So this is the partner to this enriched environment talked about by Dr. Dale Corbett in 2011?
Finally have a communication enriched environment for your hospital to set up. Did your hospital ever setup the enriched environment described by Dale Corbett? Why not? They love being incompetent?
Patients’ experiences of a Communication Enhanced Environment model on an acute/ slow stream rehabilitation and a rehabilitation ward following stroke: a qualitative description approach
Sarah D’Souzaa,b , Deborah Hersha , Erin Godeckea,b , Natalie Cicconea , Heidi Janssenc and
Elizabeth Armstronga
a
School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; b
Centre for Aphasia Recovery and Rehabilitation Research,
La Trobe University, Melbourne, Australia; c
School of Health Sciences, Hunter New England Local Health District, NSW Health, Australia
ABSTRACT
Background:
Patients in hospital following stroke express a desire to continue therapy tasks outside of
treatment activities. However, they commonly describe experiences of boredom and inactivity. An
enriched environment aims to provide opportunities for physical, cognitive and social activity and
informed the development of a Communication Enhanced Environment (CEE) model to promote patient
engagement in language activities.
Purpose:
Explore patient perceptions of a CEE model, and barriers and facilitators to engagement in
the model.
Methods: A qualitative description study from a larger project that implemented a CEE model into acute
and rehabilitation private hospital wards in Western Australia. Semi-structured interviews were conducted
with seven patients, including four with aphasia, within 22 days post-stroke who had access to the
CEE model.
Results:
Patients described variable experiences accessing different elements of the CEE model which
were influenced by individual patient factors, staff factors, hospital features as well as staff time pressures.
Those who were able to access elements of the CEE model described positive opportunities for engagement in language activities.
Conclusions:
While findings are encouraging, further exploration of the feasibility of a CEE model in this
complex setting is indicated to inform the development of this intervention.
(So write up a provisional protocol on this since no followup will occur. Survivors can at least get some recovery from this.)
IMPLICATIONS FOR REHABILITATION
Patient access to a CEE model is challenging in a hospital setting.
Patients who were able to access elements of the CEE model described positive opportunities for
engagement in language activities.
Patients’ access to the CEE model was influenced by patient factors, staff factors, hospital features as
well as staff time pressures.
ARTICLE HISTORY
Received 15 February 2021
Revised 26 July 2021
Accepted 29 July 2021
KEYWORDS
Stroke; aphasia;
Communication Enhanced
Environment model;
enriched environment;
rehabilitation
Introduction
It is recognised that the environment can influence neural remapping during early stroke recovery [1]. However, the current hospital environment may reflect what is considered impoverished
[2–10] with patients following stroke spending large proportions
of their day alone and inactive [11]. Patients in hospital following
a stroke express a desire to continue therapy tasks outside of
treatment tasks, perceiving time outside of therapy as an opportunity to practise rehabilitation activities within the real-world
environment [12]. However, boredom is commonly experienced
by patients which has the potential to negatively affect their
engagement in rehabilitation [13]. Patients report that a lack of
meaningful activity is strongly associated with boredom [13].
Boredom is highly correlated with depression and apathy and is
perceived by patients to negatively affect their participation in
stroke rehabilitation [13]. Patients following stroke perceive a lack
of stimulation and inactivity impacts their ability to “drive” their
own rehabilitation outside of therapy, describing their time outside of their therapy as “dead and wasted” [12].(p4) Nurses have
been observed to be the most common communication partner
for patients after their family members [14]. However, nurses in a
stroke rehabilitation unit report that time constraints often limit
their capacity to comfort, talk with and provide education to
patients [15]. This lack of time for communication and education
has also been identified by patients who “did not like to bother
the busy nurse” [16].
Aphasia is a communication disorder that occurs in approximately 30% of stroke survivors [17] and affects all modalities of communication including speaking, listening, reading and writing.
Aphasia is associated with higher levels of disability and has significant negative consequences for social participation, interpersonal relationships, autonomy, capacity to work and quality of life
[18]. Patients with aphasia (PWA) following stroke have been
observed to spend less than 28% of their day communicating
with others and 44% of their day alone during their first weeks of
inpatient rehabilitation [14]. Limited opportunities for language
use, and engagement in meaningful activity and social interaction
may negatively impact aphasia language recovery [3] and have
adverse consequences for health-related quality of life [7]. This
places PWA at increased risk of developing learned non-use of
language as a result of inadequate opportunities for communication [14].
An enriched environment (EE) aims to provide greater opportunities for physical, cognitive and social activity and has been
shown to contribute to significant improvements in neuroplasticity, motor recovery and a trend towards significant improvements
in cognition in animal stroke models [19]. Application of EE in an
acute7 and rehabilitation unit [20] setting has been shown to significantly increase patient engagement in physical, cognitive and
social activity. Aphasia is a complex language impairment and
PWA may need support within an EE. The principles of EE
informed the development of a Communication Enhanced
Environment (CEE) model to facilitate engagement in language
activities for patients following stroke, which incorporated the
needs of those with aphasia [21]. The definition of language activities encompassed any activity that involved the use of language
including both solitary (i.e., reading, writing) and interactive (i.e.,
talking or listening to a communication partner) language activities. This CEE model was co-designed with hospital staff and considered hospital policies and procedures and incorporated
evidence-based strategies, expert opinion, [21] and staff and
patient-perceived barriers and facilitators to their engagement in
language activity following stroke [22]. The CEE model sought to
promote access to physically enhanced communal spaces, trained
communication partners, resources, and organised social activities
[23]. Results from piloting the CEE model found that 71% of the
model was reported to be available to the intervention group
[21]. Additionally, the intervention group who had access to the
CEE model engaged in higher, but not significant, levels of language activities (600 of 816 observation time points, 73%) than
the control group (551 of 835 observation time points, 66%) [21].
This study sought to explore patient perceptions of communication interactions and language activity including the perceived
barriers and facilitators to engagement in the CEE model during
their hospital admission. The specific research questions were:
i. What are patients’ perceptions of communication interactions
and language activities during their hospital admission following stroke where the CEE model was implemented in
usual care?
ii. What do patients perceive to be barriers and facilitators to
engagement in the CEE model.
More at link.
