None listed
Conditions
Brief summary
Stroke survivors who are in an Acute Stroke Unit have been found to spend the majority of their day inactive and alone. Growing evidence recommends that stroke survivors should retrain activities of daily living and ambulatory function as early and frequently as possible. One approach found to increase activity levels during inpatient rehabilitation is the use of an enriched environment whereby physical, cognitive and social activity is enhanced by creating a stimulating environment. The effect of an enriched environment in an Acute Stroke Unit has yet not been explored. This prospective non-randomized quasi-experimental block design intervention study is focusing on enhancing exposure to an enriched environment to increase activity in an Acute Stroke Unit. We will re-organize the Acute Stroke Unit and staffing to create an enriched environment that safely stimulates patients to be more active on a physical, cognitive and social level without increasing staffing levels. The study will determine if an enriched environment can increase activity levels in people with a stroke in an Acute Stroke Unit within existing staffing levels. We hypothesize that activity levels will increase and that there will be a corresponding trend towards fewer secondary complications and improved functional outcomes for stroke survivors.
Interventions
This is a study to determine if it is feasible to create an enriched environment in an Acute Stroke Unit and if it will increase patient activity in the Acute Stroke Unit. The study involves a prospective non-randomized quasi-experimental block design with 30 people with stroke recruited to the usual care group (block 1) and 30 people with stroke recruited to the enriched environment group (block 2). Each block is estimated to last for 12 weeks. No change in staffing levels will occur during the
This is a study to determine if it is feasible to create an enriched environment in an Acute Stroke Unit and if it will increase patient activity in the Acute Stroke Unit. The study involves a prospective non-randomized quasi-experimental block design with 30 people with stroke recruited to the usual care group (block 1) and 30 people with stroke recruited to the enriched environment group (block 2). Each block is estimated to last for 12 weeks. No change in staffing levels will occur during the study. In the usual care group, usual assessment and management of people with stroke admitted to the Acute Stroke Unit will occur. In the enriched environment group, the physical and social environment of the Acute Stroke Unit will change to promote greater physical, social and cognitive activity. This will include a mix of individual and group therapies. Group activities will be organized to focus on different factors of stroke recovery e.g. education, emotional support, physical activities and leisure activities. Communal areas will be created e.g., patients can have breakfast and lunch in the treatment room together with other patients under staff supervision. Different types of equipment will be available to stimulate physical, cognitive and social activity e.g., iPads, iPods, books, games, puzzles, music. Equipment will be accessible during and outside of therapy hours. Staff members will re- organise their work routine to facilitate patient activity during the day. The enriched environment design requires being flexible from a day-to-day basis due to a fast changing patient population in the Acute Stroke Unit. A flexible week schedule with approximate 3 defined activity periods for 1 hour will be scheduled from Monday till Friday to organize and structure the enriched environment. All patients and their visitors enrolled in the experimental group (second block) will be informed that activity after stroke enhances stroke recovery and they will be encouraged to utilize communal areas and materials to facilitate activity. Family will be asked to bring the patients own clothing and items of interest to contribute to patient activity. Staff members from the Acute Stroke Unit will stimulate patients to attend the communal areas and to utilize the materials to increase their activity level during the day. Patients, visitors and staff will be advised to respect the 1-hour rest time period after lunch. To minimize risk and monitor for adverse events, blood pressure and temperature observations of patients will be performed 4 times a day. Two of the four time periods will always occur at 7.00 AM and 14.00 PM to ensure safety before peak activity levels. If SBP is greater than or equal to 200 and/ or Temperature greater than or equal to 38 degrees the subsequent activity period will be missed. After the missed period, blood pressure and temperature measurements will be repeated. When measurements are within safe limits the patient can continue to participate with the activities. When measurements are not within safe limits the patient will miss the subsequent activity period.
Sponsors
Mrs Ingrid Rosbergen
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults who are 1) admitted to the Acute Stroke Unit with the diagnosis of a stroke (ischaemic and haemorrhagic) within 24-72 hours after onset, 2) able to complete a transfer with the assistance of 2 persons or less, 3) able to follow one stage commands, 4) requires assistance for basic ADL’s, 5) premorbid MRS 2 or less and able to walk independently.
Exclusion criteria
Patient diagnosed with a rapid deteriorating health condition and/or with an active and uncontrolled mental health condition.
Outcome results
None listed