Space to Heal: Exploring the Cutting Edge of Neuroscience Facility Design

Neuroscience facilities serve patients with a wide range of conditions, from cognitive issues like Alzheimer's to mobility challenges resulting from spinal cord injuries. Patients facing cognitive disorders may feel as though they’re experiencing a space for the very first time, even though they've been there dozens of times, while patients with mobility aids require extra space to access and move through a facility. These spaces need to be intuitively accessible and comfortable every time.

From facilitating way-finding to incorporating new technologies, thoughtful design helps to create calming, restorative experiences while supporting healthcare advancement for this patient population. In the latest episode of Side of Design, we dive into the unique considerations and challenges of designing neuroscience facilities, joined by BWBR Principal Ryan Johansen, Design Leader Chris Fischer, and Senior Interior Designer Miranda McNamara Mace.

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Transcript

Matthew Gerstner: 0:00 

This is Side of Design from BWBR, a podcast discussing all aspects of design with knowledge leaders from every part of the industry. Hello and welcome to Side of Design from BWBR. I'm your host, Matt Gerstner. On this episode, we'll be digging into neuroscience facilities, a key element to healthcare advancement. We'll focus on the drive to define improved outcomes while creating calming, restorative patient experiences. Joining the conversation today from BWBR are Ryan Johanson, Principal, Chris Fisher, Design Leader, and Miranda McNamara, Senior Interior Designer. Thanks for joining us today. Everybody, Glad to have you here.

Ryan Johansen: 0:36 

Happy to be here, Matt.

Miranda McNamara Mace: 0:37 

Me too.

Chris Fischer: 0:38 

Good to see you, Matt 

Matthew Gerstner: 0:38 

Good to see you all, thank you. So we're just going to jump right into this and we're going to nail the big question first. What are some of the unique design considerations that come into play when designing for neuroscience facilities, from both an interior and exterior perspective?

Ryan Johansen: 0:56 

I'll kick us off there, Matt, and I think that's a great question and a loaded question. We'll probably spend most of the episode talking about this one, but I think first it's helpful to understand the patient population that a neuroscience facility is serving. Neuroscience is that study of the nervous system, primarily the brain and the spinal cord. So that means a patient coming to one of these facilities could be experiencing a cognitive issue, such as Alzheimer's or other related dementia or paralysis, combining them to a wheelchair from a spinal cord injury, for example. Yeah, so you've got patients with mobility issues that need more space to access the same things that you and I may need as an ambulatory patient, and you've got patients with cognitive issues that may be experiencing the space for the very first time, even though they've been there for a dozen times. Right, so it is a challenge, and in the exterior design and interior design, we need to take into consideration all of those variety of aspects.

Matthew Gerstner: 1:59 

Yeah, I mean it sounds like there's just, even though it's one subject we're talking about here neuroscience. The people coming into it can be experiencing a multitude of different things that could likely need different kinds of treatment. Is what I'm hearing.

Chris Fischer: 2:17 

Yeah, very much so. I mean, I think, to add to that, a lot of these folks are in a rehabilitation stage of their therapy rehabilitation stage of their therapy and so, being considerate of walking distance, how far it takes to get in and through the facility is another big factor that will come into play when we're talking about the overall design.

Miranda McNamara Mace: 2:36 

Yeah, it's also a lot of things considered too with finishes of the space and you know people with cognitive disabilities. They perceive things a little bit differently than your standard patient. So there's a lot of detailed things into the selecting of the palette and also some of the finishes and concept design of these spaces that that really we do a deep dive into when starting to plan for these types of projects.

Chris Fischer: 3:00 

So, when we start looking at the exterior, one of the big things is, for most of our clients is actually creating a landmark. And that's not just so that we, as architects, can create a landmark, this big gesture of a building, if you will, but it's really more about creating a place that's easily recognizable so that when you return, hey, this is familiar to me. Everything's about making things familiar for these types of patients, especially those patients that Ryan referred to with cognitive issues.

Ryan Johansen: 3:30 

How do we make sure these patients know where to go? And it starts. It doesn't start when you enter that front door. It starts when you're looking for the facility.

Miranda McNamara Mace: 3:38 

Wayfinding is a huge component of neuroscience facilities. Like you said, it's not just signage, it's more of those perceptive kind of intuitive wayfinding elements that really help someone navigate the space a little bit more easily.

Chris Fischer: 3:51 

So if you were coming up on and we've done a number of facilities, now if you're coming up on them, what does that mean? One particular piece that we used at one of our facilities was creating a tower element that stood up above the rest of not only that building but the rest of the area of the campus and that drew you to the entry piece. That tower was over the entry, it brought you into the facility from a distance and then, once you got there, it drew you right down to the front door. So that's just one way of providing wayfinding at an extremely large scale.

Miranda McNamara Mace: 4:27 

Yeah, and then once you step into the building, you know that's where a lot of patients will need kind of the most help and, like I said, perceived wayfinding is probably one of the best ways to do that. Along with signage. That's a really important aspect as well. But using identifiable elements like art and graphics, color has been really important and has shown to be important when patients are navigating even clinical spaces. So using clinic entries as a color and then continuing that color into the clinics themselves, it kind of gives the patient a little bit more of an easy way to be independent in those wayfinding elements and when coming out of the clinic, finding their way back to waiting spaces in a more independent way.

Ryan Johansen: 5:07 

And one of the things I think we have done really successfully is make sure that those wayfinding elements are layer upon layer upon layer. Right, how your brain works and remembers things is different than from how Miranda's brain works, from my brain works and from Chris's brain, Right, we all are going to remember something different Absolutely. And as we layer those wayfinding elements with an image, with a different color, with a number or a letter with that texture, it's just giving those patients options to choose what they remember and can help lead them through the facility each time they come.

Matthew Gerstner: 5:47 

Yeah, I can see how people would remember things differently, because really everybody's reality is different, based on how you perceive and how you process. Yeah, it's amazing.

Chris Fischer: 5:59 

Right, and some of that's cognitive and some of that's just directly how you see things, right. Right, having the ability to use textural elements, having the ability to have impact from a contrast point of view. Maybe your vision isn't very strong at all in this situation and it's really dependent on contrast, not so much color or even picking stuff out, but having that ability to define areas through contrasting elements. Amazing.

Miranda McNamara Mace: 6:27 

And that's one thing to consider. Just to jump on to Chris's point, contrast is a huge portion of the design process when we're looking at floor patterning and even large scale graphics. Cognitive patients, you know, see those that contrast differently than other patients. So you know making sure floor patterning doesn't have a high contrast, because a lot of times they may perceive that as you're taking a step or that you're not allowed to go into that area just with the high contrast of flooring materials. But that also is then the perception to on wall surfaces having high contrast wall graphics can sometimes be dizzying and confusing. So really keeping a really calm, healing environment, while also adding a lot of our design elements too, but just taking that into consideration when planning and designing a space.

Ryan Johansen: 7:13 

I think another important issue is, beyond the cognitive issues that we've been talking about, are those mobility issues. A patient that has experienced a spinal cord injury is now confined to a large wheelchair that maybe they're operating with their head or something like that is going to take a lot more space for them to maneuver around a door swing, for example, or into a hallway, into an exam room. So making sure that these spaces have adequate space for them, not only for those turning radii, but think of a lobby waiting area. Now we need larger waiting areas that aren't jam-packed with seats that people are going to sit in, because a wheelchair person needs to come in and park somewhere in there. So oftentimes we hear that oh, that waiting room. You know why is it wide open spaces? Well, it's because there are so many, so many of these patients have their chair with them. They need a place to park.

Matthew Gerstner: 8:18 

Really sounds like there's a lot, a lot of different things happening here to accommodate, you know, these patients because of the range of issues that could potentially they could potentially have right amazing and oftentimes they're not coming alone to these of course to these.

Ryan Johansen: 8:35 

Someone with a cognitive issue may not be able to come alone, right, they're oftentimes there with a caregiver or a family member or a family. Right, there could be multiple people that come to these, these appointments, really trying to understand what's happening with grandma, you know. So, accommodating some spaces not to say that every space needs to accommodate a family, but you need to have spaces that will accommodate those families as well. Make sure that everybody feels taken care of.

Chris Fischer: 9:09 

And along that line, we spoke a little bit earlier about wayfinding and helping people define or find the entry. Well, that's the other challenge. Especially in this day and age, with both family members dropping people off as well as people bringing themselves to the facility, you need to do the best job you can to define that entry and make it as adjacent to the parking facility as well, and so in that particular case, not only do you have to define the main entry to the building, the potential drop-off area, but also the area within the parking structure that brings you into the building and hopefully that brings you very close to that main central entry point, and again, being very cognizant of the fact that that needs very good wayfinding elements as well.

Ryan Johansen: 9:56 

Not to mention those vehicles that are bringing a lot of those patients are much larger vehicles. Right, you've got the van, you've got the metro mobility bus that you know you need to have accessibility around those, so space at that front entry is a premium.

Miranda McNamara Mace: 10:13 

And then going back to the wayfinding in the parking garage itself. A lot of times we like to translate that directly into the interior of the facility as well. So consistency is a really important thing to have. Patients will start to recognize those repeating elements and then with that, then that's an additional perceived wayfinding element that is helping you navigate the building.

Matthew Gerstner: 10:31 

With the range of conditions that people might have. I have to imagine that there is a lot of advanced technology that is occurring within these spaces. How does this play into the design considerations?

Chris Fischer: 10:43 

I think one of the biggest parts of that, especially in this day and age and for the facilities and the people who manage the facilities, is the ability to express that technology, so that people who are coming to the facility know what the facility is capable of, and being able to translate that into actual therapeutic care. How does that make a difference for them? How does that evolve into their potential cure, if you will? And so we make a high priority in that situation to allow for that technology to be expressed in more of the public and common areas than I think it used to be in the past.

Miranda McNamara Mace: 11:23 

Okay, I think technology at the forefront is a good concept for that Really having it be on display, have visual cues into 3D printing spaces or virtual reality. That's something that we've found has been kind of a helpful key for patients to understand, you know, different visuals and how things may be translated in a virtual world.

Matthew Gerstner: 11:42 

Yeah, it didn't even occur to me that there would be virtual reality or 3d printing spaces in one of these facilities. How does that come into play? So?

Chris Fischer: 11:51 

one of the key factors. Obviously you're dealing with a very complex and sensitive arena in the brain and the spinal cord, and so these neurologists, these neuroscientists, they want to do a great job of mapping anything out in advance and also sharing that care process with the patient. And so virtual reality is an ideal scenario. It's not like you can just open up the skull and look in there and say, hey, this is what we're going to do today, folks. And so having 3D models that people can hold on to and get an understanding of where things are actually at in the brain and where things might be, you know, dysfunctional in the brain, showing that aspect of it, we certainly everybody understands the idea of MRIs and that type of imaging. But if you can take that virtual picture, bring it into a room and show people exactly the process, there's a certain comfort that comes with that Right, Right and and when you're manipulating things in the unknown, I think the more education you can give, the better off you are, and virtual reality is a great venue for that.

Ryan Johansen: 12:57 

Yeah, I've seen lots of images. Could I understand what it was? Not one second, right. But if you, if you take that MRI image and put it in a 3d model and and can show a patient, okay, here's what's happening in your brain and here's where we're going to go to to take care of it, or how we're going to take care of it, it gives them a sense of relief and and it also gives the staff a sense of understanding Okay, this is what we're doing. So when it's game day, it's Super Bowl time, let's go, we're ready.

Matthew Gerstner: 13:31 

I can see how that actually helps build confidence too, between the patient and the staff. Trust, yeah, a lot of trust.

Chris Fischer: 13:40 

It's amazing and we can certainly continue on with some of the technology pieces as things are going forward as we're going. There's certainly a research aspect and we've added those labs and it's a big part of what they call translational care, whether you're going from the bench to the patient or the clinical aspect of it more directly. And in at least one of our neuroscience facilities they have that they're really studying from a research standpoint the application of different therapies gene therapies in this case, um, for looking at ways to help take care and solving Alzheimer's, for instance and so these are big parts of of the clinical aspect of this is doing the research and with the new tools like CRISPR and other pieces of the puzzle that have come into play in the last couple of years for gene editing, that gives these neurologists another tool to help apply care for many of the very challenging diseases that you see in the nervous system Amazing.

Miranda McNamara Mace: 14:52 

And another layer to that is art and music therapy. So that's been studied and shown that has helped patients as well. So doing collages, water painting, things like that in an art therapy space, along with music and being able to play music and hear music, has been shown to also help as well.

Matthew Gerstner: 15:08 

I love that. That sounds like a fascinating side to the science of working in neuroscience.

Ryan Johansen: 15:15 

Yeah, I think we always think of a rehab space to get up and walk again or to increase your mobility or things like that, but there are also those alternative therapies that really help both in the physical and the mental aspect.

Chris Fischer: 15:30 

Absolutely Right. One of the pieces that you can find with art therapy, just like anything else. Anytime you try something new and engage your brain again right, there's new pathways and new connections that can be made within the brain right, and so what they found is music and art and those types of therapies are really, really good at engaging these new pathways and finding new ways to think about things and engage those patients, which has alternative results, right.

Matthew Gerstner: 16:02 

Right, maybe we'll get some funding back into the schools for the arts then.

Ryan Johansen: 16:06 

right yeah let's do it. I think another technology aspect is some of those technologies that are useful in adapting to what you, what disorder you may have, right, so adaptive technologies such as recording your voice or voice recognition, kind of things. How do you, how do you keep people living the way they want, to live in their, in their homes, with their loved ones, for a longer period of time, without having to go into an assisted living type of situation or a nursing home? So what are those technologies that can help people live out their lives to the best of their abilities?

Matthew Gerstner: 16:51 

Yeah, I mean, it's so true because people people take so much pride and confidence in their independence, yeah. So yeah, the longer we can keep them with their families or living on their own is amazing. I love that, yeah.

Chris Fischer: 17:05 

Yeah, and along those lines, the science of that connection between the brain and these potential machines, that aid in mobility, aid in standard occupational processes for us as humans, is come a long way and these, uh, neuroscience facilities are engaging in that and it is really just part of the clinical process now, wouldn't you say yeah?

Matthew Gerstner: 17:32 

so what are some of the challenges you think you've faced on past projects, then?

Ryan Johansen: 17:37 

I think that number one challenge is helping owners understand that this is not a primary care facility. Okay, when you're thinking about, oh, this is a neuroscience clinic, let's just put up a primary care clinic, and the two of them are very different. You need you need that additional space, you need bigger doors, you need the wider hallways, you need those larger exam rooms, you need those wayfinding elements that are that are going to bring you through the space and and make it easy to navigate for this patient population. So it's just a different population and we need to take that into consideration.

Chris Fischer: 18:16 

So a specific piece to that would be when we're designing the exterior of the building. Certainly, we always want to provide access to daylight. It's huge for wayfinding, right, and it's also great to have views, but it allows you to set exterior landmarks, or, as you're moving through the building, you can always reposition yourself on the planet if you will. Where am I? Where am I, instead of just being inside a building with corridors all around you, right? Yeah, to go along with that, though, we need to be conscious of the daylight that is coming in and the glare associated with that daylight.

Chris Fischer: 18:51 

Daylight that is coming in and the glare associated with that daylight. A lot of these patients are very susceptible to glare. People with who's had concussions and are going through that may be highly susceptible to daylight and glare issues, and so having a potentially a dynamic facade is one way to handle that. We've looked into that. On projects where the glass can respond to the amount of daylight or the amount of sunlight coming in, okay. Or there's ways to handle it with exterior shading devices and so forth to allow for viewing out, but take care of most of the glare and knock down most of that direct sunlight that's coming into the building. Yeah, that's a really key aspect of these facilities providing the view, providing the access to daylight for wayfinding but at the same time, knocking down or eliminating the glare that comes with that.

Miranda McNamara Mace: 19:44 

And I'll also add shadows with that. So I had talked about a little bit of the floor contrast. So when shadows are casted onto the floor, a lot of times people could perceive that as a step or something along those lines. So being really careful with how the daylighting is coming into the space and how others may see that.

Chris Fischer: 20:00 

Yeah, one other thing that we were going to add to that and this is an evolving thing and a challenge, I think, that we've come across more and more it stems from primary care, but it's definitely occurring in this situation is how do we provide enough waiting space but not too much waiting space?

Chris Fischer: 20:18 

And one of the things that evolved in one of our latest projects was not only it was kind of a synergistic effect we allowed for less steps to get to the waiting space and, at the same time, position the waiting space so that it could see all of the entry clinic spots, and so it was a different way of thinking, because a lot of times we're like, hey, we want to get you down to your waiting area and you sit outside your door, but that means okay, if you're down at area number five or whatever else it is. That's a lot of steps to get down there and more potential to get lost along the way or whatever else that is. And so in one of our latest projects, we were able to centralize that waiting area, allow viewing to each and every potential door that you came into and then synergistically along that path, we were able to eliminate probably 40 of the steps that you needed to get to there.

Matthew Gerstner: 21:12 

Yeah, that's an interesting concept.

Miranda McNamara Mace: 21:16 

Within that waiting space itself. So furniture plans were really important to us too, creating these smaller groupings of furniture in a wide, vast, a little bit of a larger waiting space. Creating these smaller groupings really helped people feel more familiar in the space, a little bit more condensed, versus sitting in a space that has rows and rows and rows of furniture, kind of creating these little like living room effects.

Miranda McNamara Mace: 21:36 

So you know, sofa and a couple chairs, then families can gather into those smaller areas, but then those are directly related and sitting right out front your clinic entries as well. So yes, it was super nav. It was something that would be easy for navigation but also kind of feeling like you're in a familiar environment yeah.

Matthew Gerstner: 21:51 

Yeah, I can see how that could be calming and kind of give you a sense of confidence too if you're nervous about being there or if you have any kind of sensitivity issues. Yep, that's very cool.

Ryan Johansen: 22:02 

I think another challenge, Matt, that we often see is where that care team is located.

Matthew Gerstner: 22:08 

Okay.

Ryan Johansen: 22:08 

Oftentimes, again, this is not a primary care clinic. Making the or having the care team really connected with the patient is important. These patients are there, they don't know what they're going through, they're, they're in fear oftentimes, and if they're left to their to themselves, then then there's still the unknown right. But if they, if they can see the care team and the care team can see them. So you know, bringing that care team connected into the, into the core of the exam rooms and the and the patient spaces, versus having them often a staff restricted, only corridor in the back is is very important and beneficial for for the patients themselves and for the care team in collaboration and dealing with those complex yeah patient population I can see that.

Matthew Gerstner: 22:58 

How that would help build relationship too with your team incredible. So what does an optimal stakeholder and community engagement process look like?

Ryan Johansen: 23:09 

at bwbr, where our process is very collaborative right, we want to seek engagement early and often and this is no different, I would say the leaders of these departments are always in the conversation early and up front. But oftentimes that frontline staff they're the ones that know the real story and how things really work. So we want to engage them early as well and to get that underlying story behind what's really happening. But nothing can replace the patient engagement. They're the ones that have the ultimate decision on is this a place that I come to seek my care or am I going to go somewhere else? And do I feel comfortable? Do I feel valued? Do I feel valued? Do I feel like I'm going to get the best care here? So, establishing a patient advisory group early and having conversations and bringing them into the loop, asking for for what, what are they looking for what? What's going to meet their needs? And addressing those throughout the entire process, versus waiting until the design process is done and then saying here's what we're going to give you. How does that work?

Matthew Gerstner: 24:18 

Then it's too late. That sounds like a very bad way to go about things. To bring them in at the end.

Ryan Johansen: 24:25 

Yeah, yeah, we've had. We've had clients. You know, even at the end of a visit they'll during the design process. They'll show like OK, here's the latest exam room that we're looking at. What are your thoughts with this? Would this accommodate with you? Would this accommodate the other family members in the room? Have that conversation? So getting that feedback when it's lines on paper is is very valuable to make sure that we're spending our money wisely.

Matthew Gerstner: 24:50 

I say it's probably a whole lot less expensive than doing it after it's built, you bet.

Chris Fischer: 24:55 

Yeah, and, and the other aspect of that and then it's usually done is is seeing what's out there. What are what's everybody else doing in this area? Touring other facilities is critical. What do you like about this facility? What? What's working here? Do you think what's not working here? And it was really interesting to see, you know how clients of ours got to certain conclusions on things that we may have walked into and said this looks amazing, how is this working?

Chris Fischer: 25:26 

And they were like really, uh, this piece here doesn't work for our nursing staff like this, you know different specific examples that these folks who work in it every day can tell you that this is going to work or this works great Right. This is awesome. I'm glad we saw this Right. Precedents are key.

Ryan Johansen: 25:46 

Yeah, this is not neuroscience specific, but I don't think we do enough as a society to to learn from our failures. You know what are those failures? We? We fail every day, right, but what did we learn from it and how do we bring that forward and make it better?

Matthew Gerstner: 26:00 

So yeah, that's the true Testament to growth. If you're not learning from your failures, you're not growing.

Ryan Johansen: 26:07 

Yeah, yeah.

Matthew Gerstner: 26:09 

So, in in all this discussion about what's going on, are there any emerging trends or technological advancements you see on the horizon that neuroscience facilities might need to account for?

Chris Fischer: 26:22 

Well, I think we touched a little bit on it right now with with the idea of gene therapies and gene editing. I think you're going to see more and more research facilities that are going to be placed within these facilities so that there is this translational piece, and I'll explain that a little more. But the idea is that the quicker we can find a cure, quicker we can get it to the clinical side of things, quicker we can get it to the clinical side of things. And then, as we were just talking about, as Ryan was alluding to before this, this back and forth between patients and clinicians and the idea that, uh, that can then translate back to the researchers. How quickly can we get this from the bench to you know, the the table is really the key aspect of this, and I think you're going to see that trend go a lot faster, at least from the molecular biology side, with this advent of CRISPR and gene editing, and literally there are folks who are out there because we also dabble a lot in the science and technology area as well that see the future of a lot of you know diseases being tracked with a recombinant approach, messenger rna's being translated into proteins and and gene editing in that respect, taking on the clinical side of things, and they are really getting to a point where they can.

Chris Fischer: 27:55 

It's very costly in that regard, but get to a point where they can actually treat individual disease conditions. But the more individualized it is, the more costly it is. But tracking gene therapy will be huge for the clinical realm in general, but especially, I think, in neuroscience, because again getting into the brain and working inside the brain is very complex and we have a long way to go to understand that complexity.

Matthew Gerstner: 28:24 

Yeah, I mean, it's the most powerful computer on the planet, right yeah? And we haven't been able to replicate it yet, even though people are trying the other part of it that we talked a little bit more.

Chris Fischer: 28:37 

Uh, we touched on a little bit earlier, but is is just this advancement between humans and machines, right, um ai and robotics and having machines potentially become your hands Again. We know how complex it is, we know how sensitive the brain is and the spinal cord, and so being able to be as precise as possible utilizing our other technologies is absolutely critical, and seeing how that comes into play will be very interesting in the very near future. Yeah.

Matthew Gerstner: 29:13 

Well, I'm sure a lot of people have heard of Neuralink. I mean, it's in the news quite a bit and you know that's a whole technology that's being adapted to directly connecting and interfacing with the brain and being able to run things by thought. That's so yeah, I can see how the technology can just change someone's life too, for the better. So how does all of this neuroscience work fit within BWBR's overall philosophy and approach to health care design?

Ryan Johansen: 29:43 

You know, we we seek out complex, you know, challenging projects, and I think this is this is absolutely no different. This is probably the most complex and challenging project type that I've, you know, experienced and been fortunate to work on. But breaking down that complexity into a simple process, a tried and true process is is really no different than than what they're doing on on their end, right Walking a patient through what they're experiencing, how they're dealing with it, what they, what can they do next. So I think our philosophy is is to take that complexity and and to simplify it and to engage as many stakeholders as we can to understand where their needs are and make sure that we address all of their collective needs simultaneously well here is is listen to our clients and help them attain their vision for their projects or help them achieve their goals individually or as a whole for their projects, and that's where we really excel.

Chris Fischer: 31:02 

And let's be honest, none of us in this room are are neurologists. None of us are uh, not even close, not even close. So it's imperative that we are really good listeners so that we can help them achieve what they're looking for in each of their environments, and that's what makes us successful. We're good at listening and good at advising in our realm, but we need to take their expertise and turn it into space.

Miranda McNamara Mace: 31:34 

That was a fantastic summary that was great.

Matthew Gerstner: 31:36 

Is there anything else?

Chris Fischer: 31:37 

we haven't touched on that anybody wanted to talk about but the only other thing that I know that we didn't hit, there's this wonderful tiny aspect of these projects as well that gives it this great indoor outdoor quality for architecture okay, and that's the fact that rehabilitation for these projects is not only an indoor therapy process, whether you're in the pool or you're in there on different machines and working out with a pt.

Chris Fischer: 32:08 

It also takes place at an occupational level, where you go outside and you work out on ramps and stairs and different textures, on different paths or walking on the grass, because, remember, in a lot of cases you might be starting from very near ground zero for walking or moving or pulling, and so there's this wonderful synergy between a therapy garden we can create and an actual outdoor landscape sanctuary that's out there, and so that's the other wonderful aspect of these projects is that you, you get this inside outside aspect. That also means that maybe your cafe can spill out to the outside and all of this becomes this wonderful public room associated with healing, and so I think that's a very important aspect, that is a great complement to the overall building design and it's a place where people can come. People can come and whether you have any sort of neurological disorder or not, and feel a place of respite, and that could be for the staff, that could be for the patients, it could be for the potentially the general public.

Ryan Johansen: 33:22 

Yeah, and, like you said, you don't really know if you're in therapy or not. Right, you're blending those lines and you could be at the cafe, right, and still receiving receiving that therapy.

Miranda McNamara Mace: 33:36 

And that's that's why it was important to us to also, you know, do a little bit of research on biophilia, like, how can we bring the outside in, kind of have those experiences indoors as well as having the views to the exterior, but having patients to be able to experience plants and green walls and maybe it is more of a blue or green color palette, something that's you find in nature a little bit more so and have it again be a familiar aspect to the interior experience as well?

Miranda McNamara Mace: 34:04 

I love that you brought that up, because we've been kind of talking a lot of techno there were other things too, but yeah yeah, just, you know, using materials that are warm and soft and a lot of eased edges. You know, like geometry a lot of times isn't perceived how you'd want it to be, but kind of using just soft curves, softness plants, yeah, ways to break up space in more of a natural way.

Chris Fischer: 34:29 

Love it. You probably hit on this before, but just hit it on it again Natural materials, stones, woods, other things that make people feel comfortable in these environments.

Miranda McNamara Mace: 34:39 

Familiar, I think, is a really key word.

Matthew Gerstner: 34:42 

That was the word that I thought of the second. You both started talking about it. It's all very familiar. Yeah, that's fantastic.

Ryan Johansen: 34:48 

Well, and I think you know we're talking about neuroscience, specific projects, right, but I've always said every project is a health care project, right, like any of the principles that we just talked about can apply to any project. Right, we want to bring that natural light that outside in. We want to use the biophilia, we want the technology you know on display. We want to utilize all that stuff. We want spaces that are um, are not mobility limiting, right, right, um, we want to design all of that stuff into all of all of the different um projects that we, that we utilize yeah, it sounds like the trick is what's the best way to do it for each client so that it fits their needs?

Matthew Gerstner: 35:35 

Wonderful, can't thank you all enough for being here today. Thank you so much for your time, all the insights that you've provided. It's been a great conversation.

Ryan Johansen: 35:43 

Thank you. 

Miranda McNamara Mace: 35:44 

Thank you.

Matthew Gerstner: 35:45 

Thanks, matt.

Matthew Gerstner: 35:46 

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