Physical Environment

A 2008 study on the school experiences of children and young people with spinal cord injuries showed that nearly all who participated in the study had ‘experienced problems, to some degree, accessing the school’s physical environment.’*

Some of the most common problems reported were with:

– Heavy doors

– Ramps that were too steep (especially with heavy book bags on the back of their chairs)

– Classrooms that were difficult to access (meaning wheelchair users were sometimes isolated from the other students in another part of the school)

– Narrow halls or small classrooms (where students get bumped on the head or cannot manoeuvre)

When a child or young person has a spinal cord injury, an occupational therapist will often visit the school to discuss what requirements they have and what adaptations would be helpful or necessary. This would ideally also include a meeting or conversations with the child and young person so they can input on what they need and require. It is also important to understand that the requirements may change as the child or young person becomes more comfortable using equipment like wheelchairs or begins to better understand what would help them become more autonomous. Some changes that need to be made are likely to be small and not costly.

A speedy preparation is ideal but it can take a lot of time for adaptations if significant changes need to be made. It is not particularly welcoming for a student if their return is delayed because of building work being done, so ensuring physical accessibility pre-emptively is preferred where possible.

Changes to the physical environment to be considered and discussed with the child, young person, family, and occupational therapist include:

1.   Temperature control: Children with spinal cord injury above T8 have difficulty regulating body temperature and are susceptible to overheating in hot environments and hypothermia in cold environments. Attention to environmental temperature is therefore important.

2.   Lifts: Ensure students have access to lifts at any time, ideally with use of their own key.

3.   Parking: Ensure there is sufficient disabled parking and that any policies related to pick up and drop off do not exclude children or young people with spinal cord injuries.

4. Separate units: Some schools create separate units or areas for students with additional needs to use for quiet study or to work with a learning assistant. These are called different things – special units, safe zones, quiet area – but can be havens for students feeling overwhelmed or lacking confidence. However use of these areas should be the choice of the student, rather than becoming the place they work when they can’t be included in activities that other students are enjoying.

5. Specialist equipment: Some students will be provided with specialist equipment to support learning from an occupational therapist or physiotherapist. Equipment may include adjustable or soft-backed chairs or adjustable (‘high-low’) tables, adapted shower and toileting chairs, or adapted support for eating and drinking.

6.  Assistive computer technology: Relevant assistive technology related to using computers includes the following:

– different sizes of keyboards (larger or smaller)

– an adapted mouse such as a tracker ball, switch or joystick

– an integral mouse which is used by moving the lips

– eye gaze tools that track eye movements to control and move around a computer

– smartphones or tablets can be good tools for people without much dexterity in their hands but who can swipe

– voice recognition software (for example dragon software)

The types of assistive technology that a child or young person requires very much depends on their spinal cord injury. Children or young people may get support during their rehabilitation in hospital or spinal centres in using technology. Advisory teachers for children with physical and neurological needs are a good point of contact as well as organisations and programmes such as ASPIRE grants programme, ASPIRE assistive technology assessments, and AbilityNet that can help with assessment, funding or information about different types of assistive technology.

7.   Toilet / health care room / medical room:

Inadequate or inaccessible toilet facilities at school are a common experience of children and young people with spinal cord injuries. Toilets have been reported as too small, used for storage of other things or free for anyone to use and therefore always occupied. Students should ideally be given a radar key to use to open the toilet as necessary. One school adapted a toilet for a child with a spinal cord injury, which included a toilet, bed, hoist, shower and shower chair. This meant if the child had an accident they could be supported to clean themselves up at the school in privacy.

“Toilets were a key area where the school could have done more. There wasn’t anywhere to store or dispose of his catheters and his medication. The disabled toilet was used by other people including teachers who sometimes used it to get changed in, it could also be unlocked from the outside so he didn’t feel comfortable using it. The situation caused him lots of embarrassment. I would recommend schools having a disabled toilet with a shower as well in case the student has an accident they can clean themselves up with too much embarrassment.”

Janet, parent of son 17

8.   Physiotherapy rooms: Some schools have developed a physiotherapy room on school grounds, which means the student does not have to leave the premises to have physiotherapy. However, if physiotherapy is done within school, the times that it is offered should be arranged in agreement with the child or young person and their family so they don’t miss out on important social time or lessons.

9.   Changing facilities: Ensure that the facilities students use to change for PE or swimming are accessible and adequate or identify other creative solutions so that the child or young person can still access these activities without feeling excluded or singled out.

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