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

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.

Comments (11)

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I suffered a TBI at 22 years of age in 1980 and am still looking for ways to keep myself involved as life changes and the area of the brain that sustained the injury continues to change just as the muscles weaken and your eyesight fades. I am lucky enough to drive, although suffer left side paralysis, but I remain active in my DAR and UDC Chapters. My children do not speak to me or allow me to see my grandchildren because I take Aderol combined with four other physician prescribed medications to combat seizures and depression. (Funny how I raised them to become professional individuals without ever consulting them on my weakened state -- taught them to drive, attended every event, ect.---- and they loved me when I was on the old class of really hard core antispasmatic and seizure drugs.) Anyway, I'm a gardener, retired newspaper reporter, divorcee, and lonely 59 year old grandmother who owns her own home and creates coquillage and does her best to keep smiling. Best of luck to everyone. Lesliel, Covington, LA

I am encouraged that with hard work and effort my once strong family will find their strength again and all at the same time to make this time of feeling "stuck" and out of obligation turned back into the optimistic, loving, fun family they once was. It's been difficult,I am the survivor and a caregiver. My craniotomy was 3 years ago and my daughter had 9 concussions and second concussion syndrome in 6 months about 6 mo the after my journey began. It's been HELL to say the least on all of us but the blessing in me being able to understand and articulate for my daughter because I was able to identify with her and in that process found my own way back in the right direction. For a while anyways. I call it being blessed with a burden and talk about finding the blessing in a burden! Not that taking care of her was ever a burden cause it wasn't it. But since her life was impacted and put on halt during a time when head injuries are just beginning to come to light and NOT all doctors are using the same set of standards or even up to date standards of how to treat, that alone was a mountain for us for her not to get blown off because she "appeared" normal looking. So very thankful I could relate to her and be her voice when it was needed the most. Now almost 3 years later, coming thru the fire and making it around the bend still in tact as a family, barely but in this world barely counts! I am torn and feel constant confusion as my husband refuses to engage with our marriage or anything to do with me unless I am "down" with a bad day. Then out of concern, only then, am I seen by him and not walked around or avoided. After all this NOW, I am invisible. Part of me feels it's that he can't handle it but refuses to admit it and the other part feels like he is knowingly punishing me since I do let him know his actions towards me are cold and stand offish. After all that how can now be when you take our life for granted as if I am not here? I was diagnosed with a calcified mass indenting my left pons. Most likely a surgical pledget that I am not to mess with and it causes none of the deficits that I have or have dealt with for three years?! Not to worry, it happens. 3 week recovery was all I was to have and no need for rehab. My family doesn't recognize me and I don't have any memory of the first year and a half. How do you make sense of that AND stay a family on top of what is already harder then hell to make it thru? i am usually very optimistic, here lately smiling and holding myself up takes about all the energy I have. Just praying for light at the end of the tunnel no matter how bright. Resting up for what's to come and doing my best to stay hopeful and strong.

My husband lost his initiative and it's slowly coming back! They say the 1st 6mth is key with recovery but also he's had the most in the past 6 mths. (2yrs later) I send him pics of what we did for his memory and quiz him. I make him exercise even since he's a hard working landscaper & he may just swear at me to do it but I know it's not his fault. I do miss "old" hubby but I try to look for any positive progress each week to stay happy! I truly have faith he'll be back by the 5 year mark! Never though 100%. I have him do the dishwasher, fold laundry, play with the kids, do the manly things that I took over but just so he's involved. (as he wont on his own now), spend alone time with each separate short time frames, give him independence by going to appts alone (but I always ask if he feels ok to go alone). He plays golf and hockey still with his brother! He goes to cranial/sacral therapy every couple weeks. Amazing results in his mood mainly!! Worth every penny! He's got type 1 diabetes as well so that's our "worst struggle" believe it or not! His memory loss has impacted him taking enough insulin or even at all. That's honestly the worst part as he's at risk of a stroke. Yes I got used to this new life! We have 2 young kids, my son has no clue of anything. Writing so helps and sorry I'm going on! Guess I need to start my journal again! My biggest fear is if something happens to me!! My only thing that I wish I wouldn't think about everyday!! I'm focused on getting him to be 100% independent! May never be but having hope is nice! He works with his twin everyday and it's the only reason he can work!! So that is a "huge" part of his therapy!! Chain saws and all 😊 he still thinks he has a lil memory loss so it's hard as he doesn't think he has any deficits! I could go on! Stay strong as a wife/husband caregiver! A lot of people can't handle it, friends have bailed but my family I'll never let any of that happen i know it's not his fault! He's a strong guy and shouldn't be here from what Dr. said. Truly lucky! I plan vacations, date nights, concerts etc! He used to do most of that! The 1st year or more yes it was not like this, trial and error and a great dr. helping me decide what he should/can do! He's even snowboarding again! though life can be super sad, hard or ok I'm grumpy at times! I stay true to day to day thinking and only think ahead of the major important things!! I live at times hour by hour now! It takes a strong family to get through! My new life does have the same joke every night made by him and we all laugh! Now though he knows he's saying it!! It'll be a big part of the book I "never" write but we talk about!! Love reading these comments and what Rosemary writes! Her book helped me get through the beginning knowing I'm not alone! Xo

Our son is 31 and is 2 years and 9 months out from his severe tbi. Physically he looks fine but had no short term memory when he finally was able to come home with us after 15 months. We started him on Curcumin with dr approval and within 2 weeks his short term memory started very slowly returning and still is. He can't do therapy now though because of very bad anger issues at times. So we do lots of Legos, puzzles, walks, a few holes of golf at a time and he chips lots in our yard. He helps me with all chores, taking care of our dog etc. always with supervision of course and Dr is pleased that his cognitive and executive function is still very slowly improving even without official therapy. We do everything we can to keep him active physically and mentally to help him.

I can't seem to get my husband to do much.  He is 2 1/2 years in.  He is unable to walk, has trouble speaking, he cannot swallow, and his right side is weak, and it shows in his face.  He is embarrassed to go out because he thinks everyone is looking at him.  It's a constant source of controversy.  Not only is he not living his life, I'm not living mine either because I feel guilty leaving him.  I won't give up trying to get him out and about to enjoy his "new" life.  It's very frustrating  most of the time.  Even though he says he's not giving up, it seems like he already has. 

My husband doesn't need a lot of push from me; he's his own motivator. He has recovered and come further much more quickly than anyone expected. He deliberately turns things into rhymes just to make himself think of the right words; he makes up little poems and songs. Sometimes when I think he's not making any sense, he's way ahead of me in what he's thinking. Fortunately, all he's forgotten about is his time in the hospital. His memory is good. I wonder, though, if I need to stimulate him even more, in different ways than he pushes himself. He has vision issues due to glaucoma so it's hard for him to read a lot, though he does spend time online reading and posting to some groups he's interested in. I'm so glad he's taken an interest in things he cares about, because for awhile he didn't want to do any of that.
This is awesome! I found a drive inside that took me to research to get better. As I did this and as I gained in energy and cognition, I got better, so in many ways it is a smarter brain that I live with now!! I did it mostly on my own!!!
Wow!! This is awesome! As a survivor myself, I found a drive inside of me, that took me to new stimulation, learning and experiences as I gained in energy. Doing research about brain injuries also helped me immensely. I was so determined to heal it completely, get the old brain back. However, I've learned that even with deficits and all the alternative things I've found, this new brain is actually smarter in many ways!!
I am my son's caregiver and I try to include him in every decision possible. He is cognitively still having trouble and has a difficult time expressing his needs but fully understands commands. We take him for outings, walks, he tends to chores. It is constant work but trying hard to help him get his life back. He does therapy and school during the week. I love hearing suggestions and hearing the support. We are a year into our journey and open to any suggestions anyone has to offer.
My family took me to art museums, road trips to small towns nearby, walks around a local historical farm, to the library, everywhere that they know I love.