Developing a tool to assess the performance of educational built environments for students with multiple sclerosis

ABSTRACT Statistics indicate that cases of multiple sclerosis (MS), which can cause mobility and sensory disabilities, are increasing worldwide. While design criteria for educational built environments that meet MS students’ needs have been researched, the creation of holistic design guidelines (DG-MS) has rarely been investigated. This study uses holistic DG-MS to create an educational building performance assessment tool (MS-BPAT) to evaluate the suitability of educational built environments for meeting MS students’ needs. A multimethodological approach is used in which academic and medical experts evaluate the MS-BPAT for its importance, affiliation, and clarity. The MS-BPAT is then tested by assessing two high school buildings in Dammam, Kingdom of Saudi Arabia. The results indicate that the MS-BPAT tool can accurately assess the fulfillment of MS-DG design criteria in educational built environments and detect the design barriers. The MS-BPAT’s validity as an assessment tool is confirmed by comparing its results with field visits, interviews, and student satisfaction. The MS-BPAT is then finalized, and recommendations are made for improving educational built environment performance to meet the needs of students with MS.


About the research
In recent years, there has been a significant worldwide increase in the number of multiple sclerosis (MS) cases.In 2013, an estimated 2.3 million people were living with MS around the world; by 2020, this number had increased to 2.8 million (Atlas of MS, 2020).This devastating disease is the second most common cause of disability among youth after traffic accidents.MS is an autoimmune disease that affects the nervous system, including mobility and sensory abilities (Aljomah, 2017).It also affects the quality of life, employment, social relationships, and patients' productivity (Dilokthornsakul et al., 2016).
Over the past four decades, research and regulations have evolved, including many parameters to promote access to and use of buildings by persons with disabilities (Rovira-Beleta, Cuerva, Pires de Souza, Planas, & Alavedra, 2015).Furthermore, many studies have emphasized innovating architectural design practice based on the needs of disabled people and their particular interaction with the built environment, contributing to a more inclusive built environment (Heylighen, Schijlen, Van der Linden, Meulenijzer, & Vermeersch, 2016).Nevertheless, relevant research and educational institutions are not paying specific attention to MS and to its spread, classified in Europe and the United States as a disabling disease.They have also not identified how to provide appropriate, safe, and effective facilities for youth affected by MS, especially educational buildings, and spaces, which provide social, cultural, and recreational resources.Youth with MS have the right to live normal lives with their peers to not adversely affect their psychological composition and health (The National MS Society, 2010).
According to the 3rd edition of the MS Atlas, 2020, there are 2.8 million people living with MS globally.Based on 75 reporting countries, statistics show that every five minutes, someone, somewhere in the world is diagnosed with MS.MS can occur at any age; however, the average age of diagnosis globally is 32 years.Nevertheless, there are at least 30,000 people living with MS who are under 18 years, based on data from 47 reporting countries.Globally, there are twice as many females (69%) with MS as there are males (31%).In the Western Pacific and Southeast Asia regions, there are more than three times as many females than males with MS (Atlas of MS, 2020).
In Saudi Arabia, 13,120 people have MS (Atlas of MS, 2020).As mentioned by the Saudi National Society for Sclerosis, approximately 7-10 cases are recorded daily, and this number is increasing annually.In contrast to the global average age, the highest incidence rate is among young people (aged 15-20 years) in Saudi Arabia.They represent 75% of the MS population, and the number of females is three times higher than the number of males.Depression in this group has been estimated at 90% and suicide attempts at 30% for the general MS Saudi youth population (Aljomah, 2017).Nevertheless, their cognitive skills remain the same as they were before the disease; hence, it is essential that they lead normal lives with their peers without being isolated or separated in educational buildings (Aljomah, 2017).
This study expands on the Mohjah and El-Wakeel (2021) study, which took the lead in developing a holistic Design Guideline for MS students (DG-MS) to create educational built environments that would meet these students' sensory and mobility needs.In this study, we investigate, through two case studies, whether the designs of the selected educational built environments consider the needs of MS students.If they do not, does this become an obstacle that prevents this student group from using the same spaces as their peers?Failure to do so may affect their performance and depression levels.This study aims to identify the need to develop a building performance assessment tool (MS-BPAT) that can evaluate educational built environments and their suitability for MS students.Such a tool can evaluate the status of the schools' buildings and identify how to fix their educational built environment and make it friendly to students with MS.This can be achieved by the following objectives: (1) A comprehensive review of the DG-MS to create the preliminary performance assessment tool (MS-BPAT), which is a checklist to assess the performance of educational buildings with MS Students.
(2) An assessment of two cases of high school building environments to evaluate their suitability for MS students' and validate the MS-BPAT.

Literature
According to the definition given by the American National Society for Multiple Sclerosis, MS is a serious autoimmune disease and major cause of disability that affects the central nervous system, including the brain, cerebellum, brainstem, and spinal cord.This leads to an imbalance in the transmission of messages and information from the brain or spinal cord to the rest of the body, and the mechanism transmitting information may be completely disrupted.The exact cause of the disease is unknown.It usually affects people aged 15-60 years and is considered three times more serious for affected women than affected men (Jelinek, 2016).Symptoms vary from one person to another and include vision disturbances, muscle spasms, numbness of the extremities, problems with bladder control, and difficulty speaking (Brown, 2011).MS can cause a variety of mobility and sensory changes, and each person's symptoms can change or fluctuate over time (Carter, 2011).It affects most of the mobility functions in the body (Young, Pranav, & Layne, 2020).The most important symptoms and changes in mobility include problems with walking and balance, muscle spasms, nerve tremors, and speech disturbance (Pottker, 2014).Sensory changes include fatigue, constant fatigue, pain, visual disturbances, numbness of the extremities, and high body temperature (Harmon, 2016) Several studies have examined quantitative and qualitative criteria for creating educational built environments that meet MS students' needs.Polman, Thompson, Murray, Bowling, and Noseworthy (2002), for example, noted some built environment guidelines in a study that mainly focused on the treatment and management of MS patients.Helm et al. (2018), meanwhile, studied MS students in academic settings and created a handbook to help school personnel meet those students' needs.This handbook covered various issues related to children and teens with MS, such as the visible and invisible symptoms of MS, its cognitive symptoms, and the necessary accommodations and modifications in school settings.The handbook specified 83 accommodations and modifications for school settings.Only 10 focused on the physical environment, placing special emphasis on the location of seats; the others focused more on lessons, assignments, test taking, and various special personal considerations.Most studies in this area mention educational built environments in the context of various other medical or educational issues.Yet, no study has comprehensively aggregated all design guidelines for educational built environments.This is the gap the present study aims to fill.
The authors' prior research (Mohjah & El-Wakeel, 2021) forms the cornerstone of the present study.We conducted a detailed literature review for disease mobility and sensory symptoms as well as MS student needs in areas such as main entrances, classrooms, vertical and horizontal circulation, and toilets.This resulted in the creation of the comprehensive DG-MS, which includes guidelines mentioned in existing literature and guidelines developed based on the study's results.These guidelines are essential for ensuring that educational buildings meet MS students' needs and are efficient and suitable for them.This includes quantitative criteria related to the dimensions and qualitative criteria related to the materials and colors used.The current research is based on the results of this 2021 study as will be explained in the methodology section.

Methodology
This research employed a multimethodological strategy within a broad case-study-based design, as summarized in Figure 1.This study is a further step in an initial review of the criteria explored in the Mohjah and El-Wakeel (2021) study, which led to the development of a holistic design guideline (DG-MS) for educational built environments that meet MS students' sensory and mobility needs.All literature and MS students' opinions were covered in the 2021 study.The DG-MS enabled this study to deduce a building performance assessment tool (MS-BPAT) checklist.This checklist evaluates the level of achievement for each criterion in each zone or component of the four areas of the DG-MS, and it detects whether each criterion has become a barrier if it is not achieved.This can be used to evaluate the suitability of any educational built environment for MS students' needs.
Every point of the MS-BPAT checklist was validated by two architecture academics and one medical expert for its importance, affiliation, and clarity.The accuracy and effectiveness of the MS-BPAT checklist were tested using two case studies involving multiple field visits to two high school buildings in Dammam, Saudi Arabia.The researcher made contributions to understanding what MS students go through based on their diagnosis and experiences.The results were then verified by an in-depth interview with the school's representative person regarding their observations about the MS students and their complaints.One of the authors conducted the fieldwork (checklist, measurements, and interview) with the assistance of a research professional with master's degree from the college of design research hub of Imam Abdulrahman Bin Faisal University under grant number 2020-057-Des.The professional obtained the interviewees' approval, recorded the interviews, and took the photos.
Two case studies were used to test MS-BPAT and to address the value-laden and context-specific features of the design criteria from a field-based approach.The tenth and fifth secondary schools in Dammam City were selected based on the following criteria: . Schools considered having a high number of MS students based on assistance from the Saudi Society for Sclerosis. .Secondary school for girls to satisfy 'females from 15 to 20 years', the highest incident group.
. Schools that represent one of the two architectural design prototypes of governmental schools in Dammam area.
The tenth secondary school (Case Study 1, C1) represents Prototype 1 with a typical plan and construction supervised by Aramco Oil Company and the fifth secondary school (Case Study 2, C2) represents Prototype 2 with a typical plan and construction supervised by the Saudi Ministry of Education.Therefore, results can be generalized and applied to all similar schools in Dammam City.

Data collection tools
The MS-BPAT checklist (Supplement 1) was used during field visits to assess the performance of the educational built environments of two cases in response to the sensory and mobility needs of MS students by measuring the level of achievement of the DG-MS criteria.The design of the MS-BPAT checklist followed the same four sections of the DG-MS: . Section 1: The main entrance area.These include drop-off areas, sidewalk ramps, and entrance ramps. .Section 2: The classrooms, including lighting, thermal comfort, color, spatial organization, circulations, furniture properties, doors, windows, walls, and teaching technologies. .Section 3: The vertical and horizontal circulations, which include design criteria for vertical circulation elements (e.g.elevators and stairs) and horizontal circulation elements (e.g.corridors). .Section 4: The bathrooms, which include design criteria for the location of the toilet in relation to the classroom and material properties.
The in-depth interviews were conducted with the representative persons during the field visits.Two teachers who supervised the education of students with MS were interviewed from each school, in addition to the main entrance security at each school.Questions covered their direct observation of the MS students' reactions and complaints if they faced any problems or missed any of the design criteria that directly and significantly affected the needs and behaviors of the MS students.Thus, explanations were possible for the information collected by the MS-BPAT checklist.Supplement 2 presents the interview, its objectives, and questions for each section.
The results of the MS-BPAT checklist and the interview aimed to cover all the physical and observed needs and problems of the MS students; however, it must be mentioned that the MS students were not interviewed as their direct feedback and satisfaction were covered in the 2021 study.Therefore, their satisfaction rate is used during the discussion for further proof of the measurement accuracy of the checklist.
During the field visits for Cases C1 and C2, the fulfillment of the MS-DC design criteria in the four main sections listed above was observed, assessed, photographed, and recorded on the MS-BPAT checklist.The ratio of achievement of each criterion in each section was calculated according to its presence in the MS-BPAT checklist to detect barriers.A content analysis was conducted using the photographs as well as the measurement of some elements' heights and dimensions.The results were then compared with the interview results for verification.The general satisfaction of students measured in the 2021 study was also discussed to emphasize the importance of each criterion in the educational built environment.

Main entrance assessment results
The entranceway is an important architectural element in educational buildings because it forms the connection between the outside and the inside.Its suitability for MS students' needs is an indication of the school's receptiveness and interest in the presence of these students.The main entrance consists of three main zones (drop-off, pavement ramp, and entrance slope).Based on the abovementioned GD-MS framework (Alabdullah & El-Wakeel, 2022), the main entrance has 13 design criteria that combine descriptive and quantitative items (Supplement 1).
The MS-BPAT checklist result showed that 70% of the MS design criteria for the main entrance were achieved in C1, and 38.5% were achieved in C2.The lowest achievements were in the pavement ramp zone criteria (20% and 0%, respectively) while the best was the entrance ramp zone (100% and 75%, respectively) (Table 1).
This result was verified by the interviews, where the representative person in C2 confirmed that MS students asked for help when getting out of the car and heading to the main entrance because of their double vision.Thus, the need for a strong indicator or color on the pavement to clarify the path of movement.Missing this color is considered a design barrier (Figure 2).
This result was also mentioned by Helm et al. (2018), who noted that visual symptoms are the first type of symptom in many MS patients, affecting approximately 80%.In their 'Handbook for School Personnel', Helm et al. (2018) mention three major types of visual symptoms: 1) optic neuritis (inflammation), causing temporary loss of or disturbance in vision, changes in color vision, and sometimes pain in the affected eye; 2) double vision (diplopia), caused by a weakening or incoordination of eye muscles; and 3) nystagmus (arhythmic jerking of the eyes), which often does not have noticeable symptoms.√ √ The width of the paved ramp is not less than 90 cm, and the width of the sides is not less than 125 cm.

√ √
The slope of the pier is at least 1:12.√ √ Total 20% achieved 0% achieved Entrance ramp criteria The surface of the ramp is yellow and non-slip (epoxy).
√ √ The width of the entrance ramp is not less than 90 cm and does not exceed 140 cm.

√ √
The entrance ramp slope is no more than 1:20.√ √ The width of the ramp's landing is not less than 120 cm.√ √ Total 100% achieved 75% achieved Total evaluation 70% of the criteria achieved

38.5% of the criteria achieved
Source: the research.These results are also confirmed by the general satisfaction of the MS students with regard to the main entrance area mentioned in the 2021 study, as the maximum level of dissatisfaction was 50% (n = 75) for MS students who were dissatisfied with the pavement ramp zone, while only 22% (n = 33) were dissatisfied with the entrance ramp zone in their schools (Alabdullah & El-Wakeel, 2021).General dissatisfaction with the main entrance was 55%, which confirms the MS-BPAT checklist total criteria achievement average for the two schools, which is 54.3%.This demonstrates its validity as an assessment tool.

Vertical and horizontal circulations assessment results
Vertical (stairs and elevators) and horizontal (corridors) (V&H) circulations are important architectural elements in educational buildings, which connect all building areas either horizontally or vertically.The circulation elements should not be a barrier or an obstacle to accessing any space.Circulation in educational built environments consists of three main design zones (elevators, stairs, and corridors).Based on the abovementioned GD-MS framework (Alabdullah & El-Wakeel, 2021), the V&H circulations have 16 design criteria that combine descriptive and quantitative items (Supplement 1).
The MS-BPAT checklist result showed that only 12.5% of the MS design criteria for the V&H circulations was achieved in both C1 and C2.The lowest achievement was in the elevator criteria, where 0% was achieved in the two case studies (C1 has 1 elevator but not working and C2 has no elevator), followed by staircase criteria where 16.6% is achieved in the two case studies (only one criterion out of 6 was achieved, see Figure 3), while the best was the corridors criteria where only 33.3% was achieved in both cases (Table 2).These results show that the V&H areas in the two case studies can be considered design barriers, and this was also verified by the interviews, where the representative persons in C1 and C2 said that MS students were late to their classes and requested to have their classrooms on the ground floor.This is also confirmed by the general satisfaction of the MS students about the V&H circulation areas mentioned in the 2021 study, as the maximum level of dissatisfaction was 85% (n = 128) for MS students who were dissatisfied with the elevator, while only 60% (n = 90) were dissatisfied with the corridors in their schools.The general dissatisfaction with the V&H circulations was very high (n = 113), which represents 75% of the MS student sample (Alabdullah & El-Wakeel, 2021).This confirms the low total criteria achievement average (12.5%) for the two schools measured by the MS-BPAT checklist, thus demonstrating its validity as an assessment tool.
Based on the field visits and interviewees' reports, it was noted that MS students need to lean on a horizontal element attached to the wall (handrails) to support walking and motor needs.Such elements were not available in the two case studies (Figure 4).This finding supports previous literature regarding lower body adaptation and extends those findings to the realm of gait.Young et al. (2020) identified the gait parameters of step length, step time, and double support time.Handrails

Elevator criteria
The elevator button panel is constantly illuminated.√ √ The elevator keypad is on the front wall if the entrance is in the middle and on the sidewall if the entrance is on the side.

√ √
There is a handrail on three walls inside the elevator.√ √ The dimensions of the elevator cart are 129 × 203 cm if the door is in the middle and 137 × 173 cm if the door is on the side.

√ √
The height of the handrail in the elevator is 80-85 cm.√ √ The elevator keyboard panel is 90-120 cm.The highest button is at 120 cm and the lowest button is at 90 cm.

√ √
The width of the elevator door is not less than 91.5 cm.√ √ Total 0% achieved 0% achieved

Staircase criteria
The wheelchair lift is added to the stairs.
√ √ Lighting units are added along the edges of the stairs.
√  help MS patients adapt and overcome gait problems so they can take more stable steps.This criterion is missing from the MS-BPAT checklist and should therefore be added.

Classroom assessment results
The classroom-the vessel that embraces students scientifically and intellectually-is the most important component of the educational built environment.Its suitability to the needs of MS students positively affects their educational and psychological achievement and sense of equality with their peers.Classrooms should not be a barrier or an obstacle that hinders MS students from accessing their right to a normal education.Classrooms in educational built environments consist of eight main components: lighting, thermal comfort, materials, color, spatial organization, furniture, class borders and opening (doors, windows, and walls) as well as teaching technologies.Based on the abovementioned GD-MS framework (Alabdullah & El-Wakeel, 2021), the classroom area has 27 design criteria that combine descriptive and quantitative data (Supplement 1).
The MS-BPAT checklist results show that 29.6% of the MS design criteria for classroom areas were achieved in C1, and 18.5% in C2.The lowest achievements were in three components criteria, thermal comfort, furniture, and teaching technologies, where 0% was achieved in the two case studies, while the best was the color (100% for both) and the class borders and opening (50% for both), while lighting was 75% and 25%, respectively (Table 3).
These results were confirmed and verified by the interviews.The representative person in C1 confirmed a continuous demand from MS students to lower the classroom temperature to below a moderate temperature and have cooling directed at their seating areas.The representative person in C2 confirmed the same information and added that when the air condition was not working, some MS students suffered from convulsions.Additionally, MS students in C1 constantly asked to change their tables due to the low height and the students' inability to bend or use their wheelchairs (Figure 5).MS students also complained about the reflection of the light on the surface of the whiteboard, causing them headaches and temporary blindness (Figure 6).This was confirmed by Carter (2011), who found that the use of teaching surfaces reflecting light negatively affected students with MS and caused headaches, nausea, and eye muscle strain, leading to deviation of the eye over time.This is also confirmed by the general satisfaction of the MS students' classroom areas mentioned in the 2021 study, as the maximum level of dissatisfaction was 90% (n = 135) for thermal comfort, and 85% (n = 128) were dissatisfied with furniture in their schools, (Alabdullah & El-Wakeel, 2021).The general dissatisfaction with the classroom areas was very high (n = 135), representing 90% of the MS student sample, confirming the low total criteria achievement average for the two schools as measured by respectively).This demonstrates its validity as an assessment tool.

Lighting criteria
The type of industrial lighting used is fluorescent.
√ √ There is a source of lighting on the sides for users.
√ √ There is natural and industrial light dispersal.√ √ A light source is directed at the study surface.
√ √ Total 75% achieved 25% achieved Thermal comfort criteria Placement of a fan or source of ventilation and cooling to be directed at the MS student's sitting area.

√ √
The √ √ At least 70 × 100 cm space on the side of seating areas to store a wheelchair.

√ √
A cupboard near the MS student's seating areas is 70 cm high.√ √ The width of the movement path is not less than 90 cm.√ √ Total 40% achieved 20% achieved Furniture criteria The study tables have spaces for touchscreens and electronic books.
√ √ The tables have a water bottle slot.
√ √ The study seat's position is adjustable when needed, and its edges are round.

√ √
The study table height is min.80 cm and max.90 cm; the height of the table is adjustable to 19 cm above the seat of the chair, and its edges are round.

√ √
Total 0% achieved 0% achieved Class borders and opening criteria Doors open in both directions.√ √ The door handles have rounded arms coated with rubber.
√ √ The width of the door is not less than 92 cm.√ √ Windows have a width of at least 1.5 m. √ √ Total 50% achieved 50% achieved Teaching technology criteria There are no visual distractions around the teaching board, and the surface material of the whiteboard is not reflective of glare.

√ √
The teaching board is a touchscreen, and the size and brightness of the font can be controlled.

18.5% of criteria achieved
Source: the research.

Bathroom and toilet assessment results
The bathroom is one of the most important architectural elements in educational buildings for MS students because one of the common symptoms of MS is bladder inflammation and urinary incontinence (Young et al., 2020), which leads to frequent visits to the bathroom.Thus, bathroom criteria must be met to support MS students.Based on the abovementioned GD-MS framework (Alabdullah & El-Wakeel, 2021), the bathroom and toilet areas have 10 design criteria that combine descriptive and quantitative data (Supplement 1).
The MS-BPAT checklist results show that the total criteria achievement average is 80% for the bathroom and toilet areas in C1, and 40% in C2 (Table 4).These results were confirmed and verified by the interviews, where the representative persons in both case studies confirmed continuous complaints from MS students about difficulty using the toilet.This was due to the need for threesided toilet support rails, with appropriate dimensions to be able to use the toilet without assistance.Students either brought a caregiver to help use the toilet or requested assistance from their peers.This affected them both negatively by making them late to class.The narrow toilets and circulation in C2 bathrooms also do not support the needs of MS students (Figure 7).
The challenges of bladder and bowel problems are highlighted in many studies, especially bladder weakness, which occurs in approximately 70% of patients with MS.Therefore, many recommended considering the location, height, and dimensions of the toilets and toilet handrails during the design of educational buildings (Polman et al., 2002;Young et al., 2020).

Recommendations
This research recommends the importance of using the MS-BPAT checklist to ensure the suitability of educational buildings for students with MS.This will help future researchers and educational institutes upgrade their built environment to meet the needs of MS students and to prioritize these changes.The study also offers extra recommendations to improve the educational built environment for MS students, which are clarified below.

Main entrance design development recommendations
The results of the study revealed that there are design obstacles for MS students in the main entrances of female secondary schools in the Kingdom of Saudi Arabia (KSA).Therefore, some changes are needed to make the main entrance more supportive and appropriate for MS students' sensory and mobility needs, which adds to a sense of equality and integration.Some criteria have been achieved in both design prototype schools; however, the design development points can be summarized for the two high school prototypes in KSA (C1-Aramco and C2-Ministry of Education) as follows: . Provide a sheltered area in the drop-off area in front of the school entrance.
. Highlight the flooring color of the drop-off area with colors that contrast with the main floor color, preferably in yellow to emphasize the appropriate area for drop-off and to distinguish the movement path. .Add a standard pavement ramp with the width of the slope no less than 90 cm, the width of the ramp no less than 125 cm, and the slope of the ramp no less than 1:12.

Vertical and horizontal circulation design development recommendations
The results revealed that MS students face design obstacles in the circulations of female secondary schools in KSA that did not support their sensory and mobility needs.Some standards have been achieved in both design prototype schools; however, the design development points and recommendations can be summarized from the studied prototypes in KSA (C1-Aramco and C2-Ministry of Education) as follows: . The elevator is a main vertical circulation element that should be added to school buildings.
. The elevator keyboard should be illuminated continuously and located in a central location on the front and side walls.If the elevator door is not centrally located, its height should be 90-120 cm, so that the highest button is at 120 cm and the lowest button is at 90 cm. .The dimensions of the elevator body, if the door is central, should be 129 × 203 cm.If the door is located on the side, the dimensions should be 137 × 173 cm. .There should be handrails on the three sides inside the elevator, its height should be between 80 and 85 cm, and the width of the elevator door should be no less than 91.5 cm.
If the appropriate place to add the elevator is not available, as it is in the Ministry of Education Prototype C2, or if a place for the elevator has not been constructed, it can be replaced by a vertical walkway.This walkway is an alternative to the elevator if the building is not equipped with a vertical circulation that supports the mobility needs of MS students.The user can use it to reach other floors without the need for a structural foundation because the vertical walkway consists of two parallel columns between which is a horizontal panel to anchor a wheelchair.Other design barriers can also be overcome by the following: . Add a wheelchair lift to the stairs that consists of a flat horizontal electric panel installed on the external handrail of the stairs, with dimensions of 100 cm × 100 cm, to transport wheelchairs between two levels. .Make the stairs' material non-slip or resistant to movement; also, it should not reflect light, produce glare, or contain repeated patterns.The edges of the stairs should contrast with the color of the stairs and lighting units must be placed along the sides of the stairs. .Adjust the height of the stair handrail to no more than 70-75 cm.
. Change the floor material in the corridors so that it is non-slip or resistant to movement, is not reflective, and does not produce glare.It should not have repetitive patterns, and vinyl and epoxy are preferred. .Change the flooring color of the corridors in the Aramco Prototype C1 to contrast with the wall color.

Classroom design development recommendations
The results revealed that the classrooms of female secondary schools in KSA do not support all the sensory and mobility needs of MS students.Therefore, to better accommodate MS students, the following recommendations can be applied to classroom designs: . Modify the location of the artificial lighting source and provide lighting diffusers (especially in the Ministry of Education-C2 Prototype). .Provide direct lighting on the surface of the study desk.
. Provide appropriate thermal comfort so that the temperature of the classroom does not exceed 23 degrees Celsius; provide a ventilation source and cooling directly where MS students sit. .Modify the flooring and ceiling materials, avoid repetitive patterns in the materials, and use shiny or non-slip materials for easy movement on the classroom floors. .Change the seating arrangement for MS students so that they sit adjacent to the classroom door, close to the teacher, and the touch whiteboard. .Provide lockers next to the seating area for MS students no less than 70 cm high (especially in the Ministry of Education-C2 Prototype). .Provide a space no less than 70 × 100 cm to keep a wheelchair next to the seating area for MS students. .Modify the classroom location so that it is on the same level as the main entrance.
. Adjust the width of the corridor in the classroom to no less than 90 cm and identify the movement paths in the class corridors with a color that contrasts with that of the classroom floors. .Make the height of classroom study tables used by MS students no less than 80 cm and no more than 90 cm with the height of the table (with round edges and slots for a water bottle and an electronic touchscreen) adjustable to 19 cm above the chair seat. .Alter school seats used by MS students in the classroom to have round edges and joints to adjust their position when needed. .Modify the classroom door design so that the door opens in both directions.
. Change the whiteboard material so that it does not reflect light.
. Provide a smart board.

Bathroom (WC) design development recommendations
The study revealed that the design of girls' bathrooms in secondary schools in KSA does not support the sensory and mobility needs of MS students.Therefore, to better accommodate MS students, the following recommendations can be applied to the bathroom design: . Increase the number and location of bathrooms, add a unit for special needs with a shape and layout that adheres to the parallel approach, and ensure that the area of one unit is not less than 150 × 150 cm in the Ministry of Education Prototype. .Add an attached handrail with a height of 70-75 cm to the walls next to the toilet seat.
. Modify the dimensions of the sinks to a height of 80-85 cm and a depth of no more than 45 cm.
. Change the flooring material to non-slip or resistant and retain the same color used on the floors so that it contrasts with the color of the wall.
Finally, the results show that all criteria are important; however, some affect users more than others.This indicates a disparity in criteria importance, which requires future research to rank their importance among MS students.

Conclusion
The results of this study indicate that the MS-BPAT checklist can accurately assess the achievement of MS-DG design criteria in educational built environments, detect the design barriers, and thus make essential recommendations that cover all MS students' needs.The validity of the MS-BPAT checklist as an assessment tool was confirmed by comparing its result with field visits and interviews.It was found that the four sections of the MS-BPAT checklist covered all design criteria for MS students' needs; however, three additional criteria were found in the Americans with Disability Act (ADA, 2010) and are recommended to be included for the vertical and horizontal circulation design criteria section: . The height of the corridor handrail should be 80-85 cm.
. The diameter of the handrails should not be more than 5 cm and handrails shall not rotate within their fittings. .The distance between the handrail and the wall should not be less than 3.8 cm and the wall surface shall be free of any sharp or abrasive elements.
By adding these three criteria, the MS-BPAT is finalized and can be an effective assessment tool that helps researchers and educational building architects accurately assess the built environment performance and make improvements that satisfy the needs of students with MS.

Figure 1 .
Figure 1.Summary of the research methodology.

Figure 2 .
Figure 2. Pictures showing the color and material of the drop-off area pavement ramp in the two secondary schools (case study).

Figure 3 .
Figure3.Pictures showing that the width of every step is the only achieved criterion in the staircase areas, while the rest are design barriers in the two case studies.

Figure 4 .
Figure 4. Pictures showing missing handrails in C2 corridors and missing handles in C1 corridors' high handrails, representing design barriers in the two case studies.

Figure 5 .
Figure5.Pictures showing the low table heights in C1 and C2, which represent a challenge and design barrier in the two case studies.

Figure 6 .
Figure 6.Pictures showing the reflective teaching boards in the two case studies.

Table 1 .
Results of the MS-BPAT checklist, achievement of the MS design criteria in the main entrance area in the case studies.

Table 2 .
Results of the MS-BPAT checklist, achievement of the MS design criteria in the V&H circulation areas in the case studies.

Table 3 .
The results of the MS-BPAT checklist, achievement of the MS design criteria in the classroom areas in the case studies.
space temperature does not exceed 23 °C.The color of the furniture contrasts with the background color.√√ The color of the floor contrasts with the color of the walls.√√ The color of the door or its borders contrasts with the color of the walls.