Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before–after pilot study

Rosbergen, Ingrid; Grimley, Rohan; Hayward, Kathryn S; Walker, Katrina; Rowley, D.; Campbell, Alana; McGufficke, S.; Robertson, Samantha T.; Trinder, J.; Janssen, Heidi; Brauer, Sandra G.

doi:10.1177/0269215517705181

Cited by 98 publications

(98 citation statements)

References 37 publications

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“…The programme was well-tolerated by participants, and more than 90% reported satisfaction. The overall beneficial effects of EE in this study are consistent with previous studies of EE programmes (15,26,36,37). In our previous RCT (26), we reported favourable impact of the "Activity Hub" on functional and cognitive functions (such as depression, anxiety, stress); coping and self-management skills in an inpatient neurological cohort.…”

Section: Discussionsupporting

confidence: 91%

Evaluation of a technology-assisted enriched environmental activities programme for upper limb function: A randomized controlled trial

Amatya¹,

Khan²,

Windle³

et al. 2020

J Rehabil Med

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Upper limb deficits are common in people with neurological conditions. However, in practice, rehabilitation of the upper limb is frequently ignored and the amount of practice of upper limb tasks in rehabilitation settings is inadequate. Apart from their planned therapy sessions, patients in rehabilitation wards spend most of their waking hours inactive and relatively isolated. This study showed that taking part in an "environmental enrichment programme", which provided the opportunity for patients to engage in additional activities of their choice during their waking hours in the wards, was beneficial to improve upper limb function. Objective: To evaluate the effectiveness and feasibility of an intensive technology-assisted inpatient enriched environmental programme for upper limb function. Methods: Patients consecutively admitted to the rehabilitation unit randomly allocated to an intervention (enriched environmental programme, n = 46)) or a control group (usual ward activity, n = 46). Assessments were performed at baseline (T0), discharge (T1) and 3 months (T2) using validated measures. Results: At T1, the enriched environmental group showed significant improvement in upper limb func tion, compared with the control group: Action Research Arm Test (ARAT) "Total" (p = 0.002), and "Grip", "Pinch" and "Gross" subscales (p < 0.05 for all), with small effect size = 0.04-0.16. Most participants in the enriched environmental group had clinically significant improvement > 5.7 points on the ARAT "Total" compared with the control group (83% vs 44%, p < 0.001). Participants in the enriched environmental group were more involved in various forms of activities during waking hours. At T2, despite no significant betweengroup difference in ARAT scores, the majority of participants in the enriched environmental group maintained the improvement (> 5.7 points) on ARAT "Total" compared with the control group (91% vs 61%, p = 0.001). Both groups improved in other measures at both T1 and T2. Conclusion: An enriched environmental programme was feasible and effective in improving upper limb function and increasing the activity of patients during their inpatient subacute care.

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Section: Discussionsupporting

confidence: 91%

Evaluation of a technology-assisted enriched environmental activities programme for upper limb function: A randomized controlled trial

Amatya¹,

Khan²,

Windle³

et al. 2020

J Rehabil Med

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“…Numerous behavioural mapping studies have reported that patients engage in little physical activity on stroke units [e.g. 30,31]. In the present study, stroke survivors reported an increase in standing and moving once they returned home.…”

Section: Levels and Patterns Of Sedentary Behaviour After Strokesupporting

confidence: 46%

Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers

Hall

Morton

Fitzsimons

et al. 2020

Preprint

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Background: Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour.Methods: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 hours) were analysed thematically and interview data (n=31 stroke survivors, n=12 caregivers) were analysed using the Framework approach.Findings: Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.

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“…Although the importance of task specificity in optimizing rehabilitation has been acknowledged for more than a decade, 13,53 general acceptance that environmental enrichment provides robust sensorimotor benefits that may be applicable to clinical rehabilitation has only recently begun to emerge. 25,47 Promising, new clinical studies in stroke rehabilitation are using environmental enrichment principles, resulting in increased patient activity 54 and decreased time spent inactive and alone. 55 Further clinical application of environmental enrichment in conjunction with task-specific training to increase rehabilitation intensity may result in a cost-effective method of improving function and quality of life for stroke survivors.…”

Section: Strokementioning

confidence: 99%

Synergistic Effects of Enriched Environment and Task-Specific Reach Training on Poststroke Recovery of Motor Function

Jeffers

Corbett

2018

Stroke

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Background and Purpose-Reach training in concert with environmental enrichment provides functional benefits after experimental stroke in rats. The present study extended these findings by assessing whether intensive task-specific reach training or enrichment initiated alone would provide similar functional benefit. Additionally, we investigated whether the 70% recovery rule, or a combined model of initial poststroke impairment, cortical infarct volume, and rehabilitation intensity, could predict recovery in the single-pellet task, as previously found for the Montoya staircase. Methods-Rats were trained on single-pellet reaching before middle cerebral artery occlusion via intracerebral injection of ET-1 (endothelin-1). There were 4 experimental groups: stroke+enrichment, stroke+reaching, stroke+enrichment+reaching, and sham+enrichment+reaching. Reaching rehabilitation utilized a modified Whishaw box that encouraged impaired forelimb reaching for 6 hours per day, 5 days per week, for 4 weeks. All treatment paradigms began 7 days after ischemia with weekly assessment on the single-pellet task during rehabilitation and again 4 weeks after rehabilitation concluded. Results-Rats exposed to the combination of enrichment and reaching showed the greatest improvement in pellet retrieval and comparable performance to shams after 3 weeks of treatment, whereas those groups that received a monotherapy remained significantly impaired at all time points. Initial impairment alone did not significantly predict recovery in single-pellet as the 70% rule would suggest; however, a combined model of cortical infarct volume and rehabilitation intensity predicted change in pellet retrieval on the single-pellet task with the same accuracy as previously shown with the staircase, demonstrating the generalizability of this model across reaching tasks. Conclusions-Task-specific reach training and environmental enrichment have synergistic effects in rats that persist long after rehabilitation ends, and this recovery is predicted by infarct volume and rehabilitation intensity.

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Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before–after pilot study

Abstract: Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.

Cited by 98 publications

References 37 publications

Evaluation of a technology-assisted enriched environmental activities programme for upper limb function: A randomized controlled trial

Evaluation of a technology-assisted enriched environmental activities programme for upper limb function: A randomized controlled trial

Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers

Synergistic Effects of Enriched Environment and Task-Specific Reach Training on Poststroke Recovery of Motor Function

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