It is widely accepted that traumatic brain injury (TBI) often results in significant impairment to cognitive, motor and emotional functioning. Environmental factors, such as intensive engagement in cognitive, emotional, physical and psychosocial endeavors, may help to offset this impairment.
There is a growing body of evidence to support neuroplastic changes occurring as a direct result of exposure to environmental factors following a TBI. This directly counters the progressive gray matter atrophy and loss of white matter integrity that often occur in post-acute and chronic patients, resulting in functional decline.
In a recent scoping review, Frasca and colleagues conducted an extensive examination of literature in this area. They reported that therapies with critical components of environmental enrichment resulted in better recovery at all levels, with the additional benefit of functional gain. These researchers broadly defined environmental enrichment to include therapies with cognitive plus intensive physical or social stimulation.
The importance of these psychosocially-based therapies has not been ignored. Most hospital-based therapeutic TBI programs incorporate some aspect of environmental factors within the broader intervention. However, environmental factors are often discontinued following hospital discharge, resulting in a consequent decline in functioning.
Animal models have revealed that intensive engagement in cognitive, emotional, physical and psychosocial endeavors during hospital-based treatment results in substantial gains for the TBI patient. However, these gains do not continue within post-hospital or step-down environments unless the intensive engagement in cognitive, emotional, physical and psychosocial endeavors is continued during and following this transition.
Many patients are not able to continue these complex engagements due to cognitive impairment, lack of psychological assistance or lack of resources. This leads to an absence of emotional and neuromodulary engagement, which in turn results in negative neuroplasticity.
Therefore, access to rehabilitative, social, community resources and strong support networks provides the essential cognitive, social and physical stimulation needed to modulate many of the negative post-injury sequelae following TBI.
Reinforcing these findings, Miller and colleagues just published a seminal paper examining the relationship between environmental enrichment and hippocampal atrophy in moderate to severe TBI. They discovered significant negative association between intense and varied cognitive, physical and social activities at five months post-injury and bilateral hippocampal atrophy from five to 28 months post-injury.
Their findings were clear: The role of environmental enrichment in long-term neurorehabilitation and maintenance is critical.
To this aim, the following recommendations may be gleaned from the above research. First, embed therapeutic activities within the patient’s day-to-day life, instead of limiting these activities to a formal, clinical setting.
Assist the patient and his or her caregivers in creating a structure and routine that supports daily activities targeted at maintaining environmental enrichment. Here, provision of resources, guidelines and psychoeducation may prove helpful.
Social peer mentoring has shown promise as a community-based, long-term and accessible resource. For individuals living in isolated locations, mentoring may be completed through internet video chatting or similar mechanisms.
