1026 Patient Centered Environmental Enrichment Program for Early Neurorehabilitation: BrainBuilders, a Pilot Project in Review

INTRODUCTION: Translational and clinical research has demonstrated that an Enriching Environment (EE) can significantly benefit neurologic outcomes of patients with traumatic brain injury (TBI), spinal cord injury (SCI) or other lesions of the CNS. EE has been shown to enhance the recovery process by promoting neuroplasticity through increased neurostimulation, neurogenesis and stress reduction. Therefore, EE could serve as a viable preclinical model of neurorehabilitation as an adjunct therapy to the standard clinical model of post-TBI neurosurgical care. EE may be of particular importance to socioeconomically disadvantaged patients, who historically experience delays and inequities in inpatient and outpatient neurorehabilitation. METHODS: Target patient population involves inpatient Neuroscience and Neurosciences ICU and Neuro-ICU step down units. Patients qualifying for referral into the BrainBuilders program are identified by the floor nursing staff. 15 highly trained BrainBuilders volunteers approach these patients to determine participation. Daily visits and interactive activities offered by BrainBuilders volunteers include talking, board games, crossword puzzles, coloring, and walking. RESULTS: A total of 2249 unique patient visits were conducted in 34 months. Median visit time was 15 minutes. 383 patients had TBI/SCI (17%), 410 had CVA (18.2%), 92 had intra/extra axial neoplasms (4.1%), 632 (28.1%) had other medical conditions, and 732 (32.6%) were unknown. Visit activities included talking (n=1202, 53.4%), cognitive stimulation (n=77, 3.4%), and motor stimulation (n=24, 1.1%). 946 (42.1%) patients declined a visit or were unable to be seen. There was no significant association between condition type and interaction type, highlighting consistency of visit types across all conditions (p=0.1). CONCLUSIONS: BrainBuilders EE program offers a minimal-cost model of inclusive early neurorehabilitation in patients with delays in neurorehabilitative care or deficient social support. Further studies should focus on quantifying prospective clinical outcomes of patients enrolled in the BrainBuilders program.