Modification Examples

This section provides examples of modifications that can be made to the environment to support a client’s participation.

Environmental Factor Type: Physical/Built Environment

Environmental BarriersSolution Based Strategies
  • Lack of accessibility of community facilities
  • Client cannot navigate wheelchair due to the layout of the physical environment

  • Conduct site visits or contact organization to determine accessibility (e.g., visiting a yoga studio, football stadium, friend’s home)
  • Contact arena/stadium/theatre and find accessible sections and appropriate pricing
  • Make recommendations to facilitate
  • Contact arena/stadium/theatre and find accessible sections and appropriate pricing
  • Make recommendations to facilitate navigation of youth with wheelchair (e.g., arrive early to settle into space, to exit a room first, and avoid getting caught in the crowd)
  • Work with program/facility to make adaptations (e.g., rearrangement of chairs, larger aisles, space to turn), relocate activity to an accessible room
  • Work with organization to ensure that future activities are planned and booked in places that are accessible and activities that can involve everyone
  • Work with organization to advocate for increased accessibility of all its facilities
  • Unsuitable/lack of equipment or technology
  • Make recommendations for equipment adaptations and provide support to make the adaptations (e.g., attend first sailing lesson and adapt the boat using straps)
  • Team up with Physical Rehabilitation Technician to adapt equipment when the modifications are more complex
  • Find accessible program and borrow their equipment to try the activity
  • Borrow computer from school
  • Help client/family look on website, such as Kijiji, for used equipment
  • Snow in winter makes accessibility and transportation more difficult
  • Discuss adapted transportation options
  • Review public transportation routes to find most convenient way with least transfers
  • Plan more time for travel due to snow/weather in the winter time
  • Ask building(s) to make sure they salt sidewalks/paths

Environmental Factor Type: Social Supports

Environmental BarriersSolution Based Strategies
  • Client needs an assistant/supervisor to accompany them in activities
  • Client cannot access bathroom independently
  • Make arrangements with students from OT/PT/adapted Physical Education programs at university/school to assist with client’s activity (e.g., student in adapted physical education to assist with bike riding)
  • Connect client/family to various organizations that offer volunteer accompaniment to activities
  • Have client/client/client/family hire personal support worker to pick up client from school, bring to and assist during activity, and return home
  • Not able to contact friends for socializing or attending activity (e.g., client does not have friends’ phone numbers)
  • Lack of friends in the neighborhood
  • Friends do not share same interest
  • Build on strengths/support such as shared friends and activities with sibling, and supportive/resourceful family
  • Discussion around potential social activities, joining community group or society (e.g., photo camp, Manga club)
  • Connect client and/or parents with contact info of peers – teachers may be able to assist with this
  • Work on communication with friends via technology (e.g., Skype, FaceTime, text, email)
  • Limited circle of support for family
  • Assist family to access in-home support/help
  • Provide family with resources, parent support groups, alternative support services
  • Instructors do not have necessary skills/experience
  • Research adapted programs
  • Difficulty finding a qualified and responsible caregiver person to help client
  • Discussion with client/family to discover their needs
  • Help client/family write a job description (e.g., client information, needs, job details)
  • Make a list of possible places to post job (e.g., university or college programs, high school guidance offices, adapted activity programs)

Environmental Factor Type: Access to Information/Resources

Environmental BarriersSolution Based Strategies
  • Client/family lacks knowledge/access to information about resources, registration process
  • Research and contact programs/associations to obtain information regarding program, cost, logistics, adaptability, accessibility that is suitable to client’s ability and level (e.g., accessibility, type of equipment available, temperature of water, hours of free swim, registration procedure for swimming pools)
  • Provide client/family with resources and information (e.g., location, times, cost, contact person) in paper, email, phone
  • Speak to sports coordinator at adapted school regarding client’s registration and participation at school & asked about other organizations that offer specific activity in the community
  • No internet at home, unable to locate resources
  • Look for resources with the client and family
  • Provide client/family with information/phone number so they can call instead of finding info online
  • Client/family does not know where to look for volunteers/post jobs
  • Work with the client/family to write a job description that can be used in the future
  • Write out step by step instructions to post job description

Environmental Factor Type: Cultural

Environmental BarriersSolution Based Strategies
  • Language
  • Coaches/players provide English translation
  • One bilingual player specifically assists client
  • Client not able to participate in physical activity during month of Ramadan (must fast during the day)
  • Start with another type of activity first (violin) that is less physically demanding
  • Schedule classes during time of day that is less hot (mornings)

Environmental Factor Type: Institutional (Laws, Regulations, Policies)

Environmental BarriersSolution Based Strategies
  • Availability and variety of programs (type, location, size, timing)
  • Certain highly specialized activities only offered by few organizations (e.g., Powerchair soccer) and limited spaces available
  • Suitability of program when client has multiple impairments
  • Not many activities in suburban and rural areas
  • Advocate for certain activities to be included (e.g., therapist advocated for Boccia activities via a physical activity center for individuals with disabilities)
  • Place client on waiting list, ask organization about possibility of expanding team size or starting a second team if there is high demand
  • Offer different activity choice (e.g., wheelchair basketball instead of Powerchair soccer)
  • Look into inclusive programs designed specially for individuals with disabilities
  • Look into local community center activities, YMCAs, libraries for non-adapted activities and ask for inclusion/integration
  • Contact local high schools/college/university programs for volunteers (e.g., recruit existing GLEE club to involve client in one session/week)
  • Contact school teachers (e.g., art, music etc.) for ideas, contact of community organizations
  • Many family activities can become repetitive (e.g. museum, biodome, science center)
  • Look into other family activities
  • Cost of activity/programs/equipment
  • Provide client/family with resources about funding sources (e.g., Canadian Tire Jumpstart)
  • Speak to organization to advocate for reduced cost of activity (e.g., music sessions at $10/hour instead of $30)
  • Look into community center group activities instead of formal classes or sessions (e.g., yearly membership to community center that gives access to teen cooking groups, adapted Zumba, online forums)
  • Use facilities that have free/open hours (e.g., swimming pools, skating rinks)
  • Explore free seasonal activities at libraries and in municipalities and consult locally for more information (e.g., movies in the park, film making sessions at library in summer)
  • Certain leisure programs have age requirements
  • Some municipal organizations do not take young volunteers
  • Look for nonformal classes/gathering in community centers, community groups
  • Advocate for client’sinclusion in young adult program because they are close to age cut-off
  • Look for online communities
  • Ask community organizers if they know of other places that activities for specific age groups
  • Look for school-based or other types of organizations that would take young volunteers
  • Lack of availability of transportation services (especially weekends)
  • Write a letter of request advocating for transportation services on weekends for specific activities (e.g., Sunday swimming lessons)
  • Provide information/assist with application for Adapted Transport and information about using adapted transport
  • Contact other clients or participants in the program about ride sharing
  • Make plans to minimize travel time, while having logistics well organized ahead of time
  • Contact transportation company to identify strategies to reduce delays (e.g., best time of day for service)
  • Client not eligible for program (e.g., reading buddies) due to not meeting program criteria
  • Advocate for inclusion with coordinator in charge
  • Find alternate volunteer from elsewhere, and use library space and books

Environmental Factor Type: Social Supports and Attitudes

Environmental BarriersSolution Based Strategies
  • Friends are not fully aware of client’s disability/needs
  • Discuss how to teach friends about disability & the client’s needs and how they can be of assistance
  • Build on strengths (e.g., participant is open/accepting about disability, has good insight and initiative, is willing to connect/interact with friends and make new ones)
  • Program lacks the knowledge on how to accommodate activity
  • Speak with activity instructor to suggest activity/setting modification (e.g., yoga poses performed near wall, arrangement of chairs/table at church)
  • Support client and family to be advocates and help others understand how to engage client and adapt to their needs
  • Meet with the client, family, organization, volunteers to iron out plan
  • Put other therapists who are working with the client in touch with community instructor to provide more information regarding client abilities and required adaptations/accommodations
  • Anxiety of parents over child participating in activity
  • Accompany client and family to a trial of the activity, highlight the successes and ideas for further adaptations to the program or activity
  • Work with the program to adapt classes as necessary (e.g., shorter time)

Environmental Factor Type: Temporal Context

Environmental BarriersSolution Based Strategies
  • Timing & scheduling of activities (e.g., seasonal offerings, lack of programs in summer, within timeline of therapy involvement)
  • Some activities are already in session or have not yet begun, registration dates over or to begin in several months
  • Think about accessing volunteers at different times of the year (e.g., when students are on holiday)
  • Look into available seasonal programs or camps
  • Consider seasonal variations of activities (e.g., skating in winter or indoor rollerblading during offseason)
  • Identify times or create times where client does community based leisure activity instead of their usual passive leisure activity
  • Provide client/family with resources that they can refer to when it is the right season for the activity
  • Too many things to organize to make it to the activity
  • Timing of activity conflicts with client/family schedule
  • Work with client/family to identify friends, activities, locations and ways of achieving goal
  • Be well organized (e.g., have a plan made to reduce impact of activities on days that are more demanding or tiring, such as Mondays)
  • Have everything ready in advance to allow time to get to evening programs (e.g., lay out clothing and equipment, do homework right after school)

Additional Factors: Personal/Internal Factors

Environmental BarriersSolution Based Strategies
  • Medical: child awaiting surgery, medication change
  • Give client/family information about program (or tips for how to find information) so they can make contact when client is medically stable
  • Client is shy, feels uncomfortable & overwhelmed by large groups
  • Client unsure of physical ability to perform an activity
  • Client is not motivated or displays little interest or confidence in progress
  • Participant does not want to be in adapted class
  • Other personal issues going on in client’s life (e.g., breakup with girlfriend) that affects mood and motivation
  • Focus on activities that client enjoys
  • Look for an inclusive program that encourages diversity and focuses on abilities
  • Find small group courses, or start with private lessons and once client feels more comfortable, may be able to join group
  • Attend a trial lesson/class
  • Find a ‘family’ version of the desired activity to test out abilities
  • Try activity with the client in a safe environment or attend the first session with the client
  • Suggest the client try the activity with a family member or friend to make it less intimidating
  • Look at videos on internet (YouTube) to see how others do the activity
  • Try a Wii version of the activity first (e.g., Wii yoga provides weekly encouragements, check-ins)
  • Establish trust with the client
  • Use motivational interviewing
  • Reassure client that there is no obligation to participate

Additional Factors: Activity Demands

Environmental BarriersSolution Based Strategies
  • Activity is new
  • Try the activity (e.g., Wii yoga) at home with client
  • Build a homemade version of activity to allow practice at a reduced cost (e.g., family made a Boccia kit by modifying baseballs and allowing them to practice before the lessons)
  • Vision/focus/attention required
  • Referral to local rehabilitation centre for communication strategies and/or technology (e.g., a computer assisted communication device may be useful)
  • Ensure certain people at activity center (e.g., teachers, coordinator) knows about client’s needs and how to use the communication device—teach others how to use the technology when necessary
  • Communication difficulties
  • Referral to local rehabilitation centre for communication strategies and/or technology (e.g., a computer assisted communication device may be useful)
  • Ensure certain people at activity center (e.g., teachers, coordinator) knows about client’s needs and how to use the communication device—teach others how to use the technology when necessary

Goal: To hang out with my friends in the community and play basketball

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Physical
  • Friends’ houses and public areas, particularly bathrooms often are not accessible.
  • Gym/court area not always accessible, hoops are often too high, current wheelchair limits play.
  • Participant identified where he could hang out with his friends close to home — selected basketball court as first location.
  • Participant identified accessible areas where he could play with friends.
Social
  • Participant has friends who would like to play basketball.
  • Participant told friends he would like to play basketball in the community.
Task Demands
  • Participant reports being a good friend and is motivated to spend time with friends.
  • Participant can dribble and is good at passing but shooting is difficult.
  • Participant built on these strengths by being in touch with his friends and letting them know what he could do with them.
  • Participant practiced shooting on his own and focused on the things he is better at when playing with friends.

Goal: To ride the roller coasters at an amusement park

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Physical
  • In planning the trip, the participation team was unsure of the physical accessibility of the park.
  • Due to the distance, it was not possible to visit the park prior to the participant’s trip; however, the amusement park website provided excellent information outlining accommodations for guests with physical disabilities. This allowed the team to better plan for the trip.
Task Demands
  • Participant voiced concern over her ability to get on and off of the roller coasters independently and requested assistance for the trip.
  • OT arranged for two students from an Occupational Therapy Assistant program, who were close in age to the participant to go with the participant and provide physical assistance.
  • Participant practiced her transferring skills ahead of time to gain confidence.

Goal: To play baseball

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Physical
  • Ball diamond has gravel surface, making independent propulsion difficult.
  • OT educated baseball players about wheelchair safety.
  • Participant was pushed around the bases and assisted with retrieving the ball when needed.
  • Participant played catcher.
Social
  • Time and planning required for many.
  • Use of technology to connect remotely with the OT (e.g., through use of Skype, texting and email with consent).
  • OT enlisted the assistance of motivated family and friends to assist with planning the game.
Institutional
  • Lack of wheelchair baseball team where the participant lives.
  • Participant decided to play a pick-up game with family and friends.
Task Demands
  • Baseball is hard and may cause injury.
  • Bat is too heavy for participant.
  • Baseball changed to a tennis ball.
  • Participant used a smaller, lighter bat.
  • Participant decided against using a tee.

Goal: To attend church on Sundays

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Social/Cultural
  • Expectation to sit quietly during mass.
  • A quiet toy was brought to church to meet the participant’s sensory needs.
Task Demands
  • Participant would need to be able to smoothly exit the mass if needed without causing disruption.
  • An exit plan was practiced to smoothly exit the main room and go outside or to the washroom if the participant needed a break.
Institutional/Physical
  • Members are expected to receive communion at the front of the church. This was difficult for the participant due to mobility issues and the church layout.
  • Clergy agreed to bring communion to the family in their seats.
Physical
  • Parking and church entrance difficult with crowds.
  • Priest recommended alternative parking which is closer to the rear entrance. This entrance offered a ramp leading directly to the accessible seating area.

Goal: To ride a bike on my own

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Physical
  • Participant had difficulty getting on and off of the bike.
  • Teamed up with Physical Rehabilitation Technician to adapt the bike.
Task Demands
  • Participant was not able to balance on a 2-wheeler.
  • Participant had difficulty getting on and off the bike.
  • Participant did not want to try a three wheeled adult bike.
  • OT collaborated with participant’s physiotherapist to develop strategies to address balance.
  • Master’s student in the field of adapted physical education assisted with providing education on riding the bike.
  • Participant was supported by OT and PT in the clinic when first attempting to ride and then by the OT and his father when biking in his neighbourhood.

Goal: To join a Boccia team

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Physical
  • Lack of availability of community facilities for practice.
  • Accessible bowling alleys found to practice as an alternate to Boccia.
Social/Cultural
  • Language barrier.
  • Coaches/players provided English translation.
  • One bilingual player specifically assists participants.
Institutional
  • Lack of availability of programs in the community.
  • Information on Boccia associations made available to family.
  • OT advocated for Boccia activities via physical activity centre for individuals with disabilities.
Task Demands
  • Boccia is a new activity to the participant.
  • Participant has low vision; modification of Boccia equipment was required to facilitate safety and participation.
  • Participant and family developed homemade Boccia kit by modifying baseballs, allowing her to practice.
  • Referral to a low vision clinic.
  • Teamed up with Physical Rehabilitation Technician to adapt Boccia equipment.

Goal: To participate in a yoga class

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Physical
  • Team questioned the accessibility of the yoga studio.
  • OT visited the yoga studio in advance and shared information with family about studio’s accessibility.
Institutional
  • Participant had not done yoga in the past.
  • Participant and family reported accessible transportation to be a concern for accessing the yoga studio.
  • OT found a yoga class that fit the participant’s ability and level of experience.
  • OT provided family with information about adapted transport and assisted with the application.
Attitudinal
  • Yoga instructors expressed a lack of knowledge of how to accommodate yoga for the participant.
  • OT spoke with the yoga instructor to suggest setting participant up near the wall.
Task Demands
  • Participant voiced concern over current level of yoga skills and wanted to improve these prior to participating in the class.
  • OT and participant tried Wii yoga at home to practice and improve skills prior to the class.

Goal: Be part of visiting program at church & visit those who need encouragement

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Physical
  • Homes that participant visits are often not accessible.
  • Participant may need to navigate some stairs in order to enter the homes.
  • Participant decided that she would first visit homes or apartments with elevator access to build confidence and then would proceed to visit homes with stairs once she had more time to practice stair safety.
Social
  • Participant’s family is supportive of participation in this program and is willing to provide assistance as needed.
  • Participant’s daughter also decided to join the “visiting” program so goes with participant to visit church members and assists with accessing the homes (e.g., going up/down the stairs and carrying participant’s supplemental oxygen).
Task Demands
  • Participant has difficulty navigating the stairs.
  • Participant voiced concern over becoming easily fatigued with outings.
  • Participant and OT practiced stair safety in advance of participant joining the program to build confidence when navigating the stairs with her daughter.
  • OT provided education around energy conservation strategies and planning the trips.

Goal: To go out for coffee with my friends

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Social
  • Participant has many friends who like to go for coffee.
  • Participant let her friends know that she would like to go out for coffee.
  • Participant and OT brainstormed where friends could meet for coffee which would be easily accessible.
Institutional
  • When going out into the community, participant voiced concern that she often has difficulty finding a parking spot that is close enough for her to safely enter the building.
  • OT assisted participant in completing application for an accessible parking pass.
Task Demands
  • Participant voiced concern over ability to stand in line, order coffee, and then carry it back to her table with use of the walker.
  • Participant and OT brainstormed around times of the day in which the coffee shop may be less busy so that the lines may be shorter. Participant planned to visit at these times until she built her confidence.
  • OT and participant practiced preparing a coffee and then carrying it to the table in participant’s home prior to coffee outings with friends to build participant’s skill and confidence.

Goal: To play with my grandchildren on the floor

EnvironmentStrength / BarrierEnvironmental Intervention Strategy
Physical
  • Grandchildren’s play room is on the upper level of the home, approximately 15-stairs are required to access the play room.
  • Initially, children and grandchildren brought toys down to the main level of the home so that participant did not need to navigate the stairs.
  • As participant’s confidence grew, he started navigating the stairs up to the playroom.
Social
  • Participant has 5 young grandchildren who live locally and love playing with their grandpa.
  • Participant organized specific times when he would visit to play with his grandchildren.
Task Demands
  • Participant had difficulty getting on and off of the floor to play with grandchildren and noted significant pain through his knees while trying to attempt this.
  • Participant suggested purchasing a small stool/chair that he could sit on to be close to the ground to play with his grandchildren without needing to sit directly on the floor. OT supported this idea.
  • OT and participant practiced stair safety to access the playroom.
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