LIGHTING


illumination design-related factors that impact productivity and health outcomes in a hospital is one useful way of mitigating the environmental attributes that depress positive patient outcomes. Hence, by understanding the three essential properties


of light – brightness, color temperature, and daylight’s spatial nature – as they relate to biological regulation and attention modulation, it is possible for Estates and Facilities managers to identify ways to gain immediate advantages in critical spaces. For example, the decline in staff productivity can be partially attributed, not in an insignificant way, to a sub-par, crowded, or isolated working environment. The workplace impacts both the neurochemistry of attention and emotional resilience that are key to effective, empathetic care.


How can lighting enhance staff productivity? While the physical retrofitting of many clinical spaces takes time and substantial funding, understanding the malleable nature of perception provides an innovative approach to a complex problem. It is pertinent to ask: how can the attributes in lighting design enhance staff productivity, soothe frayed emotions during long waiting times, and even improve health outcomes when bed occupation rates have increased? Understanding how the mind and body respond to sensory-rich stimuli in stressful settings when we’re healing (or working under duress) proves advantageous when considering new lighting systems. This is the purview of an emerging field called Neuroaesthetics. In 2019, during the European Healthcare Design


Conference at the Royal College of Physicians in London, I gave a lecture titled ‘Cognitive Biophilia and Neuroaesthetics: The Restorative Impact of Perceived Open Space’. The presentation introduced a pioneering fMRI study carried out by an architect, an environmental psychologist, a neuroscientist, and an artist with experience creating visual-spatial illusions of nature. The study was published in the peer-reviewed Health Environments Research & Design Journal, the premier publication for evidence-based design (EBD). This pioneering study, ‘Nature Correlates of Nature Stimuli: an fMRI Study’, was spearheaded by Debajyoti Pati PhD, one of the most published healthcare researchers in the world, and his colleagues Dr. Cherif Amor, PhD, and Dr. Michael O’Boyle, PhD, at Texas Tech University’s College of Human Sciences, its Department of Design, and TTU’s Neuroimaging Institute. The paper examined whether there were unique patterns of brain activation associated with exposure to photographic sky compositions (representing nature stimuli), as compared with other positive, negative, and neutral images.5 The positive impact of nature images on health outcomes has been traditionally measured using behavioural and physiological indicators. The pre- conscious emotional response of positive, negative, and low valence imagery (those that evoke a weak or neutral emotional reaction) was already well understood in terms of their cortical mapping. However, there was a lack of understanding of the underlying neural mechanism that explained the positive emotional influence.


Looking at brain activity The research team was interested in studying whether nature imagery would enlist other areas of the brain when the staging was perceived as part of the interior envelope of a room, for example, as a credible opening in the ceiling versus a symbolic image that stood out as a 2D surface. While illusions have a rich tradition in Western Art


and architecture, their application had not been explored to generate bone fide perceived open space, which can yield therapeutic benefits for occupants in isolated, controlled, or stressful environments. The study generated brain maps of the neural pathways and regions associated with subjects’ perception of photographic open sky compositions – a photographic process that incorporates 20+ structural and contextual cues that render a credible illusion of vertical volume when properly staged above the ceiling plane. The research team compared the brain scans of subjects exposed with the open sky images to the results of their brain maps when the same subjects were exposed to nature imagery in control categories: positive, negative, and neutral scenes or patterns. Initial analysis of the brain maps indicated that the


photographic open sky compositions, which were captured at a perpendicular (90-degree) angle in relation to the ground, rather than the more common 60-degree angle, shared all the characteristic neural activations of positive images, including the neural correlates that trigger the psycho-physiology’s pleasure response in the Hedonic circuit. At the same time, the sky images that generated the credible illusion of vertical volume activated several other unique cortical regions. Of particular interest to the research team were the activations found in the cerebellum. Michael O’Boyle, the neuroscientist in the team, noted


that higher levels of activity in the cerebellum are often associated with aspects of spatial cognition, in particular the experience of extended space or depth perception.5 This study confirmed parallel research showing that the Parahippocampal Place Area (PPP) and the Retrospenial Complex (RSC) become engaged when we perceive a distant scene as opposed to objects near our bodies. The study was the first one to map the neuroarchitecture of illusory imagery and its effects on perception. This study earned the best research project of the


year, awarded by the International Academy of Design & Health, and the Certificate of Research Excellence (CORE), granted by the Environmental Design Research Association, on account of its rigorous methodology and impact on the design field.6


The study showed that


sky illusions could effectively be deployed to alter an occupant’s perceived proximity to a natural exterior. Environmental psychologists have long noted that there’s an inherent asymmetry between temporal and spatial dynamics in human perception. We implicitly use space as a measure of time. In other words, abundant space slows


August 2025 Health Estate Journal 63


Circadian stimulus versus Circadian light.


Mariana Figueiro, PhD, Light and Health Research Center at Mount Sinai, New York, USA


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