Environmental Enrichment to Promote Neuroplasticity and Prevent Cognitive Decline After Acquired Brain Injury

*Disclaimer: the information on this site is intended as general information only and does not serve as personal medical or therapeutic advice. Use with caution and consult a medical professional familiar with your case beforehand.

**Please note that this blog post is an adaptation of a presentation I created for NeuroRestorative.

The treatment of brain injuries has come a long way in the past 20-30 years and yet even today’s science remains limited when it comes to reversing and preventing the signs and symptoms we see post- moderate to severe brain injury. As a rehabilitation professional I often face questions from the care partners, family members and friends of persons living with brain injuries regarding ways they can help support the health and recovery of that person. Often I am hearing these questions in the first days, weeks, and months post-injury, but this concept is just as important in the years following a brain-injury because while we traditionally think of brain injuries as a one-time injury that either stays the same or gets better over time, more recent research suggests that chronic brain injury is actually a progressive condition. 

As rehab professionals working with neurologic conditions we spend a great deal of time learning about evidence-based treatment techniques for minimizing spasticity, improving gait, maximizing outcomes and so forth. We do our best to engage the patient’s support system in helping them perform a home exercise program and making sure they get to their appointments consistently but what if there was more we could recommend? What if there were changes and modifications that could be made in the living environment, whether that be a house, inpatient rehabilitation facility or long-term care facility, that could support their recovery and prevent later cognitive and functional decline for persons with brain injuries? Turns out…there is!


Like most of the conditions we treat, no two brain injuries are alike. Brain injuries can be traumatic or nontraumatic in origin. They can be focal (localized) or diffuse (spread out). They can be caused by bleeding in the brain, loss of oxygen to brain tissue, a tumor compressing brain tissue, infection and more. Their effects are dependent on the location of the injury and available medical treatments to ameliorate the damage to the nerves in the brain. While we would expect that the impairments associated with a brain injury would be progressive in the case of a growing tumor or a spreading infection, we may not think about the progression of symptoms following a stroke or traumatic brain injury where the damage is usually contained to the area of initial injury. 

Within the last ten years, however, scientific research is suggesting that a traumatic brain injury is actually just the starting point of an ongoing physiologic process and is increasingly being understood as a progressive disorder. Imaging studies over time reveal reductions in brain volume and white matter integrity beyond what would be expected to occur after scarring and edema reduction are complete. This subacute deterioration may be linked to deterioration in functional and behavioral outcomes in the years after the initial injury. Individuals who have experienced a moderate to severe TBI also have a higher incidence of developing neurodegenerative conditions like Parkinson’s Disease and Alzheimer’s. 

So what we glean from this information is that while our initial efforts may be placed on recovery and rehabilitation, we cannot forget that interventions aimed at slowing or minimizing this subacute deterioration should also be considered. Since there is a good chance an individual will not be undergoing continuous rehabilitation after their injury, it is important that we educate caregivers and care partners on steps they can take to combat this progression. This brings us to one area of their care that can be modified–the environment.

Tomaszczyk et al., 2014 note that: 

Outside of an intensive rehabilitation program, persons with TBI experience  increased idle time, boredom, and little-to-no engagement in meaningful activities. (Turner et al. 2009; Turner et al. 2007; Frasca et al. 2013). They found that persons with TBI are often isolated from former professional and social networks,  often less socially engaged, feel socially isolated and lonely, and may not be able to resume their previously challenging work activities. (Bulinski 2010; Morton and Wehman 1995). Similarly, physical barriers (e.g., accessibility) and poor communication skills serve to compound already reduced community and social integration (Fleming et al. 2013; Struchen et al. 2011). 

With reduction in leisure activities after a TBI, we see an associated increases in television watching

Reduced schedules of activity in moderate to severe TBI patients have been shown to be associated with poorer neural outcomes. 

Since the schedule of activity and surrounding environment is largely under voluntary control of parents, family, care partners, caregivers, rehab staff, etc…this is one thing we can modify, even into the chronic stages of injury, not just immediately after, to help ensure better long term outcomes for these individuals. 


In the research paradigm, environmental enrichment (EE) refers to a multifaceted form of housing that provides enhanced motor, cognitive, sensory and social stimulation. In animal studies this often includes a living environment with a variety of tunnels, toys and nesting materials that are changed regularly to maintain novelty versus a standard environment with just a couple of things that never change. The theory behind EE is that brains in richer, more stimulating environments have higher rates of synaptogenesis. Animal studies like the ones below provide evidence that EE positively effects outcomes after acquired brain injuries in rats:

So, we know that animals are benefiting from an enriched environment, but how does this relate to brain injuries in humans?

While we usually think about neuroplasticity in a positive light–this is how we promote recovery and compensation–it can also be negative. Several researchers have concluded that negative neuroplastic changes secondary to disuse contributes to chronic cognitive and neural decline. Because a person with a brain injury may be unable or not have ample opportunities to participate in activities that are as stimulating as you and I engage in, neuroplasticity begins working against them.

In the brain, the hippocampus is the center for learning and memory and imaging studies are showing atrophy in this area is correlated to the number of hours of EE a person experiences in the first year post-TBI and that engagement in the simple routines that many of these patients may adopt post-injury are not challenging enough to prevent that hippocampal volume loss. 


While there is pretty robust evidence for EE in animal studies, the human research studies are ongoing and more limited. I will present a few research studies below that outline some different EE paradigms created for human research but I want to start off by acknowledging the limitations of some of these studies. In order to determine that a particular intervention consistently produces a certain outcome, several things need to occur across multiple research studies. In EE studies, we need to see larger but fairly homogenous groups of participants post-TBI receiving similar types and dosing of EE across multiple settings and different time frames. What you will see below and which was highlighted in the Cochrane Review published in 2021 by Qin et al., is that the heterogeneity between studies at this point does not allow for conclusive recommendations for the application of EE in a population of brain-injured clients. Does this mean that EE is not helpful and we should not implement any of these strategies? No, not at this point. To my knowledge there is not evidence that these interventions are harmful or that they do not work, but we have not had enough of the right types of studies to prove with statistics exactly which aspects of EE are critical for enhancing brain plasticity and what dosing is optimal. 


One of the things I liked the most about the Jantz (2020) and Kumar & Galloway (2021) studies is that they highlight how these interventions can be applied by non-rehab professionals. While installing an overhead track system (Kumar & Galloway, 2021) may not be feasible for all homes, it underscored how creating opportunities for these adults to participate in self-selected standing activities within their home positively impacted several other mobility and social outcomes. 

Jantz (2020) also showed how goals and impairments identified by a rehab professional were used to create enrichment activities that could be implemented by non-rehab staff and family members. In this scenario the school children got to perform novel and salient activities which actually resulted in better long-term outcomes than just performing pencil push-ups, for example, over and over. 

So how can we take the somewhat limited research and apply it with our clientele, residents, patients and family members? Here are some tips:

As you can see, implementing EE strategies will take some time and should be an effort by all those involved in the person’s care, not just rehab professionals. Taking the time to find out what activities are salient to the target clients is essential and being flexible and responsive to how these are working on a daily basis is important. 


If you are excited about implementing some of these strategies at your facility or to begin educating family members and caregivers of those with brain injuries about them, here are some things to take into consideration. As we talked about in the beginning, every brain injury is different and when it comes to moderate to severe brain injuries, tolerance to new, novel and intense activities can vary from person to person and from day to day. These are some things to evaluate when determining which activities to select and when it may be time to take a break:

  • Fatigue
  • Overstimulation
  • Understimulation
  • Behavioral
  • Cognitive and Motor impairments
  • Vision impairments
  • Hearing Impairments 


As with all interventions, it is important that we acknowledge the potential barriers to implementation as it will allow us to problem-solve and prepare. Some common barriers to implementing EE are as follows:

  • Staffing or availability of persons to help
  • Budgeting
  • Space limitations
  • Meeting the needs of many individuals
  • Physical and cognitive barriers to participation
  • Lack of awareness or training of staff and family members/care partners
  • Access to transportation and equipment
  • Lack of specifics around dosing and which EE strategies are best
  • Family support 

If you’ve managed to make it this far, I hope this information gets the wheels turning about how we can further our reach and effectiveness as rehab professionals and care partners for persons with brain injuries. I am excited to see how this area of research continues to evolve over time and whether we can narrow down the dosing and interventions that will be most effective for limiting the progression of a chronic acquired brain injury. 


Belchev, Z., Boulos, M. E., Rybkina, J., Johns, K., Jeffay, E., Colella, B., Ozubko, J., Bray, M. J. C., di Genova, N., Levi, A., Changoor, A., Worthington, T., Gilboa, A., & Green, R. (2021). Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial. BMJ Open, 11(2), e039767. https://doi.org/10.1136/bmjopen-2020-039767

Bondi, C. O., Klitsch, K. C., Leary, J. B., & Kline, A. E. (2014). Environmental Enrichment as a Viable Neurorehabilitation Strategy for Experimental Traumatic Brain Injury. Journal of Neurotrauma, 31(10), 873–888. https://doi.org/10.1089/neu.2014.3328

Bramlett, H. M., & Dietrich, W. D. (2015). Long-Term Consequences of Traumatic Brain Injury: Current Status of Potential Mechanisms of Injury and Neurological Outcomes. Journal of Neurotrauma, 32(23), 1834–1848. https://doi.org/10.1089/neu.2014.3352

Briones, T. L., Woods, J., & Rogozinska, M. (2013). Decreased neuroinflammation and increased brain energy homeostasis following environmental enrichment after mild traumatic brain injury is associated with improvement in cognitive function. Acta Neuropathologica Communications, 1(1). https://doi.org/10.1186/2051-5960-1-57

Centers for Disease Control and Prevention. (2022, April 5). Stroke facts. Centers for Disease Control and Prevention. Retrieved April 20, 2022, from https://www.cdc.gov/stroke/facts.htm

Centers for Disease Control and Prevention. (n.d.). Traumatic Brain Injury and Concussion: TBI Data. Centers for Disease Control and Prevention (CDC). Retrieved April 25, 2022, from https://www.cdc.gov/traumaticbraininjury/data/

Evans, J. J., Bateman, A., Turner, G., & Green, R. (2008). Research digest. Neuropsychological Rehabilitation, 18(3), 372–384. https://doi.org/10.1080/09602010801909153

Green, R. E. A., Colella, B., Maller, J. J., Bayley, M., Glazer, J., & Mikulis, D. J. (2014). Scale and pattern of atrophy in the chronic stages of moderate-severe TBI. Frontiers in Human Neuroscience, 8. https://doi.org/10.3389/fnhum.2014.00067

International Classification of Functioning, Disability and Health (ICF). (2022, April 29). World Health Organization (WHO). Retrieved April 29, 2022, from https://icd.who.int/dev11/l-icf/en

Jantz, P. B. (2020). Implementing environmental enrichment strategies to help children who have sustained a moderate or severe traumatic brain injury. Support for Learning, 35(3), 276–297. https://doi.org/10.1111/1467-9604.12310

Khan, F., Amatya, B., Elmalik, A., Lowe, M., Ng, L., Reid, I., & Galea, M. (2016). An enriched environmental programme during inpatient neuro-rehabilitation: A randomized controlled trial. Journal of Rehabilitation Medicine, 48(5), 417–425. https://doi.org/10.2340/16501977-2081

Kumar, D. S., & Galloway, J. C. (2021). Feasibility of a home-based environmental enrichment paradigm to enhance purposeful activities in adults with traumatic brain injury: a case series. Disability and Rehabilitation, 1–7. https://doi.org/10.1080/09638288.2020.1868583

Lindberg, R. H. (2021). Nontraumatic brain injury. Brain Injury Medicine, 332–336.e2. https://doi.org/10.1016/b978-0-323-65385-5.00062-7

Masel, B. E., & DeWitt, D. S. (2010). Traumatic Brain Injury: A Disease Process, Not an Event. Journal of Neurotrauma, 27(8), 1529–1540. https://doi.org/10.1089/neu.2010.1358

Matter, A. M., Folweiler, K. A., Curatolo, L. M., & Kline, A. E. (2011). Temporal Effects of Environmental Enrichment–Mediated Functional Improvement After Experimental Traumatic Brain Injury in Rats. Neurorehabilitation and Neural Repair, 25(6), 558–564. https://doi.org/10.1177/1545968310397206

McDonald, M. W., Hayward, K. S., Rosbergen, I. C. M., Jeffers, M. S., & Corbett, D. (2018). Is Environmental Enrichment Ready for Clinical Application in Human Post-stroke Rehabilitation? Frontiers in Behavioral Neuroscience, 12. https://doi.org/10.3389/fnbeh.2018.00135

Miller, L. S., Colella, B., Mikulis, D., Maller, J., & Green, R. E. A. (2013). Environmental enrichment may protect against hippocampal atrophy in the chronic stages of traumatic brain injury. Frontiers in Human Neuroscience, 7. https://doi.org/10.3389/fnhum.2013.00506

Ng, L., Reid, I., Gorelik, A., Galea, M., & Khan, F. (2015). Environmental enrichment for stroke and other non-progressive brain injury. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd011879

Ng, S. Y., & Lee, A. Y. W. (2019). Traumatic Brain Injuries: Pathophysiology and Potential Therapeutic Targets. Frontiers in Cellular Neuroscience, 13. https://doi.org/10.3389/fncel.2019.00528

Quick brain tumor facts. National Brain Tumor Society. (2022, February 1). Retrieved May 1, 2022, from https://braintumor.org/brain-tumor-information/brain-tumor-facts/#additional-info

Scottish Acquired Brain Injury Network (SABIN). (2017). Non-Traumatic Brain Injury – Scottish Acquired Brain Injury Network – e-learning. Scottish Acquired Brain Injury Network – e-Learning. Retrieved April 27, 2022, from https://www.acquiredbraininjury-education.scot.nhs.uk/what-is-acquired-brain-injury/non-traumatic-brain-injury/

Qin, H., Reid, I., Gorelik, A., & Ng, L. (2021). Environmental enrichment for stroke and other non-progressive brain injury. Cochrane Database of Systematic Reviews, 2021(11). https://doi.org/10.1002/14651858.cd011879.pub2

Shors, T., Anderson, M., Curlik, D., & Nokia, M. (2012). Use it or lose it: How neurogenesis keeps the brain fit for learning. Behavioural Brain Research, 227(2), 450–458. https://doi.org/10.1016/j.bbr.2011.04.023

Tomaszczyk, J. C., Green, N. L., Frasca, D., Colella, B., Turner, G. R., Christensen, B. K., & Green, R. E. A. (2014). Negative Neuroplasticity in Chronic Traumatic Brain Injury and Implications for Neurorehabilitation. Neuropsychology Review, 24(4). https://doi.org/10.1007/s11065-014-9273-6

Vora, N. M., Holman, R. C., Mehal, J. M., Steiner, C. A., Blanton, J., & Sejvar, J. (2014). Burden of encephalitis-associated hospitalizations in the United States, 1998–2010. Neurology, 82(5), 443–451. https://doi.org/10.1212/wnl.0000000000000086

World Health Organization. (n.d.). International Classification of Functioning, Disability and Health (ICF). World Health Organization (WHO). Retrieved April 26, 2022, from https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health

Dressing Aids

Though the pandemic may have many of us staying in our pajamas throughout the day there are still occasions to have us putting on some fancier clothes and when the time comes, there are many types of dressing aids available to help out.

*IMPORTANT DISCLAIMER: this information is meant to alert you to the equipment that exists to help you but is not intended as a training module to use it safely. Please contact the manufacturer of each device or a qualified therapist/medical professional to help you select devices most appropriate to you and to teach you how to use it safely.

**This post may contain affiliate links from Amazon Associates or other affiliate programs through which I may earn a portion of qualifying purchases

Dressing Stick

The dressing stick is a long stick with hooks at either end. In this example the small hook on one end can hook onto zippers or shoelace loops while the larger end can help with pulling up pant legs, removing socks, and putting on shirts

RMS Deluxe 28 Inches Long Dressing Stick

Shoe Horn

Ahh the shoe horn, this simple long handled device slides in the back of the shoe to prevent that oh-so-annoying crumpling of the back of the shoe that happens when you try to slide your foot into it. They come in long and short versions that you can leave at home or carry with you.

Metal Shoe Horn Long Handle For Seniors, Set of 2

Shoe Funnel

Sometimes the shoe horn is not as simple and easy to use as the design implies. Some people find this device, the Foot Funnel Shoe Assist to be easier to use. This device slides over the back of your shoe then, after grabbing ahold of the strings, you can slide your foot in and pull up on the back. Cool, huh?

FootFunnel Shoe Assist by North Coast Medical

Sock Aid

Loss of grip or hand use, difficulty reaching down to your feet or even pain in the joints can make putting on socks tough. The sock aid spreads open the sock, allows you to slip your foot in and allows you to pull the sock up with greater ease.

The Don N’ Doffer:

This device may look daunting but it solves a common problem that many people who need to wear compression socks face: compression socks are hard as heck to get on. Even for someone with full strength and flexibility in their hands and legs pulling these suckers up is a workout. The Don and Doffer is a neat creation that actually slides the sock on very easily, saving you a ton of grief and hopefully increasing the likelihood that you will wear the socks as prescribed. This one can be a little tricky at first but their website has step by step instructions on how to use: Don N’ Doffer

Doff N’ Donner Combo Pack – Compression Stocking & Diabetic Sock Aid Kit

Button Hook

Loss of dexterity in the fingers can make buttons a real pain. Enter the button hook:

Button Hook Dressing Aids

The One Handed Bra

I don’t know about you guys but I’ve never been able to fasten a bra one-handed. There are definitely ways to do it and a quick internet video search will reveal some great how-to videos. However, I encourage you to take a look at The One Handed Bra. Bra Easy is an amazing Australia based company that developed beautiful and easy to don bras. They have a cool story and an even cooler product.


For anyone experiencing challenges with putting on or pulling up pants this nifty device holds open the pants, shorts or underwear and with the long handle allows you to reach it down toward your legs to place them in the openings then pull the garment up toward you. Note these come in different sizes!

Kinsman WingsPants Large

Clip and Pull Pants Assist 

Clips that attach to the waistband of underwear, shorts of pants can help with pulling them up from around your feet whether you are sitting, standing or lying down.

Clip and Pull Dressing Aid Strap – 2Pcs

Pants Up Easy

This innovative device was designed specifically for persons with spinal cord injury but might be useful for anyone who has difficulty standing to pull their pants up the final 25% of the way. This device can be installed on the wall or purchased as a stand-alone device that slips under your armpits so you can lift your hips out of your chair and still have hands free to pull up the pants. Check out their webpage here: Pants Up Easy

Mommas (and Dads!) on the Move

Photo by Kamaji Ogino on Pexels.com

There is no question that parenting is both tough and rewarding. One can feel overwhelmed by the endless amount of gadgets, furniture, clothing and other stuff that you have to consider buying once the new little one makes their grand entrance into the world. The internet, magazines and TV are bursting with colorful ads about the latest this or that which will make you and your little one’s life easier but lets face it, ableism is strongly at play when it comes to this industry and many people may feel at a loss as to how to adapt all these items to meet their own needs.

So what’s a parent (or sibling or babysitter or anyone else involved in childcare) to do when you can’t use both of your arms in the same way, can’t stand up to reach the changing table at its full height, use a wheelchair or crutches or a walker for mobility, have hearing or visual impairments? It may feel like the answers aren’t out there and it’s true that you have to look a little further than most but the good news is that smart and innovative people are out there working hard to solve this problem and I’m here to share some of the tools and products available to you!

**IMPORTANT DISCLAIMER: this information is meant to alert you to the equipment that exists to help you but is not intended as a training module to use it safely. Please contact the manufacturer of each device or a qualified therapist/medical professional to help you select devices most appropriate to you and to teach you how to use it safely.

**This post may contain affiliate links from Amazon Associates or other affiliate programs through which I may earn a portion of qualifying purchases

Strolling Along

Let’s face it, pushing a stroller is basically a two-handed job. So what’s a person to do when walking along behind a stroller and pushing it with both arms just isn’t gonna happen?

The Stroll-Smart Hands-Free Adaptor pictured below attaches to your waist allowing you to push the stroller using your torso instead of your hands. This could be a great solution for someone who needs to use an assistive device like this woman below or if you aren’t able to steer the stroller well with one or both hands and want a little extra support.

For parents who are wheelchair users designers have come up with several innovative attachments that combine the stroller and the wheelchair into one unit so that parent’s can transport their child safely while seated in their wheelchair. Spinalcord.com just released a great article in December 2020 highlighting several different products that are available on the market right now.

Cursum Stroller

Carriers and Nursing Products

The Tushbaby Certified Hip Seat Baby Carrier is a helpful device that supports a baby’s bottom while you carry them on your hip. This is a great option if you lack the strength, muscle endurance or confidence in your arm for holding your baby this way. Let’s face it, babies are heavy and if you have to use your dominant arm to hold them and your nondominant arm isn’t as useful to perform secondary tasks this may give you an option for supporting them with the other arm so you can continue to have the preferred hand free to take care of other things.

Breastfeeding pillows typically secure around a woman’s waist so that she can nurse with less reliance on her hands but this could easily be used by other parents and caregivers while they are bottle feeding or just to support the baby while they sleep. This product for example, the My Brest Friend Original Nursing Posture Pillow gets points both for a clever name and also for its design!

Ring slings are a great option for hands-free carrying and also for breastfeeding. Whether sitting or standing these devices can support your baby comfortably and are great for wheelchair users, parents with any kind of wrist, hand or arm pain and anyone with weakness in their arms. The Hip Baby Wrap Ring Sling Baby Carrier for Infants and Toddlers is a great example. It is hand-woven from 100% cotton and has many great reviews on Amazon.

Wheelchair Accessible/Adjustable Height Cribs

Whether you have trouble bending down and lowering your child into a crib or can’t get close enough in your chair to reach them safely at all, the adjustable height/wheelchair accessible crib option is for you. The PediaLift is a great example of a crib that raises and lowers using a remote so that a wheelchair can slide underneath the crib or so that a parent or caregiver can transfer their baby safely and comfortable. With side access doors this crib eliminates the need to reach over the top of the railing. Gertie Cribs are another example of a height adjustable crib with side access doors that allow parents easier access to the crib mattress at the height that is most comfortable for them.

Car Seats

Transferring a baby or toddler into the carseat can be nearly impossible for some people if they can’t reach the front of the seat well. Some brands have tried to solve this problem by designing car seats with a swivel base. The CYBEX Sirona S Rotating Convertible Car Seat with SensorSafe 2.1 is just one example. Now I haven’t ever used this device so I am only making you aware of its existence but can’t vouch for it’s safety or effectiveness. Because these devices are so important for preventing serious injury while riding in the car it is important that you do your own research and consult your pediatrician to ensure this device is safe for your baby before purchasing.


Bathing. We all have to do it and for babies and infants they typically require a sink or infant bath to do so safely. The problem is, these methods are hardly accessible for anyone using a wheelchair or who has a hard time standing for a long period of time. I did a pretty extensive internet search assuming there must be some kind of accessible baby bath out there but I’m saddened to say I hit a dead end. How has no one invented this yet?? One genius and handy dad did share his DIY wheelchair accessible bathing station which just goes to show that there is still a lot of room to grow when it comes to adaptive parenting equipment.

Resources for Hearing and Visually Impaired Parents

Visually and hearing-impaired parents have been successfully raising children all over the world. Though they may need different strategies than others, where there is a will, there is a way. The National Federation for the Blind has a special section for Blind Parents filled with great resources including the Blind Parents Connection Podcast, helpful videos, a Blind Parents Mentoring Program and many more helpful tools.

Also, definitely check out The Deaf Mama blog written by a mom with hearing loss who, when faced with buying baby items that worked best for her, realized other moms and dads out there could benefit from her experience!

Parenting with an Intellectual Disability or Learning Disability

Parenting with an intellectual or learning disability is absolutely possible under the right circumstances and with the right supports and help in place. As every parent’s needs will be a little different it is important to have a good network of friends, family and professionals around you to help you identify where extra help and training may be needed and what services are available in your community to help you. The Arc is the largest national community-based organization advocating for and with people with intellectual and developmental disabilities (I/DD) and serving them and their families. They are a fantastic resource on this topic and a great place to start is their guide for Parents with Intellectual Disabilities.

Hittin’ the Gym: Adaptive Exercise Equipment

Photo by Cliff Booth on Pexels.com

It is no surprise that health and fitness remain top priorities for persons with movement impairments. As mobility declines, one’s risk for developing chronic conditions such as heart disease, diabetes or hypertension increases which can add another layer of disability and further impair quality of life. Physical impairments such as difficulty or inability to walk, difficulty using the hands or upper extremities, impairments in balance and so forth can pose a challenge when it comes to going to the gym or participating in an exercise routine. 

The good news is that with a little creativity there are almost always ways to participate in physical exercise that meet your individual needs and abilities.

According to the Physical Activity Guidelines for Amercians 2nd edition, adults with disabilities or chronic conditions should be getting 2.5 to 5 hours of moderate intensity or 75-150 minutes of high intensity activities throughout each week (or a combination of both). Additionally, those that are able to do so should aim to complete at least 2 bouts of strengthening exercises involving major muscles each week (Physical Activity Guidelines for Americans, 2018). In these cases it is important to first get clearance from your doctor that it is safe to begin an exercise plan and then consult with an exercise specialist or physical therapist to attain an individualized exercise program. 

If you are ready to begin exercising many states have adaptive fitness centers outfitted with equipment that might be tailored to your needs. If you are looking to use your local gym facility or stock your own home gym these are examples of equipment that can be used to get you on the path to health and fitness.

**IMPORTANT DISCLAIMER: this information is meant to alert you to the equipment that exists to help you but is not intended as a training module to use it safely. Please contact the manufacturer of each device or a qualified therapist to help you select devices most appropriate to you and to teach you how to use it safely.

**This post may contain affiliate links from Amazon Associates or other affiliate programs through which I may earn a portion of qualifying purchases

Aerobic Conditioning

Recumbent bike/ seated elliptical: a great option for cardiovascular training for those who aren’t confident or able to walk for exercise but can move their legs well enough to use the bike. The Vanswe Recumbent Exercise Bike is a great option for those looking for a reasonable price and good adjustability. The recumbent seat fully supports the back to limit challenges to balance or core strength. Pro tip: if transferring into and out of the seat poses a challenge, look for a model like the HCI Fitness PhysioStep Recumbent Elliptical with Swivel Seat that has a swivel seat that will turn 90 deg to the side to allow for easier access. While certainly pricier, it is likely a better investment than a cheaper model that will end up sitting in the corner collecting dust because it’s too difficult to get in and out of it.

Ski ergometer: this upper body exerciser that can be used in sitting or standing, focuses on building strength in the posterior shoulder and trunk muscle which is important for healthy shoulders and neck especially for wheelchair users. The Concept2 SkiErg is a common model found in some fitness centers but with its narrow design could easily be used in the home too.

Concept2 SkiErg

Vita glide: seated upper body exerciser targets the chest muscles, the shoulder muscles and upper back. The Vita Glide consists of alternating push/pull with the upper extremities and can be used while sitting in a chair.

Upper Body Ergometer (UBE): think of a bicycle for your arms. This device sits on the tabletop and you use your arms to move the pedals forward and back while you sit or stand. These devices range in price and adjustability such as the more basic Vaunn Medical Folding Pedal Exerciser which is fully powered by your arms (or legs) and in comparison the Exerpeutic 2000M Motorized Electric Legs and Arms Pedal Exerciser which actually has a motorized assist program which helps you to move through the full cycle

Exerpeutic 2000M Motorized Electric Legs and Arms Pedal Exerciser

FES bike: FES stands for functional electrical stimulation. While this device comes at a hefty price and is most often seen within rehabilitation clinics some home options are available. This device uses electrical stimulation delivered to the muscles timed with the cycling of the bike to help re-educate muscles through an external stimulus. This device requires training to learn the proper set up and dosing and you should talk with your doctor or therapist to determine if you are a good candidate as any electrical stimulation can carry risks for certain people. The Christopher & Dana Reeve Foundation has a great resource on FES bikes for home use.

Easy Stand Glider: The Easy Stand Glider is a mix between an elliptical and a standing frame. The user can transfer into the seat easily and then through a variety of straps and supports the device will help them into a supported standing position at which point arms and legs can be moved as though standing on an elliptical. This device gives all the benefits of standing with the addition of exercise!

Pedal exercisers: lower extremity exercisers that look like either bike or elliptical pedals. The device can be placed in front of any chair or wheelchair and allow for cardiovascular and leg training. See the links in the Upper Body Ergometer section to see examples of the cycling style and check out this link to see the under desk elliptical style Sunny Health & Fitness Under Desk Elliptical

Wheelchair roller trainer: think of this as a treadmill for a wheelchair. Set up like an indoor trainer for a bicycle, this device allows a manual wheelchair user to simulate forward or backwards motion while remaining stationary. Some models even allow for modification of resistance to allow for greater challenges. These are available for standard manual wheelchair and for some sport or racing chairs. The McLain Wheelchair Trainer is an excellent example of this equipment.


Active Hands: This is an awesome company that creates gripping aids for persons with weak or insufficient grasp or hand strength. The General purpose gripping aid, Looped Exercise aids and Hook aids can be used with most handles, barbells, dumbbells and other strengthening equipment in a commercial or home gym to secure your grasp. 

General Purpose gripping aid

Cuff weights: these weights can take the place of a traditional dumbbell and provide resistance to arms and legs without worrying about having to hold onto the weight. You can buy them in a set of various weights such as the The Deluxe Cuff Ankle and Wrist Weight – 7 Piece Set or individually depending on what you need (BalanceFrom GoFit Fully Adjustable Ankle Wrist Arm Leg Weights)

Medicine ball with strap handles: hands can be inserted into the handles and the straps can be fastened tightly to compensate for weakened grip

FitBALL MedBalls with Straps – 6 lb –

Resistance bands: these bands come in different resistances and provide variable resistance to strengthen muscles throughout the body. Loops can be tied into the ends of the band if grasp is difficult. Bands can be secured to a door or other areas of the home as well to allow for different muscles to be targeted. Bands such as these AZURELIFE Resistance Bands, are a good example.

Rickshaw: The CanDo Rickshaw Rehab Exerciser strengthens arms and shoulders from a seated position. Weight plates can be loaded on the opposite side to increase or decrease resistance. 

CanDo Rickshaw Rehab Exerciser

Other Accessories

Push gloves: often used by individuals with high level spinal cord injuries but also useful for other wheelchair users, push gloves provide additional grip to decrease effort and increase efficiency of pushing the rims of the chair. Useful for everyday use and athletic endeavors. Prime Wheelchair Gloves Protective Gear Mobility Quad-Push Gloves

Elastic straps: For those with weakness in their abdominals or trunk, elastic straps such as these placed around the upper trunk and the back of the chair can better enable the exerciser to lift weights and move their upper body against resistance.

Bodypoint Universal Elastic Strap for Wheelchair


Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, Compiler; 2nd ed.). (2018). U.S. Department of Health and Human Services. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

Push and Pull: a Guide to Transfer Devices and Equipment

Photo by Anna Shvets on Pexels.com

Loss of muscle strength, range of motion or flexibility, coordination or cognition may result in difficulty independently moving and transferring oneself. We often take for granted the number of times we change position throughout the day. Rolling over in bed, getting in and out of the car or bath, on and off the toilet or different seated surface can pose a significant challenge for anyone with a mobility impairment. 

Injuries can easily occur during these transitions both to the person trying to transfer and to those trying to assist. Poor body mechanics and insufficient tools can cause back or other injuries when attempting to help someone reposition and falls can happen if someone doesn’t have the support they need. Falls are a serious cause of injury and death, especially among the elderly. In the U.S. in 2018, one in four adults reported falling resulting in 88 deaths per day amongst older adults . In fact the CDC predicts the number of yearly falls will increase from 36 million to 52 million by 2030.  The medical costs for falls alone reached over $50 billion dollars and there is a high risk for increased morbidity after each fall (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2020). 

Luckily, an entire industry of adaptive equipment has been created to assist you in maximizing both success and safety during transfers. Check out some of the helpful devices and examples below and know that this is by no means an exhaustive list, but a place to get started. 

**IMPORTANT DISCLAIMER: this information is meant to alert you to the equipment that exists to help you but is not intended as a training module to use it safely. Please contact the manufacturer of each device or a qualified therapist to help you select devices most appropriate to you and to teach you how to use it safely.

**This post may contain affiliate links from Amazon Associates or other affiliate programs through which I may earn a portion of qualifying purchases

Gait/Transfer Belts

If you’ve ever spent any time in the hospital you have likely seen the yellow bands adorning the wrists of many patients. “Fall Risk!”, they shout at any staff or passersby. Somewhere along the lines some crafty individual figured out that if we could just hold onto these folks we could hopefully avoid any untimely collisions with the floor and thus the gait (transfer) belt was born. 

These belts secure around a person’s waist, or in certain circumstances when that area is unavailable, around the upper chest and provides a place for a caregiver or attendant to grasp the person and both steady them and provide a point of leverage to help with transfers. The Cloth Gait Belt secures around the torso and is secured with a buckle mechanism that consists of teeth to hold the belt securely in place. These can be easy to locate but not necessarily easy to clean.

Click on the photo to see this in detail

Another option is the wipeable gait belt made of vinyl material that can be easily sanitized. This is an obvious benefit and may be best in some occasions. You can purchase one with a plastic clasp or metal teeth. I tend to prefer the metal teeth over the plastic clasp as I find it can be difficult to pull the belt tight enough and secure it using the plastic clasp. 

Finally, we have looped transfer belt which is constructed with a serious of loops attached along the length of the belt to allow a caregiver or family member to provide assistance with scooting, standing or transferring from, for example, a wheelchair.

Click on the photo to see how to purchase this or similar devices

Transfer boards

A simple yet genius piece of equipment. The transfer, or slide board as it is sometimes called, is typically a rectangular or oblong piece of wood or other plastic that helps to cover the gap that exists between two transfer surfaces. The space between the seat of a wheelchair and the seat of a toilet has never looked so vast until you are attempting to scoot over there and your legs aren’t helping much. 

Transfer boards come in various sizes and shapes but the basic concept remains the same. The board is somewhat slick to allow a person to slide more easily across its surface. It prevents the need to fully stand up and allows even persons with no functional use of their lower extremities to move between surfaces. One end of the board sits on the surface you are moving to and the opposite end get’s tucked under your bottom. If you have one of those fancy gait belts on someone can even help you to scoot across it. 

One piece of advice, (don’t ask me how I learned this the hard way) as tempting as it may be, do not loop your fingers through the handy dandy hand hold opening on the end of the board that you are sliding toward. Though it seems like a great way to get a firm grip, undoubtedly as your weight shifts onto that side of the board you will only succeed in smashing your fingers beneath the weight of your body. Just. Don’t. Do it. 

Click on these photos to see these boards in detail

Transfer Sheet

Much like the transfer board, the transfer sheet is a slippery piece of material whose primary goal is to move a person from here to there. These devices are primarily used to help reposition a person in bed without having to lift them. 

In one version of the transfer sheet there are actually Two sheets stacked on top of one another which are placed beneath the person by rolling them onto their side and tucking it underneath. By grasping the top sheet one can reposition the person on the bed as the top sheet slides easily across the bottom sheet thus reducing friction.

The second option is a Single transfer sheet with handles. This typically consists of a single sheet but is also placed beneath the person and used to more easily slide them laterally or up and down on the bed. 

Depending on the person and the device you may find it easiest to have a second person available to help.

Transfer Disc

A transfer disc or pivot disc allows a caregiver to transfer a patient between surfaces without them needing to take a step. Picture a lazy susan that you would put on the dining room table and spins 360 degrees to give everyone access to the goodies. Instead of on the kitchen table, however, this device sits on the floor in front of the person transferring and their feet are placed on the disc. As the person stands (partially or fully) the caregiver can direct the person’s hips toward the adjoining surface and their feet will simply come along for the ride as the disc turns. As one can imagine this device may pose a risk for falls if one does not control the transfer well so this is a good one to practice with the help of a trained professional first! 

Mechanical Lifts

Mechanical lifts come in many forms and brands. These are large in-home devices that typically consist of some sort of sling that is placed under the person being transferred which is then attached to a lift device overhead. The mechanical lift then raises the person up into the air and the device can be turned or moved throughout the house to reposition the person elsewhere such as in a chair or bed. As you can imagine these devices are costly, take up quite a bit of space and require appropriate training to use safely but some insurance plans may pick up all or part of the cost of the device and can make the difference between someone living comfortably with their loved ones in their home or in a skilled nursing facility. For insurance authorization a physician’s prescription is most likely always necessary. Make sure to do your research or talk with a DME company to determine which device is appropriate for you.

These devices are appropriate for individuals that require more than 75% assistance for transfers or who aren’t able to safely or effectively bear weight through their legs. Here are several examples of mechanical lift devices and you can click on them to see these devices and similar ones in detail.

Stand Assist Devices

The final device we are going to talk about today is a category of equipment called a stand assist device. These can be electric or manual and provide assistance to pull a person up into standing. The manual devices such as the Lumex Stand Assist Patient Transport Unit roll in close to the person and provide a set of handles from which they can pull themselves into standing and block the lower legs to keep the knees from buckling. Typically, some type of seat is available to flip behind them and then they can rest into the seat. These devices are on wheels so once the person is secured in the device it can be moved throughout the home as necessary. The electric devices look similar in design except a sling is placed behind the individual and the electronics of the device lift the person into standing for those that do not have the strength to pull themselves up. These devices may also be covered by insurance and would need a prescription from a physician. For an example, check out the Graham-Field Lumex Sit-to-Stand Battery-Powered Patient Lift 


Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. “STEADI—Older Adult Fall Prevention.” Centers for Disease Control and Prevention, 2020, https://www.cdc.gov/steadi/. Accessed 16 10 2020.