Description and effectiveness of environmental approaches to cognitive rehabilitation for traumatic brain injury: a systematic review of randomised controlled trials

Abstract

Interventions addressing cognitive impairments after traumatic brain injury (TBI) often rely on survivors’ relatively preserved capacity to learn, initiate, and consistently use rehabilitation strategies, along with the ability to apply strategies in various contexts. The cognitive functions required for such active engagement in rehabilitation are commonly impaired after TBI, consequently limiting the benefits of many existing cognitive rehabilitation approaches. Environmental approaches, which involve manipulating the environment to support cognition and function, may benefit TBI survivors, as they require minimal active involvement of the user to set up and initiate their use. Although these approaches are recommended by experts and frequently used, their effectiveness and components are largely unknown. We conducted a systematic review, searching seven databases for randomised controlled trials of adults with TBI who received environmental interventions for cognitive or related functional outcomes, compared to any control. Two reviewers independently undertook screening and data extraction following a standardised protocol. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Instruments. Ten studies were included in the review. Environmental intervention approaches included prompting, trained communication partners, feedback, and sensory stimulation. Interventions involving prompting and trained communication partners had the highest level of evidence for their effectiveness. Key methodological limitations included insufficient blinding to group allocation, randomisation concealment, reliability of outcome measurement, and lack of baseline similarity between groups. Whilst a number of environmental approaches demonstrate potential for improving the daily functioning of individuals with TBI, further research is needed.

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