Neurosensory stimulation outdoors enhances cognition recovery in cognitive motor dissociation: A prospective crossover study.
Caroline Attwell, Jane Jöhr, Alessandro Pincherle and 6 others
PMID 31282434WHAT IT FOUND
Within the same individually chosen therapy, outdoor sessions had more voluntary behaviors than indoor sessions on seven items, mainly auditory, visual, motor and swallowing.
Communication and attention did not differ. The outdoor setting cannot be separated from the therapy.
Key findings
01Outdoor sessions had significantly more voluntary or purposeful behaviors than indoor sessions on seven items of the behavioral grid.
02The outdoor advantage included auditory, visual, motor and oro-motor items, but communication and attention items did not differ.
03No unintended effects were observed, including no difference in pain scores between conditions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Twenty participants were enrolled, and five were excluded before final analysis. The included patients were 11 males and 4 females. The study was non-randomized, although the order of indoor and outdoor sessions was randomized within each patient. The outdoor sessions were not isolated from other treatments. Patients also received a daily 300-minute interdisciplinary rehabilitation program, individually chosen physiotherapy or occupational therapy, and usual hospital sounds, staff, visitors and alarms. The same therapist delivered both indoor and outdoor sessions. The paper did not measure whether therapist mood or motivation changed outdoors. Patients had to be clinically stable for transport and free of major medical problems that would interfere with safety outdoors. Results may not apply to less stable patients. Many grid items were compared. Only seven showed significant differences, and communication and attention items were null.
Declared interests
The authors declared no conflicts of interest. The study was partially supported by a grant from The Gianni Biaggi de Blasys Foundation.
The easy way to misread this
Do not read this as proof that outdoor therapy alone enhances cognition recovery. The outdoor sessions were the same individually chosen physiotherapy or occupational therapy protocol delivered within a daily 300-minute interdisciplinary rehabilitation program, and the garden added background sensory stimulation and usual hospital sounds. This small non-randomized crossover study cannot separate the outdoor setting from those other treatments.