Designing for Recovery: How Physical Environments Shape Rehabilitation Outcomes

The following article includes condensed portions of “A Structured Literature Review on the Research and Design of Rehabilitation Environments” by Samira Pasha and Mardelle Shepley, originally published in HERD: Health Environments Research and Design Journal

Why Rehabilitation Environments Deserve Their Own Playbook

Hospital architecture has long embraced evidence‑based design to reduce infections, shorten stays, and boost staff efficiency. Yet rehabilitation units for patients recovering from stroke, trauma, neurological or cardiopulmonary conditions, or invasive, long-term treatments—where patients must move, learn, and relearn daily skills—still borrow guidelines written for acute care.

That mismatch matters: Patients in rehabilitation recover differently from typical acute or critical care patients because they are in a different stage of recovery and have a different set of needs. With rehabilitation, the environment plays a significant role in the patients’ recovery. A well‑designed rehabilitation unit can help lower readmissions and mortality, foster independence after stroke or amputation, and help patients manage pain or age‑related decline.

Certain aspects of rehabilitation treatment plans that can be supported by environmental features include:

• Safe Mobility: Patients are encouraged to move and therapy often happens outside the patient room. Availability of appropriate mobility equipment and easy access to a wide range of therapy and communal spaces is a must.
• Socialization: Individuals rehearse tasks and need feedback and encouragement through socializing with peers, family members and staff. Socialization can also be part of a patient’s treatment plan to combat cognitive decline.
• Comfort and Rest: Particularly important for long-term recovery centers where weeks on the unit magnify the impact of physical environment. Appropriate levels of light, noise, accessibility, and social contact play a role in patient recovery.

In many facilities, the ability to successfully meet these criteria is challenged because the therapy environment is outdated, undersized, and located in less desirable locations with limited daylight or complicated access. In addition, guidelines on programming, planning, and design of these environments are very limited. These limitations might be responsible for the oversight in environmental quality of therapy environments and leading their upgrades to take the back seat in capital project plans. This, in turn, will result in unproportioned expansion of care programs, where outgrown therapy spaces remain buried deep into older sections of the facilities.

Key Themes to Create Better Rehabilitation Environments

Our 2024 structured literature review explored the knowledge base that can support the programming, planning and design of rehabilitation environments. Among the 32 studies identified, three themes emerged that should be considered when designing rehabilitation environments.

Theme 1 – Accessibility & Wayfinding

Mobility and mild cognitive impairment are hallmark challenges for rehabilitation patients. Studies show that when corridors double as storage or charting alcoves, walkers collide with wheelchairs and confidence plummets. Shadowing of 70 German stroke patients (Kevdzija & Marquardt 2018) produced four practical rules:

• Keep decision nodes such as junctions and elevator rides to a minimum; reduce walking distance to regular destinations.
• Ensure sight‑lines from patient rooms to therapy gyms to encourage self‑propelled visits.
• Use unrepetitive architectural cues and visual landmarks—changes in ceiling height, artwork, or flooring patterns—so every turn feels unique.
• Provide clear, legible signage at adult‑eye and seated‑wheelchair height.

When implemented, these tactics can reduce need for staff escorts, freeing therapists to treat instead of transport, and can increase spontaneous activity minutes logged by patients.

Theme 2 – Environmental Enrichment

Borrowed from neurology units, enriched environments supply varied sensory, social, and cognitive stimuli that accelerate brain plasticity. Effective enrichment is embedded in routine rather than offered as optional entertainment; otherwise, mobile patients flourish while those with severe deficits remain isolated. Anåker et al.’s 2024 review of the literature is the first comprehensive review to date on enriched environments for rehabilitation in stroke units. Jannsen et al.’s, 2022 research is another study of note which measured clinical outcomes in relation to environmental enrichment interventions.

In physical medicine and rehabilitation settings this concept can be expanded to include several environmental interventions:

• Day‑lit communal lounges with views of greenery
• Interactive projection games or virtual‑reality treadmills
• Displays of patient‑created art, signaling ownership and progress
• Outdoor circuits or, in one Brazilian hospital, boats and tramcars that make moving between buildings part of therapy (Campagnol & Shepley 2014)

Theme 3 – Purpose‑Built Spatial Quality

When spatial quality meets function, patients rate service higher and trust their care plans more (Medina‑Mirapeix et al. 2013). Colley & Zeeman used “purpose‑built” in their 2020 article to capture the alignment of design and layout with function and use in therapy environments. Key issues identified in the literature include:

• Overcrowded spaces with limited waiting areas force therapists and patients to queue for equipment. On the other hand, areas that are overly large spread staff thin, making supervision difficult.
• Early‑stage patients may need to train in private rooms before joining group classes or exercising in an open gym. Later, they can benefit from peer interaction. However, early exposure can interfere with lower physical capacity and confidence levels.
• Cluttered corridors and open gyms, inappropriate finishes, and lack of staff visibility can impact safety.
• Environment-specific temperature and noise control should ensure quality and comfort for various levels of activity and socialization.

Staff Perspectives—Two Sides of the Same Coin

Rehabilitation clinicians juggle hands‑on treatment, paperwork, and emotional coaching. Overall, studies focusing on staff underlined three needs:

• Places to concentrate away from noise—tiny touchdown rooms or acoustic pods can improve documentation accuracy.
• Recharge zones away from patient care areas with daylight and views, can reduce burnout.
• Efficient workflow can be supported by direct lines from clean supply to gym to soiled utility

Interestingly, Gawlak & Stankiewicz (2022) found that while patients crave lush suburban campuses, staff prefer urban hubs for commuting ease. Design charrettes can reconcile such tensions, for example, by taking advantage of pocket parks within dense neighborhoods. For new projects, identifying a site with easy access to public green spaces can add to the attractiveness of the program.

Research Gaps & Future Directions

Given the limited number of studies on rehabilitation environments, future research should explore many aspects of inpatient rehabilitation environments.

• Diagnostic specificity: Neuro-rehabilitation dominates the literature; little is known about mixed cognitive/orthopedic cohorts or pediatric rehabilitation.
• Long‑term metrics: Most studies stop at discharge, or report on 30-day re-admission rates at best. Tracking whether design shortens total rehabilitation episodes or maintains gains several months post‑discharge would be beneficial.
• Tool Development: More multicenter studies are needed with an objective assessment of physical environment alongside clinical outcomes including mobility and quality‑of‑life data, to help create standardized tools.

Five Practical Take‑Aways for Design Teams

1. Program for unscheduled activity. Common spaces near patient rest areas with attractive design and an array of functions can encourage movement, socialization and independence.
2. Design in layers of privacy. Beyond the patient room and private treatment tooms, provide alcoves for one‑on‑one coaching, mid‑sized lounges for peer support, and public atria for community events. If available, repeat the same arrangement in outdoor green spaces.
3. Plan storage early. A clutter‑free corridor and gym space can encourage free movement and increase safety. Adequate storage that is strategically located near treatment areas can reduce staff walking.
4. Strategize for entertainment. Tablets, projection walls, or adaptive gaming rigs should be curated and located strategically to entertain but not replace social interaction. Under such circumstances, these technologies can reduce staff burden while still promoting recovery goals.
5. Co‑create with users. Include both high‑functioning and deeply impaired patients in mock‑up walk‑throughs; their feedback can help catch design flaws before they’re poured in concrete.

Conclusion—From Space to Catalyst

Rehabilitation spaces should act as silent nurturers, nudging patients toward the next milestone. When accessibility, enrichment, and purpose‑built quality intersect, the environment itself becomes therapeutic, extending the reach of limited staff and empowering patients to reclaim autonomy.

Moving forward, facility planners must resist copying acute‑care templates for recovery units. Instead, they can leverage the growing—if still nascent—evidence base to craft environments that transform treatment from something that happens to patients into something that happens with them. In doing so, they will create facilities that remain resilient as patient needs, technologies, and reimbursement models evolve over the coming decades.

Samira Pasha, PhD, AIA is a project executive with Hammes Healthcare. She has extensive experience in healthcare planning and design and a strong background in healthcare environments research. Her work has included programming, planning, and evaluation of healthcare environments ranging from small unit renovations to healthcare campus master plans. She is a registered architect with LEAN Six Sigma Green Belt accreditation and has co-authored several publications, including two books: Design for Mental and Behavioral Health (2017) and Design for Physical Medicine and Rehabilitation (in press).

References

Anåker, A, Kevdzija, M, Elf, M. (2024) Enriched Environments in Stroke Units: Defining Characteristics and Limitations. HERD: Health Environments Research and Design. Mar 18:19375867231224972. doi: 10.1177/19375867231224972. Epub ahead of print. PMID: 38494920.

Campagnol, G., & Shepley, M. M. (2014). Positive distraction and the rehabilitation hospitals of João Filgueiras Lima. HERD: Health Environments Research & Design Journal, 8(1), 199-227. https://doi.org/10.1177/193758...

Colley, J., & Zeeman, H. (2020). Safe and supportive neurorehabilitation environments: Results of a structured observation of physical features across two rehabilitation facilities. HERD: Health Environments Research & Design Journal, 13(4), 115-127. https://doi.org/10.1177/193758...

Gawlak, A., & Stankiewicz, M. (2022). Specific Needs of Patients and Staff Reflected in the Design of an Orthopaedic and Rehabilitation Hospital—Design Recommendations Based on a Case Study (Poland). International Journal of Environmental Research and Public Health, 19(22), 15388. https://doi.org/10.3390/ijerph...

Janssen, H., Ada, L., Middleton, S., Pollack, M., Nilsson, M., Churilov, L., ... & AREISSA Trial group. (2022). Altering the rehabilitation environment to improve stroke survivor activity: A phase II trial. International Journal of Stroke, 17(3), 299-307. https://doi.org/10.1177/174749...

Kevdzija, M., & Marquardt, G. (2018). Physical barriers to mobility of stroke patients in rehabilitation clinics. In Breaking Down Barriers: Usability, Accessibility and Inclusive Design (pp. 147-157). Springer International Publishing.

Medina-Mirapeix, F., Del Baño-Aledo, M. E., Oliveira-Sousa, S. L., Escolar-Reina, P., & Collins, S. M. (2013). How the rehabilitation environment influences patient perception of service quality: a qualitative study. Archives of Physical Medicine and Rehabilitation, 94(6), 1112-1117. https://doi.org/10.1016/j.apmr...

Pasha, S., Shepley, M.M. (2024). A Structured Literature Review on the Research and Design of Rehabilitation Environments. HERD: Health Environments Research and Design Journal.17 (3). https://doi.org/10.1177/19375867241248604