Saturday, August 13, 2011

Building with a Brain Injury

This past week, Niels and I had the opportunity to give three different tours of the new house to friends. As part of our tour, we like to explain the green, energy-efficient and universal design choices we've made as we designed our home. I'd like to talk a bit about the universal design aspect.

In a nutshell, universal design is an approach to building that seeks to make a buildings and products accessible to people of all abilities. We often think of things like "handicap" parking spots at the mall or the big stalls in a public bathroom or support bars in the shower. But universal design is not limited to physical abilities. Braille signs on elevators is an example of universal design to include the spectrum of optical abilities, as are the Dutch sidewalks with grooves for canes.

Universal design is becoming more popular in new construction as owners mindful of the housing crash are building their forever homes. For many owners, this means building a ranch home, or a two-story with built-in elevator in anticipation of knees not being able to handles stairs at some point. It means wider (36" hallways and doorways to accommodate temporary or permanent wheelchairs. It means being purposeful about the height of drawers and appliances for the greatest ease of use over time.

Because I live with a brain injury, we had a different set of considerations for our design. For those unfamiliar with with traumatic brain injury, the easiest thing to say is that no two brain injuries are the same. The severity of symptoms that a person lives with (or recovers from, in happy scenarios), really depends on what kind of force caused the injury, what part of the brain was injured, and if there were subsequent injuries to the brain.

Fun (sad) fact: once you sustain a TBI, the effects of additional brain injuries are cumulative. This means, not only does a slight bump to the head affect me more than it would someone who does not live with a brain injury, but it also means that it will take me much longer to recover (if not fully) from my injury.

For the record, my original brain injury occurred on January 21, 2004 when I slipped on some ice. I sustained a second major one in 2006, and another in December 2010. There have been several minor ones in between (falling down stairs, a car accident and getting head-butted by my toddler...that I can remember). Another serious brain injury could be fatal to me, so my husband and I plan our lives with my safety in mind, and many activities I previously enjoyed are now permanently on my no-no list: volleyball, water-skiing, snow skiing, amusement rides, etc. Anything with a risk of getting hit in the head or spun around quickly is out.

My brain injuries have resulted in executive function and vision and vestibular deficits. Basically, executive function refers to the way your brain takes in, stores, and process information. This means that I struggle with memory (short-term and long term, pre-injury memory is not bad), sequencing and tasking (breaking a large task down into smaller steps, and doing things in order--rather important when cooking!), and aphasia (being able to say the word you mean when you need it.). Vestibular issues relate to balance. If I am tired or have been overwhelmed with stimuli (think of a mall, or restaurant, or anywhere where there are sounds and lights and voices, etc.), I will get dizzy and lose my balance, which means I'm at risk of falling, which is what got me here in the first place. No good.

The main vision issue I have now is that, while my eyesight is perfect with glasses or contacts, my vision is blurry because my brain does not communicate well with my eyes, so what I see may not be true. For example, I will not look out the window when my husband is driving, because I have depth perception issues and it "looks" like we're going to hit cars from all sides, even though I "know" we are not. Needless to say, I don't drive a lot.

In addition to all of this, I live with daily headaches that are worse whenever I am tired, stressed, overwhelmed, etc. Overall, as long as we are mindful of my environment, limit my outside interactions and make sure I get plenty of sleep, I function fairly well for a few hours a day, which I budget accordinly. In my pre-injury life, I was a writer and marketing director, so I still have access to those abilities, but in limited quantities, if that makes sense. When people meet me and say, "You look fine." I try to say, "Thank you. I'm having a good day."

So, in creating our brain-injury friendly house, the most important overall idea was that it needed to be a place where I had everything I need to bring the world to me. Most weeks, I'll only venture out once or twice without my husband. We envisioned a place where I could host playdates and birthday parties (the hardwood floors in our current house are far too loud to allow this), entertain friends, and provide a safe place for me to exercise. In addition, it needed to quiet, safe and subtle (strong patterns can trigger my vertigo).

Here's the plan:


  • We started out with the Insulated Concrete Form walls for our foundation. Concrete is incredible for sound-proofing. Fabulous.
  • We're putting cork floors in the kitchen and dinette. Cork has many cool features, but my favorite may just be the sound-proofing qualities, which will be a dramatic departure from our loud wood floors.
  • The great room will have carpet made of recycled material. 
  • We will have tile in the bathrooms and entry ways, but no one really hangs out there with me, so that will be fine.
  • Again, the cork and carpet are soft and will cushion any falls I am almost certain to take.
  • Good, quality construction is the greatest help in a safe house.
  • We are putting in a pony wall for our stairwell instead of balusters. Also, our stairs are extra wide (36"). Stairs are not my friend on dizzy days.
  • Another reason for the pony wall is that a row of balusters can trigger my vertigo. A solid wall will not.
  • Design choices tend toward solids and stripes, not patterns and mosaics, which, again, can trigger my vertigo. 
In addition to all the brain-related considerations, we also took into account what potential health issues we or our guests may have now or in the future. For example, my mom has arthritis, so gripping knobs is painful for her. It was easy to make the decision to use levers instead of door knobs, rockers instead of lights switches, and touch faucets and single handle faucets over double handle choices. 

For greater ease of use and accessibility, we're using all drawers with pulls in the kitchen, have an open lowered baking center that is wheelchair friendly, and have at least a 36" buffer around the islands.

We hope that this house will serve us well for the rest of our lives!
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