The OT Journal Club

-Journal Club (JC) host- Jamie Grant - Specialist Neurological Occupational Therapist, UK. Provides outpatient rehabilitation, integrating neuro-technology with traditional therapy, to maximise meaningful outcomes.

-Research title- A comprehensive review of rehabilitation approaches for traumatic brain injury: efficacy and outcomes.

-Research authors- Shen, Y., Jiang, L., Lai, J., Hu, J., Liang, F., Zhang, X. and Ma, F.

-Research method- Structured literature search - PubMed, Scopus and Web of Science databases

-Journal of publication- Frontiers in Neurology

-Publication date- 13th June 2025

>> A link to the full article can be found at the end of this JC

-Keywords- traumatic brain injury, traumatic brain injury rehabilitation, cognitive therapy, tele-rehabilitation, medical trends

-Background-

• Each year, approximately 64-74 million individuals globally sustain moderate-to-severe traumatic brain injuries (TBIs).

• Impacts can be complex and multifactorial, with physical, cognitive, behavioural and/or psychosocial deficits. TBI can significantly affecting quality of life and is a leading cause of long-term disability worldwide.

• Therefore, an integrated, multidisciplinary (MDT) rehabilitation approach is required - from medical doctors, nurses, physiotherapists, occupational therapists (OTs), speech therapists, psychologists and social workers.

-JC host's rationale for article selection-

• Internationally, incidence of severe TBI (alongside economic and societal impacts) is growing. So there is a pressing need for effective, accessible and innovative rehabilitation - to address both outcomes for individuals and the societal burden.

• This research aimed to offer a detailed perspective of existing state-of-the-art rehabilitation strategies, for moderate-to-severe TBI. It aimed to critically evaluate efficacy and impact on patient recovery. As an OT working in this field (including with neuro-technology), the broad scope and inclusion of such interventions is highly relevant to the host’s patient caseload.

• Innovative therapy modalities like VR, robotics and AI were prioritised in studies, due to their potential to enhance engagement, provide task repetition and offer real-time feedback. Such benefits are not always achievable through traditional methods.

-Findings: Current rehabilitation approaches for TBI-

• Cognitive rehabilitation (mild-to-moderate TBI) helps individuals manage problems with attention, memory and executive function. Restorative strategies aim to improve impaired cognitive functions through repeated exercises and tasks. Compensatory methods teach new ways to work around challenges.

• Cognitive problems (from severe TBI) - e.g. poor attention, forgetting information, poor decision-making, or slow thinking - can majorly impact someone’s ability to work, study, sustain relationships, or complete daily activities.

• ‘Addressing symptoms such as distractibility, memory impairments, disorganisation, frustration and feeling overwhelmed requires strategies that are general enough to provide broad benefits, yet flexible enough to accommodate personal circumstances.’

• Overall, cognitive retraining supports skills like perception, focus, understanding, learning, remembering and reasoning. Though cognitive rehabilitation aids to manage symptoms, long-term and significant improvements are still difficult to achieve.

• Harnessing neuroplasticity - the brain’s ability to reorganise its structure and function in response to learning, experiences, or injury - is a key part of post-TBI recovery. Strategies that draw on neuroplasticity include task-specific (functional) training, constraint-induced movement therapy (CIMT) and virtual reality (VR).

• VR systems have demonstrated efficacy in improving both motor and cognitive skills (post-moderate-to-severe TBI). Their immersive environments enhance engagement, facilitating high repetition; they encourage task-based practice and recovery via neuroplasticity.

• Not all trials find VR superior to conventional OT or PT alone - especially when compared to intensive therapist-led task-based training, or computer-assisted therapy modules. However, a growing evidence base suggests that ‘VR interventions may boost specific cognitive domains, such as attention, memory and executive function, particularly when integrated with tailored therapy programs.’

• Telerehabilitation can improve outcomes by offering assessments and therapy at a distance. It comes with lower costs, less travel time and better access to services.

• Artificial intelligence (AI) can support diagnosis, plan treatments, monitor progress and provide personalised therapies.

• A full cognitive and emotional profile, through neuropsychological assessment, allows clinicians to build rehab plans that directly match individual needs and goals. As deficits to memory, perception, language and intelligence are common post-TBI, neuropsychology is a vital component of recovery.

• Community-based rehabilitation programs can include job training, help finding employment and ongoing workplace support; this has been shown to increase job success and financial independence. It is also a practical and cost-effective solution, especially in developing countries.

• Standardised outcome measures: Functional Independence Measure, the Disability Rating Scale and the Glasgow Outcome Scale are regularly used to give measurable scores that reflect a person’s level of independence and disability. 

-Implications and Limitations-

Studies examined in this review show that a patient-centred care approach leads to better outcomes in executive functioning, emotional wellbeing and community reintegration. By combining conventional and technology-assisted rehabilitation, recovery in moderate-to-severe TBI can be enhanced. Effective TBI rehab relies on clinician collaboration, to address unique deficits, needs and goals. Recent reviews stress that involving neuropsychologists in rehab teams can improve outcomes, by optimising cognitive and behavioural interventions. 

This study identifies gaps in current research, as follows:

The authors of this research recommend that future studies focus on long-term effectiveness, cost-efficiency and scalable personalised care models. They should prioritise integrated approaches, including development of MDT protocols (physical therapy, cognitive rehab, counselling, etc.). Together with biomarkers and/or neuro-imaging, personalise treatment can be truly optimised. 

-Thoughts from the JC host-

I found this 'comprehensive review' to be both in-depth and broad in its scope. It offers an insightful 'toolbox' of ideas to return to my clinical practice with - and hopefully drive further improvements in how I deliver treatment.

The authors declare that research was conducted in the absence of any commercial or financial relationships, that could be construed as potential conflicts of interest. This transparency is particularly salient regarding neuro-technology devices or modalities, given the potential financial gain from inclusion in such research.

There is a limitation to specific neuro-technology devices named within the main body of this work. Inclusion could have potentially driven a more efficient knowledge translation of evidence-to-practice. However, in-text referencing does draw you to examples, via further reading.

-Original journal article-

www.frontiersin.org

Traumatic Brain Injury (TBI), particularly in moderate-to-severe cases, remains a leading cause of long-term disability worldwide, affecting over 64 million ...