Can the physical environment itself influence neurological patient activity?

Abstract

Purpose: To evaluate if a changed physical environment following redesign of a hospital ward influenced neurological patient physical and social activity.

Methods: A “before and after” observational design was used that included 17 acute neurological patients pre-move (median age 77 (IQR 69–85) years Ward A and 20 post-move (median age 70 (IQR 57–81) years Ward B. Observations occurred for 1 day from 08.00–17.00 using Behavioral Mapping of patient physical and social activity, and location of that activity. Staff and ward policies remained unchanged throughout. An Environmental Description Checklist of each ward was also completed.

Results: Behavioral Mapping was conducted pre-/post-move with a total of 801 Ward A and 918 Ward B observations. Environmental Description Checklists showed similarities in design features in both neurological wards with similar numbers of de-centralized nursing stations, however there were more single rooms and varied locations to congregate in Ward B (30% more single-patient rooms and separate allied health therapy room). Patients were alone >60% of time in both wards, although there was more in bed social activity in Ward A and more out of bed social activity in Ward B. There were low amounts of physical activity outside of patient rooms in both wards. Significantly more physical activity occurred in Ward B patient rooms (median = 47%, IQR 14–74%) compared to Ward A (median = 2% IQR 0–14%), Wilcoxon Rank Sum test z = −3.28, p = 0.001.

Conclusions: Overall, patient social and physical activity was low, with little to no use of communal spaces. However we found more physical activity in patient rooms in the Ward B environment. Given the potential for patient activity to drive brain reorganization and repair, the physical environment should be considered an active factor in neurological rehabilitation and recovery.

Implications for Rehabilitation

• Clinicians should include consideration of the impact of physical environment on physical and social activity of neurological patients when designing therapeutic rehabilitation environments.

• Despite architectural design intentions patient and social activity opportunities can be limited.

• Optimal neurological patient neuroplasticity and recovery requires sufficient environmental challenge, however current hospital environments for rehabilitation do not provide this.

Keywords:

• Physical environment
• healthcare design
• Behavioral Mapping
• brain injury
• neurological
• physical activity
• social activity
• neuroplasticity

Acknowledgements

We would like to acknowledge the support of the patients and staff at Box Hill Hospital, Melbourne, Australia for their participation in this study. We are grateful to Ms Ruby Lipson-Smith for her assistance with the architectural drawings.

Disclosure statement

The authors report no declaration of interest.

Additional information

Funding

This research was conducted as part of the first author’s PhD who received assistance from an “Australian Government Research Training Program Scholarship” for this study. The main author and Professors Bernhardt and Churilov are affiliated with NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia.