Mobility-Supporting Rehabilitation Clinics: Architectural design criteria for promoting stroke patients’ independent mobility and accommodating their changing spatial needs during the transition towards recovery

Publikation: Hochschulschrift/AbschlussarbeitDissertation

Abstract

Rehabilitation clinics remain until this day a greatly unexplored topic from the perspective of architectural design. Stroke is the most common condition that is treated in neurological rehabilitation clinics in Germany and it is a disease that causes the most complex disability. Since stroke numbers are expected to constantly grow in the future, there is a definite need for understanding the stroke survivors’ spatial needs and for accommodating them in the built environment in a way that supports their recovery process and their life after rehabilitation. This PhD thesis aims at contributing to this wide knowledge gap and at introducing new research directions focusing on the relationship between stroke patients’ and the rehabilitation built environments. Rehabilitation clinics were chosen as the research setting for this study as the environments that stroke survivors encounter after the hospital stay and where they undergo a challenging rehabilitation process with the goal of returning home to their normal lives. This rehabilitation process involves living in rehabilitation clinics for a certain period and attending various types of therapies led by a multidisciplinary team, with multiple therapies per day, every day of the week. This type of intensive therapy is important for stroke patients since the greatest amount of functional recovery can be expected in the first 3 to 6 months after the stroke onset. German neurological rehabilitation clinics are commonly transformed from other functions or newly built without evidence-based knowledge about the spatial needs of their patients. This practice creates barriers in the built environment for patients, likely hindering their recovery process and negatively influencing their psychological well-being. These barriers can most directly influence and hinder patients’ mobility within the clinic. Mobility, as the main goal of stroke rehabilitation, is often not well-supported in the built environment of rehabilitation clinics. This study, therefore, focuses on identifying barriers and facilitators to mobility in rehabilitation clinics and their architectural properties and the different experiences of patients with different mobility levels. Three empirical research methods were used to investigate the relationship between the stroke inpatients’ mobility and the built environment of rehabilitation clinics: patient shadowing, patient questionnaire and staff questionnaire. These three methods were the elements of Post-occupancy evaluation (POE) applied in seven German neurological rehabilitation clinics over the period between September 2016 and May 2018. The results show that the built environment of rehabilitation clinics hinders patients’ mobility in five main aspects: challenging wayfinding, long distances, insufficient dimensions of corridors, floor surfaces and physical obstacles. It was also found that mobility facilitators are greatly lacking. Stroke patients with the lower levels of mobility, and especially patients using a wheelchair, were found the most vulnerable to the identified barriers. Patients were also greatly inactive during their time in the clinic since 50% of the day was spent in patient rooms. They also expressed a wish for a greater variety of common spaces within the clinic. The absence of motivating spaces was likely to be another important reason for patients’ inactivity, besides the avoidance of various barriers. The architectural properties of the identified barriers and facilitators were used to develop a catalogue of architectural design guidelines that present a new model for rehabilitation buildings: the transitional model. The given recommendations are based on the obtained study results and the experience of living in rehabilitation clinics and observing their daily life for 14 weeks. The catalogue of guidelines is intended for architects, medical professionals and others included in the process of planning a rehabilitation clinic. The main goal is to provide directly applicable evidence-based recommendations for mobility supporting clinics and to facilitate the dialogue between different professions involved in the planning process.

Details

OriginalspracheEnglisch
Gradverleihende Hochschule
Betreuer:in / Berater:in
  • Marquardt, Gesine, Mentor:in
  • Kevdzija, Maja, Mentor:in
PublikationsstatusVeröffentlicht - 2020
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Schlagworte

Ziele für nachhaltige Entwicklung

Schlagwörter

  • Architecture, Stroke, Mobility, Barriers and Facilitators, Rehabilitation Clinics, Mobility-supporting Design, Shadowing, Evidence-Based Design