STROKE REHABILITATION - ARE HIGHLY STRUCTURED UNITS MORE CONDUCIVE TOPHYSICAL-ACTIVITY THAN LESS STRUCTURED UNITS

Objective: To determine if tile physical design and organizational str ucture of rehabilitation units is: related to rile amount of patients motor activity. Design: An observational study was conducted: time sam ples of the motor activity of patients following stroke were taken bet ween 7 AM and 7 PM both on weekdays and weekends. Setting: Two rehabil itation units associated with general hospitals with different physica l design and organizational structure. One unit was spread over a larg e 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 betwee n units. Results: No significant difference was found in any of tile o bserved motor activities between the units when using independent grou ps t tests (p = 0.1-0.8). Subjects in both units spent more than 70% o f then day in activities largely unrelated to physical outcome (eg, co nversing with visitors or doing nothing observable) and less than 20%; of the day in activities lilt could potentially contribute to their r ecovery (eg, in therapy or exercising independently). Conclusions: Reh abilitation units are not functioning as learning environments. The ch allenge is to identify and implement measures that will change this fi nding. (C) 1996 by the American Congress of Rehabilitation Medicine an d the American Academy of Physical Medicine and Rehabilitation