Observations in the rehabilitation hospital: twenty years of research

For the past 20 years two research groups, one in Texas and one in California, have been making systematic observations of rehabilitation hospital activities. In both programs interest in recording behavior originated with an environmental psychology orientation. The Texas investigations focused primarily on individuals with spinal cord injury, both during rehabilitation and after discharge. In California, the study populations have been primarily those with strokes. Early work revealed that patients spent a relatively small portion of the day in therapeutic routines, their activities were restricted to a few hospital locations, and the opportunities for independent behavior were limited. Later research has shown a more intensive treatment schedule, but patients still spend a significant portion of the work-day alone and not in treatment. Observations in three different hospitals showed that patients experienced very similar treatment routines. Using both mechanical and human recording methods, it was found that measures of hospital behavior were sensitive to treatment progress and were robust predictors of postdischarge outcomes. Although this work has produced insights into the operation of rehabilitation hospitals, there is little evidence that it has influenced their operations. The current organization of treatment needs to be examined, however, in light of the findings presented here.