Reimagining stroke rehabilitation through meaningful activity, music, and engagement

Supporting recovery by transforming hospital rehabilitation environments into engaging and stimulating spaces

Discover the research behind

A growing challenge

Stroke is a leading cause of disability worldwide, affecting millions of people and their families each year.

The brain can recover

The brain has the capacity to reorganize and adapt after stroke, enabling recovery through rehabilitation and meaningful stimulation.

Time matters

Neuroplasticity offers a unique window of opportunity in the first months after stroke.
However, hospital environments often provide limited opportunities for meaningful activity and social interaction.

Towards enriched rehabilitation

Our research explores enriched rehabilitation approaches that integrate music and meaningful activities into routine care.

The burden of stroke

Stroke remains one of the leading causes of acquired disability worldwide1. Within the European Union alone, there are approximately 1.12 million new cases each year, with around 160,000 occurring in Spain2. These numbers highlight a major public health challenge that affects millions of individuals and families every year.

A stroke can have a devastating impact on a survivor’s life and the lives of their caregivers. It often results in a variety of problems that go beyond physical deficits, including3,4:

  • Motor and sensory difficulties, such as weakness or loss of sensation.
  • Cognitive and perceptual challenges, including problems with thinking, memory, attention, or spatial awareness.
  • Language difficulties that can affect communication.
  • Emotional changes, such as difficulties in managing mood, depression, or apathy.

These functional changes often lead to difficulties in performing daily activities, participate in the community, or maintain family, work, and social roles5,6. Activities that once felt routine, such as working, socialising, or engaging in community life, may suddenly become difficult.

Neuroplasticity: the brain’s ability to adapt

After a stroke, the brain shows a remarkable capacity for recovery known as neuroplasticity7. This process allows the brain to reorganise itself and form new connections between neurons, helping restore lost functions.

You can think of it as the brain searching for alternative routes to perform the same task.

The recovery window

Research shows that there is a period of increased sensitivity after stroke that lasts approximately 10 weeks, or about two to three months8,9. During this time:

  • The brain is more flexible and responsive to learning.
  • Capacity for change: Neurons are actively forming new connections.
  • Rehabilitation and activity have a greater impact on recovery

This period represents a critical opportunity to support recovery and maximise improvement.

Hospital inactivity and boredorm

While we know that staying active, engaged, and socially connected supports recovery after stroke, hospital environments do not always provide enough opportunities for meaningful activity.

Clinical guidelines recommend at least three hours of therapy per day10, yet this can be difficult to achieve due to limited hospital resources.

Outside scheduled therapy sessions, many patients spend long periods inactive or alone. Research shows that stroke patients often spend11,12:

  • 50% of their time resting in bed.
  • 60% percent of their time alone.
  • 75% percent of their time inactive.

Many survivors describe hospital environments as unstimulating and report feeling bored13. There is a clear need for more meaningful activities and social interaction to support recovery and well-being.

INTRODUCING REHART

Rehart is a research line that explores how enriched rehabilitation environments can support recovery after stroke.

The program combines music-based and meaningful activities alongside standard rehabilitation to create more engaging rehabilitation experiences.

We aim to better understand how activity, social interaction, and structured programs can improve recovery and well-being during hospital rehabilitation.

Learn about the research

References for this page:

  1. Feigin, V. L., Stark, B. A., Johnson, C. O., Roth, G. A., Bisignano, C., Abady, G. G., et al. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20(10), 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0
  2. Wafa, H. A., Wolfe, C. D. A., Emmett, E., Roth, G. A., Johnson, C. O., & Wang, Y. (2020). Burden of stroke in Europe: Thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years. Stroke, 51(8), 2418–2427. https://doi.org/10.1161/STROKEAHA.120.029606
  3. Patel, M. D., Tilling, K., Lawrence, E., Rudd, A. G., Wolfe, C. D. A., & McKevitt, C. (2002). Relationships between long-term stroke disability, handicap, and health-related quality of life. Journal of the American Geriatrics Society, 50(4), 700–709. https://doi.org/10.1046/j.1532-5415.2002.50160.x
  4. Rathore, S. S., Hinn, A. R., Cooper, L. S., Tyroler, H. A., & Rosamond, W. D. (2002). Characterization of incident stroke signs and symptoms: Findings from the Atherosclerosis Risk in Communities Study. Stroke, 33(11), 2718–2721. https://doi.org/10.1161/01.STR.0000035286.87566.0F
  5. Feigin, V. L., Norrving, B., & Mensah, G. A. (2017). Global burden of stroke. Circulation Research, 120(3), 439–448. https://doi.org/10.1161/CIRCRESAHA.116.308413
  6. Hartman-Maeir, A., Soroker, N., Ring, H., Avni, N., & Katz, N. (2007). Activities, participation and satisfaction one year post stroke. Disability and Rehabilitation, 29(7), 559–566. https://doi.org/10.1080/09638280600924996
  7. Buma, F., Kwakkel, G., & Ramsey, N. (2013). Understanding upper limb recovery after stroke. Restorative Neurology and Neuroscience, 31(6), 707–722. https://doi.org/10.3233/RNN-130332
  8. Krakauer, J. W., Carmichael, S. T., Corbett, D., & Wittenberg, G. F. (2012). Getting neurorehabilitation
    right: What can be learned from animal models? Neurorehabilitation and Neural Repair, 26(8), 923-931.
    https://doi.org/10.1177/1545968312440745
  9. Dancause, N., & Nudo, R. J. (2011). Shaping plasticity to enhance recovery after injury. Progress in brain research, 192, 273-295. https://doi.org/10.1016/B978-0-444-53355-5.00015-4
  10. Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., Deruyter, F., Eng, J. J., Fisher, B., Harvey, R. L., Lang, C. E., MacKay-Lyons, M., Ottenbacher, K. J., Pugh, S., Reeves, M. J., Richards, L. G., Stiers, W., & Zorowitz, R. D. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 47(6), e98-e169. https://doi.org/10.1161/STR.0000000000000098
  11. Fini, N. A., Holland, A. E., Keating, J., Simek, J., & Bernhardt, J. (2017). How physically active are people
    following stroke? Systematic review and quantitative synthesis. Physical Therapy, 97(7), 707-717.
    https://doi.org/10.1093/ptj/pzx038
  12. McDonald, M. W., Hayward, K. S., Rosbergen, I. C. M., Jeffers, M. S., & Corbett, D. (2018). Is environmental enrichment ready for clinical application in human post-stroke rehabilitation? Frontiers in Behavioral Neuroscience, 12(July), 1-16. https://doi.org/10.3389/fnbeh.2018.00135
  13. Kenah, K., Bernhardt, J., Cumming, T., Spratt, N., Luker, J., & Janssen, H. (2018). Boredom in patients with acquired brain injuries during inpatient rehabilitation: A scoping review. Disability and Rehabilitation, 40(22), 2713-2722. https://doi.org/10.1080/09638288.2017.1354232

ABOUT

This page presents the RehArt research line, which focuses on the study of enriched rehabilitation environments in inpatient stroke rehabilitation. The aim is to provide evidence-based information for the general public, stroke survivors and families, clinicians, and decision-makers.

CONTACT

You can reach the team at:

[email protected]

FUNDED BY

This project has been funded by Grant PID2023-149792OA-I00 (MICIU/AEI/10.13039/501100011033) and by ERDF/EU from the Ministry of Science, Innovation, and Universities, and Innovation of the Spanish Goverment to EUIT University Center.

This project has received funding from the European Union’s Horizon Europe research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101126533.

PARTNER INSTITUTIONS