onsumers, families, and health care professionals
Barrier-Free Design: A
Review and Critique of
the Occupational
Therapy Perspective
Barbara Acheson Cooper, Uriel Cohen,
Betty Risreen Hasselkus
Key Words: architectural accessibility.
environmental design. literature review
This review of the occupational therapy literature on
barrier-free design identifies both a pauci~v of related
occupational therapy research on the topic and a
lack of a common conceptual base with which to
gUide the development and use of environmental as-
sessments. Nonetheless, two fledgling themes can be ex-
trapolated: tbe consistent reference to the concepts of
accessibili~v) mobility, function, and safety and an in-
creased awareness among occupational therapists re-
garding the accessibility standards developed by the
American National Standards Institute (ANSI) (ANSI,
1971, 1980). A problem-solving model suggested by de-
signersfor the 1979 revision of ANSI standards that in-
corporates these conceptual themes is described and
discussed.
Barbara Acheson Cooper, MHSC, Oil' POT, is A~sistant Professor,
A~sociate Dean, and Director of the School of Occupational
Therapy and Physiotherapy, IJ 11 Health Sciences Centre,
McMaster University, 1200 Main Street West, Hamilton, Ontar-
io, Canada IBN 3Z5. She is currently enrolled in the doctoral
program for environment behavior studies, School of Archi-
tecture and Urban Planning, University of Wisconsin-Milwau-
kee, Milwaukee, Wisconsin.
Uriel Cohen, DArch. is Associate Professor, School of Architec-
ture and Urban Planning, University of Wisconsin-Milwaukee,
Milwaukee, Wisconsin.
Berry Risteen Hasselkus, PhI), OTK, is Assistant Professor, De-
partment of Therapeutic Science, and Chair, School of Occu-
pational Therapy, University of Wisconsin-Milwaukee, Milwau-
kee, Wisconsin.
Tbis article was Clccepted!or publication August 30, 1990.
----
344
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C agree that a physical setting that fosters inde-
pendent living is often the critical factor that al-
lows persons who are frail and disabled to live in the
cominunity instead of in an institution. Although thig
statement may seem self-evident, policymakers have
heen slow to acknowledge it (Liston, 1971; Shaw, 1971;
Taira, 1984). Changes made over the past 20 years in the
form of new regulatory legislation and the adoption of
more stringent bUilding standards, however, are gradual-
ly beginning to have an impact on the problem (Martin,
1987; Steinfeld et aI., 1979; Taira, 1984). Low-cost units
specially designed to accommodate the needs of specific
groups have been and are being erected; communitie~
are hecoming increasingly aware of the need to provide
access to public buildings, services, and the neighbor-
hood at large; and heightened multidisciplinaly concern
is evident (Taira, 1984).
The occupational therapy profession has a declared
interest in barrier-free design. According to Mosey
(1986), a fundamental aspect of
the practice of occupational therapy is concern for and use of thc
nonhuman cnvironment. The nonhuman cnvironment is viewed
as an entity to be mastcred, an aid 10 facilitate the pcrformance of
life tasks. and a vehicle for assisting in the development of senso-
ry, perceptual, cognitive, and motor skills and need-fulfilling intra-
personal ancl interpersonal relationships. (I'. 3)
Mosey's (1986) views are supported hy the profes-
sion as a whole, as evidenced by educational curricula
that include as a basic component the teaching of meth-
ods used to conduct home assessments and modifica-
tions for both architectural and functional features. Fur-
ther endorsement comes from the American
Occupational Therapy A~sociation (AOTA), which identi-
fies and lists the ability to conduct home evaluations as
essential for various specialized roles (e.g., AOTA, 1981a,
1981b, 1983).
A conservative estimate of between 1.7% and 2.2% of
the population are directly affected by barrier-free design.
A more liberal view states that up to 11.6% would benefit
from the implementation of more stringent standards of
accessibility (Steinfeld et al., 1979). Persons who are el-
derly and those who are physically disabled have been
identified as the two major groups requiring assistance
with environmental modification. Barrier-free environ-
ments, both in the home and the wider community, are
essential to successful independent living for these at-risk
populations. Both the disabled and elderly populations
are increasing in number, primarily as a result of im-
proved health care. This factor, the growing awareness of
the expense and negative effects of institutionalization,
and the profound desire of these persons to remain in the
community are increasing the demand for appropriate
community-based, barrier-free housing, both new and
modified. Because of their training and skills in functional
assessment and environmental adaptation, occupational
April 1991, Votume 45, Number 4
 therapists are well suited to function as facilitators for the
independent-living movement (Hasselkus & Kiernat,
1973). Thus, we can reasonably predict that the volume of
requests for our input will increase in the immediate
future.
The framework within which occupational therapy
organizes its therapeutic approach to assessing the phys-
ical environment thus becomes particularly important.
The independent-living thrust defines the term environ-
ment broadly and clearly considers community accessibil-
ity to be as important as residential accessibility for those
whom it serves. The conceptualization used in the future
by therapists, therefore, needs to be broad enough to
include all possible bUilding types and settings. It must,
however, also allow the profession's focus on individual
function to be maintained as the unit of analysis. Ideally,
this framework must be equally acceptable and useful to
all occupational therapists, regardless of their area of
practice. Given that no one clinical strategy is currently
agreed on, such a framework for environmental assess-
ment would also need to be flexible enough to accommo-
date diverse formats. Professional consensus regarding
the conceptualization of barrier-free design and assess-
ments would provide a consistent method for data collec-
tion without restricting its subsequent clinical use. An
additional benefit would be the provision of a collective,
uniform base from which issues related to occupational
therapy and environmental access could be researched.
The present paper reviews and critiques the occupa-
tional therapy literature on barrier-free design, particular-
ly concerning the conceptual approach now used in edu-
cation, research, and practice. It suggests a model by
Steinfeld et al. (1979) as one that might provide the pro-
fession with an appropriate but more comprehensive al-
ternative to our present situation-specific approach and
yet allow the focus on individual function to be
maintained.
Lllcramrc R \'jew
Education and Practice
The major instructional texts in occupational therapy usu-
ally include sections on the topic of barrier-free design in
the sections that deal with physical disahilities or home
care. The classic general text, Willard and Spackman's
Occupational Therapy (Hopkins & Smith, 1988), ad-
dresses the need for architectural modifications but pro-
vides only brief general gUidelines for making these
changes. Additional information in chapters by Malik
(1988) and Levine (1988) discuss activities of daily living
and independent community living, respectively. Malik
(1988) listed broad areas to be considered when maklllg
home modifications, which can be restated as issues of
acceSSibility, mohility, function, and safety. Levine (1988)
stated that "the best approach for the therapist to use
The American journal of Occupational Therapy
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cannot be precisely outlined" (p. 773). She cited cultural,
economic, and personal preference variables as barriers
to a universal approach. Nonetheless, she suggested two
ways of conceptualizing the environment for treatment
purposes. First, she built on ideas from Barris, Kiel-
hofner, Levine, and Neville (1985) to propose a model of
four concentric circles. From inner to outer, these circles
represent the nonhuman environment, required func-
tional tasks, roles, and culture. Second, she suggested
Kielhofner and Burke's (1985) Model of Human Occupa-
tion as a broad organizational base that could provide a
theoretical umbrella for specific treatments and theories
used in community health care.
Trombly and Versluys (1989) discussed the evalua-
tion of architectural features within the home and com-
munity for clients with physical disabilities Although a
sample questionnaire is provided, no overall conceptual
framework is suggested. The authors stressed the impor-
tance of site visits and the inclusion of the client and
family in the assessment process, which is organized to
address function, safety, mobility, and accessibility in var-
ious architectural zones or rooms.
Information relevant to barrier-free design is some-
times buried in texts on other topics. For example, in a
text on mental health assessments, a chapter by Hassel-
kus and Maguire (1988), which may be a useful source of
knowledge for barrier-free design, may be missed by
therapists working in specialty areas other than gerontol-
ogy. Environmental assessments such as Maguire's
(198'5) 'l'ri-Level ADL Assessment organizes and rates six
c,negories of activities of daily living by environmental
level: personal, home or sheltered, and community.
Two other sources of environmental assessments for
occupational therapy are provided by home-evaluation
and home-safety checklists. The former are often devel-
oped by health care units and institutions to meet their
own needs and vary greatly in length and breadth. Similar
organiZing constructs, however, such as safety and per-
formance, arc usually used. These checklists rerresent an
icl iosyncratic approach that has been common in occupa-
tional therapy in the past. Home-safety checklists are spe-
cific examples of the organiZing construct of safety and,
like the home assessments, are varied and idiosyncratic
(cf. Tideiksaar, 1986)
In summary, major occupational therapy texts and
practice sources illustrate that environmental assess-
ments are viewed by the profession primarily as situation-
specific and centered on the home. These are often struc-
tured as room-by-room checklists to be completed by the
therapist on site in collaboration with the client and fam-
ily. None of the checklists appear to have been tested for
reliability or validity. Although no overriding conceptual
framework can be identified, there is the suggestion that
two different approaches guide the gathering of informa-
tion: a consistent cluster of concepts (safety, mobility,
accessibility, and performance) and the relatively new
345
 application of theoretical frameworks such as the Model
of Human Occupation.
journal Articles
A computer search of the major occupational therapy
journals (i.e., American journal o/Occupational Ther-
apy, Australian Journal 0/ Occupational Therapy,
Canadian Journal 0/ Occupational Therapy, Occupa-
tional Therapy in Health Care, Occupational Therapy
in Mental Health, Occupational Therapy journal o/Re-
search, Physical/Occupational Therapy in Ceriatrics,
and Physical/Occupational Therapy in Pediatrics) re-
vealed that in spite of the emphasis placed by the profes-
sion on the importance of barrier-free design, few articles
of relevance have been published over the past 20 years.
Those identified can be categorized as pOSition papers,
surveys, and clinical intervention strategies.
The earliest of all the articles found was a position
paper by Shaw (1971), which presented a historical per-
spective on the issue of architectural barriers and the
problems faced by persons with physical disabilities. Ac-
cessibility needs were categorized and discussed under
the headings of housing, education, employment, trans-
portation, and recreation. Shaw ended with an emotional
appeal to the health care community to take up the cause
of promoting barrier-free design. A more recent paper by
Taira (1984) also presented a historical overview but fo-
cused more on the needs of older people. She Cited, as
particularly useful to occupational therapy, a series of
publications from the U.S. Department of Housing and
Urban Development (HUD). Taira commented on the
importance of considering consumer preferences and
weighed the merits of architectural modifications versus
new construction. She also issued a challenge to the pro-
fession to recognize the need to become more involved,
both as practitioners and as consultants.
Four surveys are reported in the literature. Two of
these (I<iernat, 1972; Liston, 1971) were undertaken as
occupational therapy class projects. Liston surveyed
buildings at Queen's University, Kingston, Ontario, Can-
ada, for internal and external accessibility. Kiernat evalu-
ated campus facilities at the University of Wisconsin in
Madison as well as some community structures. Shaw's
(1971) five categories were used to guide the data gather-
ing of the second survey. Both grou ps of students report-
ed that they were able to influence local attitudes and that
as a result of their surveys, a number of structural changes
were made. Data for both surveys were collected in the
traditional manner by architectural zone; results are re-
ported in a descriptive manner.
A funded study by Martin (1987) addressed the ques-
tion of ease of accessibility of public buildings by the
disabled population. Martin surveyed 13 public bUildings
of valying age for compliance with 1971 American Nation-
al Standards Institute (ANSI) (ANSI, 1971) specifications.
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Compliance was measured by the percentage of specifica-
tions met by each of the buildings on a scale developed by
Martin for the study. No building was shown to be 100%
compliant, but improved accessibility for persons in
wheelchairs, particularly in the more recently constructed
buildings, was found.
In the fourth survey, McClain and Todd (1990) rated
the accessibility of 20 grocery and convenience stores in
urban and rural settings using a scoring system based on
relevant sections of the 1982 gUidelines of the Architec-
tural and Transportation Barriers Compliance Board. The
survey was conducted by one of the authors and it is
unclear if accessibility was judged by her or with the help
of someone using a wheelchair. It is also unclear how the
sample of stores was selected. Descriptive results indicat-
ed no overall differences between rural and urban stores
but greater acceSSibility of grocery over convenience
stores in both settings. The results of the survey were sent
to all 20 stores. A 6-month follow-up indicated that 5 of
the stores had complied further with accessibility stan-
dards. The authors concluded that occupational thera-
pists can be effective advocates for community accessibil-
ity and thus facilitate independent liVing for clients.
An intervention study (Wittmeyer & Stolov, 1978)
tested the effectiveness of an occupational therapy visual
instructional module of common architectural obstacles
on the ability of persons with spinal cord injuries to iden-
tify specific barriers accurately. This was part of a program
to foster independent liVing skills in recently injured pa-
tients. The 1971 ANSI standards were used to develop
both the visual instructional module and a 359-item
checklist organized around the setting and the clients'
needs. Ten clients with spinal cord injuries were random-
ly allocated to a control or an experimental group (5
persons per group) and tested on their personal assess-
ment of potential living accommodations at two points in
time. Instruction was provided to the experimental group
by means of the visual instructional mode prior to Time 2.
The group receiving instruction demonstrated an in-
creased ability to choose a more functional environment,
as compared with the control group (p < .05 andp < .01
on two global measures). Sampling and methodological
issues prevent the generalization of the interesting results
of this study, but the results do indicate questions related
to intervention strategies worth investigating by occupa-
tional therapists. Unfortunately, this has apparently not
occurred.
A multidisciplinary intervention, Project Open
House, was reported by Colvin and Korn (1984). This
undertaking proVided professional input and funding for
the making of situation-specific architectural modifica-
tions in the homes of low-income, physically disabled
residents of New York City. The occupational therapist
was responsible for completing the initial client needs
assessment, for recommending the architectural
changes, and for training the client and family in the use
April 1991, Volume 45, Numher 4
 of the modifications. The assessment form used was de-
veloped with the use of AJ'JSI standards and a concern for
safety (United Cerebral Palsy of New York City, 1984). The
authors stated that evaluations of the program suPPOrt
this as a cost-effective way of improving the quality of life
for these persons and enabling them to remain in the
community, The effectiveness of the intervention itself,
however, cannot be determined from the data reported
in the article,
The present review indicates that occupational ther-
apy research on barrier-free design is in an early phase of
development and cannot be said to demonstrate any well-
defined thrusts, Although elderly people have been iden-
tified as a target group in need of barrier-free design, no
studies specific to this group were found, The home-
based checklist orientation espoused by education and
practice is strongly evident but, again, no common con-
ceptual framework could be identified, As with the educa-
tion and practice literature, conceptual trends were noted
or could be inferred, Primarily, these were the use of ANSI
standards, followed by the use of clusters of constructs,
either Shaw's (1971) or those of accessibility, mobility,
safety, and function,
The lack of a clearly defined conceptual base pre-
sents a primary obstacle to further professional develop-
ment, lending itself to idiosyncratic interpretations and
variations of architectural assessments that cannot be
compared, Fledgling conceptual frameworks can be ex-
trapolated, the most distinct being the use of ANSI stan-
dards as well as the focus on individual needs as catego-
rized by a number of different constructs, The strongest
and most pervasive of these thrusts, the use of ANSI
standards, is discussed below,
~l Swndard
The use of ANSI standards in construction is currently
voluntary, but they have been adopted by federal agen-
cies and 50 states to form the basis for most of the cur-
rently used gUidelines on barrier-free design (Martin,
1987; Steinfeld et aI., 1979), These standards were revised
in 1980 (AJ'JSI, 1980) with input commissioned by HUD
from the University of Syracuse in New York. Phase 1 of
the research contract, supervised by Steinfeld et al.
(1979), addressed six factors:
1. The history of the barrier-free movement
2, The extent of the problem
3, Existing legislation
4. The scope of barrier-free design problems
5, Relevant research
6. The effects of barriers on the life-styles of persons
with disabilities and ways of mitigating these
effects.
The second phase built on these findings to focus on the
foJJowing:
The American Journal 01 Occupational Therapy
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1. The identification of particularly difficult design
problems and their solutions
2, Laboratory testing of design criteria
3, The collaborative development of design criteria
4, A study of the cost of erecting accessible buildings
5, An analysis of economic costs and benefits,
Six reports were published by Steinfeld et a!. (1979)
as a result of the contract (these would appear to be the
same series cited by Taira [1984]), One report is of par-
ticular interest to occupational therapists. Two sections-
the scope of barrier-free design and human factors re-
search - contain ideas that might provide the common
conceptual base that is needed by occupational therapy,
Ban-ier-Free Design
Most gUidelines and architectural assessments have fo-
cused on accessibility for persons in wheelchairs on the
assumption that an environment that is suitable for such
persons will be equally suitable for persons with other
disabilities, This, however, is not always the case; for
example, the installation of curb cuts, so useful to those in
wheelchairs, is hazardous for persons who are blind, For
the latter, the lack of a clear-cut boundary eliminates the
warning of the immediate presence of the street and the
dangers of traffic: supplementary cuing methods, such as
varying the texture of the pavement, are then reqUired,
Issues of this type pose a problem for the making of
environmental changes to improve accessibility in public
areas, In the absence of a universal solution, whose needs
should take precedence?
RecogniZing that much of the literature on barrier-
free design presented a reductionistic view, Steinfeld et
al. (1979) proposed an ideogram called the Enabler (see
Figure 1), which would allow a broader and simpler con-
ceptualization of disability and, by providing a method for
identifying problems, facilitate design decision making,
The Enabler model represents four general areas of hu-
man disability that should be considered in the designing
of environments: (a) mental functioning, (b) the senses,
(c) internal body regulation, and (d) motor impairment,
These subsume 15 specific areas of disability,
Steinfeld et al. (1979), using expert opinion and re-
search findings, then developed 13 problem identifica-
tion matrices, These matrices represent aJl the movement
and functional patterns possible in the environment With-
out being specific to area, room, or building type (see
Figure 2), Table 1 depicts an exhaustive list of movement
and functional patterns. Each matrix sets the enabler on
the abscissa and places the design factors on the ordinal.
This scheme allows problem areas to be mapped and
graded according to severity for each design concern
generated.
Advantages and limitations of this approach are dis-
cussed in some detail by Steinfeld et al. (1979). The ad-
vantages include the ability to present the pervasive di-
347

DIFFICULTY INTERPRETING INFORMATION
SEVERE LOSS OF SIGHT
COMPlETE LOSS OF SIGHT
SEVERE LOSS OF HEARING
PREVALENCE OF POOR BALANCE
INCOORDINATION
LIMITATIONS OF STAMINA
DIFFICULTY MOVING HEAD
DIFFICULTY REACHING WITH ARMS
DIFRCULTY IN HANDLING AND FINGERING
LOSS OF UPPER EXTREMITY SKILLS J -- ~:__-i--i-___:_~.
DIFFICULTY BENDING, KNEELING, ETC. K ----;,...;--..;
RELIANCE ON WALKING AIDS L---~.
INABILITY 10 USE LOWER EXTREMInES M ----.~~---'
EXTREMES OF SIZE AND WEIGHT N --E:!..........
~!::::J
Figure 1. The Enabler model. Note. From Access to the
Built Environment: A Review of the Literature (p. 75) by E.
Steinfeld, S. Schroeder, J. Duncan, R. Faste, D. Chollet, M.
Bishop, P. Wirth, and P. Cardell, 1979, Washington, DC:
U.S. Government Printing Office.
mensions of disabilities in a manner that can be easily
understood and addressed by a multidisciplinary group.
The limitations include the inability of the matrix to iden-
tify that sometimes more practical, alternate ways to ac-
cess and use the building may exist.
Human Factors Research
Most of the research reviewed by Steinfeld et al. (1979)
for their report was found in the human factors (ergo-
nomics) literature. This body of work explores the fit
between human performance and the physical environ-
ment. Steinfeld et al. were critical of the mechanistic ori-
entation of this literature, but found that it produced a
unifying concept for barrier-free design: buildings con-
ceived of as task environments. This conceptualization of
barrier-free design places acceSSibility into an integrated
framework of human performance and allows for the gen-
eration of a complete list of information needs for design
based on the task requirements of the inhabitants. As a
concept, access can be broken down into 10 basic re-
quirements (e.g., passing through openings [see Table
1]). Each of these requirements in turn has been subdi-
vided; the result is an exhaustive list of possibilities.
Steinfeld et al. (1979) reviewed and critiqued this
literature, organized by the headings of (a) functional
anthropometry, (b) biomechanics, (c) information dis-
play, and (d) specific task environments On the basis of
348
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.. .. <,- -I,
~
•
o
•
potential problem
o problem
severe problem
impossibility
r-~'
111~-l1i
En trances. [xi ts and OooT'flays AB'B2C DE FGH I J K LMN
1. Extremely narrow door openin gs
2. High thresholds or stairs at
entrance/exit
3. Not enough maneuvering space in
front of doors
4. Door swings that partially 0 bstruct
use
5. No level space in front of e "try
doors
6. Directions unclear or poorly marked
7. Illogical opening procedure
8. Great force needed to open doors
9. Stairs in path of travel to an
emergency exit or place of r e fuge
10. Revolving doors on turnstile s
Figure 2. An example of an Enabler problem matrix. Note.
From Access to the Built Environment: A Review of the Lit-
erature (p. 91) by E. Steinfeld, S. Schroeder, J. Duncan, R.
Faste, D. Chollet, M. Bishop, P. Wirth, and P. Cardell,
1979, Washington, DC: U.S. Government Printing Office.
this, they presented a useful summary of the information
available at the time and identified the existing gaps in
each of these areas of barrier-free design. Issues such as
the influence of speed, range of motion, accuracy,
strength, and endurance on function were also discussed.
Discussion
The reports issued for HUD by Steinfeld et al. (1979)
represent a thoughtful and comprehensive state-of-the-
art statement on barrier-free design and one that is con-
siderably more developed than any found in the occupa-
tional therapy literature. Although Steinfeld et al. 's report
is directed toward the design community, the ideas pre-
sented embrace those identified in our review as impor-
tant to occupational therapy. That is, they subsume the
concepts of safety, acceSSibility, mobility, and perform-
ance and address these from the perspective of the per-
son and disability, and they allow for home assessments
and for compliance with building standards. The Enabler
model acts as a problem-solVing device that permits the
lack of ability to perform activities in task environments to
be identified and rated. This method of analysis is system-
atic, exhaustive, and congruent with the occupational-
functional orientation of our profession.
Steinfeld et al.'s (1979) conceptualization is broader
and more developed than the present occupational ther-
apy site-specific mode of home assessment, because it
Apn'l 1991, Volume 45, Number 4
 Table 1
Information Needs in Designing Accessible
Environments
Task
1. Passing through openings
2. Operating electronic and
mechanical controls
3. Moving along route of travel
4. NegOtiating changes in level
5. Transferring from one body
posture to another
6. Searching for and
interpreting direction-finding
information
7. Negotiating a series of
movements in a confined
space
8. Negotiating human and
vehicular traffic
9. Using flXtures, storage, and
work surfaces
10. Avoiding hazards in the path
of access
Note. From Access to tbe Built Envimnmenl.· A Review oftbe Literature
(p 103) by E. Steinfeld, S Schroeder,]. Duncan, R. Faste, D. Chollet, M.
Bishop, P. Wirth, and P. Cal"dell, 1979, Washington, DC: US. Govern-
ment Printing OffIce.
Tbe American journal of Occupational Therapy
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Information Needs
Height of openings
Width of openings
Shape of openings
Maneuvering clearances
Configuration of control
Location vis-a-vis reach
Force of activation
Activation motion
Speed of activation
Relationship to other control
Type of feedback
Characteristics of surface
Friction between user and surface
Length of routes
Width of path
Exposure along route (to climate)
Overall paltern of circulation
Degree of slope for ramp incline
Configuration of stair nosing
Stair shape and size
Length of run fm incline of stairs
Location and configuration of
assistS
Configuration and size of landings
Number and type of assists
needed for transfer
Location and configuration of
assists
Strength of assists
Size and configuration of transfer
clearances
Size and configuration of built-in
elements that are transfer
points (e.g, toilet)
Information needs
Type of coding method
Location of display
Exposure of display
Content of information needed
Number of displays needed
Complexity of information
transmitted
Symbolic content of information
Size and configuration of
clearances
Layout of elements in a space
Proximity of elements to each
Other
Constraints on traffIc flow
Controls on now rate and
direction
Separation of human and
vehicular traffIc
Height
Approach clearances
Configuration of fixtures
Size
Definition of hazards thaI should
be avoided
Configuration of hazard-free zone
Size of hazard-free zone
Guards against exposure to
hazards
Size and configuration of warning
signals
allows both individual and group needs to be addressed
by the same model and permits homes, institutions, and
community areas to be similarly assessed. This represents
an improvement over our more limited approach. Al-
though they represent very different disciplinary bases,
both the occupational therapist and the designer gather
information on accessibility for the same purpose: to con-
struct an environment that is responSive to functional
needs and that facilitates performance. It is particularly
important to note that the adoption of the Enabler matrix
would permit a consistent format for data collection by
any discipline on aJl settings, persons, and disabilities.
The advantages of the establishment of such a common
data pool are obvious and enormous. For example, the
development of a large or representative database of in-
formation would allow for the generalization of findings
and the meaningful application of results from disparate
studies. Finally, Steinfeld et al.'s ideas have formed the
basis for the Jast ANSI revision and as such, serve to
include various levels of government on the multidisci-
plinary barrier-free design team and to proVide a gold
standard for prOViding accessible environments.
Conclusion
The profession of occupational therapy has traditionally
been concerned with accessibility and barrier-free design.
This concern has tended to be case- and home-specific. A
review of the literature indicates that both a conceptual
base and research on the topic are needed. Because the
demands for accessible environments are increasing, par-
ticularly to enable elderly and disabled persons to remain
in the community, increased occupational therapy input
will be required in the future. The literature reviewed
raises our awareness of three important issues: the need
to develop the occupational therapy base of research and
practice; the growing acceptance of ANSI standards; and
the existence of a cadre of concerned and welt-informed
designers and an architectural literature base. Steinfeld et
al.'s (1979) Enabler model may provide a viable person/
disability/function model for the extension and unifica-
tion of the present occupational therapy concepts relat-
ing to barrier-free designs as well as a link to the
multidisciplinary design team In return, we can offer the
health care perspectives and skills unique to the profes-
sion of occupational therapy, that is, our knowledge of
specific diseases and disability, of life-span development,
and of how these various processes may influence func-
tion. Together we can enhance and strengthen design
decisions and the provision of barrier-free environments
for elderly and disabled persons ....
Acknowledgments
We are gratefUl for the support of the Canadian Occupational
Therapy Foundation and the Social Sciences and Humanities
Research Council of Canada.
349
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April 1991, Volume 45, Number 4