THERAPEUTIC

ARCHITECTURE
DESIGN INDEX

Omar Youssef
Author
Omar Youssef, PhD(c)

Arid Lands Resource Sciences

University of Arizona
1955 East 6th Street, Room 208G
Tucson, AZ 85719, USA

This manuscript was submitted in conjunction with a national professional conference, “The Value of Design: Design & Health,”
hosted in Washington, D.C., April 22-24, 2014, by the American Institute of Architects Foundation, the American Institute of
Architects, and the Association of Collegiate Schools of Architecture. Conference staff have edited manuscripts for clarity and
style. This project was made possible in part by a grant from the National Endowment for the Arts.

Visit www.aia.org/DesignHealth
Abstract
The building industry as a whole is undergoing an evo-
lution in sustainability. Within healthcare facilities there
has been a particular focus on energy efficiency, indoor
air quality, and improving delivery of patients’ health
care. There are ample opportunities for architects and
designers to create conditions that productively bond
natural and human systems to fulfill the social, econom-
ic, and health needs for future generations.
A Design Index for Therapeutic Architecture integrates
the opportunity for architects to mitigate environmental
concerns and therapeutic technologies to achieve a
healthier human environment. This paper outlines the
development of a design aid matrix that integrates built
and human-health environments, as well as building and
human performance.
Keywords: energy efficiency, evolution in sustainability,
patient health care, therapeutic technologies, design aid
matrix, built environment, human-health environment,
building performance, and human performance.

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 spatial brain luminous

body sonic

thermal behavior mind

FigurE 1. Analyzing the human environment within the built environment

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Introduction
Humans’ perception of the built environment is based collaboration does not only look at reducing patient
on our ability to interpret adjacent environmental forces stays, but also looks at providing a healthier, more pro-
affecting bodily senses. Through our senses we form ductive way of living that may reduce people’s need to go
an image, and associate a memory with that image. As to a hospital in the first place.
such, memories underlie much of our rich life; humans
We need to shift our minds from preventing health
commonly associate dampness with smell, perceive
problems to causing health enhancements. Combining
dimension through echoes, and see light with shadow.
spatial design with health parameters, architects are
Knowledge stored in our memory affects our behavior
able to make decisions and take actions that protect the
by way of predictions. Often, our perception of the
natural world and preserve the environment to support
environment relies as much on the knowledge stored
future life. Further integrating environmental sustainabil-
in our memories as it does on fresh, incoming sensory
ity with therapeutic technologies achieves healthier hu-
information.
man environments. This research project has established
The built environments that we encounter affect our be- a design index to be used as a benchmark that supports
havior. Perception stimulates the brain, accessing these and facilitates architects’ integration of the built and
images and memories. Architects and designers should human-health environments.
not only be aware of how the built environment affects
The visualization to the left illustrates the inception of
our behavior, but should also strategically design living
how the idea of Therapeutic Architecture came about
spaces that consider this relationship.
(Figure 1). Components of both the built environment
Human health is essential for human performance. and the human-health environment illustrate spatial,
Architects should strive to create spaces that properly luminous, thermal, and sonic design with respect to the
drive performance through a strategic and structured human brain, mind, body, and behavior.
utilization of the built environment that stresses rigorous
Creating a design index for designers and architects to
analysis of social, physiological, and psychological im-
refer to ensures not only a healthier natural environment,
pacts. It is important to understand the role that spaces
but also a healthier human environment. The proposed
have on people and their emotions.
relationship (Figure 2) will be studied from the experi-
Architecture and neuroscience are no longer two dis- ence of the experiments that have been discussed. In the
crete disciplines. Exploring the benefits of collaboration context of this paper, special attention is paid to lumi-
between neuroscience and perception, and architecture nous intensities.
and the brain will yield a new dimension for design
benchmarks, as human brains are continuously re-
molded by environmental forces and experiences. This

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Figure 2. Design aid matrix connects performance impact areas through components of the built and
human health environments

Built Environment Human Health Environment

Performance impact areas Components Performance impact areas

building form photometric

spatial brain

orientation circadian

fenestration sight / views

insulation preference
luminous mind

ventilation temperature

shortwave reflectance visual comfort

shading thermal body anxiety

daylight performance

internal forces sweat

sonic behavior
HVAC systems glare

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Building Performance reduces a building’s internal heat load compared to that
due to artificial electric light.
Energy efficiency is one of the most cost effective ways
to enhance the environment. Humans are affected by People perceive the luminous environment through their
energy through climate change and scarcity of re- eyes and process it with their brain. Light scenes are
sources. Humans are also directly affected by energy therefore evaluated in connection to expectations.
efficiency. As spaces are more efficient, humans could
Energy Consumption
be provided with improved indoor air quality. Reduced
heat loads lessen a building’s reliance on HVAC systems The U.S. consumes almost 80% of electricity in build-
for ventilation. Dr. Chalfoun has established ten built ing operation and is the largest emitter of greenhouse
environment impact areas that have been considered gases. The building sector affects many other industries,
and used in the development of this design index. ultimately affecting the whole entire economy. When
the building sector fails, the whole economy is adversely
Luminous Intensities
affected. Building operations alone account for 40% of
Luminous intensities can be appreciated in many ways. all energy consumed in the U.S.; lighting is the largest
They can be either more or less agreeable, more or less contributor to energy consumption. Building construc-
attractive, or they could be more or less appropriate to tion and materials only count for 6% of energy con-
the function of the space. Variations of luminance and sumed in the U.S.
colors can strengthen attractiveness, trigger emotions,
The human body is the most receptive to environmental
and affect our mood.
parameters, which include the luminous environment.
The impact of lighting influences individuals and their The following section will describe how natural daylight
state of mind. A lighting installation that does not meet could be used effectively and how it affects building
the user’s sensory expectations can be considered occupants.
unacceptable even if it provides for adequate visual per-
formance. Unacceptable lighting conditions may impact
Human Performance
human performance, motivation, and productivity.
Human performance has become as important to ar-
Lighting should be designed to provide building oc-
chitects as building performance. The built environment
cupants with the right visual conditions to help them
plays a major role in human productivity in the workplace
perform visual tasks efficiently, safely, and comfortably.
and in happiness at home. Indeed, human performance
The luminous environment acts through a chain of
is influenced and changeable by the environment.
mechanisms on human physiological, psychological,
Human performance, body impact areas, and human
and sociological factors, which further influence human
thermal comfort were studied thoroughly in development
performance and productivity.
of this design index.
Daylight
Human performance is results-driven and focused on
Through history, daylight has been the primary source of achievements valued by individual performers and their
light in buildings. Natural light improves livability, adds respective organizations as a whole. The approach taken
visual excitement, and reduces electricity consumption. here emphasizes the need to determine, assess, and
Virtually all buildings in all climates can benefit from evaluate root causes.
correct daylight design. Done correctly, daylight design

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Validation and
Application
FigurE 3. Sunlight penetration causing visual In this project, two studies have been conducted to
discomfort
validate the effects of natural daylight on human body
performance: 1) photometric study, and 2) glare study.

Photometric Study
A photometric study has been conducted within
Dinsmore Room, a conference room at the University
of Arizona usually occupied for meetings events, and
classes. This experiment primarily focused on the west
façade of the room. The façade layers are comprised
of a glass façade, interior textile screen, and aluminum
framing with screen mesh. Owing to these retrofits to
the façade, high performance is expected. However,
when the room is viewed from a light intensity stand-
point, disappointing performance is revealed (Figure 3).
Figure 4 illustrates how uncomfortable the seating in
the room would be, especially during the later afternoon
hours. A test was done with one of the author’s col-
leagues sitting inside the classroom and looking straight
at the board.
RECOMMENDATION Building codes require testing of
illumination at 30” above the ground to indicate the
level of light intensity on a work plane. However, occu-
pants’ visual comfort must have a different benchmark
than this benchmark for buildings. Occupants of the
room spend most of the time looking straight ahead,
with the light from adjacent unprotected and un-shaded
windows shining into their eyes.

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FigurE 4. Subjective depth of field
STAGE 2 A physical model was used to investigate light
Foreground Middle Background movement and render calculated through a space. This
exercise is both a qualitative and quantitative study of
day lighting conditions.
This investigation will cover the following points:
1) Construction of a simple square, 1”=1’0” daylight
scale model that represents the space that will be
tested. The model will be used to explore daylight
variations within the space. The base of the model
will be 20”x20”, with a height of 10”. All surfaces will
brightness scale be white to ensure even light reflectivity within the
space. The study model will be sealed with duct tape
Glare Study on all corners to ensure that light will access only
through the window being tested, therefore ensuring
Perception of glare is caused by the fact that the occu-
an accurate test.
pied space has too much light intensity or a portion of
the space has high intensity compared to an adjacent 2) Using the House Energy Doctor’s “Artificial Sky
space with low-light intensity. Accordingly, the author Simulator,” the assessment of light distribution pat-
has conducted a two-stage experiment to measure glare: terns was analyzed through photometric measure-
ment of the model interior. There are two switches
STAGE 1 As an observational method, the image in
used to simulate conditions. One switch is used to
Figure 4 shows the human perception (subjective) com-
test for over-cast sky conditions at about 17,000 lux
pared to the measured (objective) depth of field. The
while operating the “Mirror-Box” with both switch-
intelligent human eye can naturally adjust to the various
es allows testing for clear sky conditions at about
light intensity conditions whereas a camera cannot.
22,000 lux.
The first condition (left) focuses on the foreground. The
subject of the image is vaguely visible because the light 3) Test model in four conditions. Two conditions will
intensity is very high (i.e., there is too much light). The be tested on a regular window with two sources
second condition (middle) has a partial focus on the of lighting. The other two conditions will test two
subject and on the background. It is considered to be sources of lighting again, but with a transitional
the best of all three conditions. The final image (right) zone adjacent to the window.
focuses on the background. The subject of the image is
not clearly visible.

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Figure 5. Sensor placement and results The next part will focus on the architectural solution to
Window A
Opened
Window A
Opened
promote light intensity and distribution inside the space.
Condition 1: Window A Opened & Window B Closed,
1 2 3 1 2 3 testing in one source of lighting within the space.
Condition 2: Window A Opened & Window B Opened,
testing in two sources of lighting within the space.
CONDITION 1 CONDITION 2 For the two conditions described below, sensors have
been added at the transitional zone at the window. After
Window B
Closed
Window B
Opened monitoring the readings of Test 1 in Conditions 1 & 2,
Window A
Opened
Window A
Opened
an observation was made and the transitional zone was
added.
1 4 2 5 3 1 4 2 5 3 Condition 3: Window A Opened & Window B Closed,
testing in one source of lighting within the space.
Condition 4: Window A Opened & Window B Opened,
CONDITION 3 CONDITION 4
testing in two sources of lighting within the space.
Figure 5 exposes the difference in delta intensity be-
Window B
Window B
Closed
Opened tween Sensor 1 & 3 in comparison to Sensor 2, unlike
the smaller delta intensity between Sensor 4 and Sensor
Light sensor readings 2 for Condition 4. Condition 4 is the best of all tests
conducted; however, it is not the optimum condition for
300 the actual space.

200 Some recommendations could be concluded from this

test and should be included in both the design process
Lux

100
and in the thought process of the architect or designer.
Transitional zones decrease the chance for glare to occur
1 4 2 5 3 1 4 2 5 3 1 4 2 5 3 1 4 2 5 3 as there is a decrease in the sudden drop of depths. The
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No. 1 No. 2 No. 3 No. 4 sudden drop initiates a high contrast that results in glare.
Condition RECOMMENDATIONS

1) Design spaces with multiple sources of lighting.

2) Create transition zones for spaces or within a space.
3) Do not rely solely on the objective index of quantity
of light, but also consider the subjective human
visual comfort.
4) Creation of transition zones is advantageous for both
window and space designs.

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Conclusion
This research demonstrates the importance of inte- standards—was found to be very poor to human percep-
grating the built environment—represented by architec- tion as measured vertically. Fulfillment of building codes
ture—with the human-health environment. Ten building and standards does not necessarily achieve human
performance impact areas have been identified as have visual comfort and sometimes may have an advert effect.
ten human performance impact areas. Collectively, these
Future research can support the development of all
are there areas where the greatest potential for integra-
of the integration required between the built and hu-
tion occurs.
man-health environments. To address human health, we
To demonstrate one successful integration two experi- must verify that building codes are applicable to human
ments have been conducted to 1) test the photometric comfort and efficient body performance, and we must
light intensity of a space, and 2) test glare conditions. amend those that are not.
Results of the two experiments focused on creating
transitional spaces where the human eye can adapt to
changes in light conditions. Space designers should
create a balance between them.
It is also concluded that architects and building offi-
cials should begin to develop new performance indices
that address more human performance rather than
space performance. This became evident when the light
intensity—although compliant with ASHRAE building

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Chalfoun, N. (2008). Basic Principles and Concepts of Lighting.
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