Can the physical environment itself influence neurological patient activity?

Shannon, Michelle; Elf, Marie; Чурилов, Леонид; Olver, John; Pert, Alan; Bernhardt, Julie

doi:10.1080/09638288.2017.1423520

Cited by 34 publications

(43 citation statements)

References 65 publications

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“…[35] As physical activity may enhance recovery after neurological injury, the physical environment of patients who suffer debilitating neurologic injury has been considered following such injuries, namely stroke. [36] Stroke requires rapid treatment to limit the extent and severity of brain damage; previous studies have found that every minute of delay may contribute to the destruction of 1.9 million cerebral neurons. [37] tPA is an effective treatment for acute ischemic stroke within 4.5 h of the initial onset of symptoms with greater amounts of time decreasing efficacy which further highlights the significance of time in treatment.…”

Section: Methodsmentioning

confidence: 99%

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

et al. 2019

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Stroke is the leading cause of adult disability in the US. Rapid diagnosis and treatment of stroke, in addition to efficacious rehabilitation, is invaluable. The present review aims to report the recent improvements in hybrid operating rooms (hybrid ORs), and in the organization of Neurological intensive care unit (NICUs) and dedicated stroke wards (SWs), which contribute to enhanced stroke treatment. A PubMed literature review was conducted in addition to the collection of other online media releases regarding recent organizational advances in stroke care. PubMed keywords included but were not limited to “neurological intensive care unit,” “hybrid operating room,” and “stroke ward,” while all other online information regarding recent advances in the physical organization was selected and synthesized in accord with its relevance. The current research indicates that hybrid ORs facilitate surgical innovation and improved patient care through the colocation of advanced imaging modalities and surgical capabilities. Moreover, the recent reorganization of NICUs and SWs may lead to better-quality initial treatment and rehabilitation. The present review also considers the current ER triage protocol for stroke patients, and it concludes with relevant considerations relating to the role of the physical hospital structure and organization in stroke care.

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Section: Methodsmentioning

confidence: 99%

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

et al. 2019

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“…Earlier studies showed an association between the well-being of patients and staff at healthcare facilities and the design of the physical environment [12][13][14][15]. In stroke units, the physical environment has been described as essential for patient activities and care [16][17][18]. Changes in the physical environment have been found to influence patient activity and social interactions [16].…”

Section: Introductionmentioning

confidence: 99%

“…In stroke units, the physical environment has been described as essential for patient activities and care [16][17][18]. Changes in the physical environment have been found to influence patient activity and social interactions [16]. In a recent study, patients were found to have higher levels of activity in a stroke unit that had a combination of single and multibed room designs compared to a stroke unit with only a singleroom design [18].…”

Section: Introductionmentioning

confidence: 99%

The physical environment and multi-professional teamwork in three newly built stroke units

Anåker

Koch

Eriksson

et al. 2020

Disability and Rehabilitation

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Purpose: To explore multi-professional teamwork in relation to the physical environment in three newly built or renovated stroke units. Materials and methods: An observational study was undertaken. The participants were all staff members of a multi-professional team working in the reviewed stroke units. The data were collected using behavioural mapping and semi-structured observations, and they were analysed by content analysis and descriptive statistics. Results: Out of all the observations in the behavioural mapping, very few were of two or more members from the team together with a patient. None of the included stroke units had a co-location for all the members of the multi-professional team. Three main categories emerged from the analysis of the interviews: (i) the hub of the unit; (ii) the division of places; and (iii) power imbalance. All the categories reflected the teamwork in relation to parts of the physical environment. Conclusion: The design of the physical environment is important for multi-professional teamwork. Emphasis must be placed on better understanding the impact of the physical environment and on incorporating the evidence related to multi-professional teamwork during the design of stroke units. ä IMPLICATIONS FOR REHABILITATION Understanding the link between the physical environment and effective teamwork can lead to more tailored and supportive design solutions. The design of the physical environment should be considered as a vital part of effective teamwork in stroke units. The physical environment should include shared workstations, allowing team members to meet and communicate face to face.

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“…front of the elevators, to encourage social interaction and time away from the bedside. Physical build design of the ward can impact on patient activity (Blennerhassett et al, 2018;Shannon et al, 2018). For example, a study that tracked stroke patients in a stroke unit pre and post reconstruction of the environment highlighted how location of the communal space and bed lay out (single vs. multi-bedrooms) influenced activity levels of stroke patients (Anaker et al, 2017).…”

Section: Effect Of Enrichment On Amount Of Staff Assistancementioning

confidence: 99%

“…Findings indicated that in the new build environment patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than patients in the original unit (Anaker et al, 2017). Until now, only a few studies have investigated how patient activities relate to lay out of the physical design of the unit and have highlighted that physical design may impact on patients' activity levels (Anaker et al, 2017;Blennerhassett et al, 2018;Shannon et al, 2018). While there is a push towards single bedrooms for reasons such as infection control, the possible impact on stroke recovery, activity levels and interaction with others needs to be seriously considered as well (Maben et al, 2016;Pennington & Isles, 2013).…”

Section: Impact Of the Physical Build Design Of The Unitmentioning

confidence: 99%

Feasibility of creating an enriched environment and subsequent impact on activity levels for stroke patients in an acute stroke unit

Rosbergen-Wildemors¹

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Individuals with stroke in an acute stroke unit spend the majority of their day inactive and alone.There is strong evidence that greater physical activity, and emerging evidence that greater social and cognitive activity after stroke promotes functional recovery. One approach found to increase activity levels in all these activity domains following stroke is an enriched environment, which is an intervention designed to stimulate physical, social and cognitive activity. The enriched environment is well investigated in animal models post stroke and refers to housing conditions that are designed to stimulate motor and sensory functions, as well as social and cognitive activity. Evidence has shown that rodents recovering within an enriched environment starting 24-hours post stroke showed greater functional recovery than recovery in standard housing conditions. The first clinical translation of an enriched environment was undertaken in the subacute inpatient rehabilitation setting, which showed that individuals with stroke (n=14) undergoing enriched rehabilitation were 1.2 times more engaged in 'any activity' as compared to no enrichment. However, the enriched environment has not yet been explored in an acute stroke unit. Thus, the primary aim of this thesis was to investigate whether an enriched environment embedded in an acute stroke unit could increase activity levels in physical, social, cognitive and combined activity domains across individuals with acute stroke.Study 1 examined the effect of embedding an enriched environment in an acute stroke unit on activity levels using a controlled before-after observational design. Activity levels were observed in a control group receiving usual care, and subsequently in a group who recovered in an enriched acute stroke unit. The enriched environment focused on three key areas: 1) creating a stimulating environment including communal areas for eating, socialising and group activities, and provision of resources throughout the ward and at the patient bedside; 2) involvement of patients and families to increase activity outside therapy hours, and 3) using change management strategies to support staff to implement the enriched environment within existing staffing levels. Behavioural mapping was used to determine the primary outcome measure 'any', physical, social and cognitive activity.Participants were observed every 10-minutes from 7.30am till 7.30pm on weekday and weekends.We found that the enriched group (n=30) spent a significantly greater proportion of their day engaged in 'any activity' (p=0.005), physical (p<0.001), social (p=0.007) and cognitive activity (p=0.002) as compared to the control group (n=30). Furthermore, the enriched group spent a lower proportion in a supine position, in their room and being alone. The secondary aims were to explore the impact of an enriched environment on functional outcomes, adverse events and length of stay.No differences between groups were found for functional outcomes at discharge from the acute Publications during candidature Peer...

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Can the physical environment itself influence neurological patient activity?

Cited by 34 publications

References 65 publications

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

The physical environment and multi-professional teamwork in three newly built stroke units

Feasibility of creating an enriched environment and subsequent impact on activity levels for stroke patients in an acute stroke unit

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