Yusliza Ishak (Malaysia)
Hospital Rehabilitasi Cheras Rehabilitation Medicine UnitAuthor Of 1 Presentation
ENVIRONMENTAL ENRICHMENT, REHABILITATION OUTCOME AND THE PANDEMIC: ESTABLISHING A CONNECTION
Abstract
Background and Aims
Environmental Enrichment (EE) for stroke patients encompass a dynamic environment which encourages socialization, sensori-motor activities and cognitive stimulation beyond direct therapy time. Pandemic impact of physical distancing potentially affects socialization, an important EE element. Due to pandemic-appropriate measures in hospital-setting, patients narrated reduced socialization opportunity caused by restricted communal and group activities. The aim is to establish the inpatient stroke rehabilitation outcome trend based on pre/post-EE implementation phases; prior and during pandemic.
Methods
Environmental Enrichment (EE) initiatives were implemented in structured stages based on the Exploration-Planning-Implementation-Sustainment (EPIS) Framework. EE Exploration-Planning Phase occurred in 2018. EE Implementation Phase (2019-2020) focus on multi-faceted activities using various apparatus, incorporating self-directed tasks and communal sessions with caregivers' involvement. A chronological timeline-matching approach was used to match EE implementation initiatives and rehabilitation impact indices comprising of Absolute Functional Gain (AFG) and Rehabilitation Efficiency Index (REI) utilizing Modified Barthel Index. Trending was compared for 2018 (Pre-EE Implementation/Pre-Pandemic), 2019 (EE Implementation/Pre-Pandemic) and 2020 (EE-Implementation/Pandemic) phases.
Results
Compared to 2018, there was incremental improvement in AFG and REI in 2019 (EE-Implementation/Pre-Pandemic). When compared to 2019, marginal reduction of AFG and REI was noted in 2020 (EE-Implementation/ Pandemic). Median (IQR) for AFG were 17.5(11-30), 22(13-35), 20 (9-33.5) for 2018, 2019 and 2020 respectively. Median (IQR) for REI were 0.8 (0.5-1.3), 1.1 (0.5-1.5), 1.0 (0.5-1.3) for 2018, 2019, 2020 respectively.
Conclusions
Environmental enrichment potentially promotes post-stroke recovery and improve stroke rehabilitation outcome. Although pandemic-appropriate measures may affect EE socialization component, an active effort is important to implement and embed EE initiatives in the inpatient rehabilitation setting.