Burton J. Tabaac, MD
International Stroke Conference 2021
March 17–19, 2021
Symposium: Enriched Environments and Recovery (121)
Preclinical work has shown the importance of enriched environments on post-stroke recovery. Enriched environments are designed to enhance sensory, motor, and cognitive stimulation by providing equipment, stimulation, open spaces, and a desire to want to engage in rehabilitative interventions. In rodent experiments, enriched environments include toys, ramps, tubes, mirrors, ropes, and the ability to interact with other animals. Rodents exposed to enriched environments early (but not late) post-stroke showed improved motor performance even on tasks for which they did not receive specific training. The proposed mechanisms of action are plethoric and may relate to multiple molecular pathways. Translating an enriched environment to human patients may take several forms, including access to iPads, books, puzzles, games, music, and interaction with other people. Additionally, one could imagine enrichment using virtual/augmented environments with video games and other technology that would not only increase dose and enjoyment.
This illustrious session, moderated by Dr. Steven Zeiler and Dr. Cathy Stinear, was dedicated to discuss, in a comprehensive approach, the preclinical basis of enriched environments and the underlying molecular mechanisms, and how enriched environments might be translated to clinical practice. Experts expressed how one might embed an enriched environment in an acute stroke unit and elaborated on how one might create novel virtual environments.
Dr. Dale Corbett from the University of Ottawa provided the history of environmental enrichment and underscored how such environments are the creation of a permissive regenerative state by enhancing multiple neuroplastic changes in the brain. Environmental enrichment promotes increased neurogenesis and reduces the impact of growth inhibiting factors.
Dr. Kate Hayward from the University of Melbourne posited, “Is enrichment ready for [the] clinic?” A stroke recovery trial development framework was detailed demonstrating a plethora of preclinical evidence, highlighting the need for further clinical evidence.
Dr. John Krakauer from Johns Hopkins and the KATA Design Studio presented virtual environments post-stroke. This talk was dedicated to designing experiences for patients that combine enriched, motivating, playful, social environments, with cardiovascular exercise, in an effort to enhance motor recovery. Krakauer emphasized that enrichment works through interactions; the elements are not independent and must be considered together rather than in a reductionist way.
In an effort to underscore his passion on this topic, Dr. Krakauer, a cerebrovascular expert and neuroscientist, declared, “It is high time that humans are provided with enriched environments for recovery that match those that have been created to optimize repair of the CNS in rodents!”