Acquired Brain Injury in Adults: A Review of Pathophysiology, Recovery, and Rehabilitation

Abstract

Purpose: To summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and in particular, for young adults.

Method: This paper reviews a range of ABI-associated topics including: 1) mechanisms of injury; 2) biological, individual-specific, and behavioral drivers of recovery; and 3) current methods of cognitive rehabilitation. It then narrows focus to young adults, a frequently affected and growing population to sustain ABI. The paper concludes by providing: 1) suggestions for key components of cognitive rehabilitation for young adults with ABI; 2) an example from our own research providing intensive academically-focused cognitive rehabilitation for young adults with ABI pursuing college; and 3) recommendations for future behavioral and neuroimaging studies in this area.

Conclusions: ABI is on the rise in the United States. Young adults have been sustaining ABI at higher rates over the past several decades. These injuries occur when they would otherwise be advancing their academic and career goals, making the cognitive deficits that often accompany ABI especially devastating for this group. Review of existing literature suggests cognitive rehabilitation programs that combine aspects of restorative, comprehensive, and contextualized approaches could promote recovery for young adults with ABI. Future intervention studies may benefit from including both behavioral and neural outcomes to best understand how principles of neuroplasticity- naturally embedded within many cognitive rehabilitation approaches-could be manipulated to promote cognitive recovery and long-lasting brain reorganization in this group.

Keywords: cognition; cognitive rehabilitation; neuroimaging; stroke; traumatic brain injury.

Figure 1.

A revised integrated approach to CR. Caption: This figure illustrates a revised integrated CR approach. It recommends five key objectives for an integrated CR approach (first column), details what current CR approach (second column) and principle of experience-dependent neuroplasticity (third column) aligns with each recommendation, and provides examples of how these have been implemented within the Intensive Cognitive and Communication Rehabilitation program at Boston University (ICCR; fourth column).