair Guest chair File cabinet

1 1 1 1

(72”x 29.5”) 100 (29.5” x 28”) 140 (15”x 26.5”) sqft (22.5”x 24.5”)

Computer room

Compter desks Desk chairs

3 3

(65” x 29”) (29.5” x 28”)

240 sqft

Copier space:

Copier/scanner/printer Cabinets (mail room) Shelves (mail room)

2 1 1

(2’ x 3’) (24” x 18” e.)

12” deep

100 sqft

Storage for Office Supplies:

Cabinets

1

(24” x 18” e.)

60 sqft

Admin. Collaboration

Seating Table

6 1

(20” x 20”) (5’ diam)

120 sqft

Conference/classroom:

Chairs Table

1 6

(18” x18”) (5’ x 2’)

180 sqft

Lounge/break room:

Seating End tables/Coffee Full Kitchen - D.W., REF., M.W. Table Chairs TV

8 2 1 1 4 1

(22.5”x 24.5”) 400 (2’ x2’) sqft

Computer - digital Shelves - charts

1 24

12” deep

120 sqft

Toilet Sink

2 2

(31.5” x 20”) 17” deep

130 sqft

Storage for files

Staff Restroom:

(5’ x 2’) (18” x18”)

// LOBBY/ENTRANCE SPATIAL NEEDS PRIMARY AREAS:

QUANTITY:

SF/UNIT:

NSF:

Entrance to space:

1

Information Desk:

1

120 sqft

120 sqft

Gym:

1

50-65 per machine

1,0002,000 sqft

Gym check - in desk

1

30 sqft

30 sqft

Children education/play space:

1

35 sqft per person

800 sqft

Nursery:

1

35 sqft per person

450 sqft

Daycare check - in:

1

120 sqft

120 sqft

Gallery:

1

wall/hang

wall/hang

Yoga studio:

1

20 sqft per person

700 sqft

Art studio:

1

15 sqft per person

600 sqft

Sports retail:

1

35 per person

500 sqft

Sports retail cashwrap:

1

120 sqft

120 sqft

Dining/food retail:

1

15 sqft per person

800 1,000 sqft

Dining/food cashwrap:

2

120 sqft

240 sqft

97

// LOBBY/ENTRANCE EQUIPMENT SPATIAL NEEDS PRIMARY AREAS:

EQUIPMENT:

QTY.

SIZE:

NSF:

Information Desk:

Desk

1

(72”x 29.5”)

Gym:

See chart above for equip.

1

See other chart

Gym check - in desk

Desk Desk chair

1 1

(72”x 29.5”) (29.5” x 28”)

120 sqft

Children education/ play space:

Interactive toys/equipment Seating Tables

8 2

(10” x 10”) (21” x 21”

800 sqft

Nursery:

Cribs, toddler cots Changing tables Rocking chairs

3 2 2

(58” x 33”) 35 (42.5” x 19”) sqft (35” x 25.5”) per child

Daycare check - in:

Desk Desk Chair

1 1

(72”x 29.5”) (29.5” x 28”)

120 sqft 1,0002,000 sqft

120 sqft

// LOBBY/ENTRANCE EQUIPMENT SPATIAL NEEDS PRIMARY AREAS:

EQUIPMENT:

QTY.

SIZE:

NSF:

Gallery:

Artwork displayed throughout space

1

Yoga studio:

Mirrors around room Barre around room Mats Exercise balls

1 1 20 20

(72” H) TBD See other chart

700 sqft

Art studio:

Chairs/stools Tables Sinks Storage cabinets

6 6 1 3 (6)

(18” x 18”) (5’ x 2’) (17” deep) (24” x 18” e.)

20 sqft

Sports retail:

Shelving Racks Display units

TBD TBD TBD

(16” - 31” deep) TBD

500 sqft

Sports retail cashwrap:

Cash register/check-out counter

1

120 sqft

50 sqft per person

Dining/food retail:

Food counter bars Drink bar Dining tables Chairs

1 1 7-10 30

(3’ x 3’) (18” x18”) (5’ x 2’) (18” x 18”)

1,000 sqft

Dining/food cashwrap:

Cash registers/check-out counter

2

120 sqft

25 sqft per person

per person

99

// LOBBY/ENTRANCE SPATIAL NEEDS SUPPORT AREAS:

QUANTITY:

SF/UNIT:

NSF:

Gym Storage:

1

120 sqft

120 sqft

Restrooms/showers in gym:

2- male/female

350 sqft

700 sqft

Daycare Storage:

1

120 sqft

120 sqft

Sports retail storage:

1

150 sqft

150 sqft

Dining/food storage:

1

350 sqft

350 sqft

Lockers

// LOBBY/ENTRANCE EQUIPMENT SPATIAL NEEDS SUPPORT AREAS:

EQUIPMENT:

QTY.

SIZE:

NSF:

Gym Storage:

Shelving

1

120 sqft

120 sqft

Restrooms in gym

1 ADA in each - male and female See charts above for equip.

2

350 sqft

700 sqft

Showers in gym:

1 ADA in each - male and female

2

(5’ x 3’)

Locker room in gym:

Lockers Benches

2

1.2 sqft

15 sqft 10 sqft

Daycare Storage:

Shelving

TBD

120 sqft

120 sqft

Sports retail storage:

Shelving

TBD

120 sqft

120 sqft

Dining/food storage:

Shelving Cabinet storage Counter space Refridgerator Freezer

TBD com-

350 sqft

mercial kitchen specialist

101

// CLINIC SPATIAL NEEDS STAFF/ADMINISTRATIVE AREAS:

QUANTITY:

SF/UNIT:

NSF:

Children’s Education offices

2

75 sqft

150 sqft

Gym admin. offices:

2

75 sqft

150 sqft

Staff break room

1

450 sqft

450 sqft

// LOBBY/ENTRANCE EQUIPMENT SPATIAL NEEDS STAFF/ADMIN. AREAS: Children’s Education Offices

Gym admin. offices:

Staff Break room

EQUIPMENT: Desk Desk chair Guest chair File cabinet (same ^)

Seating End tables/Coffee Full Kitchen - D.W., REF., M.W. Table Chairs TV

QTY. 2

SIZE:

NSF:

(72”x 29.5”) 150 (29.5” x 28”) sqft (15”x 26.5”) (22.5”x 24.5”)

2

150 sqft

8 2 1 1 4 1

(22.5”x 24.5”) 450

(2’ x2’)

sqft

(5’ x 2’) (18” x18”)

103

+ DIAGRAMMATIC ANALYSIS

Exploring the various ways that spaces can be connected to better improve workflow.

107 105

SPORTS MEDICINE CLINIC MATRICES LEGEND Adjacent Accessible Neutral Detrimental

Adjacency Matrix Sports Medicine Clinic 1. Waiting 2. Kiosk, Patient Check- in 3. Refreshment Table 4. Waiting Restroom 5. Clinic Manager Office 6. Storage for office supplies 7. Computer/ copier space 8. Playroom 9. Patient Education room 10. Consult room 11. Casting room 12. Exam room- standard 13. Exam room- bariatric 14. Changing room 15. Admin. Workstations 16. Admin. Collaboration 17. Private offices 18. Conference/classroom 19. Lounge/break room 20. Storage for e.records 21. Utility storage (clean) 22. Utility storage (soiled) 23. Equipment storage 24. Laundry room 25. I.T. for X-Ray/MRI 26. X-ray room 27. MRI room 28. Touchdown space for DR. 29. P.T. open gym 30. Staff restroom 31. Receptionist

Slip Resistant Flooring

Precesnse of Nature

Special Considerations

Special Equipment

H H H L

H H N N Y N Y M H H L

3. Refreshment Table

Y

H M N

Y N N Y

L

H H L

4. Waiting Restroom

Y

H N H

Y N N Y

L

H H L

5. Clinic Manager Office

N L

M H N N N Y

L

H H L

6. Storage for office supplies

N N N M N N N Y

L

L

7. Computer/ copier space

N N N H N N N Y L L N H H N N N N H H H N M L H N N N H M M N M L H N N N H M M

8. Playroom 9. Patient Education room 10. Consult room 11. Casting room 12. Exam room- standard 13. Exam room- Bariatric 14. Changing room 15. Admin. workstations 16. Admin. collaboration 17. Private offices 18. Conference/classroom 19. Lounge/break room 20. Storage for e.records 21. Utility storage (clean) 22. Utility storage (soiled) 23. Equipment storage 24. Laundry room 25. I.T. for X-Ray/MRI 26. X-ray room 27. MRI room 28. Touchdown space for DR. 29. P.T. open gym 30. Staff restroom 31. Receptionist

L

Flexibility

Y

Air Quality

2. Kiosk, Patient Check- in

Y N Y

Wayfinding

Y

Plumbing

1. Waiting

H H N

Criteria Matrix Sports Medicine Clinic

Privacy

Public Access

Y

Exterior Access

Daylight/ and or views

LEGEND H High M Medium L Low Y Yes N No Comments Bariatic seating

L

M L H H H H H H

N M L H Y Y N H L L H M N M H H Y Y Y H M M H L Highlight ability N M H H Y Y Y H M M H L Bariatric practices N M N H Y N Y H L L H L Secure storage N N M H N N Y Y M L H M Need private option N N H L Y N N Y M L H H N N M H N N Y Y M L H L Enclosed N L H L Y Y N Y H L H H N N H L Y N N Y H L H H N N N H N Y Y Y L L L L Cooling N N N M N N N H L L L L N N N M Y N N H L L L L N N N M N Y Y H L L L L Specific storage N N N M Y N N H L L L L N N N H N M L H N M L H N N L M N M H N

N Y Y H N Y Y H Y Y Y H N Y Y Y Y Y Y H

M L

M L

Cooling & storage

M M H L

See design con.

M M H L

See design con.

L

Private/collaborative

L

H L

H H H H Rubber flooring

N N H H Y N N H L L H L N N M H N N N Y L L H L

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ENTRY LEVEL MATRICES LEGEND Adjacent Accessible Neutral Detrimental

Adjacency Matrix Entry Level 1. Information desk 2. Elevator lobby 3. Restrooms 4. Janitor 5. Pump room 6. Storage 7. Stairs 8. Water fountain 9. Gym 10. Gym storage 11. Gym admin. offices 12. Gym check-in desk 13. Restooms/showers 14. Locker room 15. Children play space 16. Children education center 17. Nursery 18. Daycare check-in 19. Daycare storage 20. Daycare restooms 21. Lecture space 22. Gallery 23. Yoga studio 24. Art studio 25. Sports retail 26. Sports retail storage 27. Sports retail cashwrap 28. Dining/food retail 29. Dining/food storage 30. Dining/food cashwrap 31. Entrance to space

Precesnse of Nature

H H N

N

2. Elevator lobby

Y

H H N

Y N N H H H H L

3. Restrooms 5. Pump room

N H Y N N H L H H L N N N M Y N N H L N L L N N N M Y N N H L N L L

6. Storage

N N N M N N N L

7. Stairs

Y H L N N N Y H L Y H N N Y N N H L Y H H N Y Y Y H H N N N M N N N H L

4. Janitor

8. Water fountain 9. Gym 10. Gym storage 11. Gym admin. offices 12. Gym check-in desk 13. Restooms/showers

Y

18. Daycare check-in 19. Daycare storage 20. Daycare restooms 21. Lecture space 22. Gallery 23. Yoga studio 24. Art studio 25. Sports retail 26. Sports retail storage 27. Sports retail cashwrap 28. Dining/food retail 29. Dining/food storage 30. Dining/food cashwrap 31. Entrance to space

H High M Medium L Low Y Yes N No

Comments Y N H H H H L Clear

H

L

N L

L

H M L H H L H H H Rubber flooring N L

L

N N M M N N N L M N H L N H H L N N N H H H H L N H N H Y N N H L H H L

N H L H Y N N H L H H Y M H L Y Y Y H H H H 15. Children play space 16. Children education center Y M H L Y Y Y H H H H Y L M L Y Y Y H H H H 17. Nursery 14. Locker room

Flexibility

Y

Air Quality

1. Information desk

Wayfinding

Plumbing

Slip Resistant Flooring

Privacy

Special Considerations

Public Access

Special Equipment

Criteria Matrix Entry Level

Exterior Access

Daylight/ and or views

LEGEND

L Privacy H Related to health H Ed. opportunity H Support community

N H H M N N Y H H H H L N N N M N N N L L N L L N M L H Y N N H L H H L Y H H L N Y Y H H H H H Flexible for community Y H H N N Y N H H M H H Highlight health Y H M M N Y Y H H H H H Promote healthy mind Y H H M Y Y Y H H H H H Y H H N N N N H M H H H Encourage activity N N N M N N N L L N L L Y N H M N N N H M L H M Y H H N Y Y Y H H H H L Healthy eating habits N N N M N Y Y L L N L L Y N H M Y N Y H M L H L Y H H N N Y Y H H L H M Welcoming

109

SPORTS MEDICINE CLINIC ACCESS DIAGRAM

ENTRY LEVEL ACCESS DIAGRAM

111

1 //ALL PATIENTS ENTER INTO BUILDING

Enters Sports Medicine and Physical Therapy Clinic on second floor Patient checks in with receptionist

Patient comfortably sits in waiting area

User notices signage cues for elevator or stairs to take up to clinic area

They can watch TV, get a refreshment, read health magazines, enjoy the view or watch their child in the playroom

They wait until they are called to sign forms, update insurance etc. with desk technician

// NEW PATIENTS They sit back down and wait until they are called back by patient coordinator

Meet with physician’s assistant in exam room for procedural check ups

Waits for sports medicine doctor to come in for further examination

If doctor needs more information they may schedule or prescribe one or many of the following:

PATIENT FLOW CHART: CLINIC

2

// RETURNING PATIENTS

Patient checks in and travels to private room with patient coordinator for physical therapy treatment

Patient checks in and gets called to open P.T. gym by physical therapist

Strengthen weak muscles in private room with P.T. instructor

Strengthen weak muscles in P.T. open gym with physical therapist instructor

Potentially move to P.T. open gym to further strengthen muscles

MRI

X-Ray

Splint

Brace

3

Potentially move to private patient room to further strengthening with physical therapist

Medical Equipment

Cast

Physical Therapy Treatment

Prescription

All patients check out and set up more appointments or are discharged

//ALL PATIENTS EXIT SPACE

// POSSIBLE ANYTIME WHILE AT CLINIC

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1 //ALL VISITORS ENTER INTO BUILDING

User may ask information desk where a certain area is or they may explore the space on their own

User then decides what they want to do in the space given many options to choose from: Physical Fitness Gym Arts & Healing area Youth Education Ctr. Retail Dining

// ARTS & HEALING AREA Visitor can spend time enjoying artwork spread throughout the space or can create their own in the art studio

They can take a class such as Yoga, Pilates, Zumba etc. in exercise the studio

Visitor can experience nature through an outdoor running and walking path, or sit and relax in the garden area by the entrance

2 // YOUTH EDUCATION CENTER

Visitors can take their child/children to a daycare that educates them on how to live a healthy lifestyle

Visitors can leave their baby in the nursery where they will be watched with care Indoor and outdoor play areas with be provided to encourage physical activity

VISITOR FLOW CHART: ENTRANCE/LOBY

3

4

// PHYSICAL FITNESS GYM // R E T A I L & DINING Healthy food choices: Sandwich, soup and salad bar. Smoothie bar. Coffee bar.

Visitor can check in at gym and work-out on their own time or can schedule a time with physical trainer This area is open to any usertype and not a P.T. open gym for rehabilitation

Sports equipment and athletic wear offered in Vanderbilt branding and other brands

Various amounts of exercise equipment is provided in the space to use along with lockers rooms with showers and restrooms

Lobby Restrooms

Water Fountains

Stairs

Elevator

Visitors check out of some spaces, enjoy others or pay for their purchases

//ALL PATIENTS EXIT SPACE

// AVAILABLE ANYTIME FOR ANYONE

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+ CODE ISSUES Learning the boundaries of design through various resources.

119 117

ADA SPECIFICATIONS// BUILDING CODE COMPONENTS Accessible Routes

General

- At least once accessible route shall be provided within the site from accessible parking spaces and accessible passenger loading zones (public streets and sidewalks) and public transportation stops to the accessible building or facility entrance they serve.

- At least one accessible route shall connect accessible buildings, accessible facilities, accessible elements, and accessible spaces that are on the same site.

- An accessible route is required to connect to the boundary of each area of sport

activity. Examples of areas of sports activity include: soccer fields, basketball courts, baseball fields, running tracks, skating rinks, and the area surrounding a piece of gymnastic equipment. Where multiple sports fields or courts are provided, an accessible route is required to each field or area of sport activity.

Multi-Story Buildings and Facilities

- At least one accessible route shall connect each story and mezzanine in multi-story buildings and facilities.

- Spaces and elements located on a level not required to be served by an accessible

route must fully comply with this document. While a mezzanine may be a change in level, it is not a story. If an accessible route is required to connect stories within a building or facility, the accessible route must serve all mezzanines.

Employee Work Areas

- Common use circulation paths within employee work areas shall comply with 402.

- Common use circulation paths located with employee work areas that are less than 1000 square feet and are defined by permanently installed partitions, counters, casework, or furnishings shall not be required to comply with 402.

- Load and unload areas shall be on an accessible route. Where load and unload areas have more than one loading or unloading position, at least one loading and unloading position shall be on an accessible route.

- In court sports, at least one accessible route shall directly connect both sides of the court.

- Exercise machines and equipment is required to have an accessible route.

- Pay areas shall provide accessible routes. At least one accessible route shall be

provided within the pay area. The accessible route shall connect ground level pray components required to comply with 2412.1 and elevated play components required to comply with 240.2.2, including entry and exit points of the play components.

Parking

- Where parking spaces are provided, parking spaces shall be provided in accordance with 208.

- Minimum number of spaces:

1-25= 1

26-50= 2

51-75= 3

76-100= 4

- For hospital outpatient facilities, 10 percent of patient and visitor parking spaces provided to serve hospital outpatient facilities shall comply with 502.

- For rehabilitation facilities and outpatient physical therapy facilities, 20 perfect of patient and visitor parking spaces provided to serve rehabilitation facilities specializing in training conditions that affect mobility and outpatient physical therapy facilities shall comply with 502.

Drinking Fountains

- No fewer than two drinking fountains shall be provided. One drinking fountain shall comply with 602.1 through 602.6 and one drinking fountain shall comply with 602.7.

Exercise Machines and Equipment

- At least of type of exercise machine and equipment shall comply with 1004.

- Most strength training equipment and machines are considered different types. Where operators provide a biceps curl machines and cable-cross-over machine, both

machines are required to meet the provisions in this section, even though an individual may be able to work on their biceps through both types of equipment.

- Similarly, there are many types of cardiovascular exercise machines, such as

stationary bicycles, rowing machines, stair climbers, and treadmills. Each machine provides a cardiovascular exercise and is considered a different type for purposes of these requirements.

Play Components Number of Elevated Play Components Provided

Minimum Number of Minimum number of Ground Level Play Different Types of Ground Components Required to be Level Play Components on an Accessible Route Required to be on an Accessible Route

1

Not applicable

Not applicable

2 to 4

1

1

5 to 7

2

2

8 to 10

3

3

Building Blocks Floor or Ground Surfaces

- Floor and ground surfaces shall be stable, firm, and slip resistant and shall comply with 302.

- Carpet or carpet tile shall be securely attached and shall have a firm cushion, pad, or backing or no cushion or pad. Carpet or carpet tile shall have a level loop, textured loop, level cut pile, or level cut/uncut pile texture. Pile height shall be ½ inch (33 mm) maximum. Exposed edges of carpet shall be fastened to floor surfaces and shall have trim on the entire length of the exposed edge. Carpet edge shall comply with 303.

- Openings in floor or ground surfaces shall not allow passage of a sphere more than ½ inch diameter.

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Changes in Level

- Where changes in level are permitted in floor or ground surfaces, they shall comply with the previous section.

- Changes in level of 1evel of ¼ inch high maximum shall be permitted to be vertical.

- Changes in level between ¼ inch high minimum and ½ inch high maximum shall be beveled with a slope not steeper than 1:2.

- Changes in level greater than ½ inch high shall be ramped.

Turning Space

- Changes in level are not permitted in turning spaces.

- Circular turning space shall be a space of 60” - T-shaped space within a 60” square minimum with arms and base 36” wide minimum.

Each arm of the T shall be clear of obstructions 12” minimum in each direction and the base shall be clear or obstruction 24” minimum.

- Doors shall be permitted to swing into turning spaces

Clear Floor Space

- Clear floor or ground space shall be 30” minimum by 48” minimum - Alcoves shall be 36” wide minimum where the depth exceeds 24” - Parallel approach alcoves shall be 60” wide minimum where the depth exceeds 15”

Toe Clearance

- Space under an element between the finish floor or ground and 9 inches above the finish floor or ground shall be considered toe clearance.

- Toe clearance shall extend 25 inches maximum under an element.

- Space extending greater than 6 inches beyond the available knee clearance at 9 inches above the finish floor or ground shall not be considered toe clearance.

- Toe clearance shall be 30” wide minimum.

Knee Clearance

- Space under an element between 9 inches and 27 inches above the finish floor or ground shall be considered knee clearance.

- Knee clearance shall extend 25” maximum under an element at 9 inches above the finish floor or ground.

- Where knee clearance is required under an element as part of a clear floor space, the knee clearance shall be 11 inches deep minimum at 9 inches above the finish floor or ground, and 8 inches deep minimum at 27 inches above the finish floor or ground.

- Between 9 inches and 27 inches above the finish floor or ground, the knee clearance shall be permitted to reduce at a rate of 1 inch in depth for each 6 inches in height.

- Knee clearance shall be 30 inches wide minimum.

Protruding Objects

- Objects with leading edges more than 27 inches and not more than 80 inches above the finish floor or ground shall protrude 4 inches maximum horizontally into the circulation path.

General Egress Requirements Ceiling Height

- Egress paths have a ceiling height of not less than 7’6” although it is acceptable to have some projections that reduce the minimum headroom to 80” for any walking surface.

- Means-of-egress ramps may have a minimum headroom of 80” - Vehicular areas may have egress paths with a minimum clear height of 7’ - Egress areas about and below mezzanine floors are to have clear heights of at least 7’.

- Not more than 50% of the ceiling area of a means of egress may be reduced to an 80” height by protruding objects.

Elevation Changes

- If elevation change is less than 12” it must be sloped - When slope exceeds 1 in 20, then the transition should be made by an accessible ramp compliant with the provisions - Slopes rising less than 6” must be equipped with handrails on a floor finish that

contrasts with adjacent flooring - When objects, such as brackets or columns, occur in a means of egress, they shall not decrease the required width of the means of egress. Where these obstructions or projections do occur, additional width is needed to maintain the required egress width.

Egress Width

- Stairs are required to provide more width than corridors since people move more slowly in stairways than in corridors or passages.

- The door should project a maximum of 7” into the required width when fully opened against the wall of the passage - The opening of the door should not reduce the required width by more than one-half - Along narrow corridors, doors should be recessed. Minimum recess for a 36” door would be 29” - Nonstructural provisions, such as trim and similar decorative features, can project into the required corridor width a maximum of 1 ½” on each side Accessible Means of Egress - Stairways in an accessible means of aggress must be at least 48” wide between hand rails - “Area of Refuge”- An area where persons unable to use stairways can remain tempo rarily to await instructions or assistance during emergency evacuation - Area of refuge must provide space for one 30” X 48” wheelchair space for each 200 occupants of the space served

Doors, Gates and Turnstiles Egress Doors

- Should be no less than 80” and must have a minimum clear width of 32” (measured from the face of the door to the stop when the door is open 90 degrees.

- Side- hinged swing doors. Must swing in the direction of exit travel when serving an occupant load of more than 50 in a typical occupancy, or when serving any occu pant load in a high- hazard occupancy.

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Landings

- Width no less than that of the stairway or the door (whichever is greater) - Doors in the open position should not reduce the required width or depth of a landing by more than 7” - Minimum of 44” in length in the direction of travel, except they may be 36” long in residential occupancies - Doors in series must be at least 48” apart, not including the swing of each door.

(Where a 3’ wide door swings towards another door, the space between them must be at least 7’)

Ramps -

Minimum headroom on ramps is 80” (same distance as stairs) Ramps in a means of egress may not exceed a 1-in-12 (8%) slope Cross slopes in a ramp may not exceed 1 in 48 (2%) Ramps are limited to a vertical rise of 30” between intermediate landings Width in a means of egress shall not be less than the width of corridors, this width is typically 44” - Landings are to be provided at the top and bottom of each ramp and at changes in direction - The width of the landing shall be no less than the width of the adjoining ramps - The length of landings shall be a minimum of 60” - Landings may have a 1:48 slope (2%) for drainage - Doors opening onto a landing must not reduce the clear width to less than 42” - Ramps having a rise greater than 6” are to have handrails on both sides

Exit Signs

- Must be of an approved design, be illuminated by internal or external means, and have the capability to remain illuminated for up to 90 minutes after power is cut off, either by battery, internal illumination or connection to an emergency power source.

- Must be clearly visible and be not more than 100’ from any point in an exit-access corridor

Handrails -

Must extend horizontally for 12” beyond the top riser of a stairway Handrails are to be between 34” and 38” above the stair-tread nosing Must continue their slope for the depth of one tread beyond the bottom riser Stair width more than 30” from handrails does not count toward required egress capacity - Handrail extensions are not required where the handrails are continuous between flights

Exit

- The exit portion of a means of egress may include any of the following components: an exterior exit door at grade, exit enclosures and passageways, exterior exit stairs or ramps, and horizontal exits - Exits mark the end of the exit access and the beginning of the exit portion of a means of egress system

- Egress paths are not to lead through kitchens, storerooms, closets or similar spaces, through rooms that can be locked to prevent egress, or through sleeping areas or bathrooms in dwelling units - Egress paths may pass through kitchens that are part of the same dwelling unit or guestroom

ADA Restroom Clear Floorspace

- To accommodate a single wheelchair there must be at least 30” x 48” clear floor space - The space can be positioned for a forward or parallel approach to equipment Mounting Height Requirements - Washroom accessories may vary within a facility depending on the location of

individual accessories and the direction of reach required for their use.

- To allow side reach by people in wheelchairs, it is recommended that accessories be mounted with their dispensing mechanisms, start buttons, coin slots, or dispenser openings located 38” to 54” above the finish floor; and to ensure forward reach also, they must be located no more than 48” above the finish floor.

- However, depending on the depth of the obstruction, these can be mounted as high as 48” for forward approach and 54” for side approach. Mounting heights for children vary depending on age. The age groups are 3–4, 5–8 and 9–12 years.

Turning Space

- 60” in diameter is required by a single wheelchair to make a 180-degree turn - A 60” x 60” T-shaped turning space with 36” wide aisles to allow a three-point-turn is also acceptable

Single Door Entries

- A level and clear corridor or passageway leading to the door is recommended to be at least 48” wide - The doorway must have a minimum clear opening 32” wide when the door is open 90 degrees.

- The door should swing into a recommended minimum 60” x 60” level, clear space that has at least 18” (24” preferred) of clear floor space adjacent to the latch doorjamb.

- A minimum access aisle 48” wide is also recommended inside the washroom to

allow people in wheelchairs to get around obstructions, such as sight-barriers, and to accommodate simultaneous in and out traffic.

Opposing Doors

- Make sure that no hazard is created in the alcove by the simultaneous entry and exit of two wheelchairs.

- The width of the alcove must be a minimum of 48” plus the width of the door.

- It is difficult for a person in a wheelchair or using crutches to back up and pull open a door, so it is preferred that opposing doors swing in the same direction.

- This opposing door layout is unique because it provides doors that always open in the direction of travel, whether the patron is entering or exiting.

123

Alcoves

- Need not be large if they are properly planned. Just be sure that when the doors are in an open position, they do not diminish the minimum 48” wide access aisle required for a wheelchair to get around a sight barrier.

Open Vestibules

- Vestibules free of doors are by far the most universally usable because they are the least likely to cause problems for or prohibit use by people with disabilities.

- It is recommended that the entire passageway be at least 48” wide to accommodate simultaneous in and out traffic.

Doors

- Must push or pull open with a maximum of 5 pounds of force.

- Door handles, pulls, latches, locks, and other opening devices should have a shape that is easy to operate with one hand, without tight grasping, pinching, or twisting of the wrist; and they should be mounted no higher than 48” above the finish floor.

- Lever-operated mechanisms, push-type mechanisms, and U-shaped handles are

acceptable designs.

- If a door has a closer, it must be adjusted to provide a sweep period of at least three seconds for the door to move from an open position of 70 degrees to a position 3” from the latch.

Lavatories -

A barrier-free lavatory must not exceed a height of 34” Must extend at least 17” from the rear wall Have a clearance of at least 29” from the bottom of the apron to the finish floor To allow forward approach by people in wheelchairs, pro- vide clear floor space in

front of the lavatory that is at least 30” wide x 48” deep, with no more than 19” of the 48” extending underneath the lavatory.

- A minimum knee clearance 27” above the finish floor must extend at least 8” under the front edge of the lavatory.

- Toe clearance at least 9” above the finish floor must be provided for the full depth of the lavatory.

- If the lavatory is to be installed in a countertop, place it as close as possible to the front edge so it is accessible to even more people.

- If a wash fountain is installed in a facility, it is recommended that at least one barrier- free lavatory also be installed to accommodate those who may have difficulty using the wash fountain.

Washroom Accessories

- Must not project more than 4” into a clear access aisle if their leading edge is between 27” and 80” above the finish floor - If their leading edge is at or below 27”, then they may project any amount as long as the required minimum width of an adjacent clear access aisle is maintained.

- It is recommended that all floor-standing and surface- mounted units projecting more than 4” be located in corners, alcoves, or between other structural elements so as not to be a hazard to visually impaired

people or interfere with access aisles or wheelchair turning areas.

Mirrors

- Must be installed with the bottom edge of the reflecting surface no higher than 40” above the finish floor - A single full-length mirror is recommended in each washroom because it can be used by everyone, including children.

Soap Dispensers

- Installed over lavatories must be mounted so their push buttons are no higher than 44” above the finish floor.

- Lavatory-mounted soap dispensers and lever-handle faucets should be spaced far enough apart to avoid interference with their operations.

- It is recommended that soap dispensers that meet ADAAG specifications for controls and operating mechanisms be used throughout washrooms to provide universal usability.

Paper Towel Dispensers and Waste Receptacles or Warm – Air Hand Dryers

- Should be conveniently located in an area that is accessible to wheelchairs, preferably adjacent to a barrier-free lavatory.

- It is recommended that one hand dryer be mounted with sufficient clear floor space to allow both left- and right-hand wheelchair approaches; or provide two dryers, one for each type of approach.

- When a single hand dryer is installed in a washroom, it is recommended that the start button be located 38” to 40” above the finish floor - When two or more dryers are installed, mount one dryer so its button is 38” to 40” above the finish floor; - Locate others 41” to 48”.

Design Solutions for Large Public Washrooms

- Entrances and exits are properly laid out for universal access - Passageways and access aisles are at least 48” wide, 80” minimum clear height

throughout all circulation routes, passageways and access aisles - Wheelchair turning spaces whenever required - Accessories are fully recessed into the wall whenever possible - 30” X 48” minimum clear floor space is provided for each accessory - Lavatories, urinals, and toilet compartments meet or exceed ADAAG specifications - If 6 or more toilet compartments, there is a 36” compartment similar to the alternate compartment 36” wide in addition to the standard accessible compartment

Signs

- The international symbol of accessibility is required to be located at accessible parking spaces, accessible areas of refuge, at accessible toilet locations, at accessible entries, accessible checkout aisles, and at accessible dressing and accessible locker rooms.

125

Directional Signage

- When not all elements are accessible, there must be signage to direct people with disabilities to the nearest accessible element - These signs must have the international symbol of accessibility - Directional signage is required at inaccessible building entrances, inaccessible toilet facilities, inaccessible bathing facilities and elevators not serving an accessible route - All previous codes collected from resource (7).

SIGNAGE Zoning Sign Regulations Purpose and Intent

- Safety. Construct and display signs in a manner that allows pedestrians and motorists to identify, interpret and respond in an efficient and discerning manner to the following:

- Information related to public traffic control, directions and conditions;

- Movement of all other pedestrians and vehicles that impact traffic on a given

travelway; and

- Information other than public traffic related when displayed in a manner which

is clear, concise and noncompeting with public traffic information.

- Protection of Minors. Prohibit the location of signs that are harmful, or potentially harmful, to minors that include nudity or sexual activity through the exposure and/or exaggerated representation of genitals, buttocks and/or breasts.

- Graphic Continuity and Aesthetics. Organize signs in a manner that reduces visual

clutter and integrates signs with all other elements of the site and environs by

limiting the size, location and design of signs so that pedestrians and motorists have an equal right to view buildings, structures and natural features in the foreground and background.

- Protection of Future Public Right-of-Way. Limit the location of signs so that reasonable expansion of the public right-of-way can occur in conformance with the capital

improvements program and without disturbance of existing conforming signs.

- Activities and Services Identification. Based on a communities need to know,

provide for signs that identify the marketplace and the opportunities provided by the community.

Prohibited Signs

- It is unlawful to erect, cause to be erected, maintain or cause to be maintained, any sign not expressly authorized by, or exempted from, this title. Any prohibited sign(s) may be removed by the zoning administrator or his designee after notice to the property owner or occupant to remove such sign(s) within three days. The following signs are expressly prohibited are expressly prohibited: - Signs that are in violation of any other code adopted by the metropolitan government as stipulated in Section 17.32.020 - Signs or sign structures that interfere in any way with free use of any fire escape, emergency exit or standpipe, or that obstruct any window to such an extent that light or ventilation is reduced to a point below that required by any provision of this title or other ordinance of the metropolitan code;

- Signs that resemble any official sign or marker erected by any governmental agency, or that by reason of position, shape or color, would conflict with the proper functioning of any traffic sign or signal, or be of a size, location, movement, content, color or illumination that may be reasonably confused with or construed as, or conceal, a traffic-control device; - Signs that contain any lighting or control mechanism that causes unreasonable

interference with radio, television or other communication signals; - Signs placed upon benches, bus shelters or waste receptacles, except as may be

authorized pursuant to Metropolitan Code Section 12.48.090 - Signs erected on public property, or on private property (such as private utility poles) located on public property, other than signs erected by public authority for public purposes or as otherwise authorized by the metropolitan council;

- Signs with any copy, graphics, or digital displays that change messages by

electronic or mechanical means, where the copy, graphics, or digital display

does not remain fixed, static, motionless, and nonflashing for a period of eight seconds with all copy changes occurring instantaneously without any special

effects.

- Signs that incorporate projected images, emit any sound that is intended to attract attention, or involve the use of live animals; - Signs that emit audible sound, odor or visible matter such as smoke or steam; - Signs, within ten feet of public rights-of-way or one hundred feet of traffic-control lights, that contain red or green lights might be confused with traffic-control lights.

- Signs that are of such intensity or brilliance as to cause glare or impair the vision of any motorist, cyclist or pedestrian using or entering a public way; - Blank on-premises temporary signs; - Strings of incandescent light bulbs with wattage in excess of ten watts per bulb that are used on commercially developed parcels for commercial purposes other than traditional holiday decorations; - Signs, commonly referred to as wind signs, consisting of one or more flags which are not otherwise exempted, pennants, ribbons, spinners, streamers or captive balloons which are less than ten feet in their greatest dimension, or other objects or material fastened in such a manner as to move upon being subjected to pressure by wind;

Permanent On-Premises Signs

- Sign Types Allowed. A permanent on-premises sign may be permitted as a ground or building sign subject to the restrictions imposed by this section and other relevant restrictions imposed by this title.

- Setback and Height Restrictions. The maximum height and street setback

requirements for signs in nonresidential and mixed-use districts shall be as established by Figure 17.32.070, Permanent Ground Signs.

- Sign construction materials. All permanent on-premises signs shall be constructed of a rigid, weatherable material such as hard plastic, wood, MDO plywood, aluminum, steel, PVC, and/or Plexiglas. On-premises permanent signs shall not be constructed of nonrigid materials including, but not limited to, vinyl, fabric, canvas, or corrugated plastic. The provisions of this subsection shall not apply to approved, permitted canopies, awnings, and porticoes.

127

- Guidance for the Use of Signs.

- An on-premises sign is for the purpose of conveying information in clear, concise,

safe and compatible units to general motorists and pedestrians on travelways

and within each site.

- Size, location, method of attachment and design/lighting are regulated in

general based on districts and the type of activity therein. Permanent on premises signs are subject to the common signage plan requirements.

- On-premises building signs shall not extend above the roof line of the structure.

- On-premises wall signs shall not extend above the top of the wall or parapet

more than twenty-five percent of the height of such sign, to a maximum of

eighteen inches for a solid panel sign, or fifty percent of the height of the letter

for individual mounted letters. The above restrictions shall not apply to the

commercial amusement (CA) district provided that the sign(s) is not readily

visible from a public street external to the development or residentially zoned

property abutting the subject property.

- No permanent on-premises ground sign may be located in a required rear

setback.

- With regard to multiple frontage (frontage on more than one street) the amount of

on-premises ground signage is computed by adding all of the frontage along each

street and applying the total to the table under the appropriate district; the total on-premises ground sign area that is oriented toward a particular street may not

exceed the portion of the lot’s total ground sign area allocation that is derived from

that street. No on-premises ground sign on one street frontage on the same lot shall be closer than one hundred feet to an on-premises sign fronting on another

street, computed as the sum of distance measured continuously along the rights-of-way through a common point or points. On-premises ground signs in excess of two hundred eighty-eight square feet shall require even greater spacing as specified under each district or group of districts. On-premises building signage does not require additional computation for multiple frontage since the signage area is based solely on number of principal buildings, number of occupants and percent of

building facade.

- A single tenant or multitenant sign may be considered an on-premises sign when located within the boundaries of the same approved master development plan or unified plat of subdivision.

Zoning Considerations

Outpatient Clinic is permitting in all areas of Downtown (DTC) north, south, west, and central.

On Premises Signs- DTC District

The permitted base area for permanent on-premises ground and on-premises building signs shall be forty-eight square feet each. With the limitation that no individual on- premises building sign shall exceed six hundred seventy-two square feet, the base area may be replaced by a greater amount of signage subject to the following: - Principal building facade which faces, without obstruction, a public street and which exceeds four hundred eighty square feet; - Multiple occupancy of a building on street level.

- On-Premises Ground Signs.

On-premises ground signs shall be restricted to one sign which is an integral part of an entrance feature or one monument-type sign per street frontage. The maximum height permitted for a monument sign shall be eight feet above grade. The maximum display surface area shall be forty-eight square feet.

- On-Premises Building Signs.

1. Subject to the design criteria in Section 17.32.160 of this title, the maximum height of an on-premises building sign shall be the roof line.

2. Each principal building fifty feet or less in height may display one on-premises

building sign on each side that faces a right-of-way. The maximum signage area for each eligible side shall be calculated based on the following: Area of Building Facade in Square Feet

Maximum Sign Area in Square Feet

Less than 480

48

480- 999

96

1000- 2999

192

3000- 4999

384

5000 or more

672

- Each principal building that is greater than fifty feet in height may display one

additional on-premises building sign on each side that faces, without obstruction,

a right-of-way. The additional signage shall be located between the fifty foot level

and the roof line. The signage area per eligible side may equal that permitted on the comparable side of the principal building portion that is less than fifty feet in height.

Where there is only one eligible side at the lower elevation, the eligible higher elevation sides may each equal the one lower side.

- Each occupant at street level of a multiple-occupancy complex may display not more than two on-premises building signs on any exterior viewed portion of the complex that is part of the occupant’s unit (not including common or jointly owned area). The total sign area shall not exceed fifteen percent of the facade area of such exterior

portion, calculated to a maximum height of fifty feet, or two hundred eighty-eight square feet, whichever is less.

- All on-premises ground and on-premises building signs must be approved under an overall signage plan.

(8)

Sign Permit Process What is a Sign

- A sign is any writing (including letter, work, or numeral), pictorial representation (including illustration or decoration); emblem (including device, symbol or trademark); flag (including banner or pennant); inflatable structure; or any other figure of similar character, which is:

- A structure or any part thereof, or is attached, to painted on, or in any other

manner represented on building or other structure: and/or

- Used to announce, direct attention to, or advise.

129

When Permits are Required

Except as otherwise provided in this article, no sign shall be constructed, installed, or altered without first obtaining a zoning permit, a building permit and all other applicable permits. Application shall be made by the owner of the property on which the sign is to be displayed or by the owner’s legal representative. After construction of the sign is completed the person constructing the sign shall certify to the Department of Codes Administration that the sign was legally constructed and is within the Code. All signs shall display a permanent compliance tag, to be provided by the Department of Codes Administration, upon final approval of the permit.

When Permits are not Required

Zoning and building permits are not required for the following: 1. Exempt signs as defined by title 17.32, except those signs which are regulated by

size, height, setback, number, or duration of placement, which signs shall require a zoning permit.

2. Painting, repainting, or cleaning of sign structure or the changing of a copy on a sign designed for changeable copy.

Non-Conforming Signs

These are signs that were issued a permit prior to the adoption of the present sign ordinance, February 8, 1993, that do not comply with the present sign ordinance are considered non-conforming.

1. No solid panel wall sign shall extend above the wall or parapet more than 25% of the height of such sign to a max of 18�.

2. No individually mounted letter wall sign shall extend above the wall or parapet more than 50% of such individual mounted letters.

Tenants in multi-tenant buildings may provide the dimensions for their tenant space only and
receive a 15% maximum signage allocation with a letter from the property owner (multi-tenant application form).

[9]

- Sanitation.

All exterior property and premises shall be maintained in a safe, clean, and sanitary condition. The occupant of a building, structure, or premises, or part thereof, shall keep that part of the exterior property and premises that such occupant occupies or controls in a safe, clean, and sanitary condition.

- Premises Identification. All buildings and structures within Metropolitan Nashville

and Davidson County shall have approved address numbers posted in accordance with following: 1. Residences are to have their numbers at least three inches in size, on a contrasting background, and in a position to be plainly visible and legible from the street or road fronting the property. The numbers may be attached to the residence or the mailbox, if the mailbox is next to the street.

2. Numbers posted on the outside of nonresidential buildings must be six inches, or

larger, on a contrasting background, and in a position to be plainly visible and legible from the street or road fronting the premises. Numbers posted on interior

doors or spaces (such as a lease space in a mall) must be at least three inches in size.

3. Multifamily buildings shall have their numbers displayed to be plainly visible and legible, on a contrasting background, and a minimum size of six inches in height.

Identifying numbers, at least three inches in height shall also be posted on or at the doors of individual dwelling units.

Interiors of Buildings and Structures

1. General. The interior of a building or structure and any equipment therein shall be maintained in good repair, structurally sound, and in an otherwise clean and sanitary condition. Occupants shall keep that part of the building or structure that they occupy or control in a clean and sanitary condition. Every owner of a building or structure containing a rooming house, a hotel, a dormitory, two or more dwelling units, or two or more nonresidential occupancies, shall maintain, in a clean and sanitary condition, the shared or public areas of the structure and exterior property.

2. Structural Members. All structural members shall be structurally sound and capable of supporting the imposed loads.

3. Interior Surfaces. All interior surfaces, including windows and doors, shall be

maintained in good, clean and sanitary condition. Peeling, chipping, flaking, or abraded paint shall be repaired, removed, or covered. Cracked or loose plaster, decayed wood, and other defective surface conditions shall be corrected.

4. Stairs and Walking Surfaces. Every stair, ramp, landing, balcony, porch, deck or other walking surface shall be maintained in sound condition and in good repair.

5. Handrails and Guards. Every handrail and guard shall be firmly fastened and capable of supporting normally imposed loads and shall be maintained in good condition.

6. Interior Doors. Every interior door shall fit reasonably well within its frame and shall be capable of being opened and closed by being properly and securely attached to jambs, headers, or tracks as intended by the manufacturer of the attachment hardware.

Light

- Habitable Spaces. In residential occupancies, every habitable space shall have at least one window of approved size facing directly to the outdoors or to a court. The minimum total glazed area for every habitable space shall be eight percent of the floor area of such room. Wherever a wall or other obstructions face a window of a

habitable space and such obstruction is located less than three feet from the window and extends to a level above that of the ceiling of the habitable space, such window shall not be deemed to face directly to the outdoors nor to a court and shall not be included as contributing to the required minimum total window area for the habitable space.

EXCEPTION: Where natural light for rooms or spaces without exterior glazing areas is provided through an adjoining room, the unobstructed opening to the adjoining room shall be at least eight percent of the floor area of the interior room or space, but not less than twenty-five square feet. The exterior glazing area shall be based on the total floor area being served.

131

- Common Halls and Stairways. Every common hall and stairway in residential

occupancies, other than in one- and two-family dwellings, shall be lighted at all times with at least a sixty watt standard incandescent light bulb or an equivalent compact fluorescent light (CFL), light emitting diode (LED), or other form of lighting of equal illumination for each two hundred square feet of floor area of said common hall or stairway, provided that the spacing between lights shall not be greater than thirty feet.

- In other than residential occupancies, means of egress, including exterior means of egress stairways, shall be illuminated at all times with a minimum of one foot candle at floors, landings, and treads.

- Other Spaces. All other spaces in residential and nonresidential buildings and structures shall be provided with natural or artificial light sufficient to permit the maintenance of sanitary conditions, the safe occupancy thereof, and the safe utilization of the appliances, equipment, and fixtures.

Fire safety requirements- Means of Egress

1. General. A safe, continuous, and unobstructed means of egress shall be provided from any point in a building or structure to the public way, in accordance with the

requirements of the building code and fire code as adopted by the metropolitan government.

2. Emergency Escape and Rescue Openings. Basements with habitable rooms and every sleeping room shall have at least one openable emergency escape and rescue window or exterior door opening. Where openings are provided as a means of escape and rescue, they shall have a sill height of not more than forty-four inches. The net clear opening dimension required by this chapter shall be obtained by the normal operation of the window or door opening from the inside. Escape and rescue window openings with a sill height below the adjacent ground level shall be provided with an approved window well.

3. Minimum Net Clear Opening. All emergency escape and rescue openings shall have a minimum net clear opening of four square feet.

4. Minimum Net Clear Opening Height. All emergency escape and rescue openings 5. Minimum Net Clear Opening Width. All emergency escape and rescue openings shall have a minimum net clear opening width of twenty inches.

6. Operation. Required emergency escape and rescue openings shall be operational from the inside of the room or space without the use of keys or special tools, knowledge, or effort. Bars, grilles, grates, or similar devices are permitted to be placed over emergency escape and rescue openings provided the minimum net clear opening size complies with the building code and such devices shall be releasable or removable from the inside without the use of a key, tool, or force greater than that which is required for normal operation of the escape and rescue opening.

Where such bars, grilles, grates, or similar devices are installed in existing buildings, smoke detectors shall be installed in accordance with Section 16.24.550 [8]

LIGHTING The main organizations that specify lighting- related building codes are: - American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE).

Section 9 specifies lighting. http://www.ashrae.org

Egress Lighting

- Defined: lighting provided to aid in the process of exiting a building or a space in the case of an emergency.

- Lighting must be maintained on the path of egress, as well as exit signs of appropriate size, luminance, and color located at paths and egress ways indicating the direction of exit and actual exit point.

- Emergency lighting is to be provided at all exits and aisles, corridors, passageways, ramps, and lobbies leading to an exit. All exit signs must be lit at all times.

- Exit lighting must be connected to an emergency power source that will assure

illumination for at least 1 ½ hours in case of power failure.

Luminaire Thermal Protection

- Protection of all luminaire is a necessity for recessed lights and wall construction with cavity voids.

- In commercial construction, “thermal breaks” around the luminaires are designed to keep the insulation at least 3” from any component of the luminaire.

- No part of a hanging luminaire/pendant fixture/track fixture/ceiling fan can be within 8’ above the top of the bathtub rim or within 8’ above a shower threshold.

Sustainable Lighting

Possible LEED Points for engergy conscious designing regarding lighting.

IEQ Credit 6.1: Controllability of Systems- Lighting 1 Point

INTENT: To provide a high level of lighting system control by individual occupants or groups in multi-occupant spaces (e.g., classrooms and conference areas) and promote their productivity, comfort and wellbeing.

REQUIREMENTS: Provide individual lighting controls for 90% (minimum) of the building occupants to enable adjustments to suit individual task needs and preferences. Provide lighting system controls for all shared multi-occupant spaces to enable adjustments that meet group needs and preferences.

POTENTIAL TECHNOLOGIES & STRATEGIES: Design the building with occupant controls for lighting. Strategies to consider include lighting controls and task lighting. Integrate lighting systems controllability into the overall lighting design, providing ambient and task lighting while managing the overall energy use of the building.

SS Credit 8: Light Pollution Reduction INTENT:

To minimize light trespass from the building and site, reduce sky-glow to increase night sky access, improve nighttime visibility through glare reduction and reduce development impact from lighting on nocturnal environments.

133

REQUIREMENTS: Project teams must comply with 1 of the 2 options for interior lighting AND the requirement for exterior lighting.

For Interior Lighting: OPTION 1:

Reduce the input power (by automatic device) of all nonemergency interior luminaires with a direct line of sight to any openings in the envelope (translucent or transparent) by at least 50% between 11 p.m. and 5 a.m. After-hours override may be provided by a manual or occupant-sensing device provided the override lasts no more than 30 minutes.

OPTION 2: All openings in the envelope (translucent or transparent) with a direct line of sight to any nonemergency luminaires must have shielding (controlled/closed by automatic device for a resultant transmittance of less than 10% between 11 p.m. and 5 a.m.).

IE Q Credit 8.1: Daylight and Views—Daylight 1 Point

INTENT: To provide building occupants with a connection between indoor spaces and the outdoors through the introduction of daylight and views into the regularly occupied areas of the building.

REQUIREMENTS: Through 1 of the 4 options, achieve daylighting in at least the following spaces1: Regularly Occupied Spaces 75%= 1 Point

OPTION 1. Simulation: Demonstrate through computer simulation that the applicable spaces achieve daylight illuminance levels of a minimum of 10 footcandles (fc) (110 lux) and a maximum of 500 fc (5,400 lux) in a clear sky condition on September 21 at 9 a.m. and 3 p.m. Provide glare control devices to avoid high-contrast situations that could impede visual tasks.

However, designs that incorporate view-preserving automated shades for glare control may demonstrate compliance for only the minimum 10 fc (110 lux) illuminance level.

OPTION 2. Prescriptive Use a combination of sidelighting and/or toplighting to achieve a total daylighting zone (the floor area meeting the following requirements) that is at least 75% of all the regularly occupied spaces.For sidelighting zones: achieve a value, calculated as the product of the visible light transmittance (VLT) and window-to-floor area ratio (WFR) of daylight zone between 0.150 and 0.180.

OPTION 3. Measurement Demonstrate through records of indoor light measurements that a minimum daylight illumination level of 10 fc (110 lux) and a maximum of 500 fc (5,400 lux) has been achieved in applicable spaces. Measurements must be taken on a 10-foot (3-meter)

OPTION 4. Combination Any of the above calculation methods may be combined to document the minimum daylight illumination in the applicable spaces.

POTENTIAL TECHNOLOGIES & STRATEGIES Design the building to maximize interior daylighting. Strategies to consider include building orientation, shallow floor plates, increased building perimeter, exterior and interior permanent shading devices, high-performance glazing, and high-ceiling reflectance values; ly, additionally, automatic photocell-based controls can help to reduce energy use. Predict daylight factors via manual calculations or model daylighting strategies with a physical or computer model to assess footcandle (lux) levels and daylight factors achieved.

IE Q Credit 8.2: Daylight and Views—Views 1 Point

INTENT: To provide building occupants a connection to the outdoors through the introduction of daylight and views into the regularly occupied areas of the building.

REQUIREMENTS: Achieve a direct line of sight to the outdoor environment via vision glazing between 30 inches and 90 inches (between 0.8 meters and 2.3 meters) above the finish floor for building occupants in 90% of all regularly occupied areas. Determine the area with a direct line of sight by totaling the regularly occupied floor area that meets the following criteria: - In plan view, the area is within sight lines drawn from perimeter vision glazing.

- In section view, a direct sight line can be drawn from the area to perimeter vision glazing.

- The line of sight may be drawn through interior glazing. For private offices, the entire floor area of the office may be counted if 75% or more of the area has a direct line of sight to perimeter vision glazing.

- For multi-occupant spaces, the actual floor area with a direct line of sight to perimeter vision glazing is counted.

POTENTIAL TECHNOLOGIES & STRATEGIES Design the space to maximize daylighting and view opportunities. Strategies to

consider include lower partitions, interior shading devices, interior glazing and automatic photocell-based controls.

[10] - Lighting also accounts for 20% to 50% of energy consumption in a building depending upon the building type. The ENERGY STAR program identifies energy- efficient

products to reduce greenhouse emissions.

[11]

135

OCCUPANCY CLASSIFICATION Business Group B:

Business Group B occupancy includes, among others, the use of a building or structure, or a portion thereof, for office, professional, service-type transactions, or for conducting public or civic services, including the incidental storage of records and accounts and the incidental storage of limited quantities of stocks of goods for office use or purposes.

Business Group B occupancies shall included, but not be limited to:

Clinic- outpatient, including group medical centers, and neighborhood family care centers.

Maximum Floor Area Allowances Per Occupant: 100 gross for B Allowable Height and Building Areas: Unlimited for Group B, Type 1 A Occupancy load: 14,000 square feet/100 gross (load factor)

MATERIAL Interior Finish Classification Limitations - Business and Ambulatory

Exits: A or B

Exit Access Corridors: A or B

Other spaces: A, B, or C - Health Care- New

Exits: I or II

Exit Access Corridors: Other spaces: N.A. - Class A interior wall and ceiling finish- flame spread, 0-25 (new applications), smoke developed, 0-450.

- Class B interior wall and ceiling finish- flame spread, 26-75 (new application), smoke developed, 0-450.

- Class C interior wall and ceiling finish- flame spread, 76- 200 (new application), smoke developed, 0-450.

- Class I interior floor finish- critical radiant flux, not less than 0.45 W/cm2 - Class II interior floor finish- critical radiant flux, not more than .22W/cm, but less than .45W/cm2.

- Automatic sprinklers- where a complete standard system of automatic sprinklers is

installed, interior wall and ceiling finish with a flame spread rating not exceeding Class C is permitted to be used in any location where Class B is required and with a rating of Class B in any location where Class A is required; similarly, Class II interior floor finish is permitted to be used in any location where Class I is required, and no critical radiant flux rating is required where Class II is required.

These provisions do not apply to new detention and correctional occupancies.

-

Reception areas in Business occupancies and waiting areas in Health Care occupancies would be considered part of the exit access corridor.

[26]

137

+ DESIGN CONSIDERATIONS Examining avenues that will be crucial to successful design

141 139

LIGHTING AND COLOR - Includes: Art, aesthetics, functionality - Impact peoples perceptions, responses to environment - Affect recovery rates and can improve quality of staff, patients and visitors - Eliminate wasted time - Colored rooms: balance tension and created greatest concentration. Grey = not good - Cool colors: promote relaxation are calming and promote sleeping - Warm colors: promote physical activity - Neutral colors: minimize attention

Overall Objective= to improve:

Ambience

Confidence and safety

Accessibility and inclusion

Attractive environments and visual stimulation

Stress reduction

Sense of place and spatial orientation

Enhanced patient recovery, staff productivity

Ease of navigation and way finding

Energy efficiency

Compliance with disability discrimination act

Empower specifiers and design teams

Corporate badging of key areas

Main routes to focus on:

Entrance

Front of house/reception

Waiting areas Corridors

Day/consulting rooms

Wards (Hallways)

Color and Way Finding

- Signage - Hierarchy of spaces, landmarks and prominent features, destinations and

differentiations between facilities - Can initiate sensory acuity, cognitive mapping and understanding form - Patients are more likely to use colored visual cues rather than signage

Color Coding

- Colors should be checked with the visually impaired - Should be used for simply zoning of no more than four spaces of a building - Should use colors that are known by their descriptive feel

Color Specification

- VIPs require color contrast on all potential obstacles for safety reasons - Materials checked for reflection and glare - Color and contrast are required in situations where tonal detail can give people

Color and Lighting

- Balance between extremes of lighting, ex: dark corridors that run into bright patches of sunlight – can cause problems for older people.

- Transition between daylight and nighttime can dramatically change appearance of interior.

- Shear colored blinds added to a window can ultimately change the feel to a room - Colored textiles can immediately improve the appearance of patient environments – duvet covers or top blankets [Dalke]

141

MATERIALS MATERIALS FOR HEALTHCARE DESIGN -

EHP-free PVC-free No BFRs No VOCs Bio-based Flame retardants (Halogenated PBDEs) Sustainable Antimicrobials Radiation- emitting products Avoid materials that contribute to unhealthy indoor air quality

MATERIALS TO AVOID IN HEALTHCARE DESIGN:

Chlorinated Building Materials:

Polyvinyl chloride (PVC) often referred to as “vinyl”

- pipes and conduit

- water proofing - siding

- roof membranes

- door and window frames

- resilient flooring

- carpet backing

- wall covering - signage

- window treatments - furniture - wire

- cable sheathing

Chlorinated polyethylene (CPE) - Geomembranes

- wire and cable jacketing

Chlorinated polyvinyl chloride (CPVC)

- water pipes PBT Based Material Treatments:

Brominated Flame Retardants (BFRs), particularly PBDE (polybrominated

diphenyl ether).

- Furniture foam and fabrics

Perfluorochemicals (PFCs) (most notably PFOA) ­ - Furniture & dividers - stain and non-stick treatments, including

- Scotchguard®, Teflon®, Stainmaster®, Scotchban®, and Zonyl®

Heavy Metal Additives and Components: Mercury - thermostats - thermometers - switches

- Fluorescent lamps. For lamps, seek the lowest possible mercury content

and recycle used lamps. (Using low mercury FL lamps still results in

less mercury in the environment than using incandescent lamps as the

extra mercury released by coal fired power plants to power those

incandescents would out weigh the mercury in the lamps.)

Lead - flashing

- terne, copper and other roof products - solder

- wire insulation jacketing (most PVC wiring but apparently you can now

buy even PVC wire without lead) Cadmium

- Paint (use GreenSeal paints to avoid)

- Some PVC products (as a stabilizer)

MATERIAL TRENDS:

- PVC/vinyl interior-finish products, including flooring and wall coverings, are no longer allowed for healthcare design use.

- Vinyl wall guards are being replaced by polycarbonate, ABS blends and polyethylene.

- Window treatments are being replaced with polyethylene and polyester.

- Carpet is being made up of polyefins, polyurethane and recycled polyvinyl butyral.

- Vinyl floors are being replaced with rubber and polyolefins and linoleum flooring.

- Improved coefficient of friction means fewer slip-fall accidents.

- Easily cleanable, with no hazardous chemicals.

- PLA (a polylactide corn-based plastic) is now being used in wall coverings, divider

fabrics and carpet.

[34/35]

143

+ Overview of Schematic Phase Final design proposal for Flex Vanderbilt Medical Complex

149 145

GET READY TO......

V a n d e r bi l t m e d i c a l

c o m p l e x

...... not just your muscles, but also your mind, health knowledge and taste buds!

Flex Vanderbilt Medical Complex provides visitors with an exciting variety of healing, learning and fitness options. From art classes, to relaxing in yoga, to weight training; there are opportunities for everyone of all ages to participate in. Whether you have an appointment upstairs with the Sports Medicine and Physical Therapy clinic or are just buying a pair of tennis shoes, you can drop your child off and know that they will not only be having fun playing, but also learning how to live a healthy lifestyle. While having an exercise break, visitors can also enjoy the healthy choices offered by the dining facility that is included on the first level. Following the example of Vanderbilt University, Flex values learning and promotes education of body systems, expressing the mind and nutrition to promote and overall holistic education environment. Dynamic design features embody the Vanderbilt Flex brand and greet visitors while guiding them throughout the building to create a unique and memorable experience that they will tell others of and continue to come back to.

147

INITIAL BUBBLE DIAGRAMS: Entry Level

STG.

ACCESSIBLE

ART STUDIO

YOGA STUDIO

RETAIL GALLERY

ADJACENT

C.IN. GYM STG.

OUTSIDE VIEW

GYM

R.R. LOCK. SHOWER R.R. LOCK. SHOWER

GYM OFFICE

NURSERY

STG.

RR

RR

CHILDREN’S PLAYROOM

C.IN. INFO STAIRS

OFFICE

ELEVATOR BACK OF HOUSE DINING STAFF BREAK

149

INITIAL BUBBLE DIAGRAMS: Clinic Level

COLLAB. OFFICEOFFICE OFFICE

IT

FILES

OFFICE OFFICE

BREAK/ CONFERENCE ADMIN. LOUNGE OFFICES COPY/MAIL

OFFICE WAIT OFFICE C.IN. CHANGE

OFFICE

GYM

XRAY

MRI

IT CHANGE CHANGE

ACCESSIBLE

ADJACENT OUTSIDE VIEW

LAUN.

EXAM ROOMS

P.EDU.

CKOUT COMP.

STG.

CAST

DOC.

C.MNG. STAIRS ELEVATOR WAITING

EXAM ROOMS

CHECKIN DESK

DOC. RR

RR

CKOUT

EXAM ROOMS

STG.

CAST 151

INITIAL BLOCKING DIAGRAMS

ENTRY LEVEL

CLINIC LEVEL

153

+ FLOORPLAN

+Entrance View

155

+ Dining

+ Children’s Education 5

+ FLOORPLAN

157

6

+ Waiting Area

+ P.T. Gym

+ MRI Room

+ Patient Exam Rooms

159

LITERARY RESOURCES Abdel-Malek, K., Yang, J., Brand, R., and Tanbour, E. (2004). Towards Understanding the

Workplace of Human Limbs. Ergonomics, 47(13), 1386-1405.

Baskaya, A., Wilson, C., and Ozcan, Y. (2004). Wayfinding in an Unfamiliar Environment:

Different Spatial Settings of Two Polyclinics. Environment and Behavior, 36(6).

Bautz, A. (2012). CommunityCare: An outpatient autoimmune clinic fostering a network

of patients and caregivers through medical, educational, and social interaction.

(Order No. 1533472, University of Washington). ProQuest Dissertations and

Theses, , 125. Retrieved from http://ezproxy.uky.edu/login?url=http://search.

proquest.com/docview/1312738826?accountid=11836. (1312738826).

Berry, David C; Miller, Michael G; Berry, Leisha M. (2007). An Analysis of the

Professional Journal Reading Habits and Attitudes of Certified Athletic Trainers.

The ICHPER-SD Journal of Research in Health, Physical Education, Recreation,

Sport & Dance. 2(2). 12-18.

Black, J. D., Palombaro, K. M., & Dole, R. L. (2013). Student Experiences in Creating

and Launching a Student-Led Physical Therapy Pro Bono Clinic: A Qualitative

Investigation. Physical Therapy, 93(5), 637-648. doi:10.2522/ptj.20110430.

Brawley, S., Fairbanks, K., Nguyen, W., Blivin, S., & Frantz, E. (2012). Sports Medicine

Training Room Clinic Model for the Military. Military Medicine, 177(2), 135-138.

California Pacific Orthopaedics and Sports Medicine; local bay area orthopaedic clinic

expands its operations in marin county to cater to a growing need for sports

medicine care in the area. (2012). Biotech Week, 148.

Chen, A. (2005). Good joints. Interior Design, 76(2), 132-132,134,136. Retrieved from http://ezproxy.uky.edu/login?url=http://search.proquest.com/docview/23495523 6?accountid=11836.

Dalke, H., & Little, J., Niemann, E., Camgoz, N., Guillaume, S., Hill, S., Stott, L. (2005).

Elsevier. Colour and lighting in hospital design, 38(2006), 343-365.

Daykin, N; Byrne, E; Soteriou, T; O’Connor S. (2008). The impact of Art, Design and

Environment in Mental Healthcare: A systematic Review of the Literature. The

Journal of the Royal Society for the Promotion of Health. 128(2). 85-94.

Davis, B. (2011). Rooftop Hospital Gardens for Physical Therapy: A Post-Occupancy

Evaluation. Health Environments Research and Design Journal, 4(3), 14-43.

Derman, W. (2011). Guidelines for the composition of the travelling medical kit for

Sports Medicine professionals. International SportMed Journal, 12(3), 125-132 Draper, H. (2012). Pain center waiting room design: An exploration of the relationship

between pain, comfort and positive distraction. (Order No. 1508585, Arizona

State University). ProQuest Dissertations and Theses, , 113. Retrieved from http:// ezproxy.uky.edu/login?url=http://search.proquest.com/docview/1011000826?accou ntid=11836.

Guiney, Anne. (2003) Let’s Get Physical. Interior Design, 74(2), 88.

Hackett, S. L. (2008). Improving administrative operations for better client service

and appointment keeping in a medical/behavioral services clinic. (Order No.

1463557, University of North Texas). ProQuest Dissertations and Theses, , 64-n/a.

Retrieved from http://ezproxy.uky.edu/login?url=http://search.proquest.com/docvie

w/304539433?accountid=11836. (304539433).

Haskell, W.L., I.-M. Lee, R. R. Pate, K.E. Powell, S. N. Blair, B. A. Franklin, C. A. Macera,

G. W. Heath, P.D. Thompson,. (2007). Physical Activity and Public Health: Updated

Recommendation for Adults from the American College of Sports Medicine and

the American Heart Association. Special Communications, 39(8), 1423-1434.

Hutson, Michael. (1987, November 7). Why Sports Injury Clinics? British Medical

Journal (Clinical Research Edition), 295 (6607), 1210.

Jones, M. L. (2004). High school principals’ satisfaction with clinic and hospital-based

outreach athletic training services. (Order No. 3147920, The University of

Southern Mississippi). ProQuest Dissertations and Theses, , 90-90 p. Retrieved

from http://ezproxy.uky.edu/login?url=http://search.proquest.com/docview/305127

151?accountid=11836. (305127151).

Layne, J. E. (2007). Dissemination of and adherence to a community-based strength

training program for older adults. (Order No. 3283085, Tufts University).

ProQuest Dissertations and Theses, , 139. Retrieved from http://ezproxy.uky. edu/login?url=http://search.proquest.com/docview/304800026?accountid=11836.

(304800026).

Lou, C., Lin, J., and Su, K. (2005). Recycling Polyester and Polypropylene Nonwoven

Selvages to Produce Functional Sound Absorption Composites. Textile Research

Journal, 75(5), 390-394.

Lu, Jun, PhD; Hignett, Sue, PhD. Using Task Analysis in Healthcare Design to Improve

Clinical Efficiency, HERD : Health Environments Research & Design Journal. 2(2).

60-9.

Nakauchi, S. and Onouchi, T. (2008). The Detection and Modification of Confusing

Color-Combination for Red-Green Dichromats to Achieve a Color Universal

Design. Color Research and Application, 33(3), 203-211.

Nanda, U., Eisen, S., and Baladandayuthapani, V. (2008). Undertaking an Art Survey

to Compare Patient Versus Student Art Preferences. Environment and Behavior,

40(2), 269-301.

New LLU pediatric clinic offers central location for services. (2009, Aug 27). El Chicano Weekly.

Park, J. (2009). Color Perception in Pediatric Patient Room Design: Healthy Children vs.

Pediatric Patients. Health Environments Research and Design Journal, 2(3), 6-28.

Perkins, O. (2001, Aug 15). Roll with it: Adaptive sports clinic puts disabled athletes on

wheels. Colorado Springs Independent.

Rich, Valerie J, PhD, ATC, CSCS, WEMT-B. (2009) . Clinical Instructors’ and Athletic

Training Students’ Perceptions of Teachable Moments in an AthleticTraining

Clinical Education Setting. Journal of Athletic Training. 44(3), 294-303.

Schwebel, D., Binder, S., Sales, J., and Plumert, J. (2003). Is There A Link Between

Children’s Motor Abilities and Unintentional Injuries? Journal of Safety Research,

34(2), 135-141.

Shoemaker, L. K., RN, MSN, DHA, NEA-BC; Kazley, A. S., PhD; White, A., PhD. (2010).

Making the Case for Evidence-Based Design in Healthcare: A Descriptive Case

Study of Organizational Decision Making. HERD: Health Environments Research

& Design Journal. 4(1). 56-88.

Stern, A., MacRae, S., Gerteis, S., Harrison, T., Fowler, E., Edgman-Levitan, S., Walker,

J., and Ruga, W. (2003). Understanding the Consumer Perspective to Improve

Design Quality. Journal of Architectural and Planning Research, 20(1), 16-28.

161

Sun, B. (2011). Simulation modeling and analysis of a multi-resource medical clinic.

(Order No. 1504999, University of Louisville). ProQuest Dissertations and Theses,

, 97. Retrieved from http://ezproxy.uky.edu/login?url=http://search.proquest.com/

docview/913000119?accountid=11836. (913000119).

Tamarin, N. (2008). Zimmer gunsul frasca architects: University of oregon athletic

medicine center, eugene. Interior Design, 79(15), 50-51. Retrieved from http:// ezproxy.uky.edu/login?url=http://search.proquest.com/docview/55475767?accoun

tid=11836 Sport and spa mix at Zimmer Gunst Frasca’s athletic medical center

for the University of Oregon.

Tinetti, M. (2003). Preventing Falls in Elderly Persons. The New England Journal of

Medicine, 348(1), 42-47.

Ulrich, R. S, PhD; Zimring, C., PhD; Zhu, X., BArch, PhD; MS, Jennifer, MS; Seo, Hyun Bo, MArch; Choi, Young-Seon, MArch; Quan, Xiaobo, PhD; Joseph, Anjali, PhD.

(2008). A Review of the Research Literature on Evidence-based Healthcare

Design. HERD: Health Environments Research & Design Journal. 1(3). 61-125.

University of Bolton - sports injuries clinic to set pace. (2008). The Times Higher

Education Supplement : THE, (1848), 12.

Wilkins, K., Wolkoff, P., Knudsen, H., and Clausen, P. (2007). The Impact of Information

on Perceived Air Quality- ‘Organic’ vs. ‘Synthetic’ Building Materials. Indoor Air,

17(2), 130-134.

RESOURCES 1. http://www.dordt.edu 2. http://www.socalpaincenter.com 3. http://www.punjabilinks.com 4. http://blog.onwardhealthcare.com 5. http://faircount.com 6. http://www.vailortho.com 7. 2010 ADA Standards for Accessible Design 8. http://library.municode.com 9. http://nashville.gov 10. http://www.usgbc.org/resources/leed-new-construction-v2009-current-version 11. http://www.uncg.edu/iar/elight/learn/establish/lcodes.html 12. http://www.tennessean.com/article/20110918/BUSINESS02/309180033/Gulchbecoming-heart-Nashville 13. http://www.civicdesigncenter.org 14. http://www.yllc.org 15. http://www.vanderbilthealth.com/orthopaedics/33390 16. http://www.goperformanceandfitness.com/about/philosophy.html 17. http://getfitathleticclub.com/about-get-fit/ 18. Assessment of Sports Medicine Timeline. (2010). Retrieved October 14, 2013 from http://timerime.com/en/timeline/1062772/Advancement+of+Sports+Medicine.

19. History of Medicine Timeline. Retrieved October 14, 2013 from http://www. datesandevents.org/events-timelines/10-history-of-medicine-timeline.htm 20. Miller, L. 11 Biggest Sports Medicine Trends for 2011. (2010). Becker’s Orthopedic Review. Retrieved October 14, 2013 from http://www.beckersspine.com/sportsmedicine/item/2497-11-biggest-sports-medicine-trends-for-2011

21. Gensler Design Forecast 2013. The Future of Health and Wellness. 27-31. 2013 22. <http://www.myfuture.com/careers/details/sports-medicine-physicians_29-1069.11> 23. Nationwide Childrenâ&#x20AC;&#x2122;s Hospital. <http://www.nationwidechildrens.org/before-yoursports-medicine-visit> 24. NC State University. (1997). The principles of universal design. 2.0, http://www. ncsu.edu/ncsu/design/cud/pubs_p/docs/poster.pdf 25. www.suncalc.net 26. The Codes GuideBook for Interiors. Sharon Koomen. 5th edition.

27. http://www.beckersspine.com/sports-medicine/item/14299-7-big-trends--concernsfor-sports-medicine-physicians-in-2013.

28. http://cdn.theatlantic.com/static/mt/assets/jamesfallows/nobel-medal.jpg 29. http://www.two-views.com/images/MRI%20machine.jpg 30. http://media.web.britannica.com/eb-media/03/131403-004-12E4888B.jpg 31. http://www.orkposters.com/images/portlandBW.gif 32. http://uamedical.com/upload_files/category_image/0z44has.jpg 33. NC State University. (1997). The principles of universal design. 2.0, http://www. ncsu.edu/ncsu/design/cud/pubs_p/docs/poster.pdf 34. Lent, T. (2006, May 31). Next-generation materials for healthy hospitals.http://www. healthcaredesignmagazine.com/article/next-generation-materials-healthy-hospitals0?page=3 35. Healthy building network. (2012). http://www.healthybuilding.net/target_materials. html 36. http://www.beckersspine.com/sports-medicine/item/14299-7-big-trends--concernsfor-sports-medicine-physicians-in-2013 37. http://www.wbdg.org/design/outpatient.php 38. http://i2.cdn.turner.com/cnn/2011/images/12/16/fitness.trends.pdf 39. http://matsinc.com/blog/architect-designer-news/fitness-facility-design 40. http://www.gensler.com/uploads/documents/Gensler_Design_Forecast_01_04_2013. pdf 41. http://www.amssm.org/BrochureImages/WhatisaSportsMe-1.pdf 42. http://Sentara.com 43. http://Exploreheathcareers.org 44. http://Fyi.uiowa.edu 45. Growth and Research Funding. (2012). Vanderbilt University Medical Center Office of Research. Retrieved October 14, 2013 from http://www.vanderbilt.edu/oor/aboutvumc-research/achievements/growth-research-funding/ 46. Guide for Patients and Visitors. (2013). Vanderbilt University Medical Center.

Retrieved October 14, 2013 from http://www.vanderbilthealth.com/newsite/information. php 47. History of Vanderbilt University. (2013). Vanderbilt University. Retrieved October 14, 2013 from http://www.vanderbilt.edu/about/history/

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https://www.google.com/search?q=gymnast&espv=210&es_sm=91&source=lnms&tbm=isch&sa=X&ei=o-nUqubF4eHqQHOrIGABw&ved=0CAkQ_AUoAQ&biw=1111&bih=658#facrc=_&imgdii=_&imgrc=W UqellKaexbvUM%3A%3BVZx47QOWy4vkbM%3Bhttp%253A%252F%252Fwww.trbimg.com%252Fimg501b4cb5%252Fturbine%252Fchi-us-gymnast-douglas-wins-womens-allaround-g-002%252F600%3Bhtt p%253A%252F%252Farticles.chicagotribune.com%252F2012-08-02%252Fsports%252Fchi-us-gymnastdouglas-wins-womens-allaround-gold-20120802_1_jordyn-wieber-komova-and-aliya-mustafina-gabbydouglas%3B600%3B396

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