Is environmental enrichment useful for recovering from stroke and other non-progressive brain injury?

Stroke and traumatic brain injuries are the leading causes of death and disability worldwide, affecting the functional abilities, activities, and societal participation of survivors. Traditional rehabilitation services are provided by trained rehabilitation professionals, but it has been shown that patients following a stroke often spend a large proportion of the day in their bedroom, engaged in solitary behaviour and being inactive. Questions have been raised as to whether the rehabilitation environment itself, outside of limited therapy hours, is maximally conductive to recovery. Evidence from animal research shows that environmental enrichment, which aims to modify the environment for physical, social, and cognitive activities, may enhance functional recovery after a brain lesion. In clinical practice, environmental enrichment is defined as an adjunct service, not part of the formal rehabilitation services; it may include computers with internet access, reading material, audiobooks, video games, board games, interactive recreational activities, and music stations. Actually, the concept that a stimulating, engaging environment may promote stroke and brain trauma recovery is rather well established, and rehabilitation guidelines may recommend it, but what is the evidence of benefit to these patients?  

Helen Qin and other authors have recently conducted a systematic review to investigate the effects of environmental enrichment on well-being, functional recovery, activity levels, and quality of life in people who have a stroke or non-progressive brain injury. Multiple global databases were searched on October 26, 2020, searching for trials randomly assigning patients either to environmental enrichment or to standard services and comparing their relative effects. Only a single study with 53 participants with stroke was selected. It compared environmental enrichment (provision of reading materials, board and card games, gaming technology, music, artwork, computer with Internet, etc., that are conducive to physical, cognitive, and social activities) with standard services in an inpatient rehabilitation setting. The main outcomes are related to psychological well-being and coping. The evidence was of very low quality and follow-up was at three months only. The authors stated that they were uncertain of the results because the trial was very small and highly prone to bias. However, the gap in current research does not mean that environmental enrichment is ineffective; this is a feasible, sustainable intervention that deserves further investigation. So, further research is needed with strong study designs and consistent outcome measurement to verify whether environmental enrichment is effective, cost-effective, and safe for stroke or non-progressive brain injury patients.

             Francesca Cecchi