Environmental enrichment for adults with neurological conditions: A systematic review

Background/Aims: Environmental enrichment is proposed to improve neurological recovery through neuroplasticity. The objective of this systematic review is to determine whether environmental enrichment improves neurological outcomes. Methods: An extensive search in PubMed (1966 to March 2015), EMBASE (1988 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), Cochrane Controlled Trials Register (March 2015) and PsycINFO(1806 to March 2015) was performed. Studies that compared environmental enrichment to control conditions in a controlled design or pre/post-test and/or time series with a minimum of five participants were included. A best evidence synthesis based on methodological quality was performed using GRADE. Studies were grouped by single or multimodal environmental enrichment. Results: Three studies (two randomised controlled trials and one controlled clinical trial) were identified. Based on these two ‘moderate’ quality and one ‘low’ quality studies, there is ‘low level’ evidence for music for improvement in cognitive function and mood but not quality of life; and for light for improvement of fatigue, and ‘very low level’ evidence for multimodal environmental enrichment for the improvement of activity levels. Conclusions: Current evidence tentatively suggests that environmental enrichment improves cognitive function, mood and activity levels; however further high-quality studies are needed for conclusive findings. Specifically, further studies are needed to determine the relative effectiveness of various environmental enrichment interventions, as well as the optimal ‘dose’ of environmental enrichment.