Environmental approaches to cognitive rehabilitation for traumatic brain injury: A scoping review

Environmental approaches to cognitive rehabilitation following traumatic brain injury (TBI) are recommended in international guidelines and frequently used in practice, yet their effectiveness and components are poorly understood. Existing synthesis of the literature has focused on randomized controlled trials (RCTs), with prompting and trained communication partners showing the strongest evidence. However, as environmental interventions are typically individualized, they may be investigated using non-RCT designs. This review aimed to synthesize evidence beyond RCTs regarding the effectiveness and components of environmental approaches. We conducted a scoping review, searching for non-randomized controlled studies of adults with TBI who received environmental interventions for cognitive or related functional outcomes. Seven databases were systematically searched. Two reviewers independently undertook screening, data charting, and critical appraisal. Twenty studies were included. Prompting interventions had the strongest evidence of effectiveness, while communication environment modifications, feedback, and physical setting adaptations were investigated by few but promising studies. Intervention components were diverse, with environmental strategies targeting functional and cognitive outcomes, underpinned by compensatory hypothesized mechanisms of action. Findings suggest that several environmental approaches demonstrate potential for improving functional outcomes after TBI. However, a practice-to-research gap remains, providing impetus for further research.