An Enriched, Immersive Rehabilitative Environment for Those with Traumatic Brain Injury

PROJECT SUMMARY Severe traumatic brain injury (sTBI) can lead to permanent motor and cognitive deficits and often result in exclusion from participation in society. Recovery of function through neurotherapy can continue years after the injury. However, it is a slow process in a sterile environment and difficult to integrate into one’s life. For

decades, the concept of enriched environments, that is, scenarios that combine cognitive, social and physical stimuli, have shown neuroplastic benefits in animal models. Recent calls have been made to translate environmental enrichment to humans. Our long-term goal is to combine the principles of enriched

environments and vocational reintegration for an immersive therapy for adults with sTBI. This project continues our work on the therapeutic café, a multimodal platform which combines therapies and first-phase vocational training. In this proposed work, we will recruit chronic sTBI survivors to participate in a randomized controlled

pilot experiment that compares immersive therapy in the café to conventional physical and occupational therapy. The participants in the immersive group will participate in a fully functioning kiosk located at the MetroHealth Rehabilitation Institute cafeteria over a six-week training program under the supervision of a

therapist. The kiosk is equipped with a harness to protect from falls and is stocked with hot and cold refreshments. Participants will interact with customers, collect payment, restock items and clean the area, all with guidance from the therapist. The conventional therapy group will participate in physical and occupational

therapy for an equivalent duration as the immersive group. Our goal is to compare immersive to conventional therapy to obtain preliminary data for a larger clinical trial. In Aim 1, we compare the differences in two therapy strategies based on clinical measures of gait, balance, upper limb movement and function, and cognition. In

Aim 2, we examine the differences in physical activity between groups by quantifying limb and joint motion with wearable sensors. We expect to find that for the same amount of motion, immersive therapy results in greater improvements in clinical measures because it engages speech, cognition, and physical function in a real-world

manner. This work is important because it uses a randomized controlled trial to evaluate an innovative motivating, real-world, vocational therapy option for people with the most severe level of TBI. This is innovative as it is a completely new platform for combining therapeutic gains and community participation in this

population. The work also helps define how to quantify the amount of therapy activities and illustrates how it can be used to understand the relationship between physical activity and clinical outcomes.