32 Chapter 2 the availability of recreational activities (eg bingo), as well as communal areas for eating, socializing and daily group activities.59,60 Until recently, an enriched environment remained largely a laboratory phenomenon with little translation to the clinical setting. In animals, an enriched environment proved to be a robust intervention for fostering brain plasticity and recovery from various types of brain injury, including stroke.61 This latter research showed that the ideal enriched environment encourages socialization, exercise, sensory and cognitive stimulation, and task-specific exercise. Reasons for the lack of studies in a clinical setting include difficulties in standardizing enriched environmental conditions across clinical sites, a lack of knowledge concerning what aspect of enrichment represents critical or active ingredients for enhancing brain plasticity, and the actual required ‘dose’ of enrichment is unknown.61 A few recent studies on an enriched environment were performed in a clinical setting. One study in a post-acute mixed rehabilitation unit showed that patients in an enriched environment were more likely to be engaged in cognitive, physical and social activities and less likely to be inactive, alone or asleep compared to patients not in an enriched environment.59 Another study in an acute stroke unit of an Australian hospital showed similar results. The patients rehabilitating in an enriched environment were 71% of the day engaged in any activity vs 58% of the control group. In the physical domain this was 33% vs 22%, the social domain 40% vs 29%, and in the cognitive domain 59% vs 45%. Patients in the enriched environment had a significantly shorter length of stay.60 Team dynamics A rehabilitation team (usually) consists of a physician, nurses and therapists such as occupational therapists, physical therapists, psychologists, social workers and speech and language therapists.4 Rehabilitation is a team effort and the way teams are organized affects the results of rehabilitation. Most of the rehabilitation teams evolved over time from intradisciplinary teams through multidisciplinary and interdisciplinary teams to transdisciplinary teams, resulting in more intensive collaboration.62-64
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