The impact of environmental enrichment in an acute stroke unit on how and when patients undertake activities

Abstract

Objectives:

To explore the effect of environmental enrichment within an acute stroke unit on how and when patients undertake activities, and the amount of staff assistance provided, compared with a control environment (no enrichment).

Design:

This is a substudy of a controlled before–after observational study.

Setting:

The study was conducted in an Australian acute stroke unit.

Participants:

The study included stroke patients admitted to (1) control and (2) environmental enrichment period.

Intervention:

The control group received standard therapy and nursing care, which was delivered one-on-one in the participants’ bedroom or a communal gym. The enriched group received stimulating resources and communal areas for mealtimes, socializing and group activities. Furthermore, participants and families were encouraged to increase patient activity outside therapy hours.

Main measures:

Behavioral mapping was performed every 10 minutes between 7.30 a.m. and 7.30 p.m. on weekdays and weekends to estimate activity levels. We compared activity levels during specified time periods, nature of activities observed and amount of staff assistance provided during patient activities across both groups.

Results:

Higher activity levels in the enriched group (n = 30, mean age 76.7 ± 12.1) occurred during periods of scheduled communal activity (P < 0.001), weekday non-scheduled activity (P = 0.007) and weekends (P = 0.018) when compared to the control group (n = 30, mean age 76.0 ± 12.8), but no differences were observed on weekdays after 5 p.m. (P = 0.324). The enriched group spent more time on upper limb (P < 0.001), communal socializing (P < 0.001), listening (P = 0.007) and iPad activities (P = 0.002). No difference in total staff assistance during activities was observed (P = 0.055).

Conclusion:

Communal activities and environmental resources were important contributors to greater activity within the enriched acute stroke unit.

Keywords

Stroke rehabilitation environmental enrichment activity acute stroke unit behavioral mapping

Get full access to this article

View all access options for this article.

References

World Health Organization. International classification of functioning, disability and health: ICF. Geneva: World Health Organization, 2001.

Ulrich

RS.

View through a window may influence recovery from surgery. Science 1984; 224: 420–421.

Van Hoof

Rutten

PGS

Struck

et al . The integrated and evidence-based design of healthcare environments. Architect Eng Design Manag 2015; 11: 243–263.

McDonald

Hayward

Rosbergen

ICM

et al . Is environmental enrichment ready for clinical application in human post-stroke rehabilitation? Front Behav Neurosci 2018; 12: 135.

Janssen

Ada

Bernhardt

et al . An enriched environment increases activity in stroke patients undergoing rehabilitation in a mixed rehabilitation unit: a pilot non-randomized controlled trial. Disabil Rehabil 2014; 36: 255–262.

Khan

Amatya

Elmalik

et al . An enriched environmental programme during inpatient neuro-rehabilitation: a randomized controlled trial. J Rehabil Med 2016; 48: 417–425.

Rosbergen

Grimley

Hayward

et al . Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before–after pilot study. Clin Rehabil 2017; 31: 1516–1528.

Nursiswati

Halfens

RJG

Lohrmann

Change in care dependency of stroke patients: a longitudinal and multicenter study. Asian Nurs Res (Korean Soc Nurs Sci) 2017; 11: 113–118.

Rosbergen

ICM

Grimley

Hayward

et al . The effect of an enriched environment on activity levels in people with stroke in an acute stroke unit: protocol for a before-after pilot study. Pilot Feasibility Stud 2016; 2: 36.

10.

Rosbergen

ICM

Brauer

Fitzhenry

et al . Qualitative investigation of the perceptions and experiences of nursing and allied health professionals involved in the implementation of an enriched environment in an Australian acute stroke unit. BMJ Open 2017; 7: e018226.

11.

Stroke Foundation. Clinical guidelines for stroke management 2010. Melbourne, VIC, Australia: Stroke Foundation, 2010.

12.

Goldstein

Samsa

GP.

Reliability of the National Institutes of Health Stroke Scale: extension to non-neurologists in the context of a clinical trial. Stroke 1997; 28: 307–310.

13.

Briggs

Felberg

Malkoff

et al . Should mild or moderate stroke patients be admitted to an intensive care unit? Stroke 2001; 32: 871–876.

14.

Janssen

Ada

Bernhardt

et al . Physical, cognitive and social activity levels of stroke patients undergoing rehabilitation within a mixed rehabilitation unit. Clin Rehabil 2014; 28: 91–101.

15.

Bernhardt

Dewey

Thrift

et al . Inactive and alone: physical activity within the first 14 days of acute stroke unit care. Stroke 2004; 35: 1005–1009.

16.

Janssen

Ada

Karayanidis

et al . Translating the use of an enriched environment poststroke from bench to bedside: study design and protocol used to test the feasibility of environmental enrichment on stroke patients in rehabilitation. Int J Stroke 2012; 7: 521–526.

17.

Harris

Eng

Miller

et al . A self-administered Graded Repetitive Arm Supplementary Program (GRASP) improves arm function during inpatient stroke rehabilitation: a multi-site randomized controlled trial. Stroke 2009; 40: 2123–2128.

18.

Grol

Bosch

Hulscher

et al . Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q 2007; 85: 93–138.

19.

Thomas

French

Coupe

et al . Repetitive task training for improving functional ability after stroke: a major update of a Cochrane review. Stroke 2017; 48: e102–e103.

20.

Veerbeek

van Wegen

van Peppen

et al . What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS ONE 2014; 9: e87987.

21.

English

Hillier

Kaur

et al . People with stroke spend more time in active task practice, but similar time in walking practice, when physiotherapy rehabilitation is provided in circuit classes compared to individual therapy sessions: an observational study. J Physiother 2014; 60: 50–54.

22.

Hokstad

Indredavik

Bernhardt

et al . Hospital differences in motor activity early after stroke: a comparison of 11 Norwegian stroke units. J Stroke Cerebro Dis 2015; 24: 1333–1340.

23.

Stroke Foundation. Clinical guidelines for stroke management 2017. Melbourne, VIC, Australia: Stroke Foundation, 2017.

24.

White

Janssen

Jordan

et al . Tablet technology during stroke recovery: a survivor’s perspective. Disabil Rehabil 2015; 37: 1186–1192.

25.

Mallet

Shamloul

Corbett

et al . RecoverNow: feasibility of a mobile tablet-based rehabilitation intervention to treat post-stroke communication deficits in the acute care setting. PLoS ONE 2016; 11: e0167950.

26.

King

McCluskey

Schurr

The time use and activity levels of inpatients in a co-located acute and rehabilitation stroke unit: an observational study. Top Stroke Rehabil 2011; 18(suppl. 1): 654–665.

27.

Bernhardt

Chan

Nicola

et al . Little therapy, little physical activity: rehabilitation within the first 14 days of organized stroke unit care. J Rehabil Med 2007; 39: 43–48.

28.

Loft

Martinsen

Esbensen

et al . Call for human contact and support: an interview study exploring patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions. Disabil Rehabil 2019; 41(4): 396–404.

29.

Shannon

Elf

Churilov

et al . Can the physical environment itself influence neurological patient activity? Disabil Rehabil 2018; 17: 1–3.

30.

Blennerhassett

Borschmann

Lipson-Smith

et al . Behavioral mapping of patient activity to explore the built environment during rehabilitation. HERD 2018; 11: 109–123.

31.

Anaker

von Koch

Sjostrand

et al . A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction—the significance of the built environment. PLoS ONE 2017; 12: e0177477.