Does an Enriched Environment affect patient activity levels at the Oxfordshire Stroke Rehabilitation Unit?


Despite much innovation in stroke care over the past 10 years, patients remain inactive and alone, even in rehabilitation settings. Increased activity levels post stroke can improve functional outcomes, independence, and have a positive impact on quality of life. In recent years the concept of enriched environments gained traction as a potential method to increase activity levels without significant change in services resources or staffing. An enriched environment is simply one which promotes physical, cognitive and social activity through an enabling ethos and accessibility to relevant resources. The evidence base is rooted in animal models, which have shown increased potential for neuroplasticity in rats who, post-stroke, are confined in an enriched environment compared to those in an impoverished environment. It is thought there is potential for this theory to be extrapolated to human populations with preliminary positive findings coming from researchers in Australia. The aim of this project was to implement an enriched environment at the Oxfordshire Stroke Rehabilitation Unit, measure its impact on patient activity levels and evaluate the feasibility of the project.

initial activity analysis indicates
Patients within the service spent 45% of the observed time alone.
50% of the time was spent inactive or sleeping.
71% was spent at their bedside.


An initial patient activity analysis was conducted on a weekday and weekend day during the hours of 8am to 4pm in February 2020, at the 20 bed inpatient stroke rehabilitation unit. Data on patient's location and level of physical, cognitive and social activity was collated at 15 minute intervals throughout the recording period. Data was analysed and presented to the multi-disciplinary team as part of two training sessions on the concept of enriched environments. At the end of the training sessions participants were encouraged to write down ideas on how the service could become a more enriched to enable patient's to be more active. This information was collated and enriched environment champions were identified from professions across the multi-disciplinary teams. A working party was initiated to implement suggestions. A repeat activity analysis is to be conducted in October 2020 to evaluate the impact of the changes within the service.


Results: Findings from the initial activity analysis indicate patients within the service spent 45% of the observed time alone. 50% of the time was spent inactive or sleeping. 71% was spent at their bedside, as opposed to in communal or rehabilitation areas such as the therapy gym. It is worth noting the observed time was only during the hours of 8am and 4pm, perceived by the team as the most 'active' times of the day. Impact of the enriched environment project on activity levels, and discussion regarding the feasibility of the project will be presented in November.

Conclusion(s): Patients spent large proportions of the day at their bedside and were inactive for 50% of the observed time. This is in line with national and international data sets but at odds with evidence which suggests increased activity improves outcomes. Enriched environments may have a positive effect on this.

Cost and savings

Not applicable. 


It is hoped this project will show there is potential for enriched environments to be implemented in rehabilitation settings, with minimal additional resource or cost, to affect positive change on patient's lives.

Top three learning points

No further information. 

Funding acknowledgements