Document Type : Original Research Paper

Authors

1 M.A. in Architecture, Department of Architecture, Safadasht Branch, Islamic Azad University, Safadasht, Iran.

2 Assistant Professor, Department of Architecture, Damavand Branch, Islamic Azad University, Damavand, Iran.

Abstract

ExtendedAbstract
Background and Objectives: Multiple Sclerosis (MS) disease is a mental and physical illness related to environmental conditions. The environmental factors are effective in the development or prevention of the disease. MS is a complex disease featuring a vast spectrum of signs adversely influencing the patients’ abilities to perform daily routine activities. The problems of MS patients include physical and psychological aspects. Due to the high rates of the disease, the special condition of MS patients, and the lack of specific rehabilitation centers for patients, it is important to pay attention to proper environmental design to improve their mental health. The purpose of this research is to design a rehabilitation center that is appropriate to the mental and emotional conditions of MS patients. Designing a space for MS patients by considering environmental and architectural factors and the proper use of these factors can reduce symptoms (stress, fatigue, depression, and motor disorder). However, the problem currently lies in the idea that no study has attended to the role and the importance of environmental factors parallel to reducing MS symptoms. The environments designed for these patients do not feature a single difference from those designed for the others, healthy or sick. No environment has been designed proportionate to the psychological and physical status and situation of these patients.
Methods:In the present study, a descriptive method was employed in the first stage, and the information was collected via reviewing the credible articles and books on relevant subjects. Considering the fact that many psychologists and psychiatrists deal with MS patients whose psychological conditions have worsened following the development of multiple sclerosis and the subsequent physical and movement disorders, qualitative methods are used in the following sections. Psychiatrists and psychologists working with MS patients’ treatment and healthcare centers and MS Patients Association and Rehabilitation Centers have been interviewd, and the information obtained from the content analysis has been used to identify their problems and needs. In line with this, 30 psychiatrists and psychologists were randomly selected from various centers as the study sample to be interviewed. After investigating the interviews using content analysis, the common points of the literature review and psychologists’ ideas were collected. In the present study, the effective environmental factors, including sunlight, color, music, gathering spaces, open spaces and nature, fitting spaces, sport, hydrotherapy, and rehabilitation facilities, were investigated. The importance of the points underlined by the psychologists was also verified.
Findings: Sports therapy is a treatment specific to MS patients, and, besides improving MS patients’ physical situation, it can improve their psychological and mental health. Therefore, it is better to design a compound and consider spaces for playing sports and walking to improve the physical and psychological health of MS patients. Hydrotherapy, as a nonmedicinal treatment method, can increase the flexibility of the muscles and bones, thereby mitigating the muscular spasms and enhancing the vigor and stamina of an individual, and reduce their pain. The sunlight has a positive effect on the psyche and mind of the patients when their declined bodies crave comfort. Moreover, the appropriate use of natural light during the day better helps energy productivity. So, the proper design of the windows (dimensions, forms, and orientations) can provide the highest rate of sunlight gain. Considering the positive effects that color has on humans’ lives, the proper and pertinent use of colors and their correct application can cause positive effects on the psychological status of the patients. Considering the psychological and physical problems of MS patients and their need for conversation and confabulation for soothing their pains, the architects and designers should consider spaces for their gathering and social interaction inside and outside the healthcare and treatment centers of MS patients. According to the materials above and considering the problems of MS patients, including stress, depression, fatigue, imbalance, and movement disorders, the architects and designers must consider their security and tranquility via the proper design of green spaces or open spaces for MS patients. Since the Iranian garden is more prominent than the other patterns for its transparency and legibility, it can be utilized to provide tranquilizing effects, reduce stress, and enhance satisfaction in MS patients. Music therapy should be considered in treatment programs to facilitate the messaging process in the nervous system of these individuals, which can slacken the disease progress.
Conclusion: According to the results of the research, the design of outdoor space and the use of nature and green space inside and outside the complex, the access to natural light and the design of a suitable space for walking and sports, and the use of rehabilitation facilities and appropriate geometry in the design of space, avoiding complexity,  and the use of appropriate color are effective in reducing the stress, depression, and exhaustion in MS patients. Considering the importance of environmental factors influencing the general reduction of MS symptoms, light and color were found less important. However, creating open spaces, using natural elements, fitting the space, and providing gathering space are the most effective factors in reducing the general MS symptoms in patients.

Graphical Abstract

Investigation and evaluation of architectural patterns in reducing the symptoms of Multiple Sclerosis (MS) patients

Highlights

- Gather information and review the interview through content analysis and find common ground between the research background and the statements of psychologists.
- Conclusion based on the degree of importance of environmental factors in reducing the symptoms of MS patients (stress, depression, fatigue and mobility problems).
- According to the results of this study, environmental factors of light and color have the lowest score and open space and nature, space adaptation and designing gathering space have the highest score in reducing patients’ symptoms.

Keywords

Ackerman KD, Heyman R, Rabin BS, Anderson BP, Houck PR, Frank E, et al. Stressful life events precede Exacerbation of multiple sclerosis. Psychosom Med 2006;64(6):916-20.
Aldridge D, Schmid W, Kaeder M, Schmidt C, Ostermann T. Functionality or aesthetics? A pilot study of music therapy in the treatment of multiple sclerosis patients. Complementary therapies in medicine. 2005; 13(1): 25-33.
Alirezaei M. Guide to the standard design of hospital spaces. Tehran: Mahkameh; 2010: 4-10[Book in Persian].
Ardalani, H. & Ardalani, M. (2010). Practical tips about the properties of paints in the hospital.
Arias, P,Cudeiro , J. 2010, Effect of rhythem auditory stimulation on gait in parkinsonian patient with and without freezing of gait . plos one 5,e9675.
Ascherio, A and Munger, K. (2008) Epidemiology of multiple sclerosis from risk factors to prevention. Seminars , in Neurology,28(1),17-28.
Barker P, Fraser J. Sign design guide: a guide to inclusive signage. London: JMU; Harpenden: Sign Design Society. 2004
Bateman. A, Bale, J. (2009).”Sporting Sounds,relationships between sport and music “ USA and Canada , Taylor & Francise e_Library . PP :76-82
Bethoux, f. (2012). multiple sclerosis International Federation (MSIF),56,22-45.
Birren F. Color psychology and color therapy: A factual study of the influence of color on human life. Martino Fine Books. 2013
Braunwald, Fauci. Kasper, Hauser, Longo, Jameson (2001). "Harrison's principle of internal medicine". 15th ed. New York. McGraw Hill Co. PP: 2452- 2461
Chwastiak, L.A. & Ehde. (2007). D.M. Psychiatric Issues in Multiple Sclerosis. Psychiatric Clin North Am 2007;30(4):803-17.
Compston ,A.(1997) Genetic epidemiology of multiple sclerosis. Journal of nurology Neurosurgery and Psychiatry .62-553, 61.
Cooper Marcus, C.( 2003). Healing Havens. Landscape Architecture (August): 84-88.
Dave, E. (2007).”Musice during Exersies : Does Tempo Influence Psychophysical Responses” ? Published in Psycho.philica.com
Daykin, Norma,Byrne, Ellie, o’Connor Susan, soteriou,Tony: (2008),The impact of art, design and  environment in Mental healthcare:a systematic review of the literature, The journal of the Royal society for the promotion of Health,128(2),pp 85-94.
Dee Jonathan and Taylor leslie,(2008),colour therapy,Translated by mehdi Ganji, salavan  publications, Tehran.
Diego Luque ,Córdoba, María D. Luque de Castro, Metabolomics:A potential way to know the  role of vitamin D on multiple sclerosis, Journal of Pharmaceutical and Biomedical, Analysis, Volume 136, 20 March 2017, Pages 22-31.
Diette GB, Lechtzin N, Haponik E, Devroates A & Rubin HR. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia. Chest 2003; 123(3): 941-8.
Dijkstra K, Pieterse  ME & Pruyn A. Stress-reducing effects of indoor plants in the built healthcare environment: the mediating role of perceived attractiveness. Preventive Medicine 2008; 47(3): 279-83.
Dutro.A.R(2007).Light Image Thrapy in the Health care Environment.East Tennessee state University Dissertation
Esmaeili, M. & Hosseini, F. (2009). Multiple Sclerosis and stressful thought habit. Nursing Research, pp. 25-32.
Ford R. How I woke up presentation in with design in mind in RIBA in 19/06/02. London: Isle of Wight Healthcare NHS Trust. 2002
Forwell, S. (2011). Introduction to fatigue in ms- taking a comprehensive approach, ms in focus fatigue.
Gill JM. Which button? Designing user interfaces for people with visual impairments.  Royal National Institute for the Blind. 2000; p. 28
Guinness, MC. Peter, S. (1999). "The diagnosis of multiple sclerosis: peplau's interpersonal relations model in practice". Rehabil Nurs. 24 (1); PP:30- 36
Hale L, Schou E, Piggot j, Littman A, Tumilty S. The effect of combined exercise program for people with Multiple sclerosis: a Case series. Newzeland Jornal of physiotherapy. 2003Nov; 31(3):130-8.
Halper June, Costello Kathleen, Harris Colleen, chapter 6.  Nursing Practice in Multiple Sclerosis. A Core Curriculum, 2nd Edition. New York: Demos Medical Publishing; 2006. p 215-245.
Hernandez-Reif M, Field T, Field T, Theakston H. Multiple sclerosis patients benefit from massage therapy. Journal of Bodywork and Movement therapies. 1998; 2(3): 168-74.
Holland, NJ. Madonna, M. (2005). "Nursing grand journal multiple sclerosis". Journal nerosci, 37 (1). PP:15-19.
Howarth AL. Will aromatherapy be a useful treatment strategy for people with multiple sclerosis who experience pain? Compleme Ther Nurs Midwifery 2002; 8(3): 138-41
Huntley, A. Ernst, E. (2000). "Comlementary and alternative therapies for treating multiple sclerosis symptoms". A systematic review Co mplement Ther Med. 8: PP:97-105
Itten Johannes,(2005), the elements of color,Translated by behroz zhale dost, efaf Publications, Tehran.
Johnson SK, Terrel D, Sargent C, Kaufman M. Examining the effects of stressors and resources on multiple sclerosis Among African Americans and Whites. Journal of Stress and Health 2007;23(2): 207-13.
Kaplan, R. (2001). “The Nature of the View from Home: Psychological Benefits”. Environ- ment and Behavior, 33 (4): 507-542
Kasper D, Braunwald E , Fauci A, Houser S, Longo D, JamesonJ. Harrison's principles of Internal Medicine, Volume 2, 16th edition, New York, Mc Grow- Hill Co, 2005; p: 2461
Kolanowski, A. M. (1992). The clinical importance of environmental lighting to the elderly. Journal of Gerontological Nursing. 18, 10-14.
Lohr VI & Pearson-Mims CH. Physical discomfort may be reduced in the presence of interior plants. Horttechnology 2000; 10(1): 53-8.
Luscher, Max. (2010). Psychology of color, Translated by leila mehrdad pe, hesam Publications,Tehran.
MacKay G, Neil JT, Holgate B & Rugendyke A. The effect of green exercise on state stress and anxiety and mood: the role of perceived greenness, exercise cognitions and connection to nature, Western Australia: University of Canberra, 2012
Marcus CC & Barnes M. Gardens in healthcare facilities: uses, therapeutic benefits, and design recommendation. University of California at Berkeley, The Center for Health Design: 1995; 1-9.
Masoudinejad, S. (2013). Sky as Landscape:Sky in Landscape Preferences Soffeh Fall  2013 , Volume 23, Number 62; Page(s) 27 To 44.
Mc Andrew FT. Environmental psychology. Translated by Mahmoudi R. 2nd ed. Tehran: Vaniya; 2013: 336-56[Book in  Persian].
Mcllveen B, Robertson J.V. A Randomised Controlled Studv of the Outcome of Hydrotherapy for Sbbjects with Low Back or Back and Leg Pain. Physiotherapy 1998; 84(1): 17-26
Mehdizadeh, S., Nikogftar, F., Nikogftar, A. (2011). A Comparative Study on Approaches to Achieve Tranquility, Calmness and Meditation in Traditional Gardens of Iran and Japan. Garden of Nazar (8) 17, pp. 31-42.
Miller, N. Pilot Study Reveals Quality Results, Lighting Design & Applications, 1994
Mills NJ, Allen S, CareyMorgan S. Does Tai Chi/Qi Gong help patients with Multiple Sclerosis. J Body work and Mov Ther 2000; 4(1): 39-48.
Minnaert M. Light and color in the outdoors. New York, Springer. 1995; p. 293.
Mirfanderski, M.A. (2004). What is an Iranian garden? Where is the Persian garden?
Mitchell A, Benito-Leon J, Morales Ganzalez MJ, Rivera-Navarro J. Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of  wellbeing  Lancet Neurol 2005;4(9): 556- 66.
Mitsonis CI, Zervas IM, Mitropoulos PA, Dimopoulos NP, Soldatos CR, Potagas CM, et al. The impact of stressful life events on risk of  relapse in women with MS. Euro Psychiatry Journal 2008; 23(8): 497-504.
Monti F, Agostini F, Dellabartola S, Neri E, Bozicevic L & Pocecco M. Pictorial intervention in a pediatric hospital  environment: effects on parental affective perception of the unit. Journal of Environmental Psychology 2012; 32)3(: 216-24.
OConnor,P.(ed) (2002) Key issues in the diagnosis and treatment of multiple sclerosis An overview Neurology 59,sup.3,s1-31
Phiri, M (2003), One Patient One Room – Theory and Practice: An evaluation of The Leeds Nuffield
Schuschke G, Christiansen H. Patient-related color preference and color design in the hospital. Zentralbl Hyg Umweltmed. 1994; 195(5-6): 419-31.
Sherman SA, Varni JW, Ulrich RS & Malcarne VL. Post-occupancy evaluation of healing gardens in a pediatric cancer center. Landscape and Urban Planning 2005; 73(2-3): 167-83
Tahbaz, M. (2004). Pyramid/shade window frame, Ph.D. dissertation in Architecture, Faculty of Architecture and urbanism, Shahid Beheshti University, P. 7.
Thornton, EW., Tedman, S., Rigby, S. th. H. & young, c. (2006). worries and concerns of patients with multiple sclerosis: development of an assessment scule. Mult  Scler. 12(2),pp.196-203.
Tod wiler, (1985). Personnel plan the hospital translations by Mr. mohammad reza  Frosat at the company House of Iran
Ulrich, R.S. (1984). “View through a window may influence recovery from surgery”. Sci- ence, 224: 420–421
Ulrich, R.S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M., & Zelson, M. (1991). “Stress recovery during exposure to natural and urban environments”. Journal of Environmental Psycholog.
Ulrich,R.S. 1999. Chapter 2,  Effects of Gardens on Health Outcomes: Theory and Research. . In Cooper Marcus C and M Barnes Ed., NHealing Gardens: Therapeutic Benefits and Design Recommendations : 27-86  . New York: John Wiley & Sons.
Van den Berg AE, Koole SL & Van der Wulp NY. Environmental preference and restoration: how are they related? Journal of Environmental Psychology 2003; 23(2): 135-46.
Vernolia C. Healing environments. Berkeley: Celestial Arts. 1988
Vouyovitch, S.P., Debouverie, M., Guillemin, F., Vandenbergh, N., Anxionnat, R. & Vespignani, H. (2006). Fatigue in Multiple Sclerosis is related to disability, depression and quality of life. J Neuro Sci 2006;243(1-2), pp.39-45.
Walch, J. M., Rabin, B. S., Day, R., Williams, J. N., Choi, K., & Kang, J. D. (2005). The effect of sunlight on postoperative analgesic medication usage: A prospective study of spinal surgery patients. Psychosomatic Medicine, 67(1), 158–163
Ward Thompson C. Linking landscape and health: the recurring theme. Landscape and urban planning 2011; 99(3-4): 187-95
Wijk H, Berg S, Sivik L, Steen B. Color discrimination, color naming and color preferences in 80-year olds. Aging (Milano). 1999; 11(3): 176-85.
Ziemssen Tjalf December 2011, Journal of the neurological sciences:Symptom management in patients with multiple sclerosis, volume 311, Supplement1,Pages S48–S5.