Nabil Rajjoub - Recovery center for amputated children

Recovery of a Future Nabil Rajjoub

DIA 2016/17 1st. supervisor Joris Fach 2nd. supervisor Roger Bundschuh

2

CONTENT

5

RECOVERY by Joris Fach

7

RECOVERY OF A FUTURE

8

THE SYRIAN WAR

22

30

TYPES AND EFFECTS OF AMPUTATION

46

PLAY THERAPY

RECOVERY PROCESS

62 LOCATION 74 PROGRAM 84

CONCEPT

95

DRAWINGS

112

BIBLIOGRAPHY

3

4

RECOVERY

by Joris Fach In a health obsessed society, in which fitness clubs and organic food stores spring up at every street corner, the loss of agility and productivity is not an option. Hence, whenever bad luck does strike, it causes daily routines to collapse. Recovery always takes too long and lasting dysfunctions are ruinous. As such, our health has become part of a social equation, differentiating often underfunded public care from exclusive private rehabilitation centers. Additionally, the ownership of health-related data has become highly sensitive, as it is utterly valuable to both pharmaceutical companies, as well as future employers.

Overall, however, the health care industry is one of the most reliably growing ones of recent years. Hospitals have expanded into imposing conglomerates of impenetrable bigness that often fail to connect to their context on almost every level. Pharmaceutical enterprises treat themselves to lush campuses, marking their newly acquired power and influence.

Keeping all of the above in mind, we will commence the semester by looking at the human body itself, understanding its organic functions and amazing resilience, but also study sports injuries, chronic diseases, psychological instabilities, drug addictions and their respective treatments. As the radius of mobility become restrained, the design of immediate surroundings becomes crucial. We will thus speculate on productive environments for recovery, imagining paradisiacal states of urban arcadia in which physical rehabilitation overlaps with exciting cultural programs, making every step of a recovery an exciting one for both body and mind.

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6

RECOVERY OF A FUTURE

by Nabil Rajjoub Every person since childhood grows up dreaming of a great future. However incidents might strike our bodies carrying with it a major shift in our daily life and change the vision of the future that we have dreamed about. Particularly limb amputation is one of those incidents that does not Pass transiently and affect the person‘s daily life posing a negative effect physically as well as psychologically. Those effects have even a bigger impact when they happen in the early ages of a person life, since children‘s body are more fragile and keep growing. Adding to that it is very difficult for children to accept and acclimate to such a tragic loss.

The conflict in my country Syria has completed the 6th year and this tragic war has produced a frightening number of victims and injured people. Unfortunately almost half of them are children and limb loss among them is very common. Despite the tragic loss of their limps, these children also have to battle with the effects of the war, losing their homes, their education and their beloved ones. This facts calls for an urgent intervention to help those children passing this tragic.

Many Syrians families have decided leaving and starting over in Europe, attempting the dangerous trip across the Mediterranean Sea from Turkey to Greece. Not all of them make it across alive. Those who do make it still face steep challenges such as the language and cultural differences and that is adding a new layer to deal with for those children who arrived to Europe with limp amputation.

I see my project as a starting point to help those unfortunate children to recover and retrieve back into a normal childhood life. Having said that, I want to introduce an architectural intervention which helps them get the necessary guidance and knowledge that is needed for them to grow up and have the future they always dreamed of. In other words the project is about a recovery of their future.

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Destruction in my home city - Homs, Syria - 2015, Illustration by Arch.Marwa al-sabwni

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Syrian war

SYRIAN WAR Now in its fifth year, fighting in Syria has unleashed one of the worst humanitarian crises in modern history, uprooting half of the nation’s population. More than 4.2 million people have sought refuge in neighboring countries, including Lebanon, Jordan, Turkey, and Iraq. Nearly half are children.

Families are struggling to survive inside Syria, or make a new home in neighboring countries. Others are risking their lives on the way to Europe, hoping to find acceptance and opportunity. And harsh winters and hot summers make life as a refugee even more difficult. At times, the effects of the conflict can seem overwhelming.

Turkey

Syria Iraq

Mediterranean sea

Jordan

Syrian war

9

People have been forced to leave their countries since the very notion of a country was created, wars, conflict and persecution have forced more people than at any other time since records began to flee their homes and seek refuge and safety elsewhere.

Globally, one in every 122 humans is now either a refugee, internally displaced, or seeking asylum. If this were the population of a country, it would be the world’s 24th biggest.

10 Bangladesh

3.5

(1971 - 1972)

Afghanistan

0.2

15

(1980 -present)

Hungary (1956)

1.8

2nd World war

Indochina

(1939 - 1945)

(1975 -1990)

0.1 Guatemala

(1978 -1982)

1940

1950

1960

1970

Selected population movements forced by conflict (1940 - 2016 ) in millions

10

Syrian war

1980

Since early 2011, the main reason for the acceleration has been the war in Syria, now the world’s single-largest driver of displacement.

Every day last year on average 42,500 people became refugees, asylum seekers, or internally displaced, a four-fold increase in just four years.

1.2 Balkans

(1991 - 1995)

4.1

2 Rwanda

Syria

(1994)

“ It is terrifying that on the one hand there is more and more impunity for those starting conflicts, and on the other there is seeming utter inability of the international community to work together to stop wars and build and preserve peace“.

(2011- Present) UN High Commissioner for Refugees, António Guterres.

1.1 Somalia

2.1

(1991 -Present)

Iraq (2004 - Present)

1990

2000

2010

2020

Syrian war

11

.Korea 0.5 S a 0.2 Argentin

a rali Aust

4.5

ia lays

61

16

9

a 5M

zil Bra

ca

eri Am

a

d na Ca

Elsewhere

Neighbouring countries

Germany 600

Sweden 11 0 Hungary

72

Croatia 55

Total after-war population

39

15,633

Syria

Netherland 31

20

20,500

19 15

11

nd

erla witz

9

S

nce

Fra

8 ian

7

it

ain

5

12

Syrian war

.2 gia 0 Geor

0.4 Ireland

0.7 Czech Republic

Poland 0.7

Ukraine 0.9

1.1 Finland

1.2 Malta

Rom

No

Syrian Refugees by country, 2016 UNHCR numbers in ‚000

2

2.2

3 pr us Cy

Ru s

sia

Sp

ani a

Br

3.5

ium Belg

ay

ark

Denm

rw

Armenia

Total pre-war population

Italy

Austria

SCATTERED SYRIANS The Syrian crisis has generated the largest refugee movement since the Rwandan genocide and is described as the defining refugee crisis of our era. According to the United Nations High Commissioner for Refugees, Antonio Guterres, Syrian refugees are about to replace Afghans as the world’s largest refugee population.

Turkey 2,654

Within this refugee population older, disabled and injured refugees face specific challenges that contribute to their vulnerability, yet, studies of humanitarian programming show that these same groups are often neglected in the assessment, data collection, design and delivery of responses.

Lebanon 1,147

Jordan 623

Iraq 234

31 12

Liby

5.4

0.7

M

Middle east & North africa a

Yem

en

Tun

8 0.

or oc

isia

n

119

da Su

co

Egypt

Europe

Syrian war

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SCREAM, Syrian artist Wissam Al Jazairy, Mix media on canvas

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Syrian war

WAR AND CHILDREN Children who have escaped violence in Syria are brutality losing parents, loved ones, and friends and being displaced and out of school. The impact of the crisis on a generation of children is a grave concern.

While most will survive the conflict physically, the immediate and long-term well-being of children remains a serious concern.

More than 50 % of Syrian refugees are children who‘ve lost everything

Syrian War

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Coloring my future workshop : a collection of drawings, stories and quotes, by syrian children, and the aim is to share children’s voices and raise awareness about their daily reality, including their dreams and fears while growing up in war.

”We sleep to the sound of gunshots. We wake up to the sound of gunshots.”

“I am extremely sad when I am absent from school.”

“I wish we could dig a hole and throw all the garbage inside so that the mosquitos go away.”

“We don’t play because of snipers and shelling in our neighborhood.”

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Syrian war

“It is the right of a child to play.

It is the right of a child to live with family.

It is the right of a child to learn.

It is the right of a child to express his personal identity.

It is the right of a child to watch television.�

Syrian war

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DOLL , Syrian artist Wissam Al Jazairy, Mix media on paper

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Syrian war

CHILDREN WAR FACTS

Many refugee children have to work to support their families. Often they labor in dangerous or demeaning circumstances for little pay.

Between 2 million and 3 million Syrian children are not attending school. The U.N.children’s agency says the war reversed 10 years of progress in education for Syrian children.

Children are susceptible to malnutrition and diseases brought on by poor sanitation, including diarrheal diseases like cholera.

Children are more vulnerable to sexual abuse and exploitation in unfamiliar and overcrowded conditions. Without adequate income to support their families and fearful of their daughters being molested.

Children who have lost

Family

Home

School

Friends

“Never in recent memory have so many children been subjected to such unspeakabl brutality.”

Anthony Lake . executive director for United Nations Children’s Fund 2015

Syrian war

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THE JOURNEY Many Syrians are also deciding they are better off starting over in Europe, attempting the dangerous trip across the Mediterranean Sea from Turkey to Greece. Not all of them make it across alive. Those who do make it still face steep challenges — resources are strained, services are minimal and much of the route into western Europe has been closed.

The risks on the journey to the Europe can be as high as staying: Families walk for miles through the night to avoid being shot at or caught by border guards who will send them back.

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Syrian war

It‘s starting to get very cold.Our plan is to reach a safe shelter where we can rest.

We‘ve crossed both seaand land with our young children. We‘ve had long stretches without cleanwater and proper food.

My pregnant wife hasn‘t received prenatal care.

We don‘t know when we will be able to see a doctor.

My son got his leg wounded in the wood,we couldn‘t provide medical aid and I think he got Gangrene ‫ي‬

I have heart disease and I don‘t have much medication left. Physical exhaustion might worsen my condition.

Syrian war

Most of us are stressed and anxious about our future. We‘re often shunned because people think we carry infectious diseases.

My son has food poisoning, with nausea and diarrohea.

He is dehydrated and weak. Will I be able to explain his condition to a doctor ?

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TYPES AND EFFECTS OF AMPUTATION Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. Limb amputations cause disabilities for men, women and children in all countries.

War and landmines are a major cause of amputation, but natural disasters, accidents and disease also contribute to the number of people who have amputated limbs.

There Is nothing I can‘t do

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Types And Effects of Amputation

1.5%

0.5%

2%

31%

3%

Through Shoulder (Shoulder Disarticulation) Forequarter

Above Elbow (Transhumeral)

Through Elbow (Elbow Disarticulation)

Below Elbow (Transradial)

Through Hip (Hip Disarticulation)

Hand amputations

Above Knee (Transfemoral)

Through Knee (Knee Disarticulation)

Through Ankle (Ankle Disarticulation)

Below Knee (Transtibial)

4%

8%

2%

1%

47%

Percentage of the different limb amputation types

Types And Effects of Amputation

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TYPES OF AMPUTAION Upper limb amputations : Vary from the partial removal of a finger to the loss of the entire arm and part of the shoulder. The following list provides a summary of the typical forms of upper limb amputation: Partial hand amputation : amputations can include fingertips and parts of the fingers.

The thumb is the most common single digit loss.

Metacarpal Amputation : this involves the removal of the hand with the wrist still intact.

Wrist disarticulation : this form of amputation involves the removal of the hand and the wrist joint.

Below elbow amputation (transradial) : the partial removal of the forearm below the elbow joint.

Elbow disarticulation : the amputation of the forearm at the elbow.

Above elbow amputation (transhumeral) : the removal of the arm above the elbow.

Shoulder disarticulation and forequarter amputation : is the removal of the entire arm including the shoulder blade and collar bone.

Forequarter amputation Shoulder disarticulation

Above elbow amputation

Below elbow amputation

Wrist disarticulation

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Types And Effects of Amputation

Lower limb amputations : vary from the partial removal of a toe to the loss of the entire leg and part of the pelvis.

The following list provides a summary of the typical forms of lower limb amputation: Partial foot amputation : this commonly involves the removal of one or more toes. This amputation will affect walking and balance.

Ankle disarticulation : an amputation of the foot at the ankle, leaving a person still able to move around without the need for a prosthesis.

Below knee amputations (transtibial) : an amputation of the leg below the knee that retains the use of the knee joint.

Through the knee amputations : the removal of the lower leg and knee joint. The remaining stump is still able to bear weight as the whole femur is retained.

Above knee amputation (transfemoral) : an amputation of the leg above the knee joint.

Hip disarticulation : the removal of the entire limb up to and including the femur. A variation leaves the upper femur and hip joint for better shape profile when sitting.

Hind quarter amputation Hip disarticulation

Above knee amputation Through knee disarticuBelow knee amputation

Forefoot amputation

Types And Effects of Amputation

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Knee disarticulation amputation Line of incision

knee disarticulation is an amputation done between bone surfaces, rather than by cutting through bone. In a knee disarticulation, the residual limb can generally tolerate some end weight bearing and provides a long mechanical lever that is controlled by strong muscles.

The person retains a full-length femur, and the thigh muscles tend to be stronger because they are released at their distal (far) end, rather than transected at mid-muscle.

Patellar ligament being sutured to the cruciate ligaments

Knee disarticulations have particular advantages for children who are still growing because the growth plates at both the top and bottom of the femur are preserved.

Gastrocnemius bellies

Myocutaneous Medial condyle of femur flap

The shape of the stump in this type of amputation provides greater balance and stability without rotation than that of stumps in higher amputations. The patient can walk with an excellent gait almost immediately.

Without a prosthesis the patient can kneel in work or play, bearing weight on the end of the stump in much the same way as the Symes amputee can on his longer stump.

Completed closure

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A bulbous appearance and a longer knee center than the contra lateral side are among the chief disadvantages of this level.

Types And Effects of Amputation

Guillotine amputation Guillotine amputations are performed in case of emergency, either for speed or for control of infection before a second, and it is a common type in war areas, The initial guillotine amputation helps control the infection, eliminate the bacteremia, and provide a safer wound environment for a definitive amputation at a later date. Thus, it is preferred as a first stage to control infection followed by a definitive below-the-knee amputation.

Divide the skin, muscle and bone at or near the same level.

Tie all bleeding vessels and cut the nerves sharply while under gentle tension, allowing them to retract into the wound.

Debride and lavage the wound every 2–5 days until it is free of dead tissue and infection. At that point, perform a definitive amputation and closure.

Guillotine Amputation

Types And Effects of Amputation

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CHILDREN AMPUTATION The child with a limb amputation presents a more difficult challenge to the healthcare provider due to the potential for continuing growth and development. children’s limbs will naturally change size and shape quickly due to normal growth. This will necessitate more frequent prosthetic socket changes and limb length assessments. Because of the frequent changes there is an added cost to maintaining the child in a properly fitting prosthesis.

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Types And Effects of Amputation

The special feature of amputations in children is the growth potential of the bone in the stump. The quickly growing bone may stretch the skin and even protrude. This will need a revision amputation to excise the excess bone.

This is the most common complication in a child with an acquired amputation. The problem will be evident by age 12 and can result in painful skin stretching and ulceration. This problem is critical if it occurs over a weight-bearing surface such as the end of the thigh bone (femur) or shin bone (tibia).

To manage a child with existing or potential bony overgrowth, focus on preventing excess weight bearing on the end of the limb. Avoiding direct end weight bearing is critical. This problem is noted when the prosthetic limb is not long enough for the patient’s limb. Frequent prosthetic adjustments to prevent this problem are necessary.

Surgery is the treatment of choice, especially if modifying the prosthesis cannot relieve the problem of weight-bearing.

Tibia Fibula

typical “pencil point� overgrowth of tibia and fibula that leads to tenting of the skin and inability to use the prosthesis.

Types And Effects of Amputation

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RECOVERY PROCESS Understanding the time frame of recovery from lower limb amputation is essential to the design and implementation of any postoperative management strategy. placing an emphasis on shortening the time of healing and recovery following limb loss is not necessarily the wisest path. recovery period after the amputation of a lower extremity typically is 12 to 18 months and simply cannot be rushed. This recovery period includes activity recovery, reintegration, prosthetic management, and training.

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RECOVERY PROCESS

1

Preoperative Stage The difficult process of level selection, preoperative education, family emotional support, physical therapy and conditioning, nutritional support, and pain management also all occur in this stage of care.

2

Acute Hospital Postoperative Stage (5-14 days) The acute hospital postoperative stage is the time in the hospital after the amputation surgery. This hospital time typically ranges from 5 to 14 days.

3

Immediate Postacute Hospital Stage (6-8 weeks) In general, this stage begins with hospital discharge and extends 4, 6, or even 8 weeks after surgery. This is the time of recovery from surgery, a time of wound healing, and a time of early rehabilitation. Frequently, end points of this stage are characterized as the point of wound healing and the point of being ready for prosthetic fitting.

4

Intermediate Recovery Stage (4-6 months) This is the time of transition from a postoperative strategy to the first formal prosthetic device. during this stage the most rapid changes in limb volume occur, due to the beginning of ambulation and prosthetic use. The immediate recovery period begins with the healing of the wound and usually extends 4 to 6 months from the healing date.

Although difficult to define, this stage ends with the relative stabilization of the residual limb size, as defined by consistency of prosthetic fit for several months.

5

Transition to Stable Stage (6-14 months) This period is defined as a period of relative limb stabilization after the fourth stage when rapid limb volume changes occurred. Although limb volume changes are not as drastic as in this stage, the limb will continue to change to some degree, for a period of 12 to 18 months after initial healing. this transition is defined by a change from a rapidly changing limb to a slower maturation of the limb.

In this phase the kid should move toward social reintegration and higher functional training and development as well as becoming more empowered and independent.

RECOVERY PROCESS

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Let‘s play outside in the park with the others

It is fun to exercise and play at ones

Hey, let‘s go and play with the others !

Yes, you will start practicing with your new leg soon

Intermediate Recovery Stage (4-6 months)

can I walk again?

Dad,where is my leg ?

4

gangrene went bad, we have no choice but amputation

Don‘t worry son you will be ok !!

2 Preoperative Stage (not defined)

1 Acute Hospital Postoperative Stage (5-14 days)

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RECOVERY PROCESS

There is nothing I can‘t do !

Recovered

Yeah, but we will get a new cool leg

So, you also don‘t have a leg like me ?

ARCHITECTURAL INTERVENTION

Can I walk now without help ?

Transition to Stable Stage (6-14 months)

5 don‘t worry it will get better it just needs practice

I don‘t like my new leg, it is not comfortable !!

The wound is fresh and need time to heal

3

Immediate Postacute Hospital Stage (6-8 weeks)

Nurse, give me the scalpel please

RECOVERY PROCESS

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EXERCISES FOR THE PERSON WITH AN AMPUTATION

A person with an amputation improves greatly if he is taught some of the basic goals of exercising, which are: To improve or maintain the range of motion of all the limbs,To Improve the strength of the limbs,To Improve endurance for daily activities, and right Positioning.

Range of Motion : After amputation the tissues of the remaining limb immediately begin to shorten and contract due to pain, immobility, muscle imbalances and loss of tissue elasticity as a result of surgery and skin grafts. This leads to a loss of range of motion in the joints known as a contracture.

Contractures can make it difficult to wear a prosthesis, difficult to walk and can cause pain, Range of motion can be improved through proper positioning when sitting or lying down, stretching and performing active movement. It is very important to avoid contractures because contractures cause many problems with prosthetic use and fitting.

Positioning refers to how someone stands, sits or lies down. Proper positioning will reduce the formation of contractures. Some correct as well as some incorrect body positions are given below.

Incorrect position

Lying flat with the limb propped up on pillows

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RECOVERY PROCESS

Correct position

Incorrect position

Seated with the residual limb supported and knee straight.

Seated with the residual limb unsupported and knee bent.

Correct position

Lying on stomach with thigh flat on bed is the best resting position. limb propped up on pillows. Encourage as a sleeping position.

RECOVERY PROCESS

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Stretching Techniques : Encourage the person or a caregiver to stretch the tight tissues of all limbs, especially the limb with the amputation. Things to remember about stretching: good stretch means the body part is moved until a tolerable amount of tension occurs.

Mild discomfort is normal if it diminishes after the stretch is removed. Each stretch should be held steady without bouncing for 30 seconds, and repeated 10 times. Stretching should be performed at least 3 times a day or throughout the day, every day

Stretching for lower extremity amputations

Knee to the chest, other leg flat on the mat Pull one leg towards the chest while pressing the other leg flat against the bed or mat. Mild pulling is felt in both hips.

Repeat stretch with the opposite leg pulled toward the chest, and the other leg pressing flat to the mat or bed.

A caregiver can assist with this stretch by pushing one thigh to the chest while keeping the other leg flat on the mat.

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RECOVERY PROCESS

Stretching for upper extremity amputations

Shoulder elevation stretch

Shouldercross-body stretch

Lift the limb upward using the other hand to push until a good stretch is felt just below the armpit.

Stretches the limb across the body using the other hand to pull it across. A good stretch is felt in the back of the shoulder.

Bending the elbow

Straightening the elbow

Sit with the elbow supported on a table. Bend the elbow and use the opposite arm to push the elbow to bend A stretch isfelt on the back of the elbow and arm.

Sit with the elbow supported on a table. Use the other hand to push on the end of the limb,straightening the elbow. The stretch is felt in the front the arm.

RECOVERY PROCESS

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Strengthening : Exercises to improve strength and active range of motion should begin soon after amputation, postoperative day 2 or 3, in order to maximize the person’s function and mobility. Things to remember about strengthening: All exercises should be done until the person experiences muscle fatigue. This usually occurs with 3 to 5 sets of 10 to 20 repetitions, with 10 seconds of rest between sets and 1-2 minutes between each different exercise. Make the exercise harder by adding resistance if a person can perform 3 sets of 15 repetitions against gravity. Resistance is increased by adding weight or force. The person should not be over exerting, if so reduce the resistance or number sets and repetitions.

Exercises for lower extremity amputations

Legs apart position Lie on your side, lifts up the top leg in line with the body and then return to the starting position. The exercise is repeated with the other leg. May add a weight for added resistance.

Sit ups Lie flat with the arms across the chest, and then lift the head and shoulders forward until the shoulder blades rise off the surface.

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RECOVERY PROCESS

Stationary bicycle for lower extremity

Stationary bicycle for upper extremity

To ride a stationary bicycle, the rear wheel is suspended off the ground upon the stabilized blocks, and should be secured into the upright position using rope. The front wheel can rest on the ground but must also be stabilized. The intact limb is secured to the pedal.

The bike can be modified for upper extremity use by simply turning the bike over onto its seat and handlebars and stabilizing the frame. The person simply sits behind the front wheel and pedals with herarm(s). More permanent modification is to remove the wheels and prop the frame of the bicycle up on blocks or a table.

Hip extension with resistance Lie on your side, lifts up the top leg in line with the body and then return to the starting position. The exercise is repeated with the other leg. May add a weight for added resistance.

RECOVERY PROCESS

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Mobility : For most people with bilateral amputations the only safe option for mobility is with a wheelchair or wheeled cart. Mobility is done using the hands to move the wheels. Once a doctor states the incisions are well healed, an individual may be able to tolerate walking on the knees with padded protectors.

walking on the knees with padded protectors.

Exercises for using Prosthesis : A person with a lower extremity amputation who is beginning to walk again must learn some basic skills with the prosthesis to make it easier and more enjoyable to walk. The basics involve being able to properly shift bodyweight onto the prosthesis and balance on the prosthesis. Doing the following exercises in front of a full length mirror will allow the person to view her posture and movements better.

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RECOVERY PROCESS

Balancing the Intact Leg on a Ball Stand with the intact leg on top of a sturdy ball, with both arms supported. Keeping the foot on the ball move it forward and backward, then side to side. Repeat 20 times each direction. Progress to moving the ball in clockwise, then counter-clockwise circles.

Repeat 20 times each direction.

from the Heels to the Toestance Stand with the hands on stable support surface. For example, the back of a chair or parallel bars. Then move the bodyweight forward until it is on the toes and then roll back to the heels. Progress by holding on with one hand and then no hands and then repeat 30 times.

Stepping up with the Intact Leg Stand in front of a 10 to 20 cm height step with both arms supported Then shift the weight onto the prosthetic leg, and step up with the intact leg. Note: One should not bend too far forward, try to stand tall.

RECOVERY PROCESS

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A knight would be fitted with a prosthesis for him to do battle — a hand that could hold a shield or a leg to place in a stirrup.

Only the wealthy could afford a prosthesis.

Dark ages

Prostheses were made of iron, steel, copper and wood.

Renaissance

Frenchman Ambroise Pare introduced modem amputation surgery and invented an above-knee prosthesis with a peg leg, fixed position foot, knee-lock control and an adjustable harness.

Late 1500

Although popular culture envisions pirates with peg legs, there were advances made in prosthetic design.

Civil War amputee James Hanger invented the Hanger limb made of barrel staves.

1700 - 1900

Post WWII

Today‘s prostheses are made with lighter materials. With today‘s technological advances, engineers are working on prosthetic devices that do what the person intends.

42

After WWII, veterans demanded improved prosthetic function.

Today

RECOVERY PROCESS

HISTORY OF PROSTHETICS

424 B.C. to 1 B.C. An artificial leg dating to about 300 B.C. was unearthed at Capua, Italy, in 1858. It was made of bronze and iron, with a wooden core, apparently for a below-knee amputee.

The Dark Ages (476 to 1000) The Dark Ages saw little advancement in prosthetics other than the hand hook and peg leg.

Most prostheses of the time were made to hide deformities or injuries sustained in battle. A knight would be fitted with a prosthesis that was designed only to hold a shield or for a leg to appear in the stirrups, with little attention to functionality. Outside of battle, only the wealthy were lucky enough to be fitted with a peg leg or hand hook for daily function.

The Renaissance (1400s to 1800s) The Renaissance ushered in new perspectives of art, philosophy, science and medicine. By returning to the medical discoveries of the Greeks and Romans concerning prosthetics, the Renaissance proved to be a rebirth in the history of prosthetics. Prostheses during this period were generally made of iron, steel, copper and wood. late 1500s French Army barber/surgeon Ambroise ParÊ is considered by many to be the father of modern amputation surgery and prosthetic design. He introduced modern amputation procedures (1529) to the medical community and made prostheses (1536) for upper- and lower-extremity amputees. He also invented an above-knee device that was a kneeling peg leg and foot prosthesis that had a fixed position, adjustable harness, knee lock control and other engineering features that are used in today’s devices. His work showed the first true understanding of how a prosthesis should function.

World War I & II World War I did not foster much advancement in the field. But this war eventually led to the formation of the American Orthotic & Prosthetic Association (AOPA). Following World War II, veterans were dissatisfied with the lack of technology in their devices and demanded improvement. The U.S. government brokered a deal with military companies to improve prosthetic function rather than that of weapons. This agreement paved the way to the development and production of modern prostheses

RECOVERY PROCESS

43

EMOTIONAL AND PSYCHOLOGICAL ISSUES Children with an amputation will need to work with their family members in the adjustment to a new body image. Doll playing for children younger than seven years and quiet discussion with older children with amputation may be a benefit. Topics that should be discussed include how the child feels about the way they look, how other people react to the child’s appearance, and their ability to play and fit in with other children. As the child approaches teen-age years issues of sexuality and appearance may reappear and efforts should be made frequently to address these topics.

Often the child will react to the amputation in the same way that the adult in his life reacts.

If the family of the child feels that he has limited ability and cannot fully participate in life then the child will often limit himself.

Ideally, the child should be encouraged to participate in age appropriate activities and sports within his ability. Participation in sports and school activities also help to improve and maintain self-esteem.

Often times, it is helpful to teach the child’s peers or classmates about the prosthesis, the cause of the amputation, and treatments, so they are not frightened or intimidated by the prosthesis. A discussion with teachers about “show and tell” in the classroom is often helpful for both the child and his peers. The discussion can be led either by the child himself showing the prosthesis and answering questions, or the parents and teacher.

Although the child should always be encouraged to participate with their able bodied peers, many children benefit from meeting other children with amputations or adult role models with amputation. Whenever possible, healthcare workers or support groups are encouraged to host activities such as sports days, picnics or camps for children with an amputation to that they can meet and socialize with children and adults with similar problems.

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Page Title

Death and life, Syrian artist Wissam Al Jazairy, Mix media on canvas

Page Title

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PLAY THERAPY Play therapy draws on the proven therapeutic power of play, using professional therapists as catalysts and support to help children with their troubles through play activity. Play therapy may also be of value beyond the clinical setting, conducted through parents as well as in preschools.

Play therapy, in which children are encouraged to act out their feelings and dilemmas through play and fantasy, draws on the power of play to give palpable expression to children’s concerns. Play therapy is consistent with children’s tendencies to “play out” problems outside of clinical intervention, reenacting troubling experience as a way to come to terms with conflicted feelings

46

PLAY THERAPY

Adults

Children

The difference in movement and exploring new spaces between adults and children

PLAY THERAPY

47

PLAY SPACES A good healthcare environment for children should enable to navigate for some activities alone, encourage children to use their abilities, and make them feel safe as home.

A children’s healthcare, in addition to medical treatments are usually supported by environmental therapies, such as interacting with other children, socializing, or improving their skills thorough plays and enriched spaces. In order to have an efficient therapy, the spaces should enable concentration, relaxation and disable stress, Therefore environment should provide appropriate light, acoustics, volume, way finding, needs for privacy and relaxation while avoiding stress.

Therapy units refer to a wide variety of children from different age groups, or with various illnesses and injuries. In a wider perspective, what unites them is that they are not healthy, and the play therapy unit aims to encourage them to enjoy their time, as if they were healthy. Children in play therapy join the activities as a part of their hospital stay, or as a free visit when they come for a regular day visit. In addition to activities guided by therapists, parents and siblings are also involved in the process, allowing children to spend more time with their families, gives them individual value Differing from their daily routine, here they have the freedom to choose the activities they want to join and learn new skills. In other words, they are encouraged to explore, learn, discover, socialize while they are distracted from their pain.

48

PLAY THERAPY

Immediate Postacute Hospital Stage

Intermediate Recovery Stage 2

Intermediate Recovery Stage 1

Transition to Stable Stage

PLAYING SPACES

Encourging

Social Interaction

Relaxing disable stress

Privacy levels

Formal recovery procedure and the relation with playing spaces

PLAY THERAPY

49

Way finding

Privacy

outside spaces

Interaction

50

PLAY THERAPY

Way finding As the therapy unit encourages the children to decide the activities they want, It is important to enable them to achieve things on their own. Joining the activities in the unit, children should be capable to find their own route, navigate to discover, without stress and hesitating of “Will I be able to find it? What if I get lost?”

The design intervention can start with “way-finding” to enable the child to find his/her own route in the building. When children are unhealthy, they have difficulties in remembering.

Therefore the planning should refer to their memories, easy to understand, and remarkable so they can recall and make connections.

Privacy Children do not feel stressed to find their direction when they navigate in a building with clear orientation. Privacy also has a similar effect as way-finding. With sense of privacy, a child feels more secure, and even confident. A child trying to learn or exercise would feel anxious and uncomfortable when he/she feels others watching, which can also cause discourage and distraction. The level of stress is very important in a healing process, and since children are continuously developing, it might have more powerful effects.

Outside spaces Reconnect the space to urban fabric, discussing against the 60s approach of pulling hospitals from urban centers and internalized planning. The new design will emphasize that kids with disabilities are also a part of city, and bring variety. Connecting the building to urban, another key element is blending exterior and interior together, bringing the exterior to interior, as daylight or nature, extending the borders of therapy spaces to outside.

Interaction Social interaction is something we often have either with our families, friends or in public environments we share with others. During treatments the only interaction the patients have are with their families and medical staff.

New approaches in healthcare for children, encourage more and more interaction with other people, which also makes them feel more valuable as a part of a bigger group. While some therapies are involving group activities with other patients, some therapies involves member of their own families to maintain the closeness of their home environment.

PLAY THERAPY

51

SOCIAL INTERACTION IN PLAY SPACES : When we think about playing spaces, we should look more closely into the all interaction possibilities between all space users ( disable children - normal children - families - staff - teenagers ....), to clarify the problems and suggest the possible solutions.

Teenagers

Children

Problem Way of playing for a six years old child is so different from 13 years old teenager, in fact mostly the older children will find it annoying to be with smaller children while playing, since children always tend to play with the same age group

Possible solution Zoning of playing spaces is the one possible solution for this type of interaction, giving each age group different playing areas, even thought this division shouldn‘t be with complete barriers but rather using smart ways to guide each group into certain area.

52

PLAY THERAPY

Children

Staff

Problem psychological studies showed that children prefer playing without any supervision, and they feel more free to explore by themselves, rather than having an adult watching every move of them while playing.

Possible solution For private play spaces a one side see-through glass material is one of the solutions, while in semi-public play spaces one possible key is to avoid direct supervisions from the staff and let the family members participate in this process.

Family

PLAY THERAPY

53

Disabled child

Normal child

Problem At first interaction between normal and disable children in play spaces, the difference in ability to play become very obvious, which could put the disable child down and bring a Counterproductive result.

Possible solution Create a playing environment that challenge both normal and disable children in the same way and avoid the activities that shows clearly the differences, (direct running) for example.

54

PLAY THERAPY

PLAY ELEMENTS : Choosing smartly the elements of play and integrate these elements in children recovery process will help to put the children in right direction to recover physically and emotionally.

WALL CLIMPING

INTERACTION GAMES

WATER/SWIMMING

BALL TRAINING

PLAY THERAPY

55

SAFETY SURFACES The below table shows the advantages and disadvantages for different types of safety surface for play areas, illustrating which one is the best for the kids with disability.

+

56

Grass

Readily available and Environmentally friendly/ Vandal resistant Likely to be better for drainage than bound surfaces dependent on soil types and water table.

bark

Can be sustainably sourced/ Very good impact absorbency/Low friction for those with restricted mobility/Vandal resistant Easy inspection of foundations/Good for drainage.

sand

Good impact absorbency and Can be sustainably sourced Vandal resistant/ Low friction for those with restricted movement/ Good for drainage.

Rubber tiles

Resistant to wear in daily use/ Good for wheelchair access/ Easy visibility of debris on surface/ Can help add colour to a site.

Grit

Works well used alongside sand as a contrasting texture/ And good impact absorbency/ Good for drainage.

PLAY THERAPY

$

low

Medium

Medium

High

Medium

Choosing the best surface for the activities planned will add play value to a scheme,some surfaces such as sand and grit are high in play value but not for wheeled play.

Very vulnerable to erosion and wear/ Regular maintenance required Impact absorbency will vary depending on soil types and conditions.

Higher maintenance costs, will need regular topping up/ Can get dirty Poor for wheelchair access/ Poor visibility of debris and Can leave foundations exposed.

Higher maintenance costs/ Abrasive effect will increase wear on equipment/ Impact absorbency reduces when wet (or frozen) / Poor for wheelchair access and visibility of debris/ Can leave foundations exposed.

Difficult to inspect foundations/ May increase surface water run-off/ Can be ignited if a bonfire is constructed on the surface.

As sand but less prone to migration/ Need to specify carefully to ensure that the materials are not able to combine to form a solid mass.

PLAY THERAPY

57

ARCHITECTURE FOR DISABILITY Starting from disability rather than treating it as an afterthought to building design is the key to generate some truly radical,creative architectural solutions. Creating environment that encourage both normal and disable children to feel the same in term of using spaces.

58

PLAY THERAPY

Barrier free design standards should satisfy anyone who is hampered in his mobility or functioning (as compared with a nondisabled person) as a result of obstacles put in his way by the design of a building, the choice of hardware and equipment, and the arrangement of outside space.

wheelchair users and elderly handicapped persons have a common need of hard, nonslip, even floor surface. Avoid loose gravel and provide continuing common surface not interrupted by steps or sudden changes in level, and other obstructions such as manhole covers, light or telephone poles. The spaces should be marked with signages in braille.

Barrier Free Environment is one which enables people with disabilities to move about safely and freely and to use the facilities within the built environment. The goal of barrier free design is to provide an environment that supports the independent functioning of individuals so that they can get to, and participate without assistance, in every day activities.

PLAY THERAPY

59

60

PLAY THERAPY

ESCAPING

PLAY THERAPY

61

LOCATION Many of refugees that escaped the war are located in neighbor country such as Turkey, Jordan,Lebanon and Iraq, even thought it is still hard to introduce such an intervention in this countries due to the fact that this countries still face a lot of difficulties to provide the refugees with the basic needs.

On the other hand Germany in Europ is one of the main destination for the people from conflict areas and amputation is a common problem among them in addition to that Germany itself has a high number of children amputation ( around 1000 per year ) and still there is not a special facility for that most of the treatment taking place in the hospital or other rehabilitation facilities.

600

Germany 110

Sweden 72 55

Hungary Croatia

39 31

Austria Netherland Armenia Denmark

20 19 15

Belgium 11 9 8

Switzerland France Britian Spain Russia Norway

7 5 3

Refugees by country, 2016 UNHCR, numbers in ‚000

62

LOCATION

EUROPE MAP

LOCATION

63

BERLIN Berlin as a capital of Germany and with a population of 3.5 million people is a main destination for a lot of refugees which make it an ideal choice as a site for this architectural intervention since it will allowing more range of people to get benifit from the services of the center.

GERMANY MAP

64

LOCATION

As mentioned in previous chapter reconnecting the space to urban fabric, discussing against the 60s approach of pulling hospitals from urban centers and internalized planning is one of the main design tendency. The new design will emphasize that kids with disabilities are also a part of city, and bring variety. That is why connecting the site with urban fabric is important for that the chosen site is located in the heart of Berlin city in between of Schoneberg and Kreuzberg.

BERLIN MAP

LOCATION

65

GLEISDREIECK PARK land once occupied by an old railway crossing and now it is a large urban-scale metropolitan park.

S BAHN YORCKSTRASSE S Bahn station near the site which provide easy accessibility to the site from all the city

ST. JOSEPH HOSPITAL Big hospital located to the north of the site in addition for clinics spicialized in children health

66

LOCATION

POTSDAMER PLATZ the site is located in less than one kilomiter south of famous potsdamer platz

MEHRINGPLATZ The site separated the neighbourhoods of Kreuzberg to the east and Schรถneberg to the west.

TEMPELHOF OLD AIRPORT Tempelhof old airport is now consider as the biggest shelter for refugees in Berlin .

LOCATION

67

GLEISDREIECK SITE The site is located just over a kilometre south of Potsdamer Platz, near the left bank of the Landwehr Canal, the park of Gleisdreieck is the most important part of the site since it is a large urban park that integrate the different urban zones which converged there.

This park could play a major role in design process, be a part of therapy strategy, and at the same time integrate the local comunity and urban fabric with the building.

At the south side of the site there is S Bahn YorckstraĂ&#x;e which provide easy accessibility to the site from all the city.

250

90

68

LOCATION

110

There is a road located on one side of the site, while the park is on the other side, and a one meter level diffrence between the two side, this two sides connected by main of long ramps. S-Bahn bridge floats over the site, dividing it into almost 3/4 to 1/4 propotion , the height of the bridge goes from 7 to 8 meters.

LOCATION

69

70

LOCATION

S-Bahn bridge floats over the site, dividing it into almost 3/4 to 1/4 propotion , the height of the bridge goes from 7 to 8 meters.

Children playing areas in the park, facing 2 sides of the site, offering the opportunity to use these play grounds as a part of the design.

Car access to the site from the west side of the land, which at the same time facing the resdintal part of the area.

LOCATION

71

HISTORY OF THE SITE The site was an extensive, triangular-shaped area of waste ground once separated the neighbourhoods of Kreuzberg to the east and Schöneberg to the west. Known as Gleisdreieck, meaning “triangle of rails”, it was formed by the intersection of different railway lines that had entered Berlin from the south since the mid-nineteenth century.

Railway lines, sheds and warehouses of three old railway stations located in very close proximity ─Dresdner Bahnhof (1875-1882), Potsdamer Bahnhof (1838-1944) and Anhalter Bahnhof (1839-1952)─ accumulated on a raised platform of some twenty hectares at a height of four metres above the city level.

As the infrastructure gradually ceased to be used the whole area became increasingly run down and neglected, to the point of being used as a rubbish tip after 1945. Meanwhile, vegetation took over, turning it into a surprising natural enclave in the middle of built-up territory. The closeness of the Berlin Wall also contributed to the fact that Gleisdreieck was for decades clearly identified as no-man’s-land. Only the homonymous U-Bahn station in Berlin’s underground railway system testified to its existence through its name.

Shortly before the fall of the Berlin Wall, however, the German Museum of Technology was installed in the north-western third of the sector, attracting large numbers of visitors and giving visibility to the site. Nevertheless, it was the unification of the city that gave the zone more centrality, whereupon finding a destiny for it became an imperative need.

Image prior to the intervention. Photo map from 1943. The Gleisdreieck railway triangle took shape between the neighbourhoods of Kreuzberg and Schöneberg.

72

LOCATION

GLEISDREIECK PARK

On the eastern side of the meadow there is quite a thick forest of preexisting maples, oaks, birches and lemon trees as well as new trees of these species.

The project as a whole was planned around a large central meadow, crossed from east to west by a concrete footpath and from north to south by a pair of railway lines.

On the northern side of the meadow there is a large concrete slab which, well oriented to the south, functions as a big sunny terrace, full of benches complete with footrests.

The transversal concrete footpath starts in the east, clearing the four metres difference in height of the platform by means of a stairway.

View of the park from the concrete terrace into the direction of the choosen site.

Concave surfaces for skateboards.

LOCATION

73

PROGRAM The building spaces are varied in order to cover all users needs from children and families to doctors and staff ending up with daily visitors.

Staff Accommodation Adminstration

Post operation unit

Physical therapy

Swimming

Staff

Doctors

Playing Private

Playing Private

Daily clinic

Playing semi public

Accommodation

Learning space

Emergency

Canteen Family unit

Playing public (park)

Reciption

public awareness

Initial distribution of spaces showing a central playing method

Accommodation : In this section we find spaces related to long staying period of recovery process, mainly bed rooms in direct contact with private playing space. This section provide relax and calm environment for the children.

Family unit : Children families are a main part of the recovery process and it is Important to provide families with spaces to stay with their children during recovery process. This part is in direct connection with the children accommodation.

74

PROGRAM

Administration, Staff : Offices and work spaces which is necessary for any facility, this section is in direct connection with staff rooms.

Staff accommodation : Since recovery process is a long process and it require 24/7 attendance of the doctors and therapist, it is necessary to provide them with spaces for long staying.

Physical therapy : Main part of regular recovery process, where we find all the sport halls and necessary equipments, for children to strength their limbs and start using prosthetics, this area connected with swimming pool which consider as a part of the physical therapy.

Swimming pool : Considered as private playing space, since play therapy is the main method that is followed in the process, the swimming area could extended into semi public play space.

Playing private : Spaces dedicated only for amputated children and their families, this spaces are used mainly in early stage of recovery process where the interaction with normal children could not be preferable yet Playing semi public : The main part of intervention, this space is a connection area for most of other building spaces , in this space all children from outside could come and spend time with amputated children under certain procedure.

Playing public : Outside playing spaces which ill almost be merged with a playing spaces in the park.

Canteen : Providing the facility with needed meals for all users, this area is open for all users and for public.

Learning spaces : This area is for all programs that is needed to integrate the children and educate them about their new situation, providing the opportunity for the families as well to be part of these sessions.

Public awareness : This area is oriented to the public, here the children and families from outside could join in educational program about amputation. This space could be part of the park.

Post operation unit : This space for the children in early stage of recovery process where an intense medical care for the wound is needed, this section is in direct connection with doctors rooms and should enable relaxing and calm for the children.

Daily clinic : Dedicated for the regular visit if children after they leave the building and finish their recovery process

PROGRAM

75

Staff Accommodation Adminstration

Physical therapy

Swimming

Staff

Playing Private Playing semi public

Accommodation

Family unit Reciption

Canteen Playing public (park)

Entrance

76

PROGRAM

FUNCTIONAL DIAGRAM

Post operation unit

All the spaces in the building are divided into three groups of privacy ( Private - Semi private - Public ). this division provides more understanding for different spaces and the relation between each one of them .

Doctors

Centred play space is the main characteristic of the spaces distribution, and the next diagram shows clearly all building spaces and how it relate to each other :

Daily clinic Playing Private

Emergency

Learning space public awareness

Public Semi-Private Private

PROGRAM

77

Staff Staff Accommodation Swimming

Playing Private Physical therapy Post operation unit Doctors Daily clinic Emergency Playing semi public Accommodation Family unit Reciption Canteen Playing public (park) Learning space public awareness

Preferable

Essential

Possible

Relationship diagram between all Building spaces

78

PROGRAM

public awareness

Learning space

Playing public (park)

Canteen

Reciption

Family unit

Accommodation

Playing semi public

Emergency

Daily clinic

Doctors

Post operation unit

Physical therapy

Playing Private

Swimming

Staff Accommodation

Staff

Adminstration Adminstration

PROGRAM

79

PRIVACY OF SPACES Playing spaces are divided into three levels of privacy that goes in respond to recover process for amputated children, starting from private spaces in early stages of recovery, then semi private where children from outside could participate under certain procedures, till we find a public play space which is blended with the park.

EXPLORE

PUBLIC

SHARING COMMUNITY

SEMI PRIVATE

5

4

PRIVATE

4

3

Immediate Postacute Hospital Stage

80

PROGRAM

Intermediate Recovery Stage

Gleisdreieck park Recovered

5

Transition to Stable Stage

SOCIAL

PLAY

FRIENDS

FAMILY CALM

SAFE

PROGRAM

81

VISION STATEMENTS :

PLAYFULNESS play therapy as a main method in design process, it is where the basic architectural elements ( walls - ceiling - staircases ...) become a part of playing activities.

This methode is to encourage the children to enjoy their time, as if they were healthy.

Children in play therapy join the activities as a part of their hospital stay, or as a free visit when they come for a regular day visit. In addition to activities guided by therapists, parents and siblings are also involved in the process.

82

VISION STATEMENTS

BRINGING EXTERIOR TO INTERIOR Connecting the interior spaces into urban fabric, discussing against the approach of pulling hospitals from urban centers and internalized planning. The new design will emphasize that kids with disabilities are also a part of city, and bring variety.

Connecting the building to urban, the key element is blending exterior and interior together, bringing the exterior to interior, as daylight or nature, extending the borders of therapy spaces to outside.

VISION STATEMENTS

83

CONCEPT The conceptual thought is based on an envelope which is divided into three zones based on the level of privacy: private, playing, and public zones. Within this envelope I have placed all the functions in the form of boxes. These boxes are distributed according to the zones. In the private zone the arrangment is more dense in order to achieve more intimacy. As soon as they reach the playing zone they spread out into more open spaces and eventually open up completly in the public zone.

The spaces in between the boxes become the buildings playground and at the same time provides the circulation through the building. This will give children the freedom to choose the activities they want to join and learn new skills. In other words, they are encouraged to explore, learn, discover, socialize while they are in this playground.

84

Concept

Private

Play

Public

Divide the envelope into three zones

Distribute the functions as boxes with density according to the zones

Use the Inbetween spaces as playground

Concept

85

1

Envelope follows the site shape and placed at the street side

2

86

Introduce public and private entrances

Concept

3

Divide it into three blocks according to the main 3 zones, to control circulation

4

Provide conncetions

Concept

87

WALLS AS PLAYING ELEMENT

The walls of the boxes will be utilized as a playing element which can be transformed ( mirrors - climbing - chalkboards .....etc ). The solid walls are oriented to the private zone and used as playing element, the walls that contains window opinings and curtain glass are oriented to the public side to provide more visibility and visual connection.

Each of these boxes are provided with a skylight, which is formed by extending one of the corners for each box. This will provide a natural light in these spaces and give the interior a sculpted and playful volume.

88

Concept

Skylight

Climbing

Two-way mirror

wall

Chalkboard

Visual conneciions

Concept

89

IN BETWEEN SPACES AS PLAYGROUND The spaces that is created between the main function will represent the playground of the building. These spaces contains variety of functions and zones. The activities that need less physical movment placed closer to the private zone, where the children still in early stage of thier recovery process, and it becomes more vital toward the public zone where it become more about exploring and interacting with others.

Play spaces

90

Concept

Concept

91

PERCEPTION OF THE PLAY SPACE

As a result of the function arrangements and openings orientation, the play spaces will read diffrently from the private and public entrances. where from the private one the spaces feels more intimate and secured, while from the public entrance it reads more open.

Private Entrance

92

Concept

Public Entrance

Concept

93

94

DRAWINGS

95

Green area Playgrounds Roads

Site Plan

96

Drawings

Drawings

97

+- 00

Staff Swimming pool + 90

Clinic

Staff

A

Clinic

Water Therapy

Bed room Doctors

Floor plan

98

Drawings

Physical Therapy

B

class room canteen

A Workshop

+ 90

multipurpose space Clinic

Clinic

Clinic

+ 90

B

Drawings

99

14

16

100

Drawings

15

13

1

8 14 14 4

5

2

3

6 8

7 9

10

11

12

1.

2.

3.

4.

5.

Bed rooms Sitting area Playing area Interactive games Physical Therapy

6. Water Therapy 7. Reading area 8. Staff

Drawings

9. swimming pool 10. Calm area 11. Workshop 12. Learning space 13.Chess area 14.Clinics 15.Canteen 16.Multipurpose space

101

Section BB

-+ 00

Private Garden

Private terraces

Bed room

Clinc

Private playing

Section AA

102

Drawings

Private courtyard

Water therapy

Reading area

+ 90

-+ 00

Calm zone

Swimming pool

Playing Courtyard

Physical Therapy

+ 90

Playin courtyard

Playground

Public Entrance

Drawings

Multipurpose hall

103

screed Steel mesh Water proofing Thermal insulation Rainforced concrete

Detail Section

Concrete slap Thermal insulation Sand blinding

104

Drawings

Compacted earth

Double glazing skylight

Auminum rain gutter

Playwood panels Wooden pattern Concrete slap Thermal insulation Sand blinding Compacted earth

Drawings

105

106

Drawings

Drawings

107

108

Drawings

Drawings

109

Playing spaces

110

Drawings

Learning space

Drawings

111

BIBLIOGRAPHY Books : Murphy, Douglas. Fundamentals of Amputation Care and Prosthetics. Rehab Post Surgery.

New York: Demos Medical, 2014. Page 36-43.

Dudek, Mark. Spaces for Young Children, Second Edition: A Practical Guide to Planning, designing and building the perfect space. The space. London: NCB, 2012. Page 23-37.

Boys, Jos. Doing Disability Differently: An Alternative Handbook on Architecture, dis/ability and designing for everyday life. Re-connecting architecture with dis/ability. New York: Routledge, 2014. Page 61.

U.S. Department of Veterans and affairs. Surgical Services design guide. Technical Considerations, Architectural. Northwest, Washington, D.C. 2016. Page 24.

Manuals & Guidelines : Shackell, Aileen, Nicola Butler, Phil Doyle and David Ball. „Design for Play: A guide to creating successful play spaces“. The advantages and disadvantages of different types of safety surface: Page 87-88. Accessed January 9, 2017. http://www.playengland.org.uk/ media/70684/design-for-play.pdf World Health Organization, United States Department of Defense, MossRehab Amputee Rehabilitation Program, MossRehab Hospital, USA. „The Rehabilitation of People with Amputations“. Exercise for the Person with an Amputation: Page 42-72. Accessed December 22, 2016. http://docplayer.net/960920-The-rehabilitation-of-people-with-amputations. html Central Public Works Department, Ministry of Urban Affairs & Employment, India. 1998. „Guidelines and space standards for Barrier free Built environment for Disabled And Elderly Persons“. Design Elements within the Building Premises: Page 21-45. Accessed November 18.

2016. http://cpwd.gov.in/Publication/aged%26disabled.PDF International Committee of the Red Cross. „exercises for lower-limb amputees“. Advanced exercises: Page 47-56. Accessed January 2, 2017. https://www.icrc.org/eng/assets/files/ other/icrc_002_0936.pdf

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BIBLIOGRAPHY

Reports : World Health Organization. 2011. „World Report On Disability“. Recommendations: Page 261. Report. Accessed November 21, 2016. http://www.who.int/disabilities/world_ report/2011/report.pdf Handicap International. 2013. „Hidden victim of the Syrian crisis: disabled, injured and older refugees“. People with specific needs: in-depth analysis of individual conditions: Page 18.

Report. Accessed November 2, 2016. https://data.unhcr.org/syrianrefugees/download. php?id=5812 United Nations Children’s Fund (UNICEF). 2013. „Children with Disabilities“. Explosive remnants of war: Page 54. Report. Accessed January 5, 2017. https://www.unicef.org/ sowc2013/files/SWCR2013_ENG_Lo_res_24_Apr_2013.pdf Handicap International. 2016. „Syrian Crisis Situation Report“. Accessed November 27.

2016.https://d3n8a8pro7vhmx.cloudfront.net/handicapinternational/pages/2159/ at tachments/original/1454522300/Syria_Situation_Repor t_Januar y_2016. pdf?1454522300 Cagil, Kayan. „Neuro- architecture, Enriching healthcare environments for children“. Ma Thesis, Chalmers University of Technology, 2011. Accessed January 12, 2017. https://issuu. com/cagil/docs/newneuroarchitecture_cagil_part_1_a4

Journals and Articles : Kim M. Norton. „ A Brief History of Prosthetics“. InMotion, 17, Issue 7,( November/December 2007). Accessed November 4, 2016. http://www.amputee-coalition.org/resources/abrief-history-of-prosthetics.

Omer, Sevil. „Syria CISIS: SCARS OF WAR, Amid conflict in Syria and neighboring countries, a sense of childhood is slipping away“. World Vision Magazine, Issue 8, (April 2015).

Accessed November 12, 2016. https://magazine.worldvision.org/stories/syria-crisis-scars-of-war.

BIBLIOGRAPHY

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Online Sources : Disabled World. „The Syrian War and People with Disabilities“. Accessed December 3, 2016. https://www.disabled-world.com/editorials/syria.php.

Refugees operational portal by UNHCR. „ Syrian Asylum Applications“. Accessed November 4, 2016. https://data.unhcr.org/syrianrefugees/asylum.php Save the refugees. „Children Refugee facts“. Accessed November 18, 2016. http://www. savetherefugees.ca/child-refugee-landing.

Mercy corps. „Quick facts: What you need to know about the Syria crisis“. Accessed November 17, 2016. https://www.mercycorps.org/articles/iraq-jordan-lebanon-syriaturkey/quick-facts-what-you-need-know-about-syria-crisis.

Handicap International. „Rehabilitation“. Accessed November 24, 2016. https://www. handicap-international.de/rehabilitation The American Academy of Orthotists & Prosthetists. „Postoperative Management of the Lower Extremity Amputation“. Accessed December 9, 2016. http://www.oandp.org/olc/ lessons/html/SSC_02/07stages.asp?frmCourseSectionId=514F4373-8EDF-434A-BA08C221FA8ABD71.

Amputee Coalition organization. „One Step at a Time: Recovering From Limb Loss“. Accessed December 17, 2016. http://www.amputee-coalition.org/senior_step/recovering.html.

Limbs 4 Kids. „Returning to school after a limb amputation“. Accessed December 7, 2016. http://limbs4kids.org.au/wp-content/uploads/2015/07/Fact-Sheet-10-Returning-toSchool-after-a-Limb-Amputation.pdf Centre de Cultura Contemporània de Barcelona. „Park am Gleisdreieck Berlin (Germany)“.

Accessed January 5, 2017. http://www.publicspace.org/en/works/g047-park-amgleisdreieck

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BIBLIOGRAPHY

115

c

I Dessau International Architecture School Anhalt University Department 3 Š 2016/17