Recreational Therapy For Traumatic Brain Injury

Recreational therapy has emerged as a promising approach in the rehabilitation of individuals with traumatic brain injury (TBI), offering a holistic and engaging way to improve cognitive, physical, and emotional well-being. Do you know in what ways can recreation become therapeutic among individuals with traumatic brain injury? If interested, continue reading this will give you some insights.

Overview 

Recreational therapy (RT, also known as therapeutic recreation) is a systematic process that incorporates leisure and recreational activities to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological, physical, and emotional health, recovery, and well-being. Aiming to improve and maintain physical, cognitive, emotional, social and spiritual functioning in order to facilitate full participation in life. Recreational therapy has thus been recognized as a holistic therapeutic, healing approach.¹ 

Traumatic brain injury (TBI) is brain damage that disrupts normal brain functioning, caused by a sudden impact or jolt to the head. Result in a wide range of physical, cognitive, and emotional impairments. Symptoms can vary from mild (such as headaches or dizziness) to severe (including memory loss, difficulty speaking, or behavioural changes). While it has been a major cause of death and disability in the U.S., TBI will require medical attention and rehabilitation for functional management and improvement.

the purpose of recreational therapy is to restore, remediate, and rehabilitate one’s level of functioning and independence, and also to reduce/eliminate the limitations and restrictions upon participation. Among the TBI perspectives, proposed to promote neuroplasticity, enhance motor skills, foster psychological resilience, and facilitate social connections. Recreational therapy has thus been recognized as effective for TBI survivors to rehabilitate and reintegrate into their communities, to fully participate and live an independent and fulfilling life.² 

Understanding traumatic brain injury 

Causes and Incidence 

Traumatic brain injury (TBI) is an injury that affects how the brain works. It can be caused by a bump, blow, jolt, or penetrating injury to the head. While falls are the primary cause among children and older adults, motor vehicle accidents and assaults also contribute as an explanation for TBI. Furthermore, participation in contact sports and certain occupations, such as construction and mining, are also more prone to TBI occurrence. While TBI could affect people of any age. Its incidence still varies on different factors like locations, ethical groups, and socioeconomic status, with some groups more affected by TBI.^3,4 

Physical, cognitive, and emotional consequences

Due to the several damages, the whole brain would become less efficient upon TBI. It can lead to a myriad of physical, cognitive, and emotional symptoms: 

• Physical: Problems with movement, balance and coordination, headache, dizziness, fatigue, sensory disturbances, plus bladder and bowel incontinence⁵ 
• Cognitive: Memory loss, difficulties with concentration, problem-solving, processing speed, speech, reasoning, judgement and multitasking⁶
• Emotional: Mood swing, irritability, depression, anxiety, emotional lability, lack of insight, and personality and/or behavioural changes⁵

These consequences bring substantial adverse effects on one's quality of life, making daily activities challenging, thus leading to feelings of frustration and isolation. 

Long-term implications for daily functioning

In the long run, TBI survivors may face persistent challenges in daily functioning. memory and attention deficits may impose TBI survivor’s difficulties in performing tasks at work or school, upon financial management, and relationship maintenance. Physical limitations may necessitate one to seek assistance with mobility and self-care activities. Nonetheless, emotional changes can strain interpersonal relationships and hinder social interactions. Rehabilitation and support services are essential for maximising independence and quality of life for TBI survivors, so as to address their ongoing needs and promote adaptation to their new circumstances.⁵

Role of recreational therapy in TBI rehabilitation 

Holisticity in addressing physical and cognitive impairments

Recreational therapy plays a crucial role in TBI rehabilitation through its holistic focus on physical and cognitive impairments. By incorporating tailored activities such as sports, art, and music, individuals with TBI can improve motor skills, coordination, and range of motion, despite their post-injury sedentary lifestyle. Nonetheless, it facilitates rehabilitation but also stimulates cognitive processes, promoting neuroplasticity, functional independence, and safety awareness.^7,8,9 

Enhancing emotional well-being and coping skills

Recreational therapy also focuses on enhancing emotional well-being and coping skills among TBI survivors. Engaging in enjoyable activities could provide a therapeutic outlet for emotional expressions, stress reduction, and self-esteem boosting. Guided and supported by therapists through sessions, individuals with TBI would learn effective coping strategies in managing the emotional challenges associated with their injury, thereby fostering emotional resilience and stability.^7,9 

Promoting social integration and community reintegration

Recreational therapy would also play a vital role in social integration promotion and community reintegration for post-injury TBI individuals. participation in group activities could encourage social interaction, communication skills, and teamwork, facilitating the social network rebuilding. By engaging in leisure activities within their community, individuals with TBI can regain confidence, develop meaningful relationships, and gradually reintegrate into society. This aspect of recreational therapy could thus foster a sense of belonging, whilst empowering TBI survivors to lead fulfilling lives beyond their rehabilitation journey.^7,8,9

Recreational therapy interventions for TBI 

Adaptive sports and physical activities

Adaptive sports and physical activities play a crucial role in the rehabilitation of individuals with TBI. Tailored to TBI survivors’ cognitive and physical abilities, these activities are ensured for their safe and effective participation, through special equipment utilisation sometimes. Adaptive sports not only provide physical exercises but also help to promote independence, social interaction and self-confidence among individuals with TBI. No matter whether it's wheelchair basketball, fishing, or yoga. These activities, regardless of the modified equipment, rules, or regulations, would focus on motor skills, and coordination improvements. While physical activity causes the release of endorphins, positive feelings among the brain and body can be created, thereby promoting overall physical well-being, which also potentially benefits sleep and mood.^10,11 A sense of purpose and accomplishment can be attained by returning to challenging yet meaningful interests. Due to the combination of factors, among the production of higher fitness levels, and a greater sense of self individuals with TBI could experience a sense of empowerment, facilitating their functional independence and quality of life.^7,9,12 

Cognitive recreation

Cognitive recreation is another fundamental element of recreational therapy for TBI. With the utilisation of games and puzzles, cognitive functions such as memory, attention, and problem-solving skills can be stimulated. Not only can these activities enhance the cognitive abilities of TBI individuals, but they can also provide enjoyable and meaningful experiences. Memory and concentration activities like memory games and word puzzles, could challenge the cognitive abilities of TBI individuals in a supportive and engaging way. As such, TBI individuals could work towards cognitive functioning improvement with their overall cognitive well-being enhanced, through cognitive recreation.⁹ 

Expressive arts therapies

Expressive art therapies offer unique opportunities for emotional expression and communication among individuals with TBI. While music and art therapy could allow individuals to express themselves creatively, regardless of verbal limitations or cognitive impairments. On one hand, music therapy can facilitate individuals’ emotional expressions, stress reduction and mood enhancement, through engagements in activities like singing, songwriting, or musical instrument playing. Meanwhile, upon the creative outlet provided by art therapy, individuals with TBI could explore their feelings and experiences through various art forms, such as painting, drawing, or sculpting. Moreover, drama therapy could also help to facilitate communication skills and social interaction among TBI individuals through role-playing, improvisation, and storytelling activities. Expressive art therapies can thereby significantly contribute to the emotional and mental well-being of TBI survivors, so as to promote their self-awareness, self-expression, and interpersonal connections.¹³ 

All in all, by incorporating these interventions into the rehabilitation program, TBI survivors can achieve meaningful life quality improvements and functional independence. 

Tailoring recreational therapy plans for TBI 

Tailoring a recreational therapy plan for TBI patients is essential for the provision of effective rehabilitation and overall well-being promotion. As previously mentioned, TBI would manifest as an assortment of symptoms. Each TBI survivor presents with unique challenges and impairments, among physical, cognitive, and emotional aspects, thereby in need of personalised interventions to address their specific needs. 

Accordance to severity and nature 

The first and foremost consideration in tailoring recreational therapy for TBI survivors is the accordance with their respective severity and nature. individuals with mild TBI may require different interventions compared to those with moderate to severe TBI. For example: patients with more severe impairments may benefit from activities focused on basic motor skills and coordination, and those with milder impairments could participate in more complex activities targeting cognitive stimulation and emotional expression. 

Comprehensive assessment collaborate with health professionals 

A comprehensive assessment of the patient’s current abilities and limitations is a must. While it includes understanding the extent of motor, cognitive, and emotional deficits, any other co-occurring conditions that could potentially impact their participation in recreational activities, should also be taken into consideration. 

A collaboration among various health professionals can benefit as follows:⁵

By having a clear picture of strengths and weaknesses, therapists can design tailored interventions to address the specific needs of the TBI individual, while maximising current abilities. 

Personal interests and preferences 

Considering patients’ interests, preferences, and goals is a crucial element in the development of an effective, customised recreational therapeutic treatment plan. Not only enhancing motivations and enjoyment, engaging patients in activities that align with their interests, can also foster a sense of autonomy, and empowerment, meanwhile as a confidence booster along the rehabilitation journey among TBI survivors. 

Flexibility 

Flexibility is also crucial in the tailoring of recreational therapeutic treatment plans for TBI individuals. As patients progress through their recovery, their abilities and needs may change over time, requiring adjustments to the therapy plan. Therapists must remain open-minded and adaptive, upon modifying activities, setting new goals, and incorporating different approaches as necessary to meet the changing needs of the patient. 

Challenges and considerations 

Recreational therapy plays a crucial role in the holistic rehabilitation of traumatic brain injury (TBI). Despite its effectiveness, it still comes with its own set of challenges and considerations, as follows:

Addressing sensory sensitivities and cognitive fatigue

Some TBI survivors encounter distress upon hypersensitivity, which can exacerbate their symptoms and hinder their participation in recreational activities. Therapists will have to tailor interventions to accommodate their heightened sensory sensitivities, by employing strategies such as controlled environments, adaptive equipment, and gradual exposure to stimuli. Meanwhile, cognitive fatigue is also common among TBI patients, impairing their attention and concentration and engaging in prolonged activities. Recreational therapists need to structure the sessions carefully, incorporate frequent breaks, simplify instructions, and modify activities to customise the cognitive load of treatments upon exhaustion prevention.¹⁴ 

Safety protocols for physical activities

Safety protocols are also predominant when incorporating physical activities into recreational therapy sessions. TBI survivors usually encounter difficulties in mobility, balance, and coordination, as well as weak muscles. They are more prone to falls and injuries. Therapists must collaborate with physical therapists well, throughout the mobility assessment to implement appropriate modifications and supervise the activities closely to minimise risks, while ensuring a safe environment for leisure activities participation.^5,15 

Training and certification for recreational therapists in TBI 

To become a TBI-specialised recreational therapist in the UK, while a direct therapeutic recreation degree is not available. One will need to pursue their targeted career path in a combination of relevant education, practical experience, and specialised training. 

Here are a few general steps to follow: 

Relevant education 

Starting by obtaining a bachelor’s degree from a related field. For instance, occupational therapy, psychology, or social work. Enrol courses or modules that typically address TBI rehabilitation and therapeutic interventions. They may offer you a solid foundation.¹⁶ 

Practical experiences 

Seek practical experiences through various career pathways, internships, placements, or volunteering in healthcare settings specialising in TBI rehabilitation. Be exposed to working with TBI patients, understand their needs, and take trials of therapeutic recreation activities implementations customised for their abilities and challenges. 

Pursue additional certificates or specialised training targeting TBI rehabilitation. Relevant courses or workshops can be viewed by the British Association of Brain Injury Case Managers (BABICM) or the UK Acquired Brain Injury Forum (UKABIF). 

Specialised training 

Attend conferences, workshops, or further education courses regarding TBI and its management. Be updated about the latest advancements and practices in therapeutic recreation for TBI, through continuous engagement in professional developmental activities.¹⁶ 

Collaboration with interdisciplinary TBI rehabilitation teams

Upon rehabilitation settings, work closely with the patient’s rehabilitation team to help them in achieving their therapeutic goals.⁸ 

FAQs 

What activities should you avoid after a TBI?

Avoid activities that are physically demanding (e.g., heavy house cleaning, weightlifting/working out) or require a lot of concentration (e.g., balancing your chequebook). They can make your symptoms worse and slow your recovery.

Can the brain rewire itself after TBI?

Yes, the brain can rewire itself after TBI through a process called neuroplasticity, which involves the brain forming new connections and reorganising its structure to compensate for damaged areas.

Why do people with brain injuries sleep so much? 

There are chemicals in our body that help us to sleep. An injury can change the way that these chemicals affect the body. If brain mechanisms for starting and stopping sleep are injured, a condition called post-traumatic hypersomnia may result in a person sleeping many hours more than normal.

What is neuro fatigue after brain injury?

Neurological fatigue is an overwhelming feeling of tiredness which can be debilitating enough to prevent people from doing everyday activities like getting dressed, going to the shops or preparing food. Unlike physical fatigue, neurological fatigue is not alleviated by taking a rest

Does spasticity go away after TBI? 

Many patients who show spasticity in the early phase after severe TBI do not go on to have permanent spasticity when evaluated after 3–6 months.

Summary

All in all, recreational therapy plays an essential role in Traumatic Brain Injury (TBI) rehabilitation, through tailored interventions to focus on the physical, cognitive, emotional, and social recovery. During purposeful leisure activities engagement, recreational therapy not only helps to promote motor skills, cognitive function, emotional regulation, and social interaction but neuroplasticity can also be facilitated, contributing to TBI individuals' comprehensive well-being and quality of life. While there is still not much therapeutic recreation employment in TBI rehabilitation, exploration of wider adoption is vital, due to its offerings of holistic support and traditional therapies complementation. research has proved that recreation therapy has consistently demonstrated improvements in physical function, cognitive abilities, mood, and social engagement among TBI survivors. With its undeniable potential, recreational therapy inclusion in the complementation of TBI rehabilitation programs can improve recovery outcomes and empower individuals to achieve meaningful recovery while maximising their potential for independent living.