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‘Alternative’ Rehabilitation approaches

Posted in Rehabilitation Articles on 17th Feb 2020

In the rehabilitation section of this edition we have chosen to focus on ‘alternative’ therapeutic approaches utilising music or animals. This reflects a growing interest in the importance of providing a stimulating therapeutic environment for patients as they undergo rehabilitation. There is evidence that patients undergoing inpatient rehabilitation are bored1 and inactive.2 Patients treated in ‘enriched’ environments show greater levels of physical activity, social interaction and cognitive activity.3

Importantly, in the current financial climate, this was achieved without increasing staffing numbers; it is a change in mindset and also having availability of resources to support these interactions. Environmental enrichment can include provision of equipment to enhance activity away from the bedside e.g. iPads, books, puzzles, newspapers, games, music and magazines. It can also include provision of daily group sessions, with a varied focus, for example: self-management education, emotional support, communication, physical activities. Some of the interventions in studies on stroke units may already be occurring on rehabilitation wards e.g. communal mealtimes, but there is still scope to look at relatively easy and cheap changes that could enhance a patient’s rehabilitation journey and potentially improve rehabilitation outcomes and reduce length of stay. It is essential that rehabilitation environments enable people to continue to participate in meaningful activities and supporting interaction with family members as this can facilitate the transition to living with what is often a long term disability. Being hospitalised following an acquired brain injury entails many losses – loss of function, loss of independence, loss of role within family and society and a loss of identity. Physiological losses are compounded by a physical separation from family and also in some cases a virtual separation (the single most common complaint on our ward used to be the lack of WiFi signal). Loss of access to hobbies and cognitive stimulation from work often compounds the boredom. Hobbies and activities that interest people are intrinsically more rewarding and motivating than therapist-driven exercises. Diane Playford at the recent BSRM meeting spoke about the importance of ‘play’ or non-structured activity during rehabilitation and encouraged us to think of ways of incorporating more opportunities for play within our units. I hope these two articles will continue to stimulate that discussion.

Emily Thomas, Rehabilitation Editor

References
1. Kenah et al. Disability and rehabilitation. 2018;40(22):2713-22)
2. Janssen et al. Clin Rehabil. 2014;28(1):91-101. doi: 10.1177/0269215512466252. Epub 2012 Nov 28).
3. Rosbergen et al. 2017 Clinical Rehab https://doi.org/10.1177/0269215517705181.