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Rehabilitative and therapeutic neuroarchitecture

When assessing people’s functioning and health we are increasingly taking account of the potential or actual influences of the physical attributes of their direct environments. In the current framework of the International Classification of Functioning, Disability and Health (ICF), such contextual factors are regarded as either facilitators of, or barriers to, a person’s functioning. This development mirrors recent interest within the field of architecture and design in the effect of man-made structures on the human central nervous system. The ambition of neuroarchitecture as a field has been to promote the study of the perception of, and response to, architectural stimuli in order to provide a strong evidence base for designing places and spaces that provide a positive context for human experiences. Several functions have been the focus of investigation, including sensation and perception, movement, navigation, decision-making, learning and memory, and emotion. Data emerging from these studies may be used when designing private or public structures for general purpose. It may also serve to inform architectural requirements for the optimization of functioning of certain groups, such as typically developing children and those with developmental challenges. For example, classrooms can be designed in ways that better support the cognitive activities of students, or laboratories can be conceived to facilitate interdisciplinary activities of researchers. Further, results from studies conducted in selected medical conditions have been tentatively translated into design principles that are applicable to healthcare environments. These principles include reducing environmental stressors, facilitating social support, and giving patients a sense of control. They also emphasize ‘positive distraction’ provided by environmental features that attract individuals’ attention away from the stressful aspects of an experience while eliciting positive affects. Positive distractions include stimuli that foster well-being, such as artwork, music, physical exercise, pets, and views of or access to nature (e.g. therapeutic or healing gardens). Such distractions have the potential to mitigate environmental stressors as well as provide patients with opportunities for social interaction and a sense of control. Application of these principles is recommended for the patient and their family in order to enhance recovery. However, benefits for staff and caregivers have also been observed in terms of satisfaction, effectiveness, and staff retention, following environmental arrangements such as appropriate lighting, direct access to daylight, noise reduction, or provision of respite areas. To date, the principles of therapeutic architecture have been purposefully used in only a limited number of buildings, mostly general hospitals and departments or institutions of geriatrics, psychiatry, or rehabilitation, with generic objectives such as ‘enhancing well-being’. The facilities may also feature specific landmarks supporting sensory and cognitive processing, social interaction, or motor cognition, though there has been little objective evaluation of these effects. In contrast, therapeutic gardens have been very popular. They are now quite common in children’s hospitals; oncology, mental and behavioural health or dementia care facilities; homes for the elderly; and other settings in the community. There is a growing body of evidence on the benefits of therapeutic gardens to the health of patients, staff, and visitors. Yet, many of the designated therapeutic gardens in healthcare facilities fail to meet evidence-based guidelines. This may point to the need for an interdisciplinary collaborative framework in which users, families, therapists, psychologists, physicians, scientists, engineers, architects, healthcare facility managers, policymakers, and other professionals share existing knowledge, develop new knowledge, experiment together, and bring innovative projects to fruition. Architectural structures might thus be designed with highly specific thera-peutic and rehabilitative objectives. In creating such a framework, the next step should be an alliance of professionals involved in functioning, disability, and health with neuroarchitects and designers of therapeutic environments. This partnership can be achieved through meetings, teaching, research projects, and practice in the field. This is an untapped and potentially very exciting area for development.