Archive for category REHABILITATION

[ARTICLE] Modification of Hand Muscular Synergies in Stroke Patients after Robot-Aided Rehabilitation – Full Text

Posted by Kostas Pantremenos in Paretic Hand, REHABILITATION, Rehabilitation robotics on March 27, 2022

Abstract

The central nervous system (CNS) is able to control a very high number of degrees of freedom to perform complex movements of both upper and lower limbs. However, what strategies the CNS adopts to perform complex tasks are not completely clear and are still being studied. Recent studies confirm that stroke subjects with mild and moderate impairment show altered upper limb muscle patterns, but the muscular patterns of the hand have not completely investigated, although the hand represents a paramount tool for performing activities of daily living (ADLs) and stroke can significantly alter the mobilization of this part of the body. In this context, this study aims at investigating hand muscular synergies in chronic stroke patients and evaluating some possible benefits in the robot-aided rehabilitation treatment of the hand in these subjects. Seven chronic stroke patients with mild-to-moderate impairment (FM>30

) were involved in this study. They received a 5-week robot-aided rehabilitation treatment with the Gloreha hand exoskeleton, and muscle synergies of both the healthy and injured hand were evaluated at the beginning and at the end of the treatment. The performed analysis showed a very high degree of similarity of the involved synergies between the healthy and the injured limb both before and after the rehabilitation treatment (mean similarity index values: H-BR: 0.88±0.03, H-AR: 0.94±0.03, BR-AR: 0.89±0.05). The increasing similarity is regarded as an effect of the robot-aided rehabilitation treatment and future activities will be performed to increase the population involved in the study.

1. Introduction

Motor coordination represents one of the most fascinating aspects of human nature. The central nervous system (CNS) is able to control a very high number of degrees of freedom to perform complex movements of both upper and lower limbs [1]. However, the strategies that the CNS uses to perform complex tasks are not yet completely clear and are still being studied [2]. Many studies have shown the existence of motor primitives, which would allow the CNS to manage the complex architecture of the human body, guaranteeing complex movements starting from simple movements [3]. Muscular synergy, from the Greek language, means “working together” and was introduced for the first time in a work of Bernstein as “…solution to the problem of selecting one movement among the infinite possibilities of motor solutions to perform a specific task…” [4,5]. It has been suggested that complex movements are constructed through smaller blocks (i.e., muscular synergies) able to involve different muscle groups, in order to overcome the difficulties related to the coordination of a high number of degrees of freedom [1,3,6].

The upper limb and the hand are very complex districts of our body, able to perform very precise movements, such as grasping and manipulating of small objects [2]. A detailed understanding of the mechanisms governing such complex movements would have enormous implications in the rehabilitation and prosthetic fields.

Muscle synergies are extracted from electromyographic (EMG) signals acquired from muscles involved in the movement. Several algorithms can be adopted to extract muscle synergies from EMG signals, such as non-negative matrix factorization (NNMF) [7], principal component analysis (PCA), factory analysis (FA), and inverse Gaussian [8,9,10]. The goal of such algorithms is to reduce the number of variables describing the EMG dataset, limiting the loss of information as much as possible [10].

The first studies concerning muscle synergies aimed at demonstrating that motor control could be described by a set of muscle synergies. Several studies have been conducted to select the number of synergies to be extracted and to evaluate the stability of synergies. The results already presented in the state-of-the-art have been very promising and have pushed researchers to investigate the role of muscular synergies in different fields of application ranging from sport to clinic and robotics [9]. Unfortunately, there is not a defined protocol on how many and which muscles should be selected to analyze a certain movement or a certain synergy. This choice is left to the experience of the researcher who selects the muscles on the basis of the task to be performed [3].

The monitoring of muscle patterns would allow having a quantitative picture of patients suffering from neurological disorders, such as stroke and musculoskeletal pathologies, in general for both upper and lower limbs [11,12,13,14]. An advantage of this analysis is the unobtrusiveness of the adopted sensors and the ease of execution, since the analysis and extraction of muscle synergies can be performed offline also with superficial EMG sensors. Several studies have been conducted on the alteration of the muscular synergies in subjects affected by stroke. In particular, the anomalies of the synergies of the upper limb in subjects with strong and moderate impairment were analyzed. The results showed a similarity between the synergies of the healthy and the affected limb [15]. From the literature analysis, it is evident that the presence of a particularly strong coupling of elbow flexion and shoulder movements in stroke patients affects reaching movements [15,16]. The deficit in motor performance of patients affected by stroke is due to alterations in the activation of muscular patterns. Furthermore, patients with significant neurological damage often have alterations in motor performance, evident from the analysis of muscle synergies, as observed in [17,18,19]. After a stroke, the human brain puts in place a reorganization of healthy tissue, favoring a progressive recovery of functions of the injured part of the CNS. This neural plasticity is more evident in the acute and sub-acute phase and tends to decrease in the chronic phase, as described in [20]. Over the years, the increased incidence of this pathology has pushed researchers to investigate rehabilitation solutions able to provide an adequate level of recovery and the restoration of motor function.

The introduction of robotic platforms for rehabilitation should favor the progressive recovery of muscle patterns. However, it is necessary to ensure that the use of the robot does not introduce disturbing factors in the muscle patterns [21]. Few studies have been devoted to exploring the impact of stroke in motor control, to analyze how, and how much, robot-aided rehabilitation allows improving hand control and manipulation [15,18,22], also in combination with conventional treatment or other, such as transcranial direct current stimulation [23]. Different outcomes of robot-aided rehabilitation treatment were observed, on the basis of the time elapsed since neurological damage. For acute patients, researchers observed a reduction in the number of synergies compared to the number of synergies extracted from the healthy limb [24]. Moreover, patients in the acute phase show a reduction in the number of synergies on the healthy side before a robot-aided rehabilitation treatment. This result should be interpreted, taking into account that this category of patients demonstrates a tendency for splitting and merging of muscle synergies [15,25]. In chronic stroke patients, the structure of muscle synergies involved in movement appears to remain unaltered, but the modulation of such synergies is often compromised [15,26]. Furthermore, the patient with impaired motor functions tends to show an adaptation of muscle synergies to typical characteristics of movement (such as type of movement, speed, compensation of asymmetry due to neurological damage) [15,25,26].

In such a context, the human hand represents one of the most complex anatomical districts of the human body and, thanks to more than 20 degrees of freedom, allows performing gripping and manipulation tasks. Some studies have shown that muscle synergies represent a tool for a complete description of grip control and that they can be adopted as a predictive tool to generate new hand postures [2]. An accurate analysis of muscular and postural synergies was carried out in [27]. This study showed that healthy subjects who performed gripping tasks in different configurations show a statistical overlapping among muscle synergies. This result is not trivial, as it allows us to demonstrate not only the existence of muscle synergies, but also the role they play in terms of control of the different grips [28]. Moreover, recent studies confirm that stroke subjects with mild and moderate impairment show altered upper limb muscle patterns when compared with healthy subjects during the performance of hand-reaching tasks in different directions of the space [29].

To the best of our knowledge, there are no studies analyzing the motor patterns of the hand of subjects affected by stroke after a robot-aided rehabilitation treatment, although it represents a tool of fundamental importance for performing activities of daily living (ADLs), and stroke can significantly alter the mobilization of this part of the body. Muscle synergies are useful to recognize alterations during the execution of motor tasks, since they allow highlighting the contribution of the single components that constitute complex movements in chronic stroke patients [3]. Muscular synergies of the upper limb have been adopted to evaluate possible benefits of robot-aided rehabilitation in post-stroke patients. Furthermore, it has been demonstrated a similarity between muscle synergies of affected and unaffected limbs. Similar studies have not been performed on the hand, yet. For these reasons, the aim of this work is to investigate hand muscular synergies of chronic stroke patients before and after rehabilitation treatment performed with the Gloreha Sinfonia exoskeleton. It is evident that the studies carried out so far on the muscular synergies of the hand have not shown the same evidence obtained for the upper limb in stroke subjects in combination with robot-aided rehabilitation, in order to evaluate its possible benefits on improving hand dexterity and bring muscle synergies closer to those of the unaffected limb. The advancement, compared to the state-of-the-art, is twofold: (i) to investigate the muscular synergies of the hand in subjects affected by stroke, and (ii) to quantify the effects of the robot-aided rehabilitation treatment of the hand in these subjects.

The paper is organized as follows: in Section 2, the analysis of muscular synergies, in combination with robot-aided rehabilitation, and the experimental protocol are described. Section 3 and Section 4 are focused on the experimental results obtained with post-stroke patients and their discussion. Conclusions and future work are reported in Section 5.

2. Materials and Methods

2.1. Subjects

Seven chronic stroke patients (mean age: 59.6±12.8) with mild and moderate impairment were involved in this study, as reported in Table 1. Chronic patients, although characterized by reduced level of plasticity and recovery rate with respect to acute or sub-acute patients, were involved in this study since an adequate level of muscle activation was needed to extract muscle synergies. This level, estimated by adopting inclusion criteria based on the clinical Fugl–Meyer and motor power scales, was reached only by chronic patients. The subjects had to perform treatment with the Gloreha Sinfonia (IDROGENET, Brescia, Italy) [30], a robotic glove for hand rehabilitation. At the beginning and the end of the course of treatment, the subjects’ electromyographic (EMG) signals were recorded in order to compute hand muscular synergies.

Table 1. Summary table of patients involved in this study.

Table

2.2. Experimental Protocol

As reported in Figure 1, each patient carried out a robot-aided rehabilitation treatment with the Gloreha Sinfonia, composed of five sessions per week for 4 weeks. At the beginning and at the end of the course of treatment with robot (i.e., before rehabilitation and after rehabilitation, BR and AR, respectively), sEMG signals were recorded from injured and healthy hand, by using the Delsys Trigno EMG wireless system, in order to extract muscular synergies of each subject and evaluate patient rehabilitation outcome. Moreover, each subject was evaluated using Fugl–Meyer motor assessment of the upper extremity (FM) and motor power (MP) assessment before and after the therapy program with the Gloreha robot [31,32].

Applsci 12 03146 g001 550
Figure 1. An overall view of the experimental protocol.

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[Abstract] Design of a Single-Degree-of-Freedom Immersive Rehabilitation Device for Clustered Upper-Limb Motion

Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics, Virtual reality rehabilitation on March 25, 2022

Abstract

Mechanical devices such as robots are widely adopted for limb rehabilitation. Due to the variety of human body parameters, the rehabilitation motion for different patients usually has its individual pattern; hence, we adopt clustering-based machine learning technique to find a limited number of motion patterns for upper-limb rehabilitation, so that they could represent the large amount of those from people who have various body parameters. By using the regression motion of the clustering result as the target, in this article, we seek to apply kinematic mapping-based motion synthesis framework to design a 1-degree-of-freedom (DOF) mechanism, such that it could lead the patients’ upper limb through the target motion. Also, considering rehab training generally involves a large amount of repetition on a daily basis, this article has developed a rehab system with unity3d based on virtual reality (VR). The proposed device and system could provide an immersive experience to the users, as well as the rehab motion data to the administrative staff for evaluation of users’ status. The construction of the integrated system and the experimental trial of the prototype are presented at the end of this article.

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[Abstract] Predictive models for independence after stroke rehabilitation: Maugeri external validation and development of a new model

Posted by Kostas Pantremenos in REHABILITATION on March 25, 2022

Abstract

Background: Many efforts have been devoted to identify predictors of functional outcomes after stroke rehabilitation. Though extensively recommended, there are very few external validation studies.

Objective: To externally validate two predictive models (Maugeri model 1 and model 2) and to develop a new model (model 3) that estimate the probability of achieving improvement in physical functioning (primary outcome) and a level of independence requiring no more than supervision (secondary outcome) after stroke rehabilitation.

Methods: We used multivariable logistic regression analysis for validation and development. Main outcome measures were: Functional Independence Measure (FIM) (primary outcome), Functional Independence Staging (FIS) (secondary outcome) and Minimal Clinically Important Difference (MCID).

Results: Patients with stroke admitted to a rehabilitation center from 2006 to 2019 were retrospectively studied (N = 710). Validation of Maugeri models confirmed very good discrimination: for model 1 AUC = 0.873 (0.833-0.915) and model 2 AUC = 0.803 (0.749-0.857). The Hosmer-Lemeshow χ2 was 6.07(p = 0.63) and 8.91(p = 0.34) respectively. Model 3 yielded an AUC = 0.894 (0.857-0.929) (primary outcome) and an AUC = 0.769 (0.714-0.825) (MCID).

Conclusions: Discriminative power of both Maugeri models was externally confirmed (in a 20 years younger population) and a new model (incorporating aphasia) was developed outperforming Maugeri models in primary outcome and MCID.

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[Abstract] Self-Rehabilitation for Post-Stroke Motor Function and Activity–A Systematic Review and Meta-Analysis

Posted by Kostas Pantremenos in REHABILITATION, Tele/Home Rehabilitation on March 24, 2022

Abstract

Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands.

Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation.

Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5.

Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 [6–8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes.

Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.

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[Abstract] The effect of time spent in rehabilitation on activity limitation and impairment after stroke

Posted by Kostas Pantremenos in REHABILITATION on March 24, 2022

Abstract

Background: Stroke affects millions of people every year and is a leading cause of disability, resulting in significant financial cost and reduction in quality of life. Rehabilitation after stroke aims to reduce disability by facilitating recovery of impairment, activity, or participation. One aspect of stroke rehabilitation that may affect outcomes is the amount of time spent in rehabilitation, including minutes provided, frequency (i.e. days per week of rehabilitation), and duration (i.e. time period over which rehabilitation is provided). Effect of time spent in rehabilitation after stroke has been explored extensively in the literature, but findings are inconsistent. Previous systematic reviews with meta-analyses have included studies that differ not only in the amount provided, but also type of rehabilitation.

Objectives: To assess the effect of 1. more time spent in the same type of rehabilitation on activity measures in people with stroke; 2. difference in total rehabilitation time (in minutes) on recovery of activity in people with stroke; and 3. rehabilitation schedule on activity in terms of: a. average time (minutes) per week undergoing rehabilitation, b. frequency (number of sessions per week) of rehabilitation, and c. total duration of rehabilitation.

Search methods: We searched the Cochrane Stroke Group trials register, CENTRAL, MEDLINE, Embase, eight other databases, and five trials registers to June 2021. We searched reference lists of identified studies, contacted key authors, and undertook reference searching using Web of Science Cited Reference Search.

Selection criteria: We included randomised controlled trials (RCTs) of adults with stroke that compared different amounts of time spent, greater than zero, in rehabilitation (any non-pharmacological, non-surgical intervention aimed to improve activity after stroke). Studies varied only in the amount of time in rehabilitation between experimental and control conditions. Primary outcome was activities of daily living (ADLs); secondary outcomes were activity measures of upper and lower limbs, motor impairment measures of upper and lower limbs, and serious adverse events (SAE)/death.

Data collection and analysis: Two review authors independently screened studies, extracted data, assessed methodological quality using the Cochrane RoB 2 tool, and assessed certainty of the evidence using GRADE. For continuous outcomes using different scales, we calculated pooled standardised mean difference (SMDs) and 95% confidence intervals (CIs). We expressed dichotomous outcomes as risk ratios (RR) with 95% CIs.

Main results: The quantitative synthesis of this review comprised 21 parallel RCTs, involving analysed data from 1412 participants. Time in rehabilitation varied between studies. Minutes provided per week were 90 to 1288. Days per week of rehabilitation were three to seven. Duration of rehabilitation was two weeks to six months. Thirteen studies provided upper limb rehabilitation, five general rehabilitation, two mobilisation training, and one lower limb training. Sixteen studies examined participants in the first six months following stroke; the remaining five included participants more than six months poststroke. Comparison of stroke severity or level of impairment was limited due to variations in measurement. The risk of bias assessment suggests there were issues with the methodological quality of the included studies. There were 76 outcome-level risk of bias assessments: 15 low risk, 37 some concerns, and 24 high risk. When comparing groups that spent more time versus less time in rehabilitation immediately after intervention, we found no difference in rehabilitation for ADL outcomes (SMD 0.13, 95% CI -0.02 to 0.28; P = 0.09; I2 = 7%; 14 studies, 864 participants; very low-certainty evidence), activity measures of the upper limb (SMD 0.09, 95% CI -0.11 to 0.29; P = 0.36; I2 = 0%; 12 studies, 426 participants; very low-certainty evidence), and activity measures of the lower limb (SMD 0.25, 95% CI -0.03 to 0.53; P = 0.08; I2 = 48%; 5 studies, 425 participants; very low-certainty evidence). We found an effect in favour of more time in rehabilitation for motor impairment measures of the upper limb (SMD 0.32, 95% CI 0.06 to 0.58; P = 0.01; I2 = 10%; 9 studies, 287 participants; low-certainty evidence) and of the lower limb (SMD 0.71, 95% CI 0.15 to 1.28; P = 0.01; 1 study, 51 participants; very low-certainty evidence). There were no intervention-related SAEs. More time in rehabilitation did not affect the risk of SAEs/death (RR 1.20, 95% CI 0.51 to 2.85; P = 0.68; I2 = 0%; 2 studies, 379 participants; low-certainty evidence), but few studies measured these outcomes. Predefined subgroup analyses comparing studies with a larger difference of total time spent in rehabilitation between intervention groups to studies with a smaller difference found greater improvements for studies with a larger difference. This was statistically significant for ADL outcomes (P = 0.02) and activity measures of the upper limb (P = 0.04), but not for activity measures of the lower limb (P = 0.41) or motor impairment measures of the upper limb (P = 0.06).

Authors’ conclusions: An increase in time spent in the same type of rehabilitation after stroke results in little to no difference in meaningful activities such as activities of daily living and activities of the upper and lower limb but a small benefit in measures of motor impairment (low- to very low-certainty evidence for all findings). If the increase in time spent in rehabilitation exceeds a threshold, this may lead to improved outcomes. There is currently insufficient evidence to recommend a minimum beneficial daily amount in clinical practice. The findings of this study are limited by a lack of studies with a significant contrast in amount of additional rehabilitation provided between control and intervention groups. Large, well-designed, high-quality RCTs that measure time spent in all rehabilitation activities (not just interventional) and provide a large contrast (minimum of 1000 minutes) in amount of rehabilitation between groups would provide further evidence for effect of time spent in rehabilitation.

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[Abstract] Timing and Dose of Upper Limb Motor Intervention After Stroke: A Systematic Review

Posted by Kostas Pantremenos in Paretic Hand on March 24, 2022

Abstract

This systematic review aimed to investigate timing, dose, and efficacy of upper limb intervention during the first 6 months poststroke. Three online databases were searched up to July 2020. Titles/abstracts/full-text were reviewed independently by 2 authors. Randomized and nonrandomized studies that enrolled people within the first 6 months poststroke, aimed to improve upper limb recovery, and completed preintervention and postintervention assessments were included. Risk of bias was assessed using Cochrane reporting tools. Studies were examined by timing (recovery epoch), dose, and intervention type. Two hundred and sixty-one studies were included, representing 228 (n=9704 participants) unique data sets. The number of studies completed increased from one (n=37 participants) between 1980 and 1984 to 91 (n=4417 participants) between 2015 and 2019. Timing of intervention start has not changed (median 38 days, interquartile range [IQR], 22-66) and study sample size remains small (median n=30, IQR 20-48). Most studies were rated high risk of bias (62%). Study participants were enrolled at different recovery epochs: 1 hyperacute (<24 hours), 13 acute (1-7 days), 176 early subacute (8-90 days), 34 late subacute (91-180 days), and 4 were unable to be classified to an epoch. For both the intervention and control groups, the median dose was 45 (IQR, 600-1430) min/session, 1 (IQR, 1-1) session/d, 5 (IQR, 5-5) d/wk for 4 (IQR, 3-5) weeks. The most common interventions tested were electromechanical (n=55 studies), electrical stimulation (n=38 studies), and constraint-induced movement (n=28 studies) therapies. Despite a large and growing body of research, intervention dose and sample size of included studies were often too small to detect clinically important effects. Furthermore, interventions remain focused on subacute stroke recovery with little change in recent decades. A united research agenda that establishes a clear biological understanding of timing, dose, and intervention type is needed to progress stroke recovery research. Prospective Register of Systematic Reviews ID: CRD42018019367/CRD42018111629.

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[Abstract] The Effects of Auditory Feedback Gait Training Using Smart Insole on Stroke Patients

Posted by Kostas Pantremenos in Gait Rehabilitation - Foot Drop on March 23, 2022

Abstract

This study aimed to assess the effect of the auditory feedback gait training (AFGT) using smart insole on the gait variables, dynamic balance, and activities of daily living (ADL) of stroke patients. In this case, 45 chronic stroke patients who were diagnosed with a stroke before 6 months and could walk more than 10 m were included in this study. Participants were randomly allocated to the smart insole training group (n = 23), in which the AFGT system was used, or to the general gait training group (GGTG) (n = 22). Both groups completed conventional rehabilitation, including conventional physiotherapy and gait training, lasting 60 min per session, five times per week for 4 weeks. Instead of gait training, the smart insole training group received smart insole training twice per week for 4 weeks. Participants were assessed using the GAITRite for gait variables and Timed Up and Go test (TUG), Berg Balance Scale (BBS) for dynamic balance, and Modified Barthel Index (MBI) for ADL. The spatiotemporal gait parameters, symmetry of gait, TUG, BBS, and MBI in the smart insole training group were significantly improved compared to those in the GGTG (p < 0.05). The AFGT system approach is a helpful method for improving gait variables, dynamic balance, and ADL in chronic stroke patients.

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Figure 2 The custom-made air insole: (a) Air cap insole; (b) Pneumatic-pressor sensor. (c) Peripheral unit; (d) central unit.

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[Abstract] The preliminary effects of moderate aerobic training on cognitive function in people with TBI and significant memory impairment: a proof-of-concept randomized controlled trial

Posted by Kostas Pantremenos in Cognitive Rehabilitation, TBI on March 23, 2022

Abstract

This single-blinded RCT investigated cognitive effects of aerobic exercise in persons with TBI-related memory impairment. Five participants . were randomly assigned to 12-weeks of either supervised moderate intensity aerobic cycling or an active control. Outcome measures included neuropsychological assessments and structural neuroimaging (MRI,). The exercise group demonstrated greater improvements on auditory verbal learning (RAVLT; d=1.54) and processing speed (SDMT; d=1.58). The exercise group showed larger increases in volume of the left hippocampus (d=1.49) and right thalamus (d=1.44). These pilot data suggest that 12-weeks of moderate intensity aerobic cycling may improve memory and processing speed in those with TBI-related memory impairments.

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[WEB] Traumatic brain injury in young adults: what’s different and what can be done?

Posted by Kostas Pantremenos in REHABILITATION, TBI on March 23, 2022

by Marissa Russell, MS, CCC-SLP

What do falls, motor vehicle accidents, and sports injuries have in common? Each of these incidents is a leading cause of traumatic brain injuries (TBI), or changes in brain functioning that are caused by a blow to the head. 

There are 27 million new cases of TBI worldwide. While many people experience TBIs, some groups are at greater risk than others – for example, young adults – especially those between the ages of 15 and 24. Compared to older adults, young adults face unique challenges after a TBI. In honor of Brain Injury Awareness Month this March, this article explores how TBIs affect everyday abilities in young adults and provides resources that may be particularly useful for young survivors.

What abilities in young adults can be impacted by a traumatic brain injury?

A TBI can lead to difficulties in a range of areas, such as: 

  • Cognitive skills – trouble paying attention, remembering, learning new information, organizing, planning, and problem solving
  • Language skills – trouble using and understanding language
  • Speaking skills – trouble moving the mouth and tongue to produce sounds 
  • Social skills – trouble reading nonverbal cues (e.g., facial expressions and change of tone), trouble following conversational etiquette (e.g., turn-taking)
  • Behavior – impaired judgment, reduced inhibition 
  • Regulation of emotions – mood swings or lack of emotion
  • Swallowing – trouble chewing, coughing, or choking when eating/drinking
  • Voice – changes in vocal quality or volume
  • Physical ability – trouble with balance and movement

These challenges can leave young adults in an especially vulnerable position after a TBI. During young adulthood, many individuals begin to make important decisions surrounding education, employment, lifestyle, relationships, and personal identity. While sustaining a TBI can alter this life trajectory, there are many tools available that can aid in the recovery process. 

What can young adults do to help their recovery after traumatic brain injury?

It can be beneficial to take advantage of the variety of treatment options that address the challenges young adults face after a TBI. Combining different approaches can help improve daily functioning and overall quality of life for those affected. Consider the following resources when planning the next steps post-injury:

  • Rehab Therapy – Your rehab team may include a speech-language pathologist (SLP), occupational therapist (OT), and/or physical therapist (PT). These specialists can help improve the impairments described above through therapy sessions and home exercise programs, like Constant Therapy.
  • Intensive Programs – Programs have been created to help support the higher-level cognitive, social, and language skills required to resume home, work, and community-based activities after a TBI. Search for community re-entry programs available in your area. These programs can be especially useful for young adults as they learn to navigate the new responsibilities and changes that accompany adulthood. For example, Boston University’s Intensive Cognitive-Communication Rehabilitation (ICCR) Program is geared towards helping young adults post-brain injury enter or re-enter college (this program is now offered virtually, so you do not have to live in Boston to participate!).
  • Support Groups – Not only do these groups create an understanding network of people with similar experiences, but they provide opportunities for sharing knowledge, guidance, and practicing skills (e.g., cognitive and social strategies) in a safe environment.  Search for support groups in your area and see if they are a good fit for you. Some TBI support groups are even created for young adults specifically, providing opportunities to meet peers in the same stage of life.  =
  • Counseling – Anxiety, depression, stress, and other forms of emotional adjustment are extremely common after a TBI. This can be a result of both chemical changes in the brain as well as trauma associated with the experience of a major medical event. Left untreated, these mental health changes can impact progress in rehabilitation and quality of life. Consider pairing counseling with other treatment tools to help support maximal recovery. =
  • Other tools – Because young adults are often well-versed in technology, utilizing digital therapy tools can provide an additional way to support progress. Constant Therapy provides exercises via smartphone or tablet that can help improve certain difficulties experienced after a TBI, such as trouble with attention and memory. Ask your speech-language pathologist if this could be a useful tool for you. 

Navigating life after a TBI can be overwhelming–particularly during the young adult years. The good news is that the brain is often capable of healing and compensating for damage during recovery. Understanding what resources are available is an important part of the rehabilitation process. For more information, check out the following websites:

Further Resources:

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