Creative Therapeutic Interventions for Clinicians to Promote Physical Activity in Older Adults with a Brain Injury: A Viewpoint Tucker J., Beitscher I., Koc T., Fama G., Patel J., Friedman H. YOGA ● Physical benefits of yoga include improvements in: ○ Flexibility and ROM ○ Posture and balance ○ Strength and stability ○ Motor control and coordination ○ Cardiovascular endurance 9 GROUP FITNESS ● Group fitness benefits in older adults include: ○ Improved social networks ○ Decreased depressive symptoms ○ Increased exercise intensity ○ Greater satisfaction ○ Self-recognition ○ Sense of achievement 5 MUSIC THERAPY ● Listening to music can: ○ Improve communication in individuals with aphasia ○ Improve engagement and participation ○ Reduce depression and confusion ○ Improve mood with rhythmic movements to music or active music making 10 VIRTUAL REALITY ● Virtual reality is (VR) is used to improve standing balance through motivational and adaptive exercises, resulting as a safe alternative to traditional treatment to improve static balance 6 CANINE ASSISTED THERAPY ● Canine assisted therapy aides in the management of pain and stress, as well as an improvement in verbal and non-verbal communication, mood, motivation, and emotion, resulting in enhanced therapeutic involvement 7,8 INTRODUCTION ● 47% of individuals experience chronic disability well into their later years. 1 Early implementation of appropriate treatment strategies becomes crucial in promoting physical activity and addressing related cognitive and behavioral function. ● Normal aging brain changes: ○ Decreased synaptic density 2 ○ Decreased nerve conduction velocity, resulting in delayed processing and cognitive decline 2 ○ Aging microglia can produce toxic substances ○ Size of brain decreases after 50 years with early volume loss in grey matter and white matter 2 ● Aging brain with TBI: ○ Less age related neuronal loss needed to exceed threshold adequate for manifestation of a deficit 3 ○ Worsened cognitive, behavioral, and physical state as compared to a normal aging brain 4 CLINICAL SIGNIFICANCE ● Limited knowledge exists on alternative treatment approaches to manage clients aging with a TBI ● Benefits of exercise on brain activity in TBI: ■ Physical exercise can maintain and improve pathophysiological changes from TBI 4 ■ Encourage cognitive recovery by up- regulating neuroplasticity-related growth factors 4 ■ Reduce neuronal degeneration, inhibit neuronal apoptosis and reduce lesion size ■ Up-regulation improves: ● Working, spatial, and delayed memory ● Cognition ● Auditory and visual learning ● Processing speed 4 ● This treatment approach highlights creative strategies which may be incorporated into rehabilitation programs to promote physical activity after TBI CONCLUSIONS ● Research and clinical experience reveal that aging affects survivors of TBI differently than their healthy counterparts. These clients benefit greatly from creative treatment strategies to prevent boredom, frustration, decreased motivation and subsequently result in positive physical, cognitive, behavioral, and social outcomes. ● Future research is indicated to: ○ Evaluate these interventions with larger scale studies and the use of standardized assessment measures ○ Assess the impact of these creative interventions more specifically on physical activity in the aging population and their carryover to everyday function ○ Explore a greater variety of interventions ● Results of future research would potentially lead to the development of guidelines on effective utilization of these activities to promote physical activity in aging individuals with a history of TBI. REFERENCES 1. Kumar, R.G., Olsen, J., Juengst, S.B., Dams-O’Connor, K., O’Neil-Pirozzi, T.M., Hammond, F.M., Wagner, A.K. (2019) Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury: Examining Associations With Demographics, Healthcare Utilization, Institutionalization, and 1-Year Outcomes. The Journal Of Head Trauma Rehabilitation. 34(4), 224-232. 2. Moretti, L., Cristofori, I., Weaver, S.M., Chau, A., Portelli, J.N., Grafman, J. Cognitive decline in older adults with a history of traumatic brain injury. The Lancet Neurology. 2012;11(12);1103-1112. 3. Ozen, L.J, Fernandes, M.A., Clark, A.J., Roy, E.A. Evidence of cognitive decline in older adults after remote traumatic brain injury: an exploratory study. Neuropsychology, Development, And Cognition Section B, Aging, Neuropsychology And Cognition.2015;22(5);517-533. 4. Morris, T., Gomes Osman, J., Tormos Munoz, J. The Role of Physical Exercise in Cognitive Recovery after Traumatic Brain Injury: A Systematic Review. Restorative Neurology and Neuroscience. 2016;34;977-988. 5. Hayashi, T., Kondo, K., Kanamori, S., Tsuji, T., Saito, M., Ochi, A., & Ota, S. Differences in Falls between Older Adult Participants in Group Exercise and Those Who Exercise Alone: A Cross-Sectional Study Using Japan Gerontological Evaluation Study (JAGES) Data. International Journal of Environmental Research and Public Health. 2018;15(7);1413. 6. Gil-Gómez, J.-A., Lloréns, R., Alcañiz, M., & Colomer, C. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. Journal Of Neuroengineering And Rehabilitation. 2011;8;30 7. Marcus, D. The Science Behind Animal-Assisted Therapy. Cancer Pain. 2013;17(322);1-7 8. Hediger, K., Thommen, S., Wagner, C., Gaab, J., & Hund-Georgiadis, M. Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: a randomised controlled trial. Scientific Reports. 2019;9. 9. Field, T. Yoga Clinical Research Review. Complementary Therapies in Clinical Practice. 2011;17;1-8 10.Magee, W., Clark, I., Tamplin, J., & Bradt, J. Music Interventions for Acquired Brain Injury: Findings From a Cochrane Review. Archives of Physical Medicine and Rehabilitation. 2017;98(10) CREATIVE INTERVENTIONS
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Creative Therapeutic Interventions for Clinicians to Promote Physical Activity in Older Adults with a Brain Injury: A Viewpoint
Tucker J., Beitscher I., Koc T., Fama G., Patel J., Friedman H.
YOGA● Physical benefits of yoga include
improvements in:○ Flexibility and ROM○ Posture and balance○ Strength and stability○ Motor control and
coordination○ Cardiovascular endurance 9
GROUP FITNESS● Group fitness benefits in older
adults include:○ Improved social networks○ Decreased depressive
symptoms○ Increased exercise
intensity○ Greater satisfaction○ Self-recognition ○ Sense of achievement 5
MUSIC THERAPY● Listening to music can:
○ Improve communication in individuals with aphasia
○ Improve engagement and participation
○ Reduce depression and confusion○ Improve mood with rhythmic
movements to music or active music making 10
VIRTUAL REALITY● Virtual reality is (VR) is used to improve
standing balance through motivational and adaptive exercises, resulting as a safe alternative to traditional treatment to improve static balance 6
CANINE ASSISTED THERAPY
● Canine assisted therapy aides in the management of pain and stress, as well as an improvement in verbal and non-verbal communication, mood, motivation, and emotion, resulting in enhanced therapeutic involvement 7,8
INTRODUCTION● 47% of individuals experience chronic disability
well into their later years.1 Early implementation of appropriate treatment strategies becomes crucial in promoting physical activity and addressing related cognitive and behavioral function.
● Normal aging brain changes:○ Decreased synaptic density 2○ Decreased nerve conduction velocity,
resulting in delayed processing and cognitive decline 2
○ Aging microglia can produce toxic substances○ Size of brain decreases after 50 years with
early volume loss in grey matter and white matter 2
● Aging brain with TBI:○ Less age related neuronal loss needed to
exceed threshold adequate for manifestation of a deficit 3
○ Worsened cognitive, behavioral, and physical state as compared to a normal aging brain 4
CLINICAL SIGNIFICANCE
● Limited knowledge exists on alternative treatment approaches to manage clients aging with a TBI
● Benefits of exercise on brain activity in TBI:■ Physical exercise can maintain and improve
pathophysiological changes from TBI 4■ Encourage cognitive recovery by up-
regulating neuroplasticity-related growth factors 4
■ Reduce neuronal degeneration, inhibit neuronal apoptosis and reduce lesion size
■ Up-regulation improves: ● Working, spatial, and delayed memory● Cognition● Auditory and visual learning● Processing speed 4
● This treatment approach highlights creative strategies which may be incorporated into rehabilitation programs to promote physical activity after TBI
CONCLUSIONS● Research and clinical experience reveal that
aging affects survivors of TBI differently than their healthy counterparts. These clients benefit greatly from creative treatment strategies to prevent boredom, frustration, decreased motivation and subsequently result in positive physical, cognitive, behavioral, and social outcomes.
● Future research is indicated to: ○ Evaluate these interventions with larger
scale studies and the use of standardized assessment measures
○ Assess the impact of these creative interventions more specifically on physical activity in the aging population and their carryover to everyday function
○ Explore a greater variety of interventions● Results of future research would potentially lead
to the development of guidelines on effective utilization of these activities to promote physical activity in aging individuals with a history of TBI.
REFERENCES
1. Kumar, R.G., Olsen, J., Juengst, S.B., Dams-O’Connor, K., O’Neil-Pirozzi, T.M., Hammond, F.M., Wagner, A.K. (2019) Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury: Examining Associations With Demographics, Healthcare Utilization, Institutionalization, and 1-Year Outcomes. The Journal Of Head Trauma Rehabilitation. 34(4), 224-232.
2. Moretti, L., Cristofori, I., Weaver, S.M., Chau, A., Portelli, J.N., Grafman, J. Cognitive decline in older adults with a history of traumatic brain injury. The Lancet Neurology. 2012;11(12);1103-1112.
3. Ozen, L.J, Fernandes, M.A., Clark, A.J., Roy, E.A. Evidence of cognitive decline in older adults after remote traumatic brain injury: an exploratory study. Neuropsychology, Development, And Cognition Section B, Aging, Neuropsychology And Cognition.2015;22(5);517-533.
4. Morris, T., Gomes Osman, J., Tormos Munoz, J. The Role of Physical Exercise in Cognitive Recovery after Traumatic Brain Injury: A Systematic Review. Restorative Neurology and Neuroscience. 2016;34;977-988.
5. Hayashi, T., Kondo, K., Kanamori, S., Tsuji, T., Saito, M., Ochi, A., & Ota, S. Differences in Falls between Older Adult Participants in Group Exercise and Those Who Exercise Alone: A Cross-Sectional Study Using Japan Gerontological Evaluation Study (JAGES) Data. International Journal of Environmental Research and Public Health. 2018;15(7);1413.
6. Gil-Gómez, J.-A., Lloréns, R., Alcañiz, M., & Colomer, C. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. Journal Of Neuroengineering And Rehabilitation. 2011;8;30
7. Marcus, D. The Science Behind Animal-Assisted Therapy. Cancer Pain. 2013;17(322);1-7
8. Hediger, K., Thommen, S., Wagner, C., Gaab, J., & Hund-Georgiadis, M. Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: a randomised controlled trial. Scientific Reports. 2019;9.
9. Field, T. Yoga Clinical Research Review. Complementary Therapies in Clinical Practice. 2011;17;1-8
10.Magee, W., Clark, I., Tamplin, J., & Bradt, J. Music Interventions for Acquired Brain Injury: Findings From a Cochrane Review. Archives of Physical Medicine and Rehabilitation. 2017;98(10)
CREATIVE INTERVENTIONS
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