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This is to certify that the

thesis entitled

Architectural Privacy and Performance in
Communication Therapy Settings for
Head-Injured Patients: An Assessment of
Speech-Language Pathologists' Perceptions

presented by

Diane Marie Sowash

has been accepted towards fulfillment I
of the requirements for

MA degree in HED

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ARCHITECTURAL PRIVACY AND PERFORMANCE
IN COMMUNICATION THERAPY SETTINGS
FOR HEAD-INJURED PATIENTS:

AN ASSESSMENT OF SPEECH-LANGUAGE
PATHOLOGISTS’ PERCEPTIONS

BY

Diane Marie Sowash

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of Human Environment and Design

1993

ABSTRACT
ARCHITECTURAL PRIVACY AND PERFORMANCE IN COMMUNICATION

THERAPY SETTINGS FOR HEAD-INJURED PATIENTS:
AN ASSESSMENT OF SPEECH-LANGUAGE PATHOLOGISTS’ PERCEPTIONS

BY

Diane Marie Sowash

If the interaction of environmental variables and patient
variables have an impact on the effects of remedial efforts in
head—injury rehabilitation programs, settings in which
treatments occur may have an impact on patients' behavior.

This exploratory study focused on a single environmental
pattern--architectural privacy--and its perceived impact on
the performance of speech language-pathologists and head-
injured.patients in the beginning and final stages of therapy.
A survey was used to gather qualitative and quantitive data
from speech-language pathologists employed in a random sample
of rehabilitation facilities for head-injured patients.

Descriptive statistics provided profiles of therapists,
patients, settings, architectural privacy, and performance.
The Spearman rank correlation, measured the strengths of the
relationships between architectural privacy and therapists’
and patients’ performances. Significant relationships were
found to exist between architectural privacy and performance
of speech-language therapists and head-injured patients in the
beginning and final stages of therapy. The results support the

notion that environmental inputs may have an influence on

performance.

DEDICATION

This thesis is dedicated to my husband Larry,
and son Mike, for their love and support in what at
times seemed to be a project without end.

iii

ACKNOWLEDGMENTS

I wish to thank the following faculty in the Department
of Human Environment and Design who served as my graduate
committee. Without their valuable input and guidance this
project would not have been possible.

Roberta Kilty-Padgett, Associate Professor,
Graduate Committee Chair.

Timothy Springer, Ph.D., Professor, Department Chair.
Susan Mireley, Ph.D., Associate Professor.

Richard Graham, Associate Professor.

I also wish to thank Charles Reeder, Ph.D., and Sandra

Reeder of Tamarack Clinic, whose design project aroused my
interest in the study of rehabilitation settings.

iv

TABLE OF CONTENTS

CHAPTER PAGE

I.

II.

DESCRIPTION OF THE PROBLEM
Introduction........................................1
Statement of the Problem.............. ...... ........3

Purpose of Study ....... ...... ...... . ..... ...........4

REVIEW OF LITERATURE

Environment and Behavior
People-Environment Relationship...... ........ ..7
Behavior/Environment Congruence................8
Environmental Fit.............................1O
Components of Stress in the Environment.......11
Person-Environment Compatibility..............12
Environmental Support or Hindrance............13
Environment as a Prosthetic Device............13

Privacy
Meanings for Various Groups...................14
Behavioral Mechanisms.........................15
Physical and Psychological Privacy............16
Architectural Factors and Privacy.............17

Privacy in Communication Therapy Settings

Control of Noise and Visual Distraction.......18

CHAPTER PAGE

Need for Quiet and Noisy Environments.........19
Privacy in Educational Settings

Impact of Noise on Performance................19
Privacy in Work Settings

Providing Adequate Levels of Privacy..........20

Acoustical and Visual Privacy.. ........... ....21

Effects of Visual Distractions................22

Psychological Privacy .................. .......22

III. RESEARCH OBJECTIVES

IV.

Research Hypotheses................................24

Conceptual Model .............. ....... ............ ..25
Conceptual and Operational Definitions ..... ........27
METHODOLOGY

Research Design and Procedures
Design of the Study...........................31
Sample Selection... ........................... 32
Procedure.....................................32
Instrument Description........................33
Response Rate.................................34
Data Analysis
Personal Characteristics......................35
Architectural Privacy.........................36

Relationships Between Type and Amount of
Architectural Privacy....................37

Therapy Setting......... ..... .................38

vi

CHAPTER PAGE
Performance of Therapists and Patients........38

Relationships Between Privacy and
Performance...OOOOOOOOOOOOOCCOOO000......39

Analysis of Variance..........................40
LimitationSCOOOC0....0.0.0.0000...0.00.00.00.00000041

Assumptions ...... O...0..0....0.0.0.000000000000000043

V. RESULTS
Personal Characteristics

Personal Characteristics of Speech-Language
PathOlogistSOOOO0.0.0.0....00.0.00000000044

Personal Characteristics of Head-Injured
Patients...00.00.0000...0.00000000000000045

Architectural Privacy
Type of Architectural Privacy.................50
Amount of Architectural Privacy...............52

Relationships Between Type and Amount of
Architectural Privacy....................53

Therapy Setting.OOOOOOOOOOOOOOOOOOOIO ..... 0.0.0....54
Performance of Therapists and Patients
Concentration and Communication...............57
Effects of Visual and Acoustical Conditions...59
Relationships Between Privacy and Performance......64
Relationships Between Components of
Architectural Privacy and Performance
of Speech-Language Pathologists..........64
Relationships Between Components of
Architectural Privacy and Performance

of Head-Injured Patients in the
Beginning Stages of Therapy..............67

vii

CHAPTER PAGE

Relationships Between Components of
Architectural Privacy and Performance
of Head-Injured Patients in the
Final Stages of Therapy..................70

Relationships Between Architectural
Privacy and Performance as Applied

to the Research Hypotheses....... ..... ...74
Additional Relationships..... ........... ......76
Analysis of Variance ..... .... ................ ......76

Summary of Results

Personal Characteristics of Speech-Language
PathOIgists ..... O0.00.0.0...0.0.0.000000079

Personal Characteristics of Head-Injured
PatientSOO0.0......0.00.00.00.0000000000079

Architectural Privacy.........................80

Relationships Between Type and Amount of
Architectural Privacy............... ..... 80

Therapy Setting...............................81
Performance of Speech-Language Pathologists...81

Performance of Head-Injured Patients in
the Beginning Stages of Therapy.. ........ 82

Performance of Head-Injured Patients in
the Final Stages of Therapy ....... . ...... 82

Relationships Between Architectural Privacy
and Performance .................... . ..... 83

Additional Relationships......................87

Analysis of Variance..........................87

VI. DISCUSSION
Implications of the Findings

Inferential Analyses..........................89

viii

CHAPTER PAGE
Descriptive Analyses..........................92
Generalizability and Application. ......... ....94

Directions for Future Research.....................94
Future Research Goals..............................95

Conclusion ..................... . ..... ..............96

APPENDICES

A. UCHRIS Approval LetterOOOOOOOOOOOOOOO000......97

B. Pre-Test Cover Letter.........................98

C. Survey Cover Letter ........................ ...99
D 0 survey 0 0 O O O O O O O O O O O O O O O 0 O O O O O O O O 0 O O O O O O O O O O O O 100
REFERENCES ........................... . ................. 106

ix

10.

11.

12.

13.

LIST OF TABLES

EEGE
Collapsed Age Distribution of Head-Injured Patients..46

Abilities of Head-Injured Patients at the
Beginning and Completion of Therapy.............49

Office Type and Adjacency of Workspaces..............51
Maximum Numbers of Persons Sharing a Workspace.......51

Speech-Language Pathologists’ Awareness of Visual
and Acoustical Conditions Beyond Personal
workspace.0....0....OOOOOOOOOOOOOOOOOOOOOO ...... 53

Correlation of Type and Amount of Architectural
Privacy ........... 0..0.0.0.......OOOOOOIOOOOOOOOSS

Abilities of Head—Injured Patients and Speech-
Language Pathologists to Concentrate and
Communicate in Workspaces................ ...... .58

Effects of Visual and Acoustical Conditions on
Therapists’ Abilities to Conduct Therapy........60

Effects of Visual and Acoustical Conditions on
Patients’ Abilities to Participate in Therapy...63

Correlation of Components of Speech-Language
Pathologists’ Performance and Type of
Architectural Privacy. ..... .............. ..... ..65

Correlation of Components of Speech-Language
Pathologists’ Performance and Amount of
Architectural Privacy...........................67

Correlation of Components of Patient Performance
in the Beginning Stages of Therapy and Type
of Architectural Privacy........................68

Correlation of Components of Patient Performance
in the Beginning Stages of Therapy and Amount
of Architectural Privacy........................70

TABLE PAGE

14. Correlations of Components of Patient Performance
in the Final Stages of Therapy and Type
of Architectural Privacy........................71

15. Correlations of Components of Patient Performance
in the Fianl Stages of Therapy and Amount
of Architectural Privacy........................73

16. Correlation of Composite Scores for Performance
and Privacy..OOOOOOOOOOOOOOOOOOOOOO..0.0.0.0.00076

17. P-Values for Kruskal-Wallis Analysis of Variance
of Performance Scores According to
Architectural Privacy................... ...... ..78

18. Low and Moderate Correlations of Components of
Performance and Type of Architectural Privacy...84

19. Low and Moderate Correlations of Components of

Performance and Amount of Architectural
Privacy.0.00.0.0......OOOOOOOOOOOOOOOO ...... 0.0.85

xi

LIST OF FIGURES

FIGURE IEGE

1. Model Representing Therapist’s Perception of the
Relationship Between an Environmental
Pattern, Personal Characteristics, and
Performance of Therapists and Patients.........26

2. Age Distribution of Head-Injured Patients by
quartiIESOOOOOOOOOOOOOOOOOOOOOOO0.0.0.00000000047

xii

CHAPTER I. DESCRIPTION OF THE PROBLEM

Introduction

The 1980’s, according to Dixon, G011, and Stanton (1988),
was the "decade of head injury" in the rehabilitation field.
Increasing survival rates of head-injury 'victims due ‘to
advances in medical technology, as well as the complexity of
both the disability' and recovery' patterns, have «greatly
increased the number of care models and head injury
rehabilitation programs.

Head-injured patients are persons who have received
traumatic brain injuries as a result of penetrating or
nonpenetrating head injuries. The size of this disability
group is considerable: those surviving moderate to severe
injuries number approximately 1.8 million, and those with mild
head injuries total up to seven times that figure (Dixon et
al., 1988). Two-thirds of head injury victims are under the
age of 35, with men outnumbering women 2 to 1. A large number
of head-injured patients are adolescents and young adults with
relatively normal life expectancies who have survived motor
vehicle accidents. Other causes of injuries are falls, sports
injuries, tumors, strokes, and 'temporary interruption <of

oxygen or blood flow to the brain.

2

Head-injured patients may have problems resulting from
the injuries which persist long after the acute care phase of
treatment is completed. Costs for a lifetime of medical
treatment and.extended.care for those‘with severe injuries are
estimated at $4.5 million, not including lost earnings and
other indirect costs. (Adamovich, Henderson, and Auerbach,
1985; and Dixon et al., 1988).

Physical, psychological, cognitive, and behavioral
handicaps are often the result of a head injury (Adamovich et
al., 1985). The Michigan Head Injury Alliance has identified
frequently reported physical disabilities in patients such as
problems with speech, hearing, paralysis, vision, seizures,
and coordination. Reported cognitive impairments may involve
problems with concentration and attention, perception,
planning, communication and writing skills, short and long
term memory, judgment, sequencing, reading skills, and
orientation. Also included on the Michigan Head Injury
Alliance’s list are behavioral and emotional changes in the
head-injured patient such as fatigue, anxiety, low self-
esteem, restlessness, agitation, mood swings, excessive
emotions, depression, sexual dysfunction, 1ack.of motivation,
inability to cope, and self-centeredness. Finlayson, Alfano,
and Sullivan (1987) point to patient variables such as age,
type and extent of head injury, time since onset of injury,
and motivational and emotional factors which can influence the

rehabilitation process. These variables may interact with each

3

other, with. abilities prior to injury, and "with. other
environmental variables in ways that could either augment or
detract from the effects of remedial efforts" (p. 188).

Rehabilitation of the head-injured patient is an
interdisciplinary process which treats the wide variety of
behaviors and disabilities of the patient. Ideally, members of
the rehabilitation team should represent an array of
professional disciplines such as psychiatry, neurology,
speech-language pathology, psychology, physical therapy,
occupational. therapy; nursing, social. service, ‘vocational
rehabilitation, and therapeutic recreation; plus family
membersror other significant.persons (Adamovich.et.al., 1985).
Rehabilitation professionals work together to establish a
program for the patient which has two major goals: "a) to
achieve an outcome at the highest functional level possible,
and b) to sustain the outcome over time" (Dixon et al., 1989,

p. 335).

Statement of the Problem
Head-injury rehabilitation programs are located in
hospitals or rehabilitation clinics whidh provide patients
with highly structured and comprehensive programs. Facilities
may incorporate settings for communication therapy, cognitive
retraining, social skills training, psychotherapy support

groups, prevocational therapy, individual. or’ small. group

4
treatment, family support groups, and physical fitness
(Namerow, 1987).

As previously noted, Finlayson et al. (1987) state that
the interaction of environmental variables and patient
variables may have an impact on the effects of remedial
efforts. If the overall environment is viewed from a human
ecological perspective (Bubolz, Eicher, and Sontag, 1979) as
a system in which three subordinate environments (natural,
human constructed, and human behavioral) interact with each
other and with.human organisms, then.a change in any aspect of
one of the environments will effect a change in the system as
a whole. Applied to the rehabilitation process, this approach
would suggest that not only will treatment activities affect
patients’ behavior, but that the settings in which. the
treatments occur will also have an impact on the patients’
behavior. If rehabilitation settings are consciously designed
to support the remedial activities, they may have a positive
effect on patients’ efforts to achieve the goals of their

rehabilitation programs.

Purpose of the Study
The ability to communicate effectively is essential for
persons to function in society. The purpose of this study was
to determine if, according to perceptions of speech-language
pathologists, there is a significant relationship between a

specificenvironmentalcharacteristic--architecturalprivacy--

S

and the performance of speech-language pathologists and head-
injured patients in communication therapy settings. For this
study architectural privacy is defined as the limitation, by
physical form, of the transmission and reception of
information in a space. It consists of two interrelated
features: type, which is the means used to limit the
transmission and reception of information in a space (Wineman,
1982): and amount, which is the degree to which the
transmission and reception of information in a space is
limited.

Since performance in rehabilitation facilities is
related to the rate at which a patient reestablishes the
skills necessary to regain a functional role in society, the
impact of an environmental condition on performance may
indirectly affect the reestablishment of necessary skills. The
effect of environmental variables on human behavior is
addressed in the work of Barker (1968); Bechtel (1977); Deasy
(1974 and 1985); Finlayson et al. (1987); Ittelson,
Proshansky, Rivlin, and Winkel (1974); Kaplan (1983); Wicker
(1979); Zeisel (1981); and Zimring (1981).

The privacy component of the study is upheld by those who
noted that controlling inputs from the environment may have an
influence on an individual’s performance (viz., Altman, 1976;
Archea, 1977; Margulis, 1977; and Sundstrom.et al., 1980). The
need to control visual and acoustical disturbances in

communication therapy environments is supported by the views

6
of Conners (1983), Siegel (1982), Wexler (1984), and Wbod
(1986). Research on privacy in the work setting by Goodrich
(1982), Sundstrom et al. (1980), Wineman (1982), and Zalesny
and Farace (1987) also provide support for the study.

In addition, the high costs of rehabilitation and care
for head-injured patients should oblige rehabilitation
facilities to jprovide settings *which enable ‘patients ‘to
achieve the goals of their rehabilitation programs in a timely
manner.

The study surveyed speech-language pathologists employed
in rehabilitation facilities for head-injured patients in
order to assess their perceptions of the impact of
architectural privacy on their performance and that of their
patients. Data was analyzed using descriptive and
nonparametric inferential statistics to describe the variables

and determine the strengths of relationships between them.

CHAPTER II. REVIEW OF LITERATURE

Environment and Behavior

WW

Bechtel (1977) speaks of the relationship between people
and their environment as an indirect one. Elements of social
systems, physical structures, roles, and societal components
act to moderate nature’s direct effect on people. Within a
setting these elements can "influence behavior and.become part
of the ecological input operating on persons" (p. 30), with
social factors exerting the greatest influence on nature’s
effect. It cannot be assumed, however, that because certain
elements influence behavior they can also predict behavior.

In a study involving children, Barker (1968) expected8
that behavioral outputs could be predicted based on certain
ecological inputs. The results of the study did not support
his expectation. It was found that predictions of children’s
behavior episodes from social inputs were only 50 percent
accurate, leading to the assumption that predictions from
nonsocial inputs would be much lower (Barker, 1968, p. 150).
According to Barker "the nonsocial, ecological environment
does not demand behavior,...it enters psychology only as

supportive, permissive, or resistive circumstances" (p. 150).

8

Bechtel (1977) emphasizes the important features. of
Barker’s (1968) theories. The behavior setting, with its own
schedule of behavior, has the most predictable influence on
behavior. Within. a setting the schedule of behavior is
preserved by persons who direct or help direct the behavior
such as teachers and policemen. Both social and nonsocial
features of a setting serve to sustain the behavior occurring
within it by either correcting or expelling deviating behavior

from the behavior setting.

BehaviorlEnvironment Congruence

Wicker (1979) discusses the congruence between behavior
and environment in the psychological terms of operant,
observational, and instructional learning; environmental
perception; and social exchange.

Operant-learning theory states that events which follow
a given action determine whether the action will be repeated.
Behavior which is appropriate to a behavior setting results in
events (reinforcers) that increase the probability of the
behavior recurring. Inappropriate behavior in a setting
results in events (punishments) that reduce the probability
that the behavior will recur, thereby eliminating
inappropriate behavior over time.

Observational and instructional learning theories--
learning from observing the behavior of others, and learning

from an instructor or instructional materials--employ similar

9

methods. A person must first pay attention to the material
being presented. Second, a person must retain over time the
information presented in order to reproduce it when the
stimulus is no longer present. Finally, a person must apply
the stored information to actual performance. Lack of
necessary skills or motivation, however, may prevent the
translation of information into action.

Environmental perception involves the ways in which
persons experience .and interact. with 'their surroundings.
Various combinations of the senses (hearing, sight, touch,
smell, taste) are involved as persons attempt to process an
overwhelming amount of information. Environmental perception
is made up of four basic features: a) an affective reaction of
a person based on the level of satisfaction derived from the
setting, b) an orienting reaction which determines how a
person relates to the environment or its features, c) the
categories of analysis which a person uses to describe and
differentiate the setting, and d) the identification of
environmental contingencies which allows a person to give
order to the setting and predict what might occur in it.

In the social-exchange analysis of behavior/environment
congruence the relationship between a person and the occupied
behavior setting is two-directional, each evaluating the
other. The pattern of interaction between person and setting
is dependent on the outcome or information received from the

interaction. Prolonged contact between person and setting will

10
usually result in "some.combination.of behaviors that tends to

maximize their respective outcomes" (p. 64).

Environmental Fit

Ittelson, Proshansky, Rivlin, and Winkel (1974) discuss
the problem of environmental fit in terms of a behavior-
contingent physical system in which human needs and
environmental stimuli must be balanced while in a constant
state of flux. Designing the proper environmental supports
into the system can.help maintain this balance. A well fitting
physical system is necessary for persons to function on all
levels and should be adaptive to the behaviors it supports.
Persons can adapt to "dysfunctioning environments, but there
are limits to these adaptive powers, and adaptation itself may
be made at the cost of physical and mental stress or failure
to realize defined goals" (p. 347).

While a setting can make certain patterns of behavior
possible or impossible, efficient or inefficient, it is the
activities that occur within the setting that more directly
influence behavior. A room such as a laboratory or music room
may be designed to support specific activities, suggesting
that some activities are more appropriate than others within
the setting.

Social and cultural factors also operate on behavior. A
certain type of behavior is expected in a classroom or on an

assembly line, but only to the extent that it is allowed or

11
decreed by the teacher or management. Even when a designer
knows what is desirable for a setting, he or she is "often
insufficiently aware of the limitations of the built
environment to modify long-standing patterns of behavior or

accommodate a variety of behaviors" (p. 349).

o e ts St es ' th ° e

Zimring (1981) regards the designed environment as an
interaction, within a social-physical system, between physical
elements, social structure, and individual goals and needs.
Although persons are not usually conscious of the built
environment unless it causes "harm, discomfort, pleasure, or
awe" (p. 145), they can experience stress, both directly and
indirectly, through a misfit between individual needs and
environmental components. The severity of ‘the stress is
dependent upon issues such.as the importance to the individual
of the misfit, the nature of the misfit, and the means
available for its resolution.

The design of an environment can affect the coping
strategies a person employs to resolve the misfit. A person
may attempt to either change his or her needs through
intrapersona1.means or change the situation. The situation may
be changed by selecting another setting, or by directly
exerting control over the present setting, as in closing an
office door to block out distracting noises of other workers.

If a person is not allowed to change or control the setting,

12
the goal of completing the task may be abandoned--an

intrapersonal coping strategy.

Persgn-Environment Compatibility

Kaplan (1983) discusses the requirements for an
environment which is supportive of people and their concerns.
An environment with a high degree of compatibility would allow
people to strive toward their goals, while not necessarily
giving the individual complete control of important outcomes
[such as rehabilitation goals]. Barriers that make it
difficult for people to help themselves would be eliminated.
Human choice and purpose are important concepts in such an
environment but can be undermined by distraction and coercion.
Also important to people in a supportive environment are
Opportunities for reflection.

The degree to which people can act meaningfully on their
plans and inclinations within an environment may be indicative
of environmental support. For many people their environments
are :not supportive. Lowered. sensitivity’ and flexibility,
reduced effectiveness and resiliency, and increased
irritability can all result from nonsupportive environments.
Over time such symptoms can have an impact on health and well-

being.

13

Environmental Support or Hindpance

Zeisel (1981) believes that activities can be supported
or hindered by the environments in which they take place.
Certain activities are encouraged by being easy to perform
within an environment, while others are discouraged by being
made.difficult. Such support and.hindrance of activities by an
environment uphold the notion that behavior may be consistent
with its setting. Although findings of environment-behavior
research may yield information on what "some people might tend
to do in a setting" (p. 219), Zeisel believes they cannot lead
to predictions of what will or will not be done in that

setting.

Enviponment as a Prosthetic Device

Deasy (1974) views our immediate environment as a
prosthetic device by which building components act to extend
a.person’s capabilities. These include not only anatomical and
physiological dimensions, but social and psychological
dimensions as well. Settings can aid or impede a building user
socially and psychologically in three ways by a) influencing
the stress experienced when accomplishing group or personal
goals, b) influencing the form and nature of personal
contacts, and c) influencing feelings of identity and self-
worth. Most people can adapt to environmental "handicaps" and
accomplish their goals, "but adapting has its costs in time,

frustration, nervous energy, and misdirected effort" (p. 45).

14
According to Deasy (1985) "any environment that is inadequate
for its intended purpose, that frustrates and annoys us, or
that limits our ability to accomplish our purposes has a

direct bearing on human behavior" (p. 10).

Privacy
Meanings for Various Groups

Margulis (1977) discusses the meanings of privacy for
diverse groups such as children and adolescents, middle
management executives in office settings, young psychiatric
patients, and behavioral and social scientists. Children and
adolescents viewed privacy as "controlling access to
information, being alone, no one bothering me, and controlling
access to spaces" (p. 7).

Middle management executives gave similar meanings to the
concept of privacy: "being able to work without distraction,
controlling access to information, freedom to do what you
want, controlling access to space, and being alone" (p.7).
Young psychiatric patients also viewed privacy as being alone
and controlling access to information. In addition, references
were made to getting undressed, using the toilet, and
showering.

Margulis (1977, p.9) cites the following meanings of
privacy for various behavioral and social scientists:

Privacy is the "selective control over access
to the self or to one’s group". -Altman, 1974.

 

15

Privacy refers to "the negation of potential
power-relationships betweeen [a person or group]
and others". -Kelvin, 1973.

"Privacy is the claim of individuals, groups,
or institutions to determine for themselves when,
how and to what extent information about themselves
is communicated to others." -Westin, 1967.

Privacy is equated with "control of stimulus
input from others, degree of mutual knowledge and
separateness of people from one another". -Simmel,
cited by Altman, 1974.

"Psychological privacy serves to maximize
freedom of choice, to permit the individual to feel
free to behave in a particular manner or to
increase his range of options by removing certain
classes of social constraints." -Proshansky,
Ittelson, and Rivlin, 1970.

The concept common to all groups is that of control--
"controlling access to information and controlling inputs from
others or from the environment (e.g., not being bothered,

disrupted, distracted)" (p. 9).

Behavioral Mechanisms

Altman (1976) discusses his definition of privacy as
"selective control of access to the self or to one’s group"
Four behavioral mechanisms are used to obtain and maintain
desired levels of privacy: a) verbal content and structure
(what is said and how it is said), b) nonverbal behavior (body
language and clothing used to establish boundaries between
oneself and another), c) environmental mechanisms (personal
space, territorial behavior, and the use of areas and objects
in the environment), and.d) culturally based norms and customs

(nonverval, verbal, or environmental). These mechanisms work

16

together as a system, responding and readjusting as necessary
over time to accommodate desired levels of social interaction.
This accommodation may not always be successful, however,
resulting in physical and psychological reactions in the form
of illness, stress, or anxiety. Altman cites Dubos when he
states that

people are capable of extraordinary adaption to

extreme physical and social situations. The

question is not one of survival or nonsurvival. It
is more a matter of the costs and prices paid for

successful adaptation -- whether these costs are
physical, physiological, psychological, or social
(p. 24).

Physical and Psychological Privacy

Sundstrom, Burt, and Kamp (1980) view privacy in two
ways: a) as a physical feature of the environment and b) as a
psychological state. Psychological privacy is attributed to "a
sense of control over access to oneself or one’s group" (p.
102). Having control over the information a person receives
from others and the information given about the person to
others is a part of psychological privacy. Dissatisfaction
results in situations where persons are unable to maintain a
desired level of social access.

Architectural privacy’ is the result of "visual and
acoustic isolation supplied by the environment" (p. 102).
There is a positive relationship between amounts of enclosure
and degree of architectural privacy in an environment. In

addition, persons in environments with a high degree of

1'7
architectural privacy are also able to control their
accessibility to others, which may result in an increased

sense of psychological privacy.

Apphitecturai Factops ang Privacy

Archea (1977) discusses the relationship between
architectural factors and. privacy’ in. which the jphysical
environment is viewed as "a mechanism for regulating the flow
and appearance of information" (p. 123). A person’s behavior
is viewed.as a continuous adjustment to an ever changing field
of information about surrounding events and activities. Not
only does one monitor the behavior of others (access), but
others monitor one’s own behavior (exposure), thereby
increasing a person’s accountability for his or her behavior.

In enclosed settings, visual access (seeing others) and
visual exposure (being seen) are dependent on the positions of
walls and other visual barriers. The range of a person’s
behaviorial options and obligations within the setting are
influenced by the spatial organization. "The arrangement of
the physical environment regulates the distribution of the
information upon which all interpersonal behavior depends" (p.
121). People process available information in order to
coordinate their actions with those of others. The resulting
adjustment in behavior provides additional environmental
information to be processed. Since sensory-motor capabilities

are necessary to process environmental information there may

18
be, according to Archea, a "basis for differentiating the
special privacy requirements of particular groups, like the
elderly or the handicapped" (p.135).

This last statement implies that there is a need for
research on environmental aspects of rehabilitation
environments in general and privacy aspects in particular. The
study presented herein begins by addressing architectural

privacy, specifically its relationship with performance.

Privacy in Communication Therapy Settings

Cpntroi of Noise and Visual Distractipns

Wexler (1984) speaks of the need for controlling both
noise and visual distractions when creating a speech-language
treatment setting. The selected room should be located away
from a parking lot or corridor which can generate excessive
noise. Soundproof materials should be installed to reduce
competing noise during treatment sessions. Floors should be
carpeted and extraneous noises such as ticking clocks should
be eliminated. Visual disturbances from areas outside the room
should also be avoided by covering windows in line with a
patient’s view with blinds or draperies.

Wood (1986) reiterates the need for acoustical treatment
of therapy rooms with the inclusion of acoustical tile and
insulation material as design components. Treatment rooms

should be private, to minimize distractions.

19
Need for Quiet and Noisy Enyiponments

Siegel (1982) discusses the typical communication therapy
setting where distractions are minimized so optimal
performance can be achieved. Articulation is tested in quiet
environments where the person being tested is required to
listen very carefully before responding. The situation
changes, however, outside of the clinic where the same person
will need to speak in a noisy environment, often competing
with others for attention while formulating and uttering
speech.

Siegel recommends that testing methods incorporate
features of the outside environment. Both quiet and noisy
backgrounds should be provided for some tests of speech sound
production. A person’s response in noise "provides a good
prediction of how stable a newly acquired articulation skill

has become" (p. 89).

Privacy in Educational Settings

impact of Noise on Performance

Since a therapy setting is a type of learning
environment, Conners’ (1983) discussion of the impact of noise
on the performances of school children in a 1980 study by
Cohen, Krantz, Evans, and Stokols is relevant. In tests of
auditory discrimination, mathematics achievement, and.reading
achievement, students in a school located in the air corridor

for the Los.Angeles International Airport.performed as well as

20
students in a quieter location. Students in the noisier school
did not perform as well as the other students on a puzzle
exercise, however, and demonstrated a distraction which
increased with years of exposure to the noise. They also
tended to be less persistent on the puzzle task and had

significantly higher blood pressure.

Privacy in Work Settings
The subject of privacy has been treated extensively in
research literature on the work setting, and much is
applicable to the communication therapy setting. The purpose
of each setting is to achieve goals based on the performances

of the individuals working within it.

Providing Adeguate Levels of Privacy

Goodrich (1982) discusses the provision of adequate
levels of privacy in the work place. Solid walls, acoustical
partitions, masking sound, and separation are used to create
physical privacy but may be inadequate for perceived privacy.
Sound can leak through walls and ductwork, and be funnelled
down hallways having hard wall surfaces. The lack of
background noise can increase the contrast between any sound
made and the surroundings, calling attention to the sound.
Even a private office may not be truly private in a totally

quiet environment.

21
The use of interior glass panels in an office may make
workers feel exposed and be distracting. Passersby are tempted
to look into the office and the workers may feel compelled to
acknowledge them. Too much enclosure, however, may isolate a
worker from his or her surroundings. If the sources of sudden
noises and movements cannot be seen, the worker may become

distracted and unable to concentrate on the task at hand.

Acousticai and Visual Ppivacy

Wineman (1982) also «discusses acoustical and 'visual
privacy. People talking and phone conversations are the most
annoying violations of accoustical privacy, perhaps due to
their informational content. Unpredictable, uncontrollable, or
very intense sounds can interfere‘with.task performance, which
may continue to be affected after the noise has stopped. The
use of background sound to mask conversations and other office
sounds prevents loud noises from becoming too distracting and
minimizes unpredictable sounds.

Wineman contends that visual privacy is less important
than acoustical privacy, but it does have an influence on
worker satisfaction. The lack of privacy from the view of
others may be uncomfortable and may interrupt tasks if

coworkers stop to chat.

22

Effegts of Visual Distraction

Zalesny and Farace (1987) also found activities of
persons outside a work area to be visually distracting,
tempting a person to look away from a task whenever some
movement is perceived. They found that the sense of being
spied upon can have a negative effect, creating self-
consciousness which can interfere with the ability to
concentrate. The lack of visual privacy can, however, have a
positive effect on an individual. A benefit of seeing others
working or being rewarded for increased productivity may be

the motivation of persons to work more effectively.

Psychplogical Privacy

Results of the 1980 study conducted by Sundstrom et al.
showed that architectural privacy was consistently associated
with psychological privacy. A relationship between both types
of privacy and satisfaction with workspaces and job
satisfaction was also found. Features of architectural privacy
that limit visibility and audibility, such as partitions and
buffer zones, may be related to the satisfaction with work
spaces. The status signified by a private workspace and the
link of privacy with self-identity may also be related to
satisfaction. Architectural privacy had a limited, positive
relationship with job performance in clerical and mechanical

employees. The ability to control inputs from the environment

23
such as noise and distraction may have an influence on the

performance of individuals (Sundstrom et al., 1980).

24

CHAPTER III. RESEARCH OBJECTIVES

Research Hypotheses

The primary goal of this research was to discover if

there are relationships between perceptions of architectural

privacy and performance of speech-language pathologists and

head-injured patients. To discover if these relationships

exist the following working hypotheses were proposed:

Hypotnesis 1:
There is a significant relationship between
architectural privacy and the performance of
speech-language pathologists in rehabilitation
settings.

fiypophesis 2:
There is a significant relationship between
architectural privacy and the performance of head-
injured patients in the beginning stages of therapy
in rehabilitation settings.

flypppnesis 3:
There is a significant relationship between
architectural privacy and the performance of head-
injured patients in the final stages of therapy in

rehabilitation settings.

25
Performance of head-injured patients was divided into two
stages in order to discover if there would be a difference in

the relationships as patients’ abilities improved.

Conceptual Model

Archea (1975) describes a disposition framework in which
the physical environment is seen as "a nominal arrangement of
artifacts which exhibits shape, size, relationship, and other
aspects of form or type" (p.290). Within the physical
environment, behavior is viewed as a process of a person’s
conscious assessment of environmental patterns as influenced
by individual interests, capabilities, motivations, values,
and circumstances. According to Archea (1977) a person’s
assessment of environmental patterns, or information, results
in a behavior which in turn becomes an addition to the
environmental information.

In the human ecological model developed by Bubolz et a1.
(1979) three subordinate environments interact with each other
and with an individual or group, all within the larger
environment. Each segment of the environment has an objective
reality, which exists independently of consciousness; and a
subjective reality, which is dependent on the perception of an
individual or group. There is "a relationship of reciprocal
influence" among components of the environmental system. An

interaction between any single component or person "influences

26
or acts on any other part and is influenced or acted on in
turn" (p. 30).

The disposition framework and human ecological model
form the basis of the model (Figure 1)tdeveloped.to illustrate
the relationships of the variables in this study. An
environmental pattern (architectural privacy) is assessed by
a therapist (speech-language pathologist) and a patient (head-
injured patient). These individual assessments, which are
influenced Int personal characteristics (interests,
capabilities, circumstances) of each individual, in 'turn
influence the performance of therapist and patient in a

setting. The performance of therapist and patient is also

FIGURE 1.

Model Representing the Relationship Between an Environmental
Pattern, Personal Characteristics, and Performance of
Therapists and Patients

 

Personal .
Characteristics

[Therapist’s

 

 

  

 
    
 

    
 
 

Therapist’s
Assessment

Therapist’s
Performance

 

 

 

 

 

 
     

 

 

 

 

l
Environmental | . * '
Pattern ' Reciprocal __"__ Environmental
(Architectural _‘ r ------ Relationship Pattern
Privacy) | . - .
l

 

   
    
 

 

   
      

 

  
 

Patient’s
Assessment

Patient’s
Personal
Characteristics

Patient’s
Performance

 

 
   
  

 

 

27
influenced by their respective personal characteristics. Since
therapist and patient work together in a therapy setting,
their performance results in a reciprocal relationship which
may influence the assessment of the original pattern (broken
lines) or may generate an additional environmental pattern to
be assessed (broken lines). Due to the expected variation in
patients’ mental capabilities and to protect patients’
privacy, the study was limited to the perceptions of speech-

language pathologists regarding these relationships.

Conceptual and Operational Definitions

The proposed research hypotheses focus on speech—language
pathologists’ perceptions of the independent variable--
architectural privacy; and ‘the <dependent 'variables--
performance of speech-pathologists, and performance of head-
injured patients in the beginning and final stages of therapy.
The conceptual and operational definitions for the variables
indicated in the model, as well as definitions for the therapy
setting, follow:
Speech-Language Pathologist’s Perception:

Conceptually, speech-language pathologist’s
perception is defined as his or her intuitive cognition
and judgment of environmental characteristics, personal
characteristics, and performance.

Operationally, all questions regarding the variables

in the study and their possible influences upon each

28
other were based on these perceptions. (See Survey in
Appendix D.)
Aggnipectupa; Privacy:

Conceptually, architectural privacy is defined as
the limitation by physical form of the transmission and
reception of information in a space. It consists of two
interrelated features: type, which is the means used to
limit the transmission and reception of information in a
space (Wineman, 1982); and.amount, which is the degree to
which the transmission and reception of information in a
space is limited.

Operationally, speech-language jpathologists *were
asked questions regarding the type of physical forms in
their workspaces, and the amount of transmission and
reception of visual and acoustical information in their
workspaces. (Questions 17, 19-25.)

Pepsonal Characteristics of Speech-Language Pathologists:

Conceptually, these characteristics are defined as
the traits of a therapist.who specializes in disorders of
speech and language and conducts therapy in a
rehabilitation facility.

Operationally, speech-language jpathologists *were
asked questions regarding their areas of specialization,
patient load, and demographic information. (Questions 1,

2-6, 18, 31, 32.)

29
Bensonai Characteristics of Heag-Injuped Patients:

Conceptually, these characteristics are defined as
the traits of a person who has sustained a traumatic
insult to the brain and is a patient in a head injury
rehabilitation facility.

Operationally, speech-language jpathologists ‘were
asked questions regarding therapy participation,
communication abilities, and demographic information
about their patients. (Questions 7-10.)

Speech-Language Pathologist Performance:

Conceptually, speech-language pathologist
performance is defined as the ability to conduct the
therapy required to help a patient reestablish
communication skills at the highest level possible.

Operationally, speech-language jpathologists *were
asked questions regarding their abilities to work
effectively, and the effects of environmental conditions
on their abilities to conduct.therapy. (Questions 15, 16,
26.)

Head-Injured Patient Performance:

Conceptually, head-injured patient performance is
defined as the ability to participate in therapy in order
to reestablish communication skills.

Operationally, speech-language pathologists were
asked questions regarding their patients’ abilities to

work effectively, and the effect of environmental

30
conditions on their abilities to participate in therapy,
both at the beginning and final stages of therapy.
(Questions 11-14, 27, 28.)
Therapy Setting:

Conceptually, therapy setting is defined as the area
within a rehabilitation facility which is designated as
the location for a specific rehabilition activity.

Operationally, speech-language pathologists were

asked to describe workspace preferences. (Questions 29,

30.)

CHAPTER IV. METHODOLOGY

Research Design and Procedures
pggign of Study

In order to begin to understand the relationships between
environment and behavior in rehabilitation settings, it was
decided to conduct an exploratory study which focused on a
single environmental pattern and its impact on the performance
of speech-language pathologists and head-injured patients. A
survey was used to gather data from speech-language
pathologists employed in rehabilitation facilities for head-
injured patients. The survey was designed to assess the
perceptions of speech-language pathologists regarding the
impact of architectural privacy on their performance and that
of their head-injured patients.

The proposed survey was submitted to and received
approval from the Michigan State University Committee on
Research Involving Human Subjects (UCHRIS) (Appendix A). The
committee determined that the rights and welfare of the
subjects appeared to be protected.

Upon receiving UCHRIS approval, the survey was pre-tested
by speech-language pathologists in a local rehabilitation
facility for head-injured patients to determine the

appropriateness and clarity of the questions. Three copies of

31

32
the survey, each with an explanatory cover letter (Appendix
B), were given to the Assistant Director of Tamarack Clinic,
East Lansing, Michigan, for distribution to the speech-
language pathologists in that facility. Two surveys, with
accompanying comments, were returned to the researcher within
one week. As a result of the comments, minor revisions were
made to some of the questions and others were eliminated from

the survey.

Sample Selection

A sample of 107 rehabilitation facilities was randomly
drawn from the 263 facilities listed in the "Day Treatment"
category of the 1991 National Diregpory of Head lnjppy
Rehabilitation Services. This category was selected in an
attempt to control for the functional abilities of the head-
injured patients who would be receiving therapy from the
selected speech-language pathologists. It was assumed that
patients who would be able to travel to the facility to
receive treatment on a regular basis would have at least

moderate levels of functional abilities and mobility.

Prgceguge

Surveys (Appendix D), along with an explanatory cover
letter (Appendix C), were mailed to the directors of speech-
language pathology employed in the selected rehabilitation

facilities throughout the United States. The cover letter

33
explained the purpose of the study to the participants,
informed them of their right to respond or not to respond to
the questions, and assured them of anonymity. Each survey was
coded.with.a facility number for“mailing'purposes. Upon.return
of the survey the facility code number was recorded and then

removed from the survey.

Instzunenp pescription

Speech-language pathologists were requested to answer
questions about their personal characteristics which included
area of specialization and certification, patient load, age,
sex, and height. To assess personal characteristics of head-
injured patients, respondents were asked questions regarding
age and sex distribution of their patients, length of time a
typical patient spends in therapy with them, and their
patients’ speech-language abilities at the beginning and final
stages of therapy.

Architectural privacy was assessed with questions about
the type of wall, ceiling, and floor materials; numbers of
persons working in the same space, adjacency to other
workspaces, and workspace enclosure. Speech-language
pathologists were also requested to rate the degree of their
awareness of certain visual and acoustical conditions.
Responses were recorded on a 3-step Likert-type scale which
categorized their responses.as "very aware", "somewhat.aware",

and "not aware".

34

Performance of therapists and their patients was measured
on a 3-step Likert-type scale. Respondents were asked to rate
their abilities and those of their patients tolcommunicate and
concentrate within their workspaces. Response categories were
"very well", "somewhat", "not well".

The effects of visual and acoustical conditions on
therapists’ abilities to conduct therapy, and the effects of
these conditions on their patients’ abilities to participate
in the beginning and final stages of therapy within their
workspace, were rated on a 5-step Likert-type scale. A 5-step
scale was used to assess both positive and negative effects.
Response categories were "hinders", "somewhat hinders", "has
no effect", "somewhat enhances", and "enhances". Two open-
ended questions asked for therapists’ opinions about their

therapy settings.

Response Rate

Forty-six respondents returned surveys for a response
rate of 43 percent. Not all questions were answered by all
respondents. Three surveys were.returneduwith.nozresponses. Of
these, one facility did.not offer speech-language therapy, one
facility had an outside contract for "speech services", and
one respondent questioned the validity of the questionnaire as
it applied to his/her facility. One of the completed surveys
was accompanied by a letter offering comments and suggesting

additional issues which might be considered by the study.

35
Data Analysis
Eezspnal Chapacteristics

Personal characteristics of speech-language pathologists
were measured on two scales. Responses to questions regarding
area of specialization, certification, sex, and ages of
speech-language pathologists were categorical and, as such,
were measured on the nominal scale. Responses to questions
regarding patient load (expressed as numbers of patients seen
per day, per session, and per week; and length of typical
therapy sessions) were measured on the ratio scale.

Characteristics of head-injured patients were all
measured on the ratio scale. Numbers were used to indicate
length of therapy, and percentages were used in response to
questions about the distribution of specifed characteristics
among therapists’ patients (viz., age, sex, and speech-
language abilities at the beginning and final stages of
therapy).

Descriptive statistics were used to provide profiles of.
therapists’ patient loads and. ‘head-injured. patients’
characteristics. Patient loads were indicated by the ranges of
scores and modes. Patients’ characteristics (age distribution
and communication abilities) were profiled using means,
medians, standard deviations, ranges, and the range of scores
between the first and third quartiles. The use of quartiles

gives a better picture of the dispersion by avoiding the

36
extreme scores found in a few of the responses (Rowntree,
1981).
Therapists’ responses to questions regarding their ages,
sex, specialization, and certification were tallied and

frequencies of responses were reported in percentages.

Apgnitectural Ppivacy

Units of measurement for components of architectural
privacy were on the nominal and ordinal scales. Although
responses to questions regarding type of architectural privacy
(workspace materials, persons sharing workspaces, adjacency,
and enclosure) were categorical, the method of scoring allowed
the categories to be ranked according to the effectiveness of
privacy type. A score of 1 indicated the most effective type
of architectural privacy component. For instance, in response
to the question "Is the floor of your workspace carpeted?",
a "yes" answer was scored as 1 and a "no" answer as 2.

Amount of architectural privacy was measured by degree of
awareness of visual and acoustical conditions. Responses were
ranked on a 3-step scale with the score of 1 ("not aware" of
the specified condition) indicating the least amount. of
transmission or reception of the condition into the workspace.
Responses of "somewhat aware" were scored as 2, and "very

aware" as 3.

37
In order to describe type and amount of architectural

privacy, responses were tallied and frequencies reported in

percentages.
Relapionships Bepween Type and Amount of Apgnipectupal Erivagy

A nonparametric statistical test, the Spearman rank
correlation (rm) , was used to measure the strengths of
relationships between type and amount of architectural
privacy. According to Siegel (1956) both variables to be
measured must at least be on an ordinal scale so they may be
ranked in two ordered series. In the event of ties, the tied
ranks are averaged. Ties have relatively little effect on the
value of the Spearman rank correlation, although the value of
rm” becomes slightly inflated if a correction factor is not
employed. When testing for significance using a one-tailed
test, an observed value of rm must equal or exceed the
appropriate tabled critical value in order to be significant.
The efficiency of the Spearman rank correlation is about 91%
compared to the Pearson r, the most powerful parametric
correlation.

The analysis of data measured the strengths of the 36
relationships between the individual components of each
variable to determine which components were the most
influential. A probability less than .05 (p<.05, one-tailed
test) was required to establish the existence of significant

relationships between pairs of components of type of

38
architectural privacy and amount of architectural privacy. Due
to missing data the critical value used was .261 for N - 5 =
41 (Glass and Hopkins, 1984, p. 549).

According to Norusis (1986) caution must be exercised
when examining significance levels for numerous correlation
coefficients. Some may be statistically significant even
though no relationship exists between the variables in the
population. About 5 out of 100 coefficients may have observed
significance levels less than .05 without existing

relationships among population variables (p. 318).

Ingpgpy Setting
Responses to open-ended questions about therapy settings

were tallied and the frequencies of responses reported.

Performance of Therapists and Patients

Performance of speech-language pathologists and head-
injured patients in the beginning and final stages of therapy,
was measured on ordinal scales. Abilities to concentrate and
communicate were ranked on 3-step scales with a score of 1
indicating the highest level of "very well", 2 corresponded.to
the response "somewhat", and 3 indicated "not well".

A 5-step scale was used to rate the effects of visual and
acoustical conditions on performance. Scores could range from
1 for "enhances" to a 5 for "hinders". Middle categories were

"somewhat enhances", "has no effect", and "somewhat hinders".

39
Therapist and patient performance was profiled by
tallying the responses and reporting the frequencies for each

response.

Relationships between Privacy and Performance

The Spearman rank correlation (rhug, was used.to measure
the strengths of relationships between architectural privacy
and therapist and patient performance. The first analysis of
data measured the strengths of the 48 relationships between
the individual components of each variable to determine which
components were the most influential. A probability less than
.05 (p<.05, one-tailed test) was required to establish the
existence of significant relationships between pairs of
components of architectural privacy and performance of speech-
language pathologists and head-injured patients. Due to
missing data the critical value used was .261 for N - 5 = 41
(Glass and Hopkins, 1984, p. 549).

In the second Spearman rank correlation analysis (rmw)
ordinal values of the responses to questions about each
variable were summed to arrive at a single composite score for
the variable. These scores were used in the analysis which
measured the significance of the relationships between
variables in response to the research hypotheses. The
variables in the hypotheses were a) architectural privacy, b)
performance of speech-language pathologists, c) performance of

head-injured patients in the beginning stages of therapy, and

40
d) performance of head-injured.patients in the final stages of
therapy. A p<.05 (one-tailed test) for a Type I error was
required.to reject the null hypotheses.of no relationships and
accept the working hypotheses of the existence of
relationships between architectural privacy and performance of
speech-language pathologists and head-injured patients. Due to
missing data the critical value was .261 for N'- 5 = 41 (Glass

and Hopkins, 1984).

Analysis of Variance

The Mann-Whitney two-sample median procedure was used to
determine whether or not speech-language therapists’
perceptions of themselves and their patients differed
regarding performance. Mann-Whitney is a nonparametric rank
test which compares the medians of two samples with data
stored in separate columns (Schaefer and Anderson, 1989). The
variables used represented the composite performance scores
for each of the three groups in the study. The composite
performance score for speech-language pathologists was
compared with those of head-injured patients in the beginning
and final stages of therapy. Composite performance for the two
groups of patients were also compared. A probability of less
than .05 (p<.05, one-tailed test) was required to indicate
that the medians of the two samples being compared were

different.

41

The Kruskal-Wallis analysis was applied to the data in
order to discover if speech-language pathologists’ perceptions
of themselves and their patients differed with reference to
the performance and privacy variables. Kruskal-Wallis is a
nonparametric one-way analysis of variance by ranks for more
than two samples. The sample data is stored in one column and
the group identifier in another (Schaefer and Anderson, 1986) .
The performance scores for therapists and patients (sample
data) were tested according to scores for total architectural
privacy and scores for individual architectural privacy
components (group identifier). A probability of less than .05
(p<.05, one-tailed test) was necessary to demonstrate that the
medians of the three samples being compared were different for

the various architectural privacy variables.

Limitations

The study focused on the perceptions of speech-language
pathologists about themselves, their patients, and
environmental conditions. The survey was not directed to head-
injured patients but relied on speech-language pathologists to
provide information. on jpatients’ characteristics and
performance.

In an effort to limit its length, there were a number of
issues not addressed in the survey. It was not designed to
determine a) reasons for variations in time spent by patients

in rehabilitation, b) severity and type of head injury and

42
other accompanying injuries, or c) motivational and emotional
factors. Nor did the survey address therapist variables such
as work experience, satisfaction with the work environment,
and total work load. Since the survey was designed
specifically for this study and.not extensively'pretested, its
reliability and validity must be questioned.

Environmental characteristics of facilities and settings
for the rehabilitation of head-injured patients were not
consistent throughout the sample. Not all faciities have areas
specifically designated for speech-language therapy.

Personal characteristics of head-injured patients in
rehabilitation facilities may vary by facility. Some
facilities serve a specific age group, such as the elderly, or
a single sex such as female.

It was discovered that not all facilities classified as
providing day treatment serve only those head-injured patients
with.moderate levels of functional abilities. They may be only
one part of the patient population in a given facility which
can include patients with many levels of functional abilities
and rehabilitation needs.

A larger sample taken from all rehabilitation facilities

listed in the 1991 National Directory of Head Injury

Rehabilitation Services might more accurately reflect the

 

head-injured population as a whole.

43
Assumptions

Despite the aforementioned limitations certain
assumptions can be made regarding this study. If speech-
language pathologists are certified by the American Speech-
Language-Hearing Association, having obtained a Certificate of
Clinical Competance‘, their rehabilitation methods will be
similar throughout the United States. It is also assumed for
the purpose of this study that certified speech-language
pathologists in rehabilitation settings are working in the
best interests of the head-injured patients.

The study has value as an exploratory look at an area
where extensive research has not yet been done. It raises
numerous issues for further research and serves as a beginning
for the development of insight regarding rehabilitation

environments.

 

1A Certificate of Clinical Competance is issued "to
individuals who present satisfactory evidence of their ability
to provide independent clinical services to persons who have
disorders. of communication (speech, language, and/or

hearing) . " (1989-1990 ASHA Membership Directory, 1989, p. 19) .

CHAPTER V. RESULTS

Personal Characteristics
W

The study sample consisted of speech-language
pathologists (N = 46) employed by rehabilitation facilities
throughout the united States. All study participants named
speech-language pathology as their area of specialization, and
95.65% (n = 44) were certified by the American Speech-
Language-Hearing Association.

The sample was overwhelmingly female (89.13%, n = 41).
The range of ages for the majority of the sample (52.17%, n =
24) was from 26 to 35 years, followed by 34.78% (n = 16) of
the therapists who were from 36 to 45 years old.

The most frequently occurring number of head-injured
patients seen per day by speech-language pathologists was 5.
Numbers ranged from a minimum of 4 patients seen per day to 15
per day. Session size varied from 1 to 10 patients, the mode
being 1 patient per session. The most frequently reported
session length was 60 minutes, with sessions ranging from 30
to 60 minutes in length. A typical head-injured patient was

seen from 1 to 18 times per week for speech-language therapy,

with a mode of 5 times per week.

44

45
WW

According to the 46 speech-language pathologists who
responded to the question regarding the percentage of male and
female head-injured patients in their cafe, male patients
usually outnumbered female patients. The an percentage of
male head-injured patients in rehabilitation facilities was
64.02% with a range of 40% to 90%. The mean percentage of
female head-injured.patients was 35.98% with.a range of 10% to
60%. These findings are. generally consistent. with those
reported in the literature (Adamovich et al., 1985; and Dixon
et al., 1988).

The age distribution of speech-language pathologists’
patients in the study was not consistent with.that reported in
the literature on head-injured patients. Rather than 66% of
the head-injured patients being under 35 years of age
(Adamovich et al., 1985; and Dixon et al,. 1988), the survey
indicated a mean of 41.07% of the patients as being 35 years
of age and under. The median percentage for this segment was
40. Of this segment, the mean percentage of patients in the 15
and under age group was 4.38 (median = 0%); the 16 to 25 year
group had a mean percentage of 16.27 (median = 13%); and the
group aged 26 to 35 had a mean percentage of 20.42 (median =
19%). Slightly over 33% of the survey patients were aged 56
and up. For a clearer comparison of the inconsistency, survey
data was collapsed into two age groups--35 and under, and 36

and above (Table 1).

46

TABLE 1 .
Collapsed Age Distribution of Head-Injured Patients

 

 

GROUP MEAN MEDIAN MIN. MAX.
35 & Under 41.07% 40.00% 0% 75%
36 & Above 59.04% 63.00% 0% 98%

 

The ranges of scores between the first and third
quartiles (Figure 2) provide additional information on the age
distribution of the patients in the study. The use of the
interquartile range avoids the extreme scores found.in some‘of
the responses and gives a better indicationiof dispersion than
the full range. As can be seen from Figure 2 the widest
interquartile range was for the 56 and above age group,
followed by the 26 to 35 age group. The 15 and under age group
had the smallest interquartile range.

The differences between the reported age distributions
of patients in the literature and those in the study may be
due to the relatively small sample size of the study and its
inability to accurately represent the population of head-
injured patients. The study data is more recent than that
reported in the literature, however, and may be indicative of
an increase in head injuries in the older group. Or perhaps
those patients participating in speech-language therapy
represent a subgroup whose age distribution differs from that

of the head-injured population in general.

FIGURE 2.

47

Age Distribution of Head-Injured Patients by Quartiles

0% 20% 40% 60% 80% 100%
+ --------- + --------- + --------- + --------- + --------- +
AGES 15 & UNDER (Q1 = 0%, Q3 = 2.5%)
'T
+I-- * * * *
-1
AGES 16-25 (Q1 = 5%, Q3 = 22.5%)
T """ T
---I + I ---------- * *
1 ...... 1
AGES 26-35 (Q1 = 8.5%, Q3 = 30%)
r """""" T
..... i + I---------- *
......... 1
AGES 36-45 (Ql = 7.5%, Q3 = 20%)
r """ 1
----1+ I ----- *
1 ..... 1
AGES 46-55 (Q1 - 5%, Q3 = 20%)
T """ T
---I + I--- *
1 ...... 1
AGES 56 & ABOVE (Ql = 6.5%, Q3 = 60%)
i """"""""""""" T
---- + -------------------
1 ......................... i
+ --------- + --------- + --------- + --------- + --------- +
0% 20% 40% 60% 80% 100%

The total length of time that a typical head-injured

patient spent in speech-language therapy ranged from a minimum

of 5 weeks to a maximum of 4 years and 2 months. The mean time

spent in therapy was 5.04 months, the median 2.85 months, and

the mode 5 months. The survey was not designed to determine

the reasons for the variation in therapy length, although the

48
severity and type of head injury at the onset of therapy, as
well as motivational and emotional factors play' a part
(Finlayson et al., 1987). One therapist responded with the
answer of "many years" and noted that the clients seen in the
facility are "severely' physically' disabled and often in
therapy for most of their lives."

When asked to assess patients’ speech-language abilities
at the beginning of therapy and at the completion of therapy
in the facility, therapists (N = 36) provided the following
profiles (Table 2). The mean percentage of patients able to
speak intelligibly at the beginning of therapy was 60.07%
compared with a mean of 81.13% at the completion of therapy,
resulting in an improvement of 21.06 percentage points. The
ability to describe objects, events, places, and people in a
narrative manner improved 24.58 percentage points from a mean
of 51.71% at the beginning to a mean of 76.29% at the
completion. At the beginning of therapy a mean of 44.58% of
patients were able to organize conversational speech compared
to a mean of 74.86% upon completion, improving 30.28
percentage points. An increase of 35.84 percentage points was
found in patients’ abilities to compensate for word-finding
difficulties from the beginning (mean = 40.83%) to completion
(mean = 76.67%). The ability to compensate for shallow
reasoning and problem solving showed the largest improvement,
an increase of 41.60 percentage points from a beginning mean

of 28.89% to a completion mean of 70.49%. As can be seen from

49
the standard deviations, the dispersion of values are
consistently larger for patients’ abilities at the beginning

of therapy than those at the completion of therapy.

TABLE 2.
Abilities of Head-Injured Patients at the Beginning and
Completion of Therapy

 

 

ABILITY MEAN ST.DEV. MIN. MAX.

Speak Intelligibly 1‘ 60.07% 25.05 10% 100%

Speak Intelligibly 2b 81.13% 16.27 20% 100%
Difference 21.06 ‘

Describe Objects 1 51.71% 26.98 10% 100%

Describe Objects 2 76.29% 18.80 20% 100%
Difference 24.58

Organize Speech 1 44.58% 23.43 10% 90%

Organize Speech 2 74.86% 15.74 30% 100%
Difference 30.28

Compensate Words 1 40.83% 22.15 5% 80%

Compensate Words 2 76.67% 18.59 10% 100%
Difference 35.84

Compensate Reason 1 28.89% 20.60 0% 75%

Compensate Reason 2 70.49% 14.11 30% 100%
Difference 41.60

 

Note: N = 36; Ten of the 46 respondents chose not to answer
this question. '1: abilities at'beginning of therapy. "2:
abilities at completion of therapy.

50

Architectural Privacy

Type f Architectural Privacy

Speech-language pathologists were asked to describe their
workspaces in terms of acoustical materials, number of persons
working in the space, and enclosure characteristics. Responses
to the question regarding numbers of walls or partitions of
varying heights as a means of designating types of enclosure
indicated that 93.33% (42 of 45 respondents) had four
workspace walls that extended to the ceiling. One respondent
had no partitions enclosing his/her personal workspace which
was located within a larger room with walls to the ceiling.
One respondent reported. having one ‘partition in Ihis/her
personal workspace which could be seen over when he/she was
standing but not when seated.

Respondents were asked to indicate their height in order
to estimate partition height. By knowing the respondent’ 8
height, and referring to "Selector 1a" of Humanscale llZZ§ by
Diffrient, Tilley, and Bardagyi (1983), the height of the
partition can be estimated. According to "Selector 1a" the
seated eye level height for an adult 65 inches tall (the
height of the respondent) is 45.6 inches and the height of the
top of the head is 49.7 inches. Depending on the angle of the
respondent’s sight line, the partition is likely to be 49.7
inches high or less.

A majority of respondents (73.17%, n = 30) reported

having private offices. For those therapists who indicated

51
they did not have private offices (26.83%, n = 11), the
nearest workspace was more than 7 feet away from five
respondents (12.20%); 4 to 7 feet away from two respondents
(4.88%); and adjacent to 4 feet away from four respondents

(9.76%) (Table 3).

TABLE 3.
Office Type and Adjacency of Workspaces

 

NEAREST WORKSPACE

 

Private More than 7’ 4’ to 7’ Adjacent to 4’
Office Away Away Away
73.17% 12.20% 4.88% 9.76%

 

The maximum number of persons (including patients) who
worked in.a workspace at the same time varied from.two persons
for 36.36% of the respondents, to more than four persons for
15.91% of the respondents (Table 4). These numbers include
group therapy sessions as well as therapists who shared

nonprivate workspaces.

TABLE 4.
Maximum Number of Persons Sharing a Workspace

 

More than
2 Persons 3 Persons 4 Persons 4 Persons

 

36.36% 38.64% 9.09% 15.91%

 

52

Surface materials used in the speech-language therapy
setting may be indicative of an effort to control noise,
although these materials are typically found in many office
settings. Responses indicated that acoustical ceilings were
found in 72.09% of the workspaces, and 84.44% had carpeting on
the floors. Most workspaces had doors that could be closed
(97.73%).

Hard, nonporous walls were reported in 88.89% of the
workspaces as opposed to soft, porous walls in 11.11% of the
spaces. The predominance of hard, nonporous walls may be due
to the fact that walls which extend to the ceiling and create
private offices are typically surfaced with a hard material
such as wall board, while partitions which do not extend to

the ceiling are often soft, porous, acoustical panels.

Amgunt of Architectural Privacy

Amount of architectural privacy was indicated by the
degree to which speech-language pathologists were aware of
specified visual and acoustical conditions as they occurred
beyond.their workspaces (Table 5). Most respondents were "very
aware" of background. music (74.42%), followed by' others
listening or watching (68.16%), and visibility of others
working or passing by (60.00%). Approximately one-half of the
respondents were "very aware" of air conditioner, fan, or

furnace sounds (53.33%). Contrary to Wineman’s (1382)

53
assertion that people talking and phone conversations are the
most annoying violations of acoustical privacy, 55.56% of
respondents to this survey were only "somewhat aware" of
telephone and other conversations. Respondents were also
"somewhat aware" of telephones ringing and/or office equipment

sounds (53.33%).

TABLE 5.
Speech-Language Pathologists’ Awareness of Visual and
Acoustical Conditions Beyond Personal Workspace

 

 

VERY SOMEWHAT NOT

CONDITION N AWARE AWARE AWARE
HVAC sounds 45 53.33% 33.33% 13.33%
Background music 43 74.42% 20.93% 4.65%
Phones, equipment 45 15.56% 53.33% 31.11%
Conversations 45 26.67% 55.56% 17.78%
Others watching or

listening 44 68.18% 22.73% 9.09%
Visibility of

others 45 60.00% 31.11% 8.89%

 

Relationships Between Type and Amount of Architectural Privgcy

Analysis of the relationships between the individual
components of type of architectural privacy and the amount of

architectural privacy components (Table 6) indicated a

54
moderate correlation (Williams, 1986)2 for the pair "office"
(private office or adjacency of nearest.workspace if office is
not private) and "aw spy" (others watching or listening).
According to Williams (1986) this relationship may be
considered substantial when the correlation coefficient is
between .40 and .70.

Low correlations (.261-.40 for the study, based on the
critical value of .261), indicative of definite but small
relationships, were found in the pairs "ceiling" and "aw conv"
(awareness of conversations); "persons" sharing workspace and
"aw spy" (awareness of others listening or watching); and
"office" and "aw conv". Low correlations were also found
between the component "door" (the presence of a door that
could.be closed) and."aw mus" (awareness of background music),
"aw spy" (awareness of others watching or listening), and "aw

vis" (awareness of others working or passing by).

Therapy Setting
Speech-language pathologists were asked to note one thing
they liked best about their workspace and one thing they would

change about their workspace. Privacy and/or quiet was the

 

2Williams (1986, p. 132) offers the following guidelines
for interpreting the magnitude of correlation coefficients:
<.20 slight correlation, almost negligible relationship.
.20-.40 low correlation, definite but small relationship.
.40-.70 moderate correlation, substantial relationship.
.70-.90 high correlation, marked relationship.
>.90 very high correlation, very dependable relationship.

55

TABLE 6.
Correlation of Type and Amount of Architectural Privacy

 

 

 

VARIABLE TYPE OF ARCHITECTURAL PRIVACY
COMPONENTS Wall Ceiling Floor Door Persons' Oflfia?
AMOUNT

Aw“ HVAC -.l83 .074 -.024 .251 .105 .215
Aw mus -.189 .224 .096 .352* .180 .123
Aw phn .066 .236 .071 .208 -.002 .228
Aw conv -.038 .374* .063 .252 -.037 .383*
Aw spyd .046 .125 -.012 .303* .315* .587*
Aw vis .090 .180 .041 .281* -.044 .260
*p<.05; critical value = .261. 'Persons: persons sharing

workspace. bOffice: private office or adjacency of nearest
workspace if office is not private.‘mwt aware of. Awareness
is based on therapists’ awareness of variable components.
dSpy:others watching or listening.

workspace feature best liked by 22 (53.66%) of the 41 persons
who responded to the first question. The ability to control
the environment by opening or closing the workspace door was
liked best by three persons (7.32%). Each mentioned the
importance of having the option to increase or reduce
distractions or stimuli as needed for therapy by opening or
closing the door. Freedom from visual distractions was
mentioned by one respondent. Another respondent recognized
that distraction should be a part of the therapeutic
environment ("functional distractability") since it must be

dealt with as part of real-life situations. According to the

comments made in an accompanying letter by the director of a

56
communication disorders facility "...for certain disability
groups, the introduction of outside detractors [sic] are
needed.to evaluate the status of the individual’s progress and
use of compensatory strategies."

Other items which were best liked, but not a part of the
study, dealt with issues such as access to co-workers and
materials, adequate space, lighting, and comfort.

Of the 44 speech-language pathologists responding to the
question concerning one thing they would like to change in
their workspace, two said they would not change anything.
Eleven therapists (25%), however, would reduce the noise
coming into their offices from outside. Sources of the noise
included an elevator, a nearby copy machine which had become
a staff gathering place, conversations in the next room,
telephone noise in an adjacent office, a paging system, and a
nearby activities room. One therapist commented that treatment
was done in the patient dining room. Housekeeping staff, the
paging system, and.patients going to the deck to smoke created
"a maximally disruptive environment." Another therapist felt
that.windows should be added to some offices for the option of
additional stimulation.

A larger workspace was desired by twelve (27.27%) of the
respondents, and three (6.82%) therapists would like to
decrease the number of professionals sharing workspaces.

Although not a part of this study, air flow and

temperature control were mentioned by six (13.64%) speech-

57
language therapists as something they would like to change in
their workspaces. One person noted that the temperature in the
workspace has "more effect on staff and patients."
Other desired changes had to do with the relocation of
services and activities, improved lighting, and the addition

of a computer and carpeting to the workspaces.

Performance of Therapists and Patients

Concentration and Communication

All 46 of the survey respondents answered the questions
regarding the concentration and communication abilities of
head-injured.patients and speech-language pathologists (Table
7). When asked how well their patients were able to
concentrate in the workspace in the beginning stages of
therapy, 21.47% (n = 10) of the therapists indicated "very
well", 54.35% (n = 25) selected the middle category
"somewhat", and 23.91% said "not*well" 01==11). Concentration
improved greatly in the final stages of therapy. The category
"very well" was selected by 84.78% (n.= 39) of the therapists,
with only 15.22% (n = 7) selecting "somewhat", and none
selecting "not well".

Therapists indicated that 23.91% (n = 11) of head-injured
patients’ communication abilities in the beginning stages of
therapy in the workspace were in the "very well" category.

Over one-half (56.52%, n = 26) of the patients were "somewhat"

58

TABLE 7 .
Abilities of Head-Injured Patients and Speech-Language
Pathologists to Concentrate and Communicate in Workspaces

 

 

PATIENTS’ ABILITIES NOT WELL SOMEWHAT VERY WELL
Concentrate 1' 23.91% 54.35% 21.74%
Concentrate 2b 15.22% 84.78%
Communicate 1 19.57% 56.52% 23.91%
Communicate 2 26.09% 73.91%

THERAPISTS’ ABILITIES
Concentrate 4.35% 26.09% 69.57%

Communicate 2.17% 15.22% 82.61%

 

Note: N== 46.‘1: abilities in beginning of stages of therapy.
b2: abilities in final stages of therapy.

able to communicate and 19.57% (n = 9) were not able to
communicate well. Communication improved in the final stages
of therapy to 73.91% (n = 34) for the "very well" designation,
and 26.09% (n = 12) for "somewhat". As with the ability to
concentrate in the final stages of therapy, no selections were
made of the "not well" designation.

Many speech-language pathologists (69.57%, n = 32) felt
that they were able to concentrate "very well" in their
workspace. A lesser amount (26.09%, n = 12) were able to
concentrate "somewhat", and a minority (4.35%. n = 2) were not
able to concentrate well.

Therapists were able to communicate "very well" with

their patients in their workspace according to 82.61% (n.= 38)

59
of the respondents, and "somewhat" according to 15.22% (n.= 7)
of the respondents. One respondent was not able to communicate

well.

Effects of Visual and Acoustical Conditions

Speech-language pathologists were requested to indicate
on a 5-step scale the degree to which specified visual and
acoustical conditions affected their abilities to conduct
therapy in their workspaces. Using the same scale, they were
also requested to indicate their' patients’ abilities to
participate in the beginning and final stages of therapy under
these conditions in their workspaces.

Generally, therapists thought the specified environmental
conditions had little to no effect on their abilities to
conduct therapy (Table 8). While a few respondents indicated
that.some of the conditions somewhat enhanced their abilities,
no»one indicated that the conditions enhanced their abilities.
Eighty percent of the respondents felt that air conditioner,
fan, or furnace sounds had no effect. Similarly, background
music (80.95%) and others listening to or watching them
(79.55%) had no effect. Visibility of others working or
passing by had no effect on 72.73% of the respondents.

Telephones ringing and/or office equipment sounds, and

telephone and other conversations had a slightly greater

60

TABLE 8.
Effects of Visual and Acoustical Conditions on Therapists’
Abilities to Conduct Therapy

 

SOMEWHAT HAS NO SOMEWHAT

 

CONDITION HINDERS HINDERS EFFECT ENHANCES
HVAC sounds‘ 15.56% 80.00% 4.44%
Background musicc 14.29% 80.95% 4.76%
Telephones ringing,

office equipment‘ 4.44% 46.67% 48.89%
Conversations‘ 4.44% 44.44% 51.11%

Others watching or
listening” 20.45% 79.55%

Visibility of
others” 27.27% 72.73%

 

‘N = 45.1W'= 44.°N = 42.

impact on therapists’ abilities to conduct therapy. Telephone
and other conversations had no effect on 51.11% of the
respondents’ abilities and somewhat hindered the abilities of
44.44%. Likewise, 48.89% of respondents indicated.that ringing
telephones and equipment sounds had no effect, while 46.67%
thought these sounds somewhat hindered their abilities to
conduct therapy.

According to speech-language pathologists, visual and
acoustical conditions had relatively little effect on the
majority of head-injured patients’ abilities to participate in

the beginning and final stages of therapy (Table 9). Air

61
conditioner, fan, or furnace sounds had.no effect on 71.22% of
the patients’ abilities and somewhat hindered 22.22% of
the patients’ abilities to participate in the beginning stages
of therapy. Ability to participate in the final stages of
therapy was somewhat hindered by these sounds in 10.87% of the
cases, and not affected in 86.96% of the cases.

Responses concerning background music had a similar
outcome. In the beginning stages of therapy 19.51% of
patients’ abilities to participate were somewhat hindered,
while 75.61% were unaffected. The distribution shifts slightly
in the final stages of therapy. Background music somewhat
hindered 16.28% of the head-injured patients, but had no
effect on 81.40% of the patients’ abilities to participate in
therapy.

Telephones ringing and/or office equipment sounds had a
more negative effect in both stages of therapy. Although 40%
of the patients were unaffected in the beginning stage, the
abilities of 46.67% of the patients were somewhat hindered in
this stage, and 13.33% were hindered. Telephone and equipment
sounds still somewhat hindered 34.38% of patients’ abilities
in the final stages of therapy, but had no effect on 63.04% of
the head-injured patients’ abilities to participate in
therapy.

The effects of telephone and other conversations on
patients’ abilities showed.the least.amount.of change from the

beginning therapy stage to the final stage. In the beginning

62

stage of therapy these conversations somewhat hindered 44.44%
of the patients, compared with an increase to 48.89% in the
final stages. This was the only instance in*which there was an
increase in the "somewhat hinders" category from the beginning
stage to the final stage. The "has no effect" response was
recorded for 42.22% of the head-injured patients in the
beginning stages of therapy and for 48.89% of the patients in
the final stages. As with the previous condition concerning
telephone and equipment sounds, conversations hindered 13.33%
of the patients in the beginning stages of therapy.

The two primarily visual conditions had identical
responses regarding their effects on patients’ abilities to
participate in the beginning stages of therapy. Others
watching or listening, and visibility of others working or
passing, hindered 11.36% of the head-injured patients.
Responses indicated that patients’ abilities were somewhat
hindered by both conditions in 29.55% of the cases. The two
conditions had no effect in 59.09% of the cases. There was a
slight variation in the numbers regarding the effects of the
visual conditions on patients’ abilities in the final stages
of therapy. Others watching or listening somewhat hindered
23.91% of the patients but had no effect on 73.91% of the
patients. Visibility of others working or passing by somewhat
hindered 22.22% and had no effect on 73.33% of patients’

abilities to participate in the final stages of therapy.

 

63

None of the speech-language pathologists indicated that
any of the specified conditions enhanced their patients’
abilities to participate in either the beginning or final
stages of therapy. One respondent indicated that all of the
conditions somewhat enhanced his/her patients' abilities in
the final stages of therapy.
TABLE 9.

Effects of Visual and Acoustical Conditions on Patients’
Abilities to Participate in Therapy

 

 

SOMEWHAT HAS NO SOMEWHAT
CONDITION HINDERS HINDERS EFFECT ENHANCES
HVAC sounds l“ 6.67% 22.22% 71.22%
HVAC sounds 2bc 10.87% 86.96% 2.17%
Background music 18 4.88% 19.51% 75.61%
Background music 2f 16.28% 81.40% 2.33%
Telephones ringing,
office equipment 1d 13.33% 46.67% 40.00%
Telephones ringing,
office equipment 2c 34.78% 63.04% 2.17%
Conversations 1d 13.33% 44.44% 42.22%
Conversations 2d 48.89% 48.89% 2.22%
Others watching or
listening 1c 11.36% 29.55% 59.09%
Others watching or
listening 2c 23.91% 73.91% 2.17%
Visibility of
others 1° 11.36% 29.55% 59.09%
Visibility of
others 2d 2.22% 22.22% 73.33% 2.22%

 

‘1: beginning stages of therapy.‘?: final stages of therapy.
°N=46. “N= 45. °N=

44. fN = 43. 3N

41.

64
Relationships Between Privacy and Performance
As previously stated, the primary goal of this research
was to discover if, based on the perceptions of speech-
language pathologists in rehabilitation settings, there are
statistically significant relationships between architectural
privacy and the performance of speech-language pathologists
and head-injured patients. A nonparametric statistical test,
the Spearman rank correlation (rhflg, was used to evaluate the

relationships.

Relarionships Between Components of Architectural Privacy ang
Pgrfprnance of Speech-Language Pgtnologisrs

Analysis of the relationships between the six individual
components of type of architectural privacy and the eight
performance components of speech-language pathologists (Table
10) indicated moderate correlations for the following pairs:
a) ability to "concentrate" in workspace and type or.adjacency
of nearest workspace (designated as "office" in tables), b)
ability to "communicate" with patients in workspace and type
or adjacency of nearest workspace, and c) others watching or
listening ("watch/listen") and type or adjacency of nearest
workspace. These relationships may be considered substantial
when the correlation coefficient is between .40 and .70
(Williams, 1986). Low correlations (.261-.40 for the study),
indicative of definite but small relationships, were found

mainly in the pairs which included the availability of a

65
workspace "door" that can be closed, the number of "persons"
who work in the space at the same time, and "office" type or
adjacency.
TABLE 10.

Correlation of Components of Speech-Language Pathologists’
Performance and Type of Architectural Privacy

 

 

 

VARIABLE TYPE OF ARCHITECTURAL PRIVACY
COMPONENTS Wall Ceiling Floor Door Persons‘ Ofifia?
PERFORMANCEc

Concentrate .223 .161 .005 .319* .339* .478*
Communicate .164 .223 -.043 .340* .338* .454*
HVAC sounds .081 .186 .027 .316* .191 .312*
Music .080 .239 -.082 .370* .035 .301*
Phones/equip .367* .177 .029 .144 -.082 .371*
Conversation .202 .203 -.067 .151 .028 .226
Watch/listen .187 .230 .242 .323* .308* .696*
Visibility .226 .300* .013 .263* -.016 .377*
*p<.05; critical value = .261. ‘Persons: persons sharing

workspace. bOffice: private office or adjacency of nearest
workspace if office is not private.‘Performance: the ability
to concentrate and communicate in the workspace, and the
ability to conduct therapy under the specified conditions.

Relationships between the six individual components of
amount of architectural privacy and performance of speech-
language pathologists were analyzed (Table 11). It was found
that there were moderate correlations (.40-.70) between 8

pairs and low correlations (.261-.40) between 23 pairs of the

66

components. Moderate correlations (substantial relationships)
were found to exist between therapists’ awareness of others
watching or listening ("aw spy") and a) ability to
"concentrate", b) ability 'to "communicate", and c) HVAC
sounds; and between therapists’ awareness of visibility of
others working or passing by ("aw vis") and ability to
"concentrate" . Additional moderate correlations were indicated
between similar’ awareness components and. performance
components (eg., awareness of HVAC sounds ["aw HVAC"] and
ability to conduct therapy under the condition of "HVAC
sounds", etc.). A moderate correlation was also found between
awareness of others watching or listening ("aw spy") and "HVAC
sounds".

Most of the low correlations (definite but small
relationships) were between pairs which included the following
privacy components: a) telephone and equipment sounds ("aw
phn"), b) telephone and other conversations ("aw conv"), c)
others watching and listening ("aw spy"), and d) visibiilty
of others working or passing by ("aw vis"). Pairs involving
awareness of background music ("aw'mus") and awareness of HVAC
sounds ("aw HVAC") had more slight correlations (coefficient
<.261), compared to the other privacy components (seven for
"aw HVAC", and four for "aw mus"). Seventeen of the total 48

pairs had a correlation coefficient below the critical value

of .261.

67

TABLE 11. .
Correlation of Components of Speech-Language Pathologists ’
Performance and Amount of Architectural Privacy

 

VARIABLE AMOUNT OF ARCHITECTURAL PRIVACY .
COMPONENTS Aw‘ HVAC Aw mus Aw phn Aw conv Aw spy” Aw v1s

 

PERFORMANCE

Concentrate .169 .270* .378* .261* .604* .398*
Communicate .159 .285* .263* .065 .451* .159
HVAC sounds .393* -.093 .348* .337* .537* .290*
Music .046 .398* .369* .378* .350* .278*
Phones/equip .045 .083 .405* .227 .271* .173
Conversation .085 .366* .458* .513* .344* .338*
Watch/listen .124 .009 .225 .306* .598* .290*
Visibility .063 -.003 .321* .304* .238 .600*

 

*p<.05.‘Aw: aware Of.‘Spy: others watching or listening.

gelationships Between Components Of Architectural Privacy and
Performance Of Head-Injured Patients in the Beginning Stages
Of Therapy

Analysis of the relationships between components Of type
Of architectural privacy and patients’ performance in the
beginning stages Of therapy resulted in low or moderate
correlations for 14 Of 48 pairs (Table 12). The four pairs
which showed a moderate correlation, therefore exhibiting a
substantial but small relationship, all had type or adjacency
Of nearest workspace ("Office") as one component. The

performance components of the pairs included ability tO

participate in therapy under the conditions Of a) "HVAC

68

TABLE 12. .
Correlation Of Components Of Patients’ Performance in the
Beginning Stages Of Therapy and Type Of Architectural Privacy

 

 

VARIABLE TYPE OF ARCHITECTURAL PRIVACY
COMPONENTS Wall Ceiling Floor Door Persons‘ Offim"
PERFORMANCE°

Concentrate —.090 .092 .066 .229 .041 .141
Communicate .093 .054 .012 .245 -.011 .191
HVAC sounds -.226 .148 .018 .319* .370* .469*
Music .009 .281* .109 .381* -.022 .380*
Phones/equip .167 .059 .124 .262* -.081 .219
Conversation .151 .140 .134 .262* .012 .518*
Watch/listen .285* .172 .184 .284* .163 .597*
Visibility .173 .053 .075 .284* .156 .542*

 

*p<.05. ‘Persons: persons sharing workspace. bOffice: private
Office or adjacency of nearest workspace if Office is not
private. FPerformance: the ability to concentrate and
communicate in the workspace, and the ability to participate
in therapy under the specified conditions.

sounds", b) telephone and other "conversations", c) others
watching or listening ("watch/listen"), and.d) "visibility" Of
others working or passing by.

The availability Of a workspace door that can be closed
was a component in 6 of the 10 pairs Of low correlations.
"Door" had a definite but small relationship with head-injured
patients’ abilities to participate in therapy under the

conditions Of a) "HVAC sounds", b) background "music", c)

69
telephones ringing and/or other Office equipment sounds
("phones/equip"), d) telephone and other "conversations", e)
others watching or listening ("watch/listen"), and f)
"visibility" Of others working or passing by.

The measurement Of the strengths Of the relationships
between components Of amount Of architectural privacy and
patients’ performance in the beginning stages Of therapy
resulted in moderate correlations (.40-.70) for 6 pairs and
low correlations for 12 pairs (Table 13). As with the
correlations between therapists’ performance and amount Of
architectural privacy, moderate correlations--four in this
case--were found between ‘pairs Of similar awareness and
performance components (eg., awareness Of the visibility Of
others working or passing by ["aw vis"] and the ability to
conduct therapy under the condition Of "visibility" Of others
working or passing by). The two remaining moderate
correlations were between a) awareness of others watching and
listening ("aw spy") and telephone and other conversations
("conversation"), and b) "aw HVAC" and "conversation".

Eleven of the 12 pairs having low correlations involved
the amount Of architectural privacy components dealing with
awareness Of telephone and equipment sounds, conversations,
others watching or listening, and visibility Of others; and
the performance components of background music, telephone and
equipment sounds, conversations, others watching or listening,

and visibility of others.

70

TABLE 13.

Correlation Of Components Of Patients’ Performance in the
Beginning Stages of Therapy and Amount Of Architectural
Privacy

 

VARIABLE AMOUNT OF ARCHITECTURAL PRIVACY
COMPONENTS Aw‘ HVAC Aw mus Aw phn Aw conv Aw spy” Aw vis

 

PERFORMANCE

Concentrate .165 .076 .080 .215 .111 .185

Communicate .091 -.008 .070 -.014 .019 .113

HVAC sounds .529* .151 .233 .203 .522* .136

Music .287* .447* .155 .378* .273* .235

Phones/equip .182 .121 .379* .196 .153 .126

Conversation .422* .167 .346* .310* .392* .317*
Watch/listen .239 .025 .303* .336* .569* .379*
Visibility .132 -.023 .210 .248 .300* .523*

 

*p<.05. ‘Aw: aware of. Awareness is based on therapists’
awareness of variable components. bSpy: others watching or
listening.

Relationships Between Components Of Architectural Privacy and
Perfprmance Of Head-Injured Patients in the Final Stages of
Therapy

Analysis Of the relationships between components Of type
Of architectural privacy and patients’ performance in the
final stages Of therapy resulted in low or moderate
correlations for 10 Of 48 pairs (Table 14). The two pairs

which showed moderate correlations--indicative Of a

substantial but small relationship--had type or adjacency Of

71

TABLE 14.
Correlation Of Components Of Patients’ Performance in the
Final Stages of Therapy and Type Of Architectural Privacy

 

 

VARIABLE TYPE OF ARCHITECTURAL PRIVACY
COMPONENTS Wall Ceiling Floor Door Persons‘ Office”
PERFORMANCEc

Concentrate -.043 .147 .154 .351* .254 .198
Communicate .053 .191 .018 .249 .098 .179
HVAC sounds -.314* -.008 -.096 .393* .139 .218
Music -.083 .177 .045 .359* -.027 .236
Phones/equip .241 -.097 -.006 .208 .043 .486*
Conversation .045 .035 -.186 .156 -.000 .452*
Watch/listen .177 -.041 .085 -.072 .137 .396*
Visibility .181 .052 -.193 -.074 -.150 .317*

 

*p<.05.‘Persons: persons sharing workspace. I’Office: private
Office or adjacency of nearest workspace if Office is not
private.‘Terformance is based on the ability tO concentrate
and communicate in the workspace as well as the ability to
participate in therapy under the specified visual and
acoustical conditions.

nearest workspace ("Office") as one component. The
performancecomponents Of the pairs included ability to
participate in therapy under the conditions of a) telephones
ringing and/or other office equipment sounds, and.b) telephone
and other "conversations".

"Door" had a definite but small relationship (low
correlation) with head-injured patients’ abilities to

"concentrate" in the therapists’ workspaces, and to

72

participate in therapy under the conditions Of "HVAC sounds"
and background "music". A low correlation was also evident
between type or adjacency Of nearest workspace ("Office") and
and a) "visibility" Of others working or passing by, and b)
others watching or listening ("watch/listen"). A negative low
correlation was found between "wall" surface and "HVAC
sounds".

The strengths of the relationships between components Of
amount Of architectural privacy and patients’ performance in
the final stages of therapy can be seen in Table 15. Moderate
correlations occurred for 5 pairs and low correlations for 17
pairs. Two moderate correlations were found between pairs Of
similar awareness and performance components: a) awareness Of
telephone and other conversations ("aw conv“) and the ability
tO conduct therapy under the condition Of telephone and other
"conversations", and b) awareness Of visibility ("aw vis") and
the ability tO conduct therapy under the condition Of
"visibility" Of others working or passing by. Substantial
relationships (moderate correlations) were shown to exist
between the two remaining pairs: a) the correlation between
awareness of others watching and listening ("aw spy") and
telephones ringing and/or Office equipment sounds
("phones/equip"), and b) the correlation between awareness Of
visibility Of others working or passing by ("aw vis") and

telephone and other "conversations".

73

TABLE 15.
Correlation Of Components Of Patients’ Performance in the
Final Stages of Therapy and Amount Of Architectural Privacy

 

VARIABLE AMOUNT OF ARCHITECTURAL PRIVACY
COMPONENTS Aw‘ HVAC Aw mus Aw phn Aw conv Aw spyb Aw vis

 

PERFORMANCE

Concentrate .134 .327* .188 .334* .149 .092
Communicate .135 .118 .257 .229 .049 .238
HVAC sounds .267* .082 .251 .406* .325* .293*
Music .105 .346* .106 .328* .286* .083
Phones/equip -.046 .049 .314* .283* .407* .371*
Conversation .347* .209 .362* .433* .288* .451*
Watch/listen -.021 -.254 .103 .061 .360* .174
Visibility -.055 -.286* .157 .283* .150 .438*

 

*p<.05. ‘Aw: aware Of. Awareness is based on therapists’

awareness Of privacy components. l’Spy: others watching or
listening.
Low correlations, denoting definite but small

relationships, were found between 17 pairs Of variable
components. Telephone and other conversations ("aw'conv"), and
others listening or watching ("aw spy") had the most low
correlations (four) with performance variable components. Low
indicated between awareness Of

correlations also

were
background music ("aw mus") and three performance variables,
one of which. was a .negative correlation. Three. privacy

variables--awareness Of HVAC sounds ("aw HVAC"), awareness Of

74
telephones ringing and/or office equipment sounds ("aw phn"),
and awareness Of visibility Of others working or passing by
("aw vis") --each had two definite but small relationships (low

correlations) with performance variable components.

Beleripnships Between Archirectual Erivacy ang Eerformance es
Applieg to the Researcn Hypotheses

In order to respond to the research hypotheses for this
study, the composite scores for each variable3 were analyzed
using the Spearman rank correlation (rm), a nonparametric
test which measured the strength Of the relationships between
each pair Of variables (Table 16). A p<.05 (one-tailed test)
was required tO reject the null hypotheses Of nO relationships
and accept the working hypotheses of the existence Of
significant relationships between architectural privacy and
performance Of speech-language pathologists and head-injured
patients. The critical value for each test was .261 with N -5

= 41.

Hypothesis 1:
There is a significant relationship between architectural
privacy and the performance of speech-language
pathologists in rehabilitation settings.

Results of the nonparametric statistical analysis

indicated a moderate correlation (correlation coefficient

 

3Numerical values of the responses to questions about
each variable were summed to arrive at a single composite
score for the variable.

75
.560) between architectural privacy and performance Of speech-
language pathologists. Since the relationship is considered
significant when the critical value equals or exceeds .261
(p<.05, one-tailed test) the null hypothesis Of no
relationship can be rejected. This moderate correlation is
indicative Of a substantial relationship between the two

variables.

Hypothesis 2:

There ia a significant relationship between architectural

privacy and the performance of head-injured patients in

the beginning stages .of therapy in rehabilitation
settings.

A moderate correlation (correlation coefficient .566) was
found to exist between architectural privacy and performance
Of head-injured patients in the beginning stages Of therapy.
Since p<.05 (one-tailed test) the null hypothesis Of no
relationship can be rejected. As in the previous hypothesis,

there is a substantial relationship between the two variables.

Hypothesis 3:
There is a significant relationship between architectural
privacy and the performance of head-injured patients in
the final stages of therapy in rehabilitation settings.
The correlation coefficient for the paired variables
architectural privacy and performance Of head-injured patients
in the final stages of therapy was .429. Although it is lower
than those in Hypotheses 1 and 2, it is still above the

critical value Of .261 necessary for p<.05 (one-tailed test),

so the null hypothesis Of no relationship can be rejected.

76

TABLE 16.
Correlation Of Composite Scores for Performance and Privacy

 

 

Performance
VARIABLE Therapist Patient 1‘ Emmet
2»
Architectural
Privacy .560* .566* .429*
Therapist
Performance -- .763* - .696*

 

*p<.05. ‘Patient 1: patient in beginning stages of therapy.
bPatient 2: patient in final stages Of therapy.

Addirional Relationships

An.additional finding Of the analysis was the strength.of
the relationships between therapists’ performance and
patients’ performance (Table 16). The correlation coefficient
for the paired values of speech-language pathologists’
performance and head-injured patients’ performance in the
beginning stages Of therapy was high (.763), pointing to a
marked relationship between the pairs. A similar relationship
(correlation coefficient .696), was found tO exist between
speech-language pathologists’ performance and performance Of

head-injured patients in the final stages Of therapy.

Analysis Of Variance
The Mann-Whitney two-sample median procedure was used to
determine whether or not speech-language therapists’

perceptions of themselves and their patients differed

77
regarding performance. The composite performance scores for
speech-language pathologists were compared with those Of head-
injured patients in the beginning and final stages of therapy.
A probability Of less than .05 (p<.05, one—tailed test) was
required.to indicate that the medians of the two samples being
compared were different. Results indicated that there was a
difference between speech-language pathologists’ perceptions
Of their performance and head-injured patients’ performance in
the beginning stages Of therapy (.0001<p<.05), but no
difference between therapists’ perceptions Of their own
performance and that Of head-injured patients in the final
stages Of therapy (.6972>p<.05).

Composite performance scores for head-injured patients in
the beginning stages and in the final stages Of therapy were
also compared. Results indicated that there was a difference
between the two sample medians (.0000<p<.05).

The Kruskal-Wallis analysis was applied to the data in
order to discover if speech-language pathologists’ perceptions.
Of themselves and their patients differed with reference to
the performance and privacy variables. The performance scores
for therapists and patients were tested according tO scores
for total architectural privacy and for each architectural
privacy component. A.probability Of less than .05 (p<.05, one-
tailed test) was required tO determine that the medians Of the
three samples being compared (speech-language pathologists and

head-injured patients in the beginning and final stages Of

78
therapy) were different for the various architectural privacy
components (Table 17). Results Of the Kruskal-Wallis analysis
Of variance indicated that differences existed between sample
medians in 5 Of the 13 components tested: a)
"privacy/distance" (private Office or adjacency Of nearest
workspace if Office is not private), b) "awareness of
phones/equipment" (therapists’ awareness Of phone and
equipment sounds), c) "awareness Of conversations", d)
"awareness Of [other persons] watching/listening", and e)
"awareness of visibility" Of others working or passing by. NO
differences were indicated between sample medians and the

remaining components or total architectural privacy.

TABLE 17.
P-Values for Kruskal-Wallis Analysis Of Variance Of
Performance Scores According to Architectural Privacy

 

Total Architectural Privacy .159
Wall Type .246
Ceiling Type .166
Floor Type .918
Door .091
Privacy/Distance .002*
Maximum Persons .087
Awareness Of HVAC .102
Awareness Of Music .447
Awareness Of Phones/Equipment .006*
Awareness Of Conversations .001*
Awareness of Watching/Listening .000*
Awareness Of Visibility .002*

 

*p<.05.

79
Summary Of Results
Character'stics Of S ee -La ua e Pa OlO 'sts
The typical speech-language pathologist responding to the
survey was female (89.13%) , from 26 to 35 years Of age
(52.17%) , and certified by the American Speech-Language-
Hearing Association. Speech-language pathologists most
frequently saw 5 patients per day in 60 minute sessions, which
occurred 5 times a week. The number Of patients most

frequently attending each session was one.

P so a Cha acteristics Of Head-I 'ur d atie ts

The head-injured patients who received therapy from the
study respondents were predominantly male (64.02%), with
41.07% of the patients being 35 years Old and younger. A
typical patient spent five months in speech-language therapy.
In the beginning stages Of therapy 60.07% Of the patients were
able to speak intelligibly; 51.71% were able to describe
objects, events, places, and people in a narrative manner;
44.58% could organize conversational speech; 40.83% could
compensate for word-finding difficulties; and 28.89% were able
tO compensate for shallow reasoning and problem solving. By
the end Of therapy most patients were able to a) speak
intelligibly (81.13%); b) describe Objects, events, places,
and people in a narrative manner (76.29%); c) organize
conversational speech (74.86%); d) compensate for word-finding

difficulties (76.67%) ; and e) compensate for shallow reasoning

 

80
and problem solving (70.49%). Improvement ranged from 21.06

percentage points to 41.60 percentage points.

ura ivac

Most speech-language pathologists had private Offices
(73.17%). Workspaces typically had acoustical ceilings
(72.09%); carpeting (84.44%); hard, nonporous walls (88.89%);
and.doors that could be Closed (97.73%). TwO to three persons,
including patients, worked in the space at the same time in
75% Of the cases.

Speech-language pathologists were very aware of the
following conditions as they occurred beyond their personal
workspaces: a) air conditioner, fan, or furnace sounds
(53.33%); b) background music (74.42%); C) others watching or
listening (68.18%); and d) visibility Of others working or
passing by (60%). Therapists were somewhat aware Of telephones
ringing and/or office equipment sounds (53.33%), and telephone

and other conversations (55.56%).

Relationsnips Between Type and Amount of Architectural Privecy

The Spearman rank correlation (rmm) was used to analyze
the relationships between type Of architectural privacy
components and amount Of architectural privacy components. A
moderate correlation was found for the pair "Office" (private
Office or adjacency of nearest workspace if Office is not

private) and "aw spy" (others watching and listening). Low

 

81
correlations (.261-.40 for the study) were found between the
following pairs: a) "ceiling" and "aw conv" (awareness Of
conversations); b) "persons" sharing workspace and "aw spy"
(awareness Of others listening or watching); c) "Office" and
"aw conv"; and d) "door" (the presence Of a door that could be
closed) and the components "aw mus" (awareness Of background
music), "aw spy" (awareness of others watching or listening),

and "aw vis" (awareness Of others working or passing by).

Inerapy Setting

Privacy and/or quiet was the feature therapists liked
best about their workspaces (53.66%). Twenty-five percent Of
the therapists would like to reduce the noise coming into
their Offices from outside and a larger workspace was desired

by 27.27% Of the respondents.

Performance Of Speech-Language Pathologists

Therapists were generally able to concentrate very well
(69.57%) and communicate very well (82.61%) in their
workspaces. They perceived the specified visual and acoustical
conditions as having no effect on their abilities to conduct
therapy in their workspaces: a) air conditioner, fan, or
furnace sounds (80%); b) background music (80.95%); c)
telephones ringing and/or Office equipment sounds (48.89%); d)

telephone and other conversations (51.11%) ; e) others watching

82
or listening (79.55%); and f) visibility of others working or

passing by (72.73%).

Performance of Head-Injured Patients in fieginning Stages pf
Theater

According to speech-language pathologists, head-injured
patients in the beginning stages Of therapy were able to
concentrate somewhat (54.35%) and communicate somewhat
(56.52%) when working in therapists’ workspaces. The following
visual and acoustical conditions were perceived by therapists
as having no effect on patients’ abilities to participate in
the beginning stages of therapy: a) air conditioner, fan, or
furnace sounds (71.22%); b) background music (75.61%); c)
others watching or listening (59.09%); and d) visibility Of
others working or passing by (59.09%). Telephones ringing
and/or Office equipment sounds (46.47%) and.telephone:or other
conversations (44.44%) were found to somewhat hinder patients’

abilities to participate in therapy.

Eerformance of Head-Injured Patients in the Final Stages Of
Therapy

Speech-language pathologists felt that head-injured
patients were able to concentrate very well (84.78%) and
communicate very well (73.91%) when working in therapists’
workspaces during the final stages of therapy. Therapists
perceived the following visual and acoustical conditions as

having nO effect on patients’ abilities tO participate in the

83
beginning stages Of therapy: a) air conditioner, fan, or
furnace sounds (86.96%); b) background music (81.4%); c)
telephones.ringing'and/Or'office.equipment.sounds (63.04%); d)
others watching or listening (73.91%); and 5) visibility Of
others working or passing by (73.33%). Telephone or other
conversations were found to be equally distributed between
somewhat hindering and having nO effect (48.89%) on patients’

abilities to participate in the final stages Of therapy.

Relationships Between Architectural Privacy and Performance

The Spearman rank correlation (rmm) was used to analyze
the relationships between components Of architectural privacy
and performance Of speech-language pathologists and head-
injured patients. A number Of low and moderate correlations
resulted.which are shown.in Tables 18 and 19. Low correlations
ranged from the critical value Of .261 to .40 (p<.05, one-
tailed test) which may be indicative Of definite but small
relationships between pairs. Moderate correlations ranged
between .40 and .70 (p<.05, one-tailed test) and may point tO
substantial relationships between pairs.

The greatest number Of significant correlations between
type. Of (architectural. privacy’ components and. performance
components (Table 18) were between pairs which included the
availability Of a door that can be closed ("door") and type Of
Off ice ("Office") . Significant correlations between components

Of amount of architectural privacy and performance

84

TABLE 18.
Low and Moderate Correlation of Components Of Performance and
Type Of Architectural Privacy

 

 

VARIABLE TYPE OF ARCHITECTURAL PRIVACY
COMPONENTS Wall Ceiling Floor Door Persons‘
PERFORMANCEc
Concentrate

Therapist -- -- -- .319 .339 .478*

Patient 1d -- -- -- -- -- --

Patient 2° -- -- -- .351 -- --
Communicate

Therapist -- -- -- .340 .338 .454*

Patient 1 -- -- -- -- -- --

Patient 2 -- -- -- -- -- --
HVAC sounds ‘

Therapist -- -- -- .316 -- .312

Patient 1 -- -- -- .319 .370 .469*

Patient 2 -.314 -- -- .393 -- --
Music

Therapist -- -- -- .370 -- .301

Patient 1 -- .281 -- .381 -- .380

Patient 2 -- -- -- .359 -- --
Phones/equip

Therapist .367 -- -- -- -- .371

Patient 1 -- -- -- .262 -- --

Patient 2 -- -- -- -- -- .486*
Conversation

Therapist -- -- -- -- -- --

Patient 1 -- -- -- .262 -- .518*

Patient 2 -- -- -- -- -- .452*
Watch/listen

Therapist -- -- -- .323 .308 .696*

Patient 1 .285 -- -- .284 -- .597*

Patient 2 -- -- -- -- -- .396*
Visibility

Therapist -- .300 -- .263 -- .377

Patient 1 -- -- -- .284 -- .542*

Patient 2 -- -- -- -- -- .317

 

*MOderate correlations. p<.05 for all correlation coefficients
shown; critical value = .261. ‘Persons: persons sharing
workspace. bOffice: private Office or adjacency of nearest
workspace. °Performance: the ability to concentrate and
communicate in the workspace, and the ability to conduct and
participate in therapy under the specified conditions.
Patient in beginning stages Of therapy. °Patient in final
stages of therapy.

85

TABLE 19.
Low and Moderate Correlations Of Components Of Performance and
Amount Of Architectural Privacy

 

VARIABLE AMOUNT OF ARCHITECTURAL PRIVACY
COMPONENTS Aw‘ HVAC Aw mus Aw phn Aw conv Aw spyb Aw vis

 

PERFORMANCEc
Concentrate
Therapist -- .270 .378 .261 .604* .398*
Patient 1‘ -- -- -- -- -- --
Patient 2° -- .327 -- .334 -- --
Communicate
Therapist -- .285 .263 -- .451* --
Patient 1 -- -- -- -- -- --
Patient 2 -- -- -- -- -- --
HVAC sounds
Therapist .393 -- .348 .337 .537* .290
Patient 1 .529* -- -- -- .522* --
Patient 2 .267 -- -- .406* .325 .293
Music
Therapist -- .398* .369 .378 .350 .278
Patient 1 .287 .447* -- .378 .273 --
Patient 2 -- .346 -- .328 .286 --
Phones/equip
Therapist -- -- .405* -- .271 --
Patient 1 -- -- .379 -- -- --
Patient 2 -- -- .314 .283 .407* .371
Conversation
Therapist -- .366 .458* .513* .344 .338
Patient 1 .422* -- .346 .310 .392 .317
Patient 2 .347 -- .362 .433* .288 .451*
Watch/listen
Therapist -- -- -- .306 .598* .290
Patient 1 -- -- .303 .336 .569* .379
Patient 2 -- -- -- -- .360 --
Visibility
Therapist -- -- .321 .304 -- .600*
Patient 1 -- -- -- -- .300 .523*
Patient 2 -- -.286 -- .283 -- .438*

 

*MOderate correlations. p<.05 for all correlation coefficients
shown; critical value = .261. ‘Aw: aware of. Awareness is
based on therapists’ awareness Of privacy components. bSpy:
others watching or listening. °Performance: the ability to
concentrate and communicate in the workspace, and the ability
to conduct and participate in therapy under the specified
conditions. ‘Patient in beginning stages of therapy. °Patient
in final stages of therapy.

86
components (Table 19) were more evenly distributed, although
pairs involving awareness Of HVAC ("aw HVAC") had fewer
significant correlations than the others.

TO answer the research hypotheses about the significance
of relationships between architectural privacy and performance
Of speech-language pathologists and head-injured patients in
the beginning and final stages of therapy, numerical values of
the responses to questions about each variable were summed to
provide a single composite score. Pairs of performance and
privacy scores were then correlated using the Spearman rank
correlation (rmw).

Results indicated a moderate correlation (correlation
coefficient .560) between values for the variables
architectural privacy and performance Of speech-language
pathologists. Since the relationship is considered significant
when the critical value Of .261 (p<.05, one-tailed test) is
equaled or exceeded, the null hypothesis Of no relationship
was rejected.

Similarly, a moderate correlation (correlation
coefficient .566) was found to exist between values for the
variables architectural privacy and performance Of head-
injured patients in the beginning stages Of therapy. As with
the previous pair of variables, the null hypothesis of no
relationship was rejected.

The correlation coefficient for the values Of the

variables architectural privacy and performance Of head-

 

 

87
injured.patients in the final stages Of therapy was .429. This
was above the critical value Of .261 necessary for p<.05 (one-
tailed test) so the null hypothesis Of no relationship could

be rejected.

Aggirional Relarionships

The strengths Of the relationships between therapists’
and patient’s performance were also measured. The correlation
coefficient for the values Of speech-language pathologists’
performance and performance Of head-injured patients in the
beginning stages Of therapy was .763, pointing to a marked
relationship between the pairs. A similar relationship
(correlation coefficient .696) was found tO exist between
performances Of speech-language pathologists and head-injured

patients in the final stages Of therapy.

Analysis Of Variance

The Mann-Whitney two-sample median procedure was used to
determine whether or not speech-language pathologists’
perceptions of themselves and their patients differed
regarding performance. A difference was indicated between
therapists’ perceptions Of their performance and that Of head-
injured patients in the beginning stages Of therapy
(.0001<p.05), but not between their performance and that Of
their patients in the final stages of therapy (.6972>p<.05).

Results indicated that there was a difference between

88
therapists’ perceptions Of patients’ performance in the
beginning stages Of therapy and in the final stages Of therapy
(.0000<p<.05). '

The Kruskal-Wallis analysis of variance tested the
performance scores for speech-language pathologists and head-
injured patients according to scores for total architectural
privacy and each architectural privacy component. Differences
were found to exist (p<.05) between sample medians in the
following groups: 1) "privacy/distance" (.002<p<.05), 2)
"awareness Of phones/equipment" (.006<p<.06) , 3) "awareness Of
conversations" (.001<p.<05), 4) "awareness Of
watching/listening" (.000<p<.05), and 5) "awareness of

visibiity" (.002<p<.05).

 

CHAPTER VI. DISCUSSION

Implications of the Findings

Inferenrial Analyses

The results Of the nonparametric statistical analyses in
response tO the research hypotheses demonstrated significant
relationships between architectural privacy and performance Of
speech-language pathologists and head-injured patients in the
beginning and final stages Of therapy (Table 16, p. 76). The
results are supported by those who noted that controlling
inputs from the environment may have an influence on an
individual’s performance (viz., Altman, 1976; Archea, 1977;
Margulis, 1977; and Sundstrom et al., 1980). The purpose Of
the study, tO determine if there is a significant relationship
between architectural privacy and the performance Of speech-
language pathologists and head-injured patients in
communication therapy settings, has been achieved. However,.
since the analyses for the research hypotheses were based on
composite scores for each variable, it is important to note
the relationships between individual components Of the
variables to determine which are the most influential.

Table 6 (p. 55) indicates that type Of architectural
privacy components "door" and "Office" had the highest number

Of low and moderate correlations with components Of amount Of

89

90

architectural privacy. The presence Of a door that could be
Closed in a workspace was significantly related to therapists’
awareness Of a) background music, b) others watching or
listening, and c) visibility Of others working or passing by.
Office type (private Office or adjacency of nearest workspace
if Office is .not jprivate) was significantly related. to
therapists’ awareness Of a) telephone and other conversations
and b) others watching or listening. According tO the study,
amount of architectural privacy (the degree to which the
transmission and reception Of information in a space is
limited) had the strongest relationship with the enclosure
components (doors and Office type) Of type Of architectural
privacy.

As can be seen in Table 18 (p. 84) the availability Of a
"door" that can be closed and type Of "Office" had the largest
number Of low and moderate correlations with the performance
variables. These components Of type Of architectural privacy
constitute the form Of enclosure (a private treatment room)
recommended by Wexler (1984), WOOd (1986), and Siegel (1982)
for controlling noise and visual distractions in communication
therapy settings. According to Sundstrom et al. (1980) the
ability to control inputs from the environment such as noise
and distraction may influence the performance of individuals.
The speech-language pathologists in the study agreed with the

need for such control.

91

This need is reinforced by the low and moderate
correlations between amount Of architectural privacy
components and the performance components Of concentration and
communication shown in Table 19 (p.85). For speech-language
pathologists there were significant relationships between
their ability to concentrate in their workspaces and awareness
Of a) background music, b) telephones ringing and/or Office
equipment sounds, c) telephone and other conversations, d)
others listening or watching, and e) visibility of others
working' or passing' by. Patients’ concentration ‘was
significantly related to awareness of a) background music and
b) telephone and other conversations. The relationships were
also significant between therapists’ abilities to communicate
in their workspaces and awareness Of a) background music, b)
telephone and other conversations, and c) others listening or
watching. NO significant relationships were indicated between
patients’ abilities to communicate and the amount of
architectural privacy variables. The differences between
therapists and patients may be due tO the differing sensory-
motor capabilities by which they process environmental
information (Archea, 1977), or speech-language pathologists
may be more attuned to the conditions of their workspaces due
to the longer amounts Of time spent in them.

According to Wineman ( 1982) people talking and phone
conversations are the most annoying violations Of accoustical

privacy. The use:Of background sound to mask conversations and

92
other Office sounds prevents loud noises from becoming tOO
distracting and minimizes unpredictable sounds. The
correlations in Table 19, between awareness Of HVAC sounds and
the abilities Of both patient groups to participate in therapy
under the condition Of telephone and other conversations, and
between awareness of background music and therapists’
abilities to conduct therapy under the conversation condition,
may be an indication Of the influence Of masking sounds on

performance.

Descriprive Analyses

The perceptions Of speech-language pathologists regarding
the impact Of architectural privacy on their performance and
that. Of their' head-injured. patients 'were jprofiled. using
descriptive statistics. While the majority of responses
indicated that therapists felt the specified environmental
conditions had no effect on either their performance or that
Of their patients, attention should be given to the response
frequencies in the "somewhat hinders" categories. Responses in
this category far outnumbered those in the "somewhat enhances"
category. Table 8 (p. 60) indicates the effects of visual and
acoustical conditions on therapists’ abilities to conduct
therapy. Although 48.89% to 80.95% Of respondents indicated
the conditions had no effect, it must be noted that 14.29% to
46.67% of the respondents thought that various conditions

somewhat hindered their abilities. Results were similar for

93
head-injured patients (Table 9, p. 63). Various environmental
conditions had no effect in 40% to 86.96% of the cases, but
somewhat hindered patients' abilities to participate in
therapy in 10.87% to 48.89% of the cases.

These frequencies are meaningful when determining for
whom settings should be designed. Should the focus be on the
needs Of the majority Of users, and perhaps reducing facility
costs, or should the scope be widened to include the needs Of
outlying' groups? Archea’s {contention (1977) that. certain
groups such as the elderly or handicapped may have different
privacy needs due to sensory-motor capabilities, points tO the
need for special consideration when creating environments for
these groups.

Responses to the Open-ended questions focused primarily
on privacy needs such as a private and/or quiet workspace and
the ability to control distractions--being able to increase or
decrease them as therapy required. This agrees with Siegel’s
(1982) recommendation that quiet and noisy backgrounds be .
provided for some tests of speech and sound production as a
means of determining the stability of an articulation skill.
Since the Open-ended questions were placed at the end Of the
survey, respondents may have been more conscious Of privacy

needs than they normally would.

94

a 'zab' 't and A licat'on

Due to the sampling procedure employed and rate of
return, the results Of this study should.not.be generalized.to
head injury rehabilitation settings throughout the United
States. More information is needed before meaningful
recommendations can be made regarding the effects Of
environmental components on performance in rehabilitation
settings. This exploratory study represents an attempt to
begin to understand the relationships between environment and
behavior in rehabilitation settings, but creates more

questions than it answers.

Directions Of Future Research

Future research should continue to address the issue Of
privacy and its impact on performance in rehabiltation
settings. The use of more open-ended questions in a survey and
Observation Of the subjects might help identify additional
areas Of concern. Access to records Of rehabilitation goals
for patients and their progress might prove valuable in
measuring performance.

Future research might also address the effects on
performance Of additional environmental conditions such as
type and level Of lighting, ambient temperature and
ventilation, appropriateness Of furnishings, and size and
layout Of workspaces. If the immediate environment is viewed

as a prosthetic device by which building components act to

95
extend a person’s capabilties (Deasy, 1974), then an awareness
Of the effects of the components on a person should be
understood. This understanding will facilitate the design Of

environments which support user needs.

Future Research Goals

In order to design supportive environments, performance
requirements, criteria, and specifications must be
incorporated into the programming process. This study is a
step in the development Of performance criteria, which deal
with how a facility must respond to and support users and
their' activities (Preiser, 1978). Ultimately, results of
further research could lead to the development Of performance
specifications for rehabilitation environments. Preiser (1978)
lists the three basic elements Of a performance specification:

1. Requirement: a simple statement Of what the
system must do tO meet a user need.

2. Criterion: a quantitative measure (or a
number) that states the level with which this
requirement must be met.

3. Test: a repeatable, enforceable means of
evaluating whether or not the criteria have
been met. (p. 244)

Difficulties may arise when it becomes necessary tO test the
criteria. According to Preiser (1978) a test which relies on
personal Opinions Of its evaluators is not valid since it
cannot be repeated--different evaluators may have different
Opinions. Methods must be utilized which are able to quantify

what is Often qualitative data in the evaluation of

environments.

96
Conclusion

The value Of studying the effects of environmental
conditions on the performance of speech-language pathologists
and head-injured patients in rehabilitation facilities lies in
the assertion of Finlayson et al. (1987) that the interaction
of environmental variables and patient variables may have an
impact on the effects of remedial efforts. The environmental
conditions of a communication therapy setting may indirectly
affect the reestablishment Of patients’ communication skills.
In addition, as stated in the purpose of the study, the high
costs of rehabilitation and care for head-injured patients
should oblige rehabilitation facilities to provide settings
which enable patients to achieve the goals Of their
rehabilitation programs in a timely manner. According to Deasy
(1985), "any environment that is inadequate for its intended
purpose, that frustrates and annoys us, or that limits our
ability to accomplish our purposes has a direct bearing on

human behavior" (p. 10).

APPENDICES

APPENDIX A

UCHRIS Approval Letter

MICHIGAN STATE UNIVERSITY

 

OFFICE OF VICE PRESIDENT FOR RESEARCH EAST LANSING 0 MICHIGAN 0 48824-1046
AND DEAN OF THE GRADUATE SCHOOL

January 29, 1992

Diane Sowash
1767 Sashabaw
Okemos, MI 48864

RE: ARCHITECTURAL PRIVACY AND PERFORMANCE IN REHABILITATION SETTINGS FOR.HEAD-
INJURED PATIENTS: AN ASSESSMENT OF SPEECH-LANGUAGE PATHOLOGISTS’
PERCEPTIONS, IRB #92-011

Dear Ms. Sowash:

The above project is exempt from full UCRIHS review. The proposed research
protocol has been reviewed by another committee member. The rights and welfare
of human subjects appear to be protected and you have approval to conduct the
research.

You are reminded that UCRIHS approval is valid for one calendar year. If you
plan to continue this project beyond one year, please make provisions for
obtaining appropriate UCRIHS approval one month prior to January 28, 1993.

Any changes in procedures involving human subjects must be reviewed by UCRIHS
prior to initiation of the change. UCRIHS must also be notifed promptly of any
problems (unexpected side effects, complaints, etc.) involving human subjects
during the course of the work.

Thank you for bringing this project to my attention. If I can be of any future
help, please do not hesitate to let me know.

Sincerely, '

David E. Wright, Ph. air

University Committee search Involving
Human Subjects (UCRIHS)

DEN/deo

cc: Dr. Roberta Kilty-Padgett

MSU it u Affirmative Action/Equal Opportunity Institution

97

APPENDIX B

Pre-Test Cover Letter

February 3, 1992

Dear Rehabilitation Professional,

Your facility has been selected to participate in the pretest of
a study on workspace needs in rehabilitation facilities. The
purpose of the study is to determine if there is a relationship
between architectural privacy and the performances of therapists
and their patients. Findings of the study'may have implications for
the future design of such settings.

I hope you will be able to spend about 30 minutes of your time to
complete the enclosed questionnaire. In addition, please make any
comments or suggestions regarding the appropriateness or Clarity
of the questions. Your thoughtful review of the questionnaire will
be much appreciated. You have the right to refuse to answer any
questions. You indicate your voluntary agreement to participate by
completing and returning this questionnaire. Please return it in
the enclosed envelope by February 7, 1992 so the study may proceed
in a timely manner.

If you have any questions, or would like a summary of the results
of the study, please write to me at the address below or call (517)
349-5529. Thank you for taking the time to pretest this survey.

Since

1y, 4 .
.1 W701 ~—

Diane M. Sowash
1767 Sashabaw Drive
Okemos, MIChigan 48864

 

98

APPENDIX C

Survey Cover Letter

MICHIGAN STATE UNIVERSITY

 

COLLEGE OF HUMAN ECOLOGY EAST LANSING 0 MICHIGAN 0 «824-1030
DEPARTMENT OF HUMAN ENVIRONMENT AND DESIGN

February 10, 1992

Dear Rehabilitation Professional,

I am a graduate student at Michigan State University and am
conducting a study on workspace needs in rehabilitation facilities.
The purpose of the study is to determine if there is a relationship
between architectural privacy and the performances of therapists
and their patients. Findings of the study'may have implications for
the future design of such settings.

Your facility has been selected to participate in this study. I
hope you will be able to spend about 30 minutes of your time to
complete the enclosed questionnaire. Your thoughtful responses will
help evaluate workspace needs in rehabilitation facilities, but you
do have the right to refuse to answer any questions. You indicate
your voluntary agreement to participate by completing and returning
this questionnaire. Please return it in the enclosed envelope by
February 28, 1992 so the study may proceed in a timely manner.

Since your name is not known to me you may be assured of anonymity.
The number appearing on the first page of the survey is for
facility identification and mailing purposes only and will be
removed when the survey is returned. Reports of findings will not
include names of facilities or geographic areas.

If you have any questions, or would like a summary of the results
of the study, please write to me at the address below or call (517)
349-5529. Thank you for taking the time to complete this survey.

If you do not see patients on a regular basis, please forward this
survey to a colleague in your facility who does.

Sincerely,

Diane M. Sowas
1767 Sashabaw Drive
Okemos, MIChigan 48864

 

  

MSU is on A/firnutioo Action/Equal Opportunity Institution

99

APPENDIX D

Survey

SURVEY OF SPEECH-LANGUAGE PATHOLOGISTS’ WORRSPACE NEEDS
IN REHABILITATION FACILITIES

Your thoughtful responses to the following questions will help
evaluate workspace needs in rehabilitation facilities. Thank you
for taking the time to complete this questionnaire.

Please mark the most appropriate response to each Of the following
questions as they pertain to the facility in which you received
this survey.

 

1. What is your area of Speech-language pathology( )
specialization? Audiology ( )
Other (specify) ( )

 

2. Are you certified by the American Yes ( )
Speech-Language-Hearing Association NO ( )
(Certification of Clinical Competance)?

 

 

3. How many patients do you usually see

per day? patients
4. How many patients do you usually see

per session? patients
5. How many times per week do you see a

typical patient? times

 

6. How long does a typical therapy
session last? minutes

 

7. What is the total length of time a
typical patient spends in therapy

 

 

with you? months
8. Approximately what percentage of %uale

your patients are male and female?

(Total should equal 100%) %female

100

 

9.

10.

11.

12.

13.

101

What is the approximate age 15 years and under
distribution Of your patients?
(Total should equal 100%) 16 - 25 years

26 - 35 years
36 - 45 years

46 - 55 years

detiofodédeP

56 years and.over

Please indicate the percentages of your patients who have the
following abilities at the BEGINNING of therapy and at the
COMPLETION of therapy in this facility. Numbers do NOT need
to total 100%.

BEGINNING COMPLETION

Speak intelligibly................ % %
Describe Objects, events, places,

and people in a narrative manner.. % %
Organize conversational speech.... % %
Compensate for word-finding
difficultieSOOOOOOOOOOOOOOOOOOOOOO % %
Compensate for shallow reasoning

and problem solving............... % %
How well do you think your patients Very well ( )
are able to concentrate when working Somewhat ( )
with you in your workspace in the Not well ( )

BEGINNING stages of therapy?

How well do you think your patients Very well ( )
are able to concentrate when working Somewhat ( )
with you in your workspace in the Not well ( )

FINAL stages of therapy?

How well do you think your patients Very well ( )
are able to communicate when working Somewhat ( )
with you in your workspace in the Not well ( )

BEGINNING stages Of therapy?

14.

15.

16.

17.

18.

19.

102

How well do you think your patients Very well ( )
are able to communicate when working Somewhat ( )
with you in your workspace in the Not well ( )

FINAL stages of therapy?

How well are you able to concentrate Very well ( )
in your workspace? Somewhat ( )
Not well ( )

How well are you able to communicate Very well ( )
with your patients in your workspace? Somewhat ( )
)

Not well (

Please record below the numbers of walls or partitions for
each.type‘which.encloses your personal workspace. For example,
a private office would have 4 Type A walls. A partially
enclosed workspace might have 1 Type A wall and 3 Type C
partitions. If your workspace has no walls or partitions (Type
E) indicate "0" for Number Walls or Partitions

Number Walls

or Partitions

TYPE A Wall extends to ceiling.

TYPE B Partition does not extend to ceiling but
you cannot see over it when standing.

 

TYPE C Partition can be seen over when you are
standing but not when you are seated.

TYPE D Partition can be seen over when you are
seated.

TYPE E No partition encloses your personal

workspace which is located within a
larger room with walls to ceiling.

How tall are you?

 

inches
Which best describes the Hard, nonporous ( )
surfaces of most of the Soft, porous ( )

walls in your workspace?

20.

21.

22.

23.

24.

25.

103

Is the ceiling Of your workspace covered
with acoustical tiles?

Is the floor of your workspace carpeted?

Does your workspace have a door that can
be closed?

What is the maximum number of
persons who work in your space
at one time (including patients)?

DO you have a private office?

If no, how close is the Adjacent t

nearest workspace About 1’-6

to yours? About 2’-6
About 4’-0

More than

Please indicate the degree to which you are aware of the
following conditions as they occur beyond your personal

Yes ( )
No ( )
Yes ( )
N0 ()
Yes ( )
NO ( )

2 persons
3 persons
4 persons
More than 4
persons ( )

AAA

Yes
NO

v

o l’-6"

It to 2!-6"
it to 4!-0"
II to 7l-0"
7’-0" away

VVVVV

workspace.
Very Somewhat Not
aware aware aware
Air conditioner, fan, or
furnace sounds... ........ ........ ( ) ..... ( ) ..... ( )
Background music....... .......... ( ) ..... ( ) ... ( )

Telephones ringing and/or
office equipment sounds.......... ( ) ..

Telephone and other conversations ( ) ....

Others listening to or
watching you ...... ..... .......... ( ) ..

Visibility of others working

or passing by.................... ( ) .....

104

26. Please indicate the degree to which the following conditions
(as they occur beyond your personal workspace) affect YOUR
ability to conduct therapy in your workspace.

Somewhat Has no Somewhat

Hinders hinders effect enhances Enhances
Air conditioner, fan,
or furnace sounds.. ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )
Background music... ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

Telephones ringing
and/or Office
equipment sounds... ( ) ..... ( ) ..... ( ) ..... ( )

Telephone and other
conversations...... ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

Others listening to
or watching you.... ( ) ..... ( ) ..... ( ) ..... ( )

Visibility of others
working or passing. ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

27. Please indicate the degree to which you think the following
conditions (as they occur beyond your personal workspace)
affect YOUR PATIENTS’ abilities to participate in the
BEGINNING stages Of therapy with you.

Somewhat Has no Somewhat
Hinders hinders effect enhances Enhances

Air conditioner, fan,
or furnace sounds.. ( ) ..... ( ) ..... ( ) ..... ( )

Background music... ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

Telephones ringing
and/or office
equipment sounds... ( ) ..... ( ) ..... ( ) ..... ( )

Telephone and other
conversations...... ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

Others listening to

or watching them... ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

Visibility of others
working or passing. ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

105

28. Please indicate the degree to which you think the following
conditions (as they occur beyond your personal workspace)
affect YOUR PATIENTS’ abilities to participate in the FINAL
stages Of therapy with you.

Somewhat Has no Somewhat

Hinders hinders effect enhances Enhances
Air conditioner, fan,
or furnace sounds.. ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )
BaCkground muSiCOO. () 0.... () .00.. ( ) 00.0. ( ) 0.0.0 ()

Telephones ringing
and/or office
equipment sounds... ( ) ..... ( ) ..... ( )

Telephone and other
conversations...... ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

Others listening to
or watching them... ( ) ..... ( ) ..... ( )

Visibility of others
working or passing. ( ) ..... ( ) ..... ( ) ..... ( ) ..... ( )

29. What ONE thing do you like best about the space where you

conduct therapy?

30. If you could change ONE thing about the space where you
conduct therapy what would it be?

31. What is your sex? Male ( )
Female ( )
32. What is your age? 25 years or under

26 - 35 years
36 - 45 years
46 - 55 years
56 years or over

“AAA“
vvvvv

Thank you for your time and thoughtful responses.

 

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