Stroke rehabilitation: Are highly structured units more conducive to physical activity than less structured units?

Objective: To determine if the physical design and organizational structure o Design: An observational study was conducted: time samples of the motor activity of patients following stroke were taken between 7 AM and 7 PM both on weekdays and weekends. Setting: Two rehabilitation units associated with general hospitals with different physical design and organizational structure. One unit was spread over a large area and had a highly organized daily structure; the other was small and informally organized. Subjects: Inpatients, with hemiplegia as a result of stroke who gave consent to participate. Main Outcome Measure: The nature and frequency of 14 motor activities were compared between units. Results: No significant difference was found in any of the observed motor activities between the units when using independent groups t tests (p = 0.1-0.8). Subjects in both units spent more than 70% of then day in activities largely unrelated to physical outcome (eg, conversing with visitors or doing nothing observable) and less than 20%; of the day in activities lilt could potentially contribute to their recovery (eg, in therapy or exercising independently). Conclusions: Rehabilitation units are not functioning as learning environments. The challenge is to identify and implement measures that will change this finding. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation