The best outside spaces and gardens for people with multiple sclerosis

December 11, 2023 12:51 AM

Six years ago I asked about the sorts of outside spaces that work best for chronic fatigue syndrome sufferers. I've now been asked to design a landscape to include a person with multiple sclerosis - MS. They are mid-30's, female and still walking but not that well. My client mentioned this without my prompting but in a less than open way, and I don't see a client interview helpful. So asking here is the very best next place.

Most studies lump MS in with other conditions in a way that seems dismissive. I've found little on environmental preference and changes in cognition that may occur, or how to treat outdoor spaces beyond generic disability spaces e.g. (ramps, smooth transitions, understandable colour changes and so on). The most useful has been Ranalli's architecture thesis: Making Spaces | For the EASE of Multiple Sclerosis Treatment and Research, unfortunately it is uncited and the author has only written on non-MS issues since. But it is quite an unusual thesis, even for architecture.

I would like to know what your needs, problems and experiences of MS are either as patient, treatment-provider, close-relative/friend or spatial designer re outside space:
• Perception (colour, sound, sense of smell, touch)
• Spatial-perception, scene depth-perception-especially at 30-100metres
• Plant allergens
• Social comfort in private spaces? \
• other aspects in my unknown unknown territory

I'm aware of thermoregulatory dysfunction in MS and increasingly building cold-refuges into my landscapes for human and wildlife support.

posted by unearthed to Home & Garden (9 answers total)

I have a friend with MS and he has arranged his living space so that he always has a wall or piece of furniture that he can use as a balance support as he moves from one space to another. Also "perches" to sit down on in every space where he'll be doing something. He's also low-vision, so in a garden context I'd expect that would lead to a preference for large, nearby, and high-contrast visuals, but more importantly also engagement of other senses.

This being said, every case of MS progresses differently because (as I understand it) it's kind of random which brain regions are affected and in what sequence. Unfortunately for you, this means that you're going to need to get specific information from your client, and there is likely to be no such thing as an "MS landscape architecture best practice".
posted by heatherlogan at 6:39 AM on December 11, 2023

I am, for better and worse, well qualified to answer this question! Yay?

I have MS. That said, I don't have your person's MS and everyone's is different. Also, mine is different today from what it will be tomorrow or in 1 year or 10.

That said, there are some consistencies for me: My perception is wonky. I've lost a lot of feeling in my hands. If you want me to know a surface is textured, it's going to have to be REALLY textured. My hearing and smell are OK. My sight can be affected -- either episodically for no outward reason, in relation to heat, or progressively over time.

Re: spatial perception. Mine is also fracked up; that's ten tons of fun. My proprioception is terrible. So if you ask me to close my eyes and touch my nose, I'll probably land... in a nose-adjacent zone! If I try to scratch an itch, I get the right spot on my body maybe half the time on the first try.

My balance is bad. It's one of the things that makes walking so difficult because, as I've found out the hard way, walking is actually a continuous series of balancing challenges as you move from one leg to the other. Don't get me wrong, my muscles aren't moving right either and that makes walking tough. But as my walking has declined, the lack of balance has been the single biggest hit.

I have not experienced any allergen issues.

I'm not sure what you mean by social comfort in private spaces.

I'm happy to say more and to answer in thread or by memail if you follow up, but I don't want this to slip into a disease soliloquy so I'll wrap up.

I'm not sure what I would be looking for in a scenario like this except perhaps soft surfaces to land on if I fall (no jagged rocks, please), places to sit if I need a break, and perhaps bars or poles to grab onto for balance and support along the way. Oh. And maybe shade or water sprays to cool down, since most people with MS find that their symptoms are aggravated by heat.

In conclusion, MS is stupid.
posted by fruitslinger at 7:25 AM on December 11, 2023

This is probably obvious but: for people who have trouble walking or wheelchair/rollator users -- avoid "pavers" or anything like bricks/cobbles/etc that inevitably make pathways into uneven surfaces.
posted by LobsterMitten at 7:52 AM on December 11, 2023

I have a friend with MS, and I've known her for about 15 years. The one constant in that period has been that her symptoms are always changing. So at one point she was walking well but needed frequent sitting breaks. Later she was using a mobility scooter for a period, and I suppose we'd assumed her next step would be a wheelchair...but instead she was able to progress back to walking. So I'd guess that a space would have to take into consideration that a person's needs might be ever-changing.
posted by BlahLaLa at 8:20 AM on December 11, 2023

A simple railing on one side of the primary walking area would help a great deal. Make sure it doesn't collect heat in the sun or have any splinters or rough surfaces. A railing can be held for stability, leaned on, rested against, etc, etc. And yet doesn't take up much visual or physical space. Benches are also necessary and with a railing people can feel more free to move and yet more safe while moving at the same time.
posted by seanmpuckett at 9:12 AM on December 11, 2023

People with MS are especially susceptible to heat, so check with the person to see if they'd particularly like lots of shade.
posted by theora55 at 2:46 PM on December 11, 2023

I have MS.

And I am nthing everything that fruitslinger said (especially that MS is stupid).

I would like to add that you should have varied levels of seating. Have some deeper, softer chairs as well as higher easier-to-perch-on stools. Getting up and down reliably can be an issue when you have balance and fatigue issues. A mix of more solid armchairs versus open seating and benches. And we still want some comfort too, please.

Make it inviting or maybe a bit whimsical. It's nice to have our needs accommodated, but try to avoid making the place look like a physical rehabilitation centre as much as possible. Throw in some colours, cushions, scarves (the temperature modulation is variable, just like anyone else we can get chills).

We also can have weaker grips along with decreased sensation, so having tables (again at variable heights) on which to place drinks etc. is very appreciated. Think of the grip issue as well if you are planning on serving food or drinks.

And finally, nearby and accessible toilets/washrooms.

Not everyone with MS would perhaps agree with this, but imagine that you are inviting over a bunch of slightly tipsy-to-a-bit-drunk people. That's how my body feels most days (on a spectrum).
posted by mephisjo at 7:03 PM on December 11, 2023

I have the pleasure of knowing a really awesome lady with MS that has progressed in the approx. 20 years I’ve known her from occasionally wobbly and using a cane to some days are wheelchair days, some days are trouble feeding herself days, some days she can do nearly anything with a good adjustable stool to rest on, and who the heck knows when those days will be because she sure doesn’t! As MS is progressive and different for everyone and treatments are ever evolving, your client will undoubtedly vary. But I’ve learned some great life lessons from my friend and the most important one is linked to her living with MS: when it’s a social occasion, she holds court.

By holding court I mean, she arrives on the scene (or is already there because it’s her home) and picks a spot that’s slightly to the side of all the action. In terms of outdoor spaces this mostly means places like covered porches, with view of the grill or the pool or whatever. In terms of indoors, it’s usually a table with a chair that has a supportive back, or a couch she can properly lounge on, near a bathroom but in view of the kitchen or the game room. It is not the front door or right when you come into a place, you have to get through the crowd to spend time with her, but because she is kind of magnetic people naturally form queues to spend time with her, bringing her snacks or checking in, flitting in and out. It works wonderfully, she is much less fatigued than she otherwise would be, and people organically give her moments to chill out and observe the goings-on because it’s not exactly the center of the action.

So my advice to you would be to design several such spots in this garden for your client to hold court. A shaded lounge near any outdoor cooking equipment, a cabana to relax in near a pool, a good chair to listen to music or read in that’s nestled among plantings with some other seating conveniently nearby. Of course for long term usefulness it should be fully accessible, so smooth paving and ground covers, wide paths, gentle slopes. Raised beds for herbs and vegetables so she can reach them comfortably to tend or harvest. But yeah, different areas where she can post up and people can come to her and she will have a good viewpoint of the focal areas of the garden, preferably shaded and with good lighting at night, that’s what I’d start with.
posted by Mizu at 1:08 AM on December 12, 2023

Thanks so much everyone, far more info and specific cases than I could ever find. I find where I'm asked to design a space that other family members often overlook / don't think in depth about the issues disabled people face* (so far I've not had very many cases where the disabled person was my main contact/primary client and there a limit how far I can push - there's more I'd like to say), it's interesting reading your comments as there were things that didn't gel from my clients comments, and aspects of the house design that feel unresolved - so I'd shifted design to a disabled focus (without it being explicit - I fully agree with you on thatmephisjo).

* I had a girlfriend when I was younger who was CP and in a wheelchair so may have more awareness of some things, but design for disability was barely an afterthought in my degree.

Heatherlogan - my space is large and does allow for good contrast, so I'll see how I can preserve that, and perches are a good idea. To be perfectly hones there's no such thing as landscape architecture best practice" period (it is becoming far too normalised and professionalised to be useful to real people and communities).

fruitslinger - "REALLY textured" is valuable, the walking as a series of balancing challenges is very useful. I may take up your kind offer, see how I go. re my "social comfort in private spaces" I was thinking that I've seen where disabled people needed more focus for a task and found others distracting/off-putting.

LobsterMitten - a constant problem for me where some people are in denial of what is going on (I see a lot of cases where architects and other designers are conflict-averse and just design the easy way, rather than lift the lid a bit), I much prefer asking difficult questions - and getting a better space (although it's not nice at all for me - and some jobs die at that point).

BlahLaLa - interesting about progressing back to better states.

seanmpuckett - "simple railing on one side" with this in mind I'll try and 'front-load' some of my spaces with ground sockets for a handrail system - I normally use nicer scaffold systems as they're a lot lower cost and can still be made to look very fine.

theora55 - for this site I have a lot of (mainly deciduous) trees, with areas of grass between of ~6-10metres.

mizu - There will be raised beds as I like design and making them anyway and here I can do that a little differently.
posted by unearthed at 6:24 PM on December 24, 2023