Acquired Brain Injury in Adults: A Review of Pathophysiology, Recovery, and Rehabilitation

Abstract

Purpose The purpose of this study is to summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and, in particular, for young adults. Method This review article reviews a range of ABI-associated topics including (a) mechanisms of injury; (b) biological, individual-specific, and behavioral drivers of recovery; and (c) current methods of cognitive rehabilitation. It then narrows focus to young adults, a frequently affected and growing population to sustain ABI. The review article concludes by providing (a) suggestions for key components of cognitive rehabilitation for young adults with ABI, (b) an example from our own research providing intensive academically focused cognitive rehabilitation for young adults with ABI pursuing college, and (c) recommendations for future behavioral and neuroimaging studies in this area. Conclusions ABI is on the rise in the United States. Young adults have been sustaining ABI at higher rates over the past several decades. These injuries occur when they would otherwise be advancing their academic and career goals, making the cognitive deficits that often accompany ABI especially devastating for this group. Review of existing literature suggests cognitive rehabilitation programs that combine aspects of restorative, comprehensive, and contextualized approaches could promote recovery for young adults with ABI. Future intervention studies may benefit from including both behavioral and neural outcomes to best understand how principles of neuroplasticity—naturally embedded within many cognitive rehabilitation approaches—could be manipulated to promote cognitive recovery and long-lasting brain reorganization in this group.

Optimizing our evidence map for cognitive–communication interventions: How it can guide us to better outcomes for adults living with acquired brain injury

“…Meaningful engagement with stakeholders including clinicians and PWLE is a priority in research, quality assurance, and implementation science, as it grounds the work in lived experience, makes it more relevant and useable, incorporates different kinds of knowledge, and gives voice to stakeholders to shape their own healthcare (Canadian Institute of Health Research, 2020). PPI studies involve a partnership with stakeholders as opposed to investigation of participants (INVOLVE et al., 2011).…”

“…CCDs are defined in established consensus documents as deficits in communication (auditory comprehension, verbal expression, reading, writing and social communication) that result from underlying deficits in cognition including attention, memory, information processing, reasoning, problem-solving, and executive functions or self-regulation (CASLPO Guidelines, 2015, ASHA Guidelines 2005, INCOG Guidelines, -Togher et al, 2014. ABI is defined as a brain injury that occurs after birth due to causes that are either traumatic (e.g., motor vehicle collision, fall, sport concussion) or non-traumatic (e.g., stroke, tumour, infection) and is non-progressive in nature; CASLPO, 2015;Gilmore et al, 2021). Thus, ABI is the umbrella term and traumatic brain injury (TBI) is a subcategory of ABI.…”

“…Although CCD may arise from varied aetiologies (CASLPO, 2015) this paper will focus on cognitive-communication impairments arising from ABI (e.g., TBI or concussion, stroke, encephalitis, anoxia, aneurysm, tumour, etc.) that occur after birth and are non-progressive in nature (Gilmore et al, 2021).…”

“…Using MacDonald's (2017) Model of Cognitive-Communication Competence, cognitive-communication is viewed as an overarching term that describes multiple influences on communication performance (e.g., cognitive, physical, emotional) that affect one's competence in social and family communications, community communications, and workplace communications. Cognitive-communication deficits have been shown to have a long-term impact on quality of life as they can disrupt one's abilities to build, maintain and access social connection, independence, and academic and workplace success (Togher et al, 2014;Gilmore et al, 2021;Meulenbroek et al, 2019;MacDonald, 2017).…”

Comparing the effects of Swiss-ball training and virtual reality training on balance, mobility, and cortical activation in individuals with chronic stroke: study protocol for a multi-center randomized controlled trial

“…The common balance-and mobility-related problems observed in individuals with stroke are slower gait speed, abnormal posture, poorer walking adaptability (e.g., obstacle avoidance), and greater susceptibility to falls [2]. Impaired balance and mobility function after stroke inevitably lead to restrictions in active participation in daily activities, thereby triggering a vicious cycle of social isolation and compromised quality of life [3].…”