Patients’ experiences of a Communication Enhanced Environment model on an acute/ slow stream rehabilitation and a rehabilitation ward following stroke: a qualitative description approach

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.

 

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