36 Chapter 2 There is (laboratory) evidence that an enriched environment is effective for the rehabilitation of animals with brain injury.61 This effect was also shown in two studies in a clinical setting; patients tended to be more active in the cognitive, physical and social domains in an enriched environment.59,60 There is still a lack of knowledge concerning what aspects of enrichment represent the critical or active ingredients for enhancing brain plasticity, and the required ‘dose’ of enrichment is unknown. More research is needed on these components of an enriched environment; meanwhile, however, an enriched environment seems to be an effective addition to the rehabilitation program. For creating an enriched environment, it is important to have a communal area. Furthermore, the stimulation of social interaction and the provision of material for activities is important in an enriched environment. Studies show that rehabilitation is a team effort involving multiple disciplines. Whereas in the past rehabilitation was an intradisciplinary team effort, this has evolved into interdisciplinary or transdisciplinary teams. In both interdisciplinary and transdisciplinary teams, communication and working on shared goals is important. In a transdisciplinary team the patient is seen as a team member; moreover, the responsibility of all team members for all goals is more firmly stated than in an interdisciplinary team; this results in more integration between the professionals of a transdisciplinary team.62-64 Although all studies mentioned the importance of shared goals and good communication in a rehabilitation team, not all studies included all types of team models in their research. Taking into account the role of the patient in a transdisciplinary team model and the responsibility of all team members for all rehabilitation goals, preference is given to this model; particularly when considering that patients themselves generally know best which goals they have to achieve to be able to go home. The challenge for most rehabilitation teams is to make the patient and their caregiver an equal member of the team, and for all team members to feel responsible for all rehabilitation goals. This review is the first to provide details on a CRE based on an extensive literature search and, therefore, provides the first evidence-based description of a CRE. Evidence was found that all the identified topics apply to different diagnostic groups. However, the studies on the topics mainly focused on evidence related to rehabilitation after stroke, despite the presence of more diagnostic groups in
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