Five Ways TBI Caregivers Can Enhance Environmental Enrichment and Why They Should

I read about a new study in Science Daily that confirmed what I always thought as a caregiver: that engaging, stimulating, challenging, and involving your loved one in as many healthy ways as possible after a traumatic brain injury can improve the level of outcome.

The article reported that Dr. Green, senior scientist and neuropsychologist, Toronto, and her rehab team, have been studying impediments to brain injury recovery as well as treatments to offset the impediments. “What may be occurring after a serious brain injury,” said Dr. Green, “is that damaged tissue is leaving healthy areas of the brain disconnected and under stimulated. Over time, healthy areas may deteriorate.” The article went on to say, “Importantly, they discovered that in people with chronic moderate-severe TBI, environmental enrichment — increased physical, social and cognitive stimulation — can offset this deterioration.”

As a caregiver, I often wondered if anything I did was helping Hugh after his brain injury, but instinctively, I could not leave him alone. I was constantly involving him, moving him, making him get out of bed and do things. It’s satisfying to know that this may be what helped optimize his outcome. How and why does environmental enrichment help?

When Hugh could not move his left side, we moved it for him by stretching his elbow and moving his arm above his head. Eventually, he did wall push-ups. We wanted him to be able to swim again someday, and he did. He’s back in the water surfing today.

When Hugh could not remember simple things, we played the Memory Game, a children’s game where you flip cards over and try to make matching pairs from memory. Later, as a family, we played games such as Boggle, Scrabble, or Rummikub that required memory, strategy, and cognitive speed.

When he was bored and depressed, we went for a walk, visited a gym, raked leaves, or played cards. My brother bought Hugh a subscription to the Wall Street Journal, an optimistic gesture at best, considering the shape he was in just a few months after his severe TBI, but he started reading it, and after several weeks he moved on to books. Hugh’s friend took him to high school ball games to watch a family member play, another took him for short walks and worked out with him. I took Hugh to our daughters’ dance recitals with ear plugs because the music was loud and over stimulating, but he was there, sitting in the audience processing everything that went on around him — confusing as it was for him.

Here are five ways we engaged Hugh with environmental enrichment activities at home:

1. In the morning, I asked him to look up items of interest in the paper: the weather report, latest sports information, a news article, and sometimes I asked him to read it aloud to me.
2. I had teenagers in middle school, and they asked for homework help that was in line with the level of work Hugh could handle. They also did simple worksheets with him to extend his rehab at home.
3. Our family is cuddly: the girls hugged their Dad often, Mary gave him foot rubs and he gave her foot rubs after her ballet class. I swapped neck rubs for a back rub with him.
4. When executive function was a problem, Hugh sat around a lot, so I kept making suggestions for little things to do such as: “Please, get the mail,” or “Can you fold these towels?” I also involved him in decisions: “What should we do about PTA night?”
5. I tried to ask questions that did not have a yes or no answer to spark conversation: “What did you do at rehab today?” or “What do you think we should do for fun this weekend?” Ask your loved one to elaborate on certain points to spark memory and add substance.

As caregivers, we want as many tools as possible to help our loved ones make as much progress as they can. Knowing that environmental enrichment will help can make a huge difference in the way we approach our home life and caregiving activities. There are no limits to the ways this can be creatively implemented.

Please take a minute to share how you add physical, social, and cognitive stimulation to your loved one’s life that may be helping. We can all benefit from each other’s ideas.