Bhasker Amatya, Fary Khan, Imogen Windle, Matthew Lowe, Mary P. Galea
Department of Rehabilitation Medicine, The Royal Melbourne Hospital, 34-54 Poplar Road Parkville, Victoria, Australia. E-mail: Bhasker.Amatya@mh.org.au
DOI: 10.2340/16501977-2625

Objective: To evaluate the effectiveness and feasibility of an intensive technology-assisted inpatient enriched environmental programme for upper limb function.
Methods: Patients consecutively admitted to the rehabilitation unit randomly allocated to an intervention (enriched environmental programme, n = 46)) or a control group (usual ward activity, n = 46). Assessments were performed at baseline (T0), discharge (T1) and 3 months (T2) using validated measures.
Results: At T1, the enriched environmental group showed significant improvement in upper limb func-tion, compared with the control group: Action Research Arm Test (ARAT) “Total” (p = 0. 002), and “Grip”, “Pinch” and “Gross” subscales (p < 0. 05 for all), with small effect size = 0. 04–0. 16. Most participants in the enriched environmental group had clinically significant improvement > 5. 7 points on the ARAT “Total” compared with the control group (83% vs 44%, p < 0. 001). Participants in the enriched environmental group were more involved in various forms of activities during waking hours. At T2, despite no significant between-group difference in ARAT scores, the majority of participants in the enriched environmental group maintained the improvement (> 5. 7 points) on ARAT “Total” compared with the control group (91% vs 61%, p = 0. 001). Both groups improved in other measures at both T1 and T2.
Conclusion: An enriched environmental programme was feasible and effective in improving upper limb function and increasing the activity of patients during their inpatient subacute care.

Upper limb deficits are common in people with neurological conditions. However, in practice, rehabilitation of the upper limb is frequently ignored and the amount of practice of upper limb tasks in rehabilitation settings is inadequate. Apart from their planned therapy sessions, patients in rehabilitation wards spend most of their waking hours inactive and relatively isolated. This study showed that taking part in an “environmental enrichment programme”, which provided the opportunity for patients to engage in additional activities of their choice during their waking hours in the wards, was beneficial to improve upper limb function.