Welcome to the Rehabilitation Futures, a forward-looking series of design fictions that speculate on everyday patient experiences in actual rehabilitation scenarios.

Employing the Design Fictioning method developed by Dunne & Raby (2013), the NOVELL Rehabilitation Futures translate evidence from literature, first person reflections from stroke survivors, primary data from Lipson-Smith (2019) and Kenah (2022), and data gathered in a series of speculative workshops, into a series of rich person-centred descriptions of the experience of future rehabilitation environments. The stories should be seen as a launchpad for ideation rather than a prescriptive description of outcomes.

The accompanying means objectives are a series of principles for creating rehabilitation environments that position maximum patient care and safety, and an efficient care system, above all else. Within each story, you will find bracketed numerals ‘[*]’ indicating that a means objective corresponds to the scenario being described. Hovering your cursor over these will display, at the bottom-left of your screen, the means objective relative to the number, whereas clicking on any of these numbers will direct you back to this page and the full means objective list. (remove?)

In the stories that follow, you will encounter four characters. If you are from a designbackground you may be familiar with calling these personas, while if you are from a clinical background you may call these phenotypes. The characters are provocations to stimulate ideation, but will also be used to test the success of design proposals.

Ashleigh is a young stroke survivor at the beginning of their rehab journey. They were transferred from acute care into sub-acute rehab yesterday. Ashleigh has some significant paralysis in their left side, has mobility challenges, a lot of pain, is finding it difficult to articulate words, and is suffering with diplopia (double vision). However, they have no apparent cognitive impairment. Ashleigh’s family is not participating in their recovery because most of them live interstate, and their mother lives 2.5 hours drive from the hospital.

Max had his stroke just over 1 year ago, and has checked back into rehab to try to speed up his recovery and increase his physical gains. He was last in rehab just over 12 months ago and is very focused and determined to improve his mobility. Max is resisting some home modifications because he loves his home the way it is, and wants to improve his physical abilities rather than making his home feel like a hospital with no trip hazards or loose furniture. In particular, Max’s home has an old carpet runner in his hallway that causes a trip hazard when it bunches up, but when an OT rolled it up for him, he promptly returned it once they had left. Max’s family are very proud of him for choosing to try rehab again, and regularly speak with him on the phone and via video chat.

Jeane is nearing the end of her stay in the sub-acute rehab ward and has overcome most of her physical mobility challenges. She has a global aphasia, making communication and multi-step tasks difficult, but practice and cognitive stimulation are very important for her recovery. Navigation is challenging for Jeane because of her aphasia and she struggles to follow more than one step or instruction at a time. Jeane loves being around people and prior to her stroke, she was very engaged in her local community as a volunteer with a wide range of organisations.

Muhammad is mid-way through his rehab journey and is frustrated at making very slow progress over the past few weeks. He has significant fine and gross motor challenges and finds therapies centred around ADL quite confronting because they make him realise how much he is still reliant on others. Muhammad struggles to control his emotions and becomes visibly distressed as his frustration levels increase, but when his family are visiting they help him to stay motivated and keep on practicing.

Ability to change over the long term and midterm (i.e. years or months) in response to new knowledge, requirements in clinical practice, or unprecedented new technologies.
Support the necessary technologies for administration and clinical practice. The design should be able to adapt as these technologies evolve. Technology can save time for staff, reduce costs, and make the space more responsive. Technology can promote practice, promote effective rest, maximise safety, and facilitate wayfinding.
Ability to change over the short term (i.e. hours or days) in response to different clinical programs or immediate needs of people. Some spaces should be agnostic and customisable, and more prescriptive spaces should still allow some personal control over the space. A versatile space can be altered as patients’ needs, sensitivities, and preferences change, so that it both promotes practice and is conducive to rest.
For different people and over time for one person. Support patient empowerment within clinical program (support shared decision making).
Support the use of corridors as unofficial social spaces, storage spaces, therapy areas, and so on. This may encourage patients to emerge from their rooms and engage in incidental practice.
Patients, staff, and visitors should be able to execute personal choices in regard to their environment. This will allow users to maintain a sense of control and to create a balance between relaxing-versus-stimulating and private-versus-social and to create age-appropriate spaces as needed.
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Incorporate outdoor spaces and provide views of nature from patients’ rooms, therapy areas, and communal areas. Outdoor spaces provide opportunities for “real world” practice, and public access can facilitate interaction with the community. Nature can also be rejuvenating and relaxing.
Close to transport and community services. Provide services that contribute to the community, create a sense of normalcy and “home” (including the introduction of nonhospital furnishings), encourage visitors, and provide opportunities for therapeutic practice of everyday skills.
(Also to fun and variety).
Beauty or attractiveness in the building, including views, interior design, and artwork. Aesthetics may be associated with any of the senses (sight, sound, smell, touch, and taste). This can encourage visitors and foster users’ emotional well-being.
This includes air quality, light levels, access to natural light, ceiling heights, sound levels, views of the outdoors, and orientation to the sun. In addition, the indoor environment should suit specific needs of patients with brain injury who may have sensory or perceptual differences.
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A legible space is easy to navigate and understand. Wayfinding should be intuitive for all users. This is not just about signage; environmental cues are also important. Consideration should be given to people with low literacy, people who do not speak English, and people with cognitive, visual, or other sensory impairments.
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There should be minimal manual handling of patients and equipment by staff. Requires suitable technologies (e.g. hoists, trolleys) and design choices (e.g. easily accessible equipment, storage spaces, and minimal distances between key services).
Users should easily be able to see key spaces either physically or in a technologically-mediated way. However, the objective of maximising sight lines needs to be weighed up against the need for private spaces. Being able to see your destination, or your starting point, makes the space more legible and predictable. Clear orientation for patients, plus welcoming and accessible views of spaces, will help motivate patients to move around the facility, contributing to their sense of autonomy and help foster independent movement and incidental practice throughout a facility.
Should meet or exceed the building safety requirements or guidelines as laid down by the appropriate governing agency. Support essential safety standards of care. Make sure patients know support is an available offer/choice.