31 Challenging Rehabilitation Environment for older persons Nurses played a significant role in task-oriented training. They could create opportunities to practice meaningful functional tasks outside of regular therapy sessions. Many interventions could be part of task-oriented training during and outside regular therapy sessions, such as walking (on the ground or on a treadmill), cycling program, endurance training, circuit training, sit-to-stand exercises, and reaching tasks to improve balance. The training needed to be repetitive, task-specific and meaningful for the patient.53 A review operationalized 15 components of task-oriented training: 1) functional, 2) directed toward a clear functional or everyday life activity (ADL) goal, 3) patient centered, 4) repeated frequently (overlearning and overload principle), 5) used with real-life object manipulation, 6) performed in a context-specific environment, 7) performed in increasing difficulty levels (exercise progression), 8) varied (within one task), 9) followed by feedback on the exercise performance, 10) exercised in multiple movement planes, 11) included total skill performance, 12) patient customized for training load, 13) offered in random practice, 14) occurred through distributed practice, and 15) composed of bimanual tasks. Not all components were used during a task-oriented training and the number of components used in an intervention after stroke was not associated with the size of the posttreatment effect. The components 2, 9, 13 and 14 were associated with the largest effect sizes. Although no studies have compared the importance of these components for training outcomes, they seemed to be important components of a task-oriented training program.57 Enriched environment Patients rehabilitating after stroke reported a lack of opportunities to drive one’s own recovery outside of therapy time. This was confirmed by clinical staff, who perceived a lack of places to go to, and a passive rehabilitation culture and environment. Therefore, there was a need to increase opportunities for practice and promote active engagement. Creating an enriched environment can be a good solution.5858 An enriched environment can be achieved in both communal and individual areas. Opportunities for enrichment include the provision of music, audio books, regular books and other reading materials, puzzles, games, hobby supplies, tablets and a computer with internet connection. Other possibilities are 2
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