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

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.