By Sam Pruitt, Healthcare Designer
I believe in the resiliency of the human mind and spirit. More importantly, I believe in the power of the brain to do the impossible. In the moments, days, weeks, and years following a brain injury, the survivor is confronted with all manner of complex symptoms as the brain recovers and rebuilds the intricate pathways that allow it to perform. So how do we design in a way that enables meaningful recovery? As the brain does the extraordinary, what effect does the built environment have on shaping the path toward wholeness and wellness?
In the last year, I saw firsthand the devastating effects of a severe brain injury as a close relative of mine experienced several massive strokes following a lengthy medical procedure. Whether the injury is traumatic (caused from an external force) or non-traumatic (acquired injury from stroke, aneurism, oxygen deprivation) the resulting behaviors, side effects, and deficits can be much the same. After the brain and body have stabilized from the initial trauma, the hard work begins. Many survivors experience severe, albeit temporary, behavioral episodes or wide-ranging delays between physical and cognitive recovery.
Healthcare facilities, acute and post-acute, must respond in many ways to best support the survivor on their road to recovery and total health. Here are five considerations for an impactful design response:
- Provide exposure to natural light. In any intensive care setting it is crucial to offer the patient and family exposure to the outdoors. Allowing exposure to the natural cycle from day to night allows patients to reorient themselves, stabilize, and stave off ICU delirium, which can speed recovery. In the early stages of recovery, to accurately gauge a patient’s awareness, it is crucial the facility provide an environment that enables them to regain consciousness. Providing exposure to light and encouraging natural rest/sleep cycles can promote greater periods of alertness during the day and provide a more fruitful environment for therapies to begin.
- Minimize noise. Another way to avoid ICU delirium is to control sound and artificial lighting. Mimicking the calm quiet of night and avoiding harsh lighting in the evening hours is beneficial in supporting the body’s circadian rhythm. In intensive care settings, patients may receive neuro-checks as often as every 15 minutes. By controlling ambient noise and light the facility can offer a more restful environment for patients and families that mimics life outside of the hospital. This grounding in the here and now can help a patient as they emerge from sedation or regain conscious awareness and cognitive function.
- Introduce walking space. Studies show the link between recovery speed, length of stay, and a patient’s ability to get up and get moving. In therapy, my family member was often told to complete a motion while the therapist physically helped them perform the action. In doing so, the therapist was helping the body remind the brain to control that function. There is an amazing connection between the mind and the body, and when we can stimulate the body through movement the brain benefits. It therefore stands to reason that often-overlooked corridors, spaces dedicated to movement, could prove invaluable therapeutic spaces if treated with care. By emphasizing corridor design – introducing more lighting strategies, views to the outdoors, areas of interest in the way of artwork and finishes, as well as areas of respite – the facility can provide the appropriate environment for recovery to take place.
- Provide access to nature. As the survivor’s course of treatment extends beyond the acute care setting it can be beneficial to provide avenues by which the patient can access the outdoors. Acute and post-acute rehab facilities should offer the patient and their family the opportunity to safely step outside of the facility for exposure to fresh air and sunlight and to take part in recreational activities that would normally occur outdoors. This leads to the final point.
- Promote normalcy. A successful facility response should promote a sense of normalcy and calm for the survivor and family in a time when normal cognitive and physical function have been completely or partially interrupted. As therapies progress and become more comprehensive, layering in space that supports “normal” life is a way to bridge the gap between the healthcare environment and private setting. Spaces that allow the survivor to cook, wash clothing, and practice self-care are crucial. Just as important, aspects of social design enable users to regain a part of life that has been on hold since the injury was sustained. Social spaces for activities, communal gather, sports and recreation promote a sense of normalcy and familiarity that can be key in rebuilding the neurological pathways that enable the recovery of speech, memory, and cognitive function.
Designing in a way that supports natural cycles of sleep and wakefulness can provide the backdrop for the early physiological improvements of a survivor immediately following injury. Providing an environment that is restful and pleasing to the patient, and the family, will promote engagement and participation by both. Finally, layering the facility design with aspects of normalcy and familiarity will encourage interaction and create a framework for transitioning the survivor out of the care environment. In all things, consider that the healthcare environment is not intended to merely deliver care – it is intended to deliver health.