Date Presented 04/21/2023

This study investigates the impact of self-regulation on reengagement in leisure activities with adults with traumatic brain injury (TBI). Reengagement in leisure activities significantly decreases after TBI, with apathy being a significant predictor of this outcome.

Primary Author and Speaker: Amanda Gahlot

Contributing Authors: Denise Krch, Yael Goverover

PURPOSE: Engagement in leisure activities is a significant contributor to psychological [1] and physical health [2]. However, over 80% of individuals with traumatic brain injury (TBI) report not returning to pre-injury levels of leisure participation at 1-year, and over half of those individuals were moderately to severely bothered by the changes [3]. Self-regulation (SR) has been identified as a possible contributing factor to limiting re-engagement [4]. This study aims to understand patterns of re-engagement in leisure activities following TBI and the impact of SR on leisure engagement.

DESIGN: This cross-sectional study included 55 adults living in the community at least 1-year after TBI.

METHOD: Participants completed a leisure activity survey, rating engagement in activities both before and after injury. Leisure activities were related to physical, cognitive and social domains A retained score was calculated for each domain and total leisure participation. Participants and family members completed the Frontal Systems Behavior Scale (FrSBe) designed to assess SR. Data analysis explored the characteristics and patterns of leisure engagement, relationship between self-regulation and leisure engagement, and contributions of SR to leisure engagement.

RESULTS: Descriptives showed a significant decline in participation in leisure activities after TBI, specifically in the cognitive and social domains. The FrSBe apathy scale, was significantly associated with lower leisure engagement and a predictor of leisure engagement after injury.

CONCLUSION: Leisure engagement decreases after TBI, with impaired self-regulation contributing to this outcome.

IMPACT STATEMENT: Re-engagement in leisure activities, specifically in the cognitive and social domains, should be a focus of occupational therapy (OT) intervention after TBI. SR, specifically apathy, may be an important factor in an individual’s ability to re-engage in leisure tasks.


Kim, C., Kim, J., & Thapa, B. (2021). Intensity of Leisure-Time Physical Activity and Dimensions of Mental Well-Being: A Reciprocal Approach Using Parallel Latent Growth Curve Modeling. J Phys Act Health, 18(2), 165–174.

Paggi, M. E., Jopp, D., & Hertzog, C. (2016). The Importance of Leisure Activities in the Relationship between Physical Health and Well-Being in a Life Span Sample. Gerontology, 62(4), 450–458.

Wise, E. K., Mathews-Dalton, C., Dikmen, S., Temkin, N., Machamer, J., Bell, K., & Powell, J. M. (2010). Impact of traumatic brain injury on participation in leisure activities. Arch Phys Med Rehabil, 91(9), 1357–1362.

Nalder, E., Hartman, L., Hunt, A., & King, G. (2019). Traumatic brain injury resiliency model: A conceptual model to guide rehabilitation research and practice. Disabil Rehabil, 41(22), 2708–2717.