Use of an enriched environment post-stroke: translating from bench to bedside

Despite evidence linking higher levels of activity with better outcomes, stroke patients undergoing rehabilitation in hospital settings spend the majority of their waking hours inactive and alone. Environmental enrichment, through the use of equipment and organisation of the environment to facilitate physical, cognitive and social activity, is an intervention which has been used extensively in animal models of stroke. Results from these models have demonstrated the sensorimotor and cognitive benefits of recovering in an enriched environment, however there is conflicting data suggesting no benefit. The purpose of this PhD was to determine the efficacy of environmental enrichment in animal models of stroke, and then develop and pilot test a model of enrichment in stroke survivors. Systematic meta-analytic methods were used to determine the efficacy of an enriched environment in animal models of stroke. Exposure to an enriched environment in animal models of stroke was associated with significantly better sensorimotor function and a trend towards better learning. Recovering in an enriched environment was also associated with a small but significant increase in lesion size (larger damaged area). However, the importance of this finding at an experimental level requires further investigation. To explore the feasibility of translating this paradigm from the bench to the bedside, a model of environmental enrichment incorporating both communal and individual enrichment was developed for use with stroke patients in the clinical setting. Behavioural observation was used to evaluate its effect on stroke patient activity. Patients exposed to individual and communal environmental enrichment were more likely to be active and were less likely to spend time ‘inactive and alone’ or sleeping than those recovering in a non-enriched rehabilitation unit. This thesis outlines the research undertaken in the first known attempt to translate the use of a model of environmental enrichment from the laboratory into a clinical stroke rehabilitation setting. Evidence presented demonstrates that this model of environmental enrichment can increase activity levels of stroke patients. This preliminary research sets the foundations for further exploration of the efficacy of environmental enrichment on post-stroke function, mood and quality of life.