Traumatic brain injury and post-acute decline: what role does environmental enrichment play? A scoping review

Abstract

Objectives: While a growing number of studies provide evidence of neural and cognitive decline in traumatic brain injury (TBI) survivors during the post-acute stages of injury, there is limited research as of yet on environmental factors that may influence this decline. The purposes of this paper, therefore, are to (1) examine evidence that environmental enrichment (EE) can influence long-term outcome following TBI, and (2) examine the nature of post-acute environments, whether they vary in degree of EE, and what impact these variations have on outcomes.Methods: We conducted a scoping review to identify studies on EE in animals and humans, and post-discharge experiences that relate to barriers to recovery.Results: One hundred and twenty-three articles that met inclusion criteria demonstrated the benefits of EE on brain and behavior in healthy and brain-injured animals and humans. Nineteen papers on post-discharge experiences revealed that variables such as insurance coverage, financial, and social support, home therapy, and transition from hospital to home, can have an impact on clinical outcomes.Conclusion: There is evidence to suggest that lack of EE, whether from lack of resources or limited ability to engage in such environments, may play a role in post-acute cognitive and neural decline. Maximizing EE in the post-acute stages of TBI may improve long-term outcomes for the individual, their family and society.

Сучасні Можливості Оцінювання Функціонування Та якості Життя У хворих Із віддаленими Наслідками Закритої Черепно-Мозкової Травми

“…Побутова активність відновлюється, як правило, до вихідного рів-ня, а суспільна та професійна залишаються низькою, що підтверджується літературними даними [7] та було продемонстровано в проведеному дослідженні. Навіть порушення в категорії відпочинку та дозвілля відмітили більше третини всіх пацієнтів.…”

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

“…Findings from animal studies demonstrate that an “enriched environment” of physical and cognitive stimulation enhances histologic, cognitive, and behavioral recovery from TBI. 150–152 An enriched environment consists of opportunities to participate in physical activities, social networks, and intellectual activities, most of which are restricted when rest is prescribed for patients. In contrast, impoverished environments, particularly during brain maturation, are reported to stunt synaptic plasticity and cognitive development.…”

Enriched Environment and Effects on Neuropathic Pain: Experimental Findings and Mechanisms

“…Yet, the scope and role of EE in clinical pain management have not been clearly defined or directly investigated by any study. Existing clinical EE studies were mostly done in neurorehabilitation units to promote patient activity levels, from which EE may currently only represent a generalized term that describes the multiple add‐on activity modalities that can facilitate conventional patient rehabilitation . Nonetheless, environmental modifications and lifestyle changes were indicated to enhance neuroplasticity, improve cognitive performance, and relieve chronic pain .…”

“…On the other hand, recent clinical research has demonstrated the efficacy of EE in promoting neurorehabilitation, such as in stroke and traumatic brain injury (TBI) patients . Of note, neuropathic pain is prevalent after stroke and TBI .…”