Brain injury, anxiety, and the sensory system: how they overlap and what helps 🧠✨🔊

Brain injury often changes more than thinking and movement. It can alter how people sense the world and how their body responds to stress. Those sensory changes can feed anxiety and make ordinary days harder. This article explains how sensory processing and anxiety interact after an acquired brain injury, gives concrete day to day examples, and summarizes evidence based neuroprotective factors that occupational therapists can use to support clients.

How sensory changes and anxiety connect after brain injury

After an acquired brain injury many people develop increased sensitivity to light, sound, touch, or movement, or they may become under responsive to certain input. These sensory differences are common and strongly associated with emotional distress including anxiety and heightened arousal (de Sain et al., 2024; Martindale et al., 2023).

Neurobiological research links sensory over responsivity after brain injury to altered activity in limbic structures that process threat and emotion. In animal models, heightened auditory sensitivity after injury amplifies fear conditioning and increases amygdala reactivity, providing a mechanistic bridge from altered sensory processing to anxiety (Hoffman et al., 2019).

Everyday examples: How sensory overlap shows day to day

1. Morning routine and light sensitivity: A client with mild to moderate brain injury avoids windows in the morning because bright sunlight causes discomfort, headaches, and a rising sense of dread. The result is delayed grooming, missed appointments, and increasing anxiety about leaving the house (de Sain et al., 2024).

2. Grocery store and auditory overload: Crowded stores with music, checkout beeps, and multiple conversations trigger sensory overwhelm. The client experiences racing heart, poor concentration, and panic like symptoms that make shopping impossible without a caregiver (Martindale et al., 2023).

3. Social gatherings and tactile sensitivity: A client who now finds firm hugs unpleasant begins to withdraw socially. Reduced social engagement increases loneliness and anxiety, which in turn reduces opportunities for cognitive stimulation and emotional regulation practice. Social support is a protective factor that may be lost when sensory issues cause withdrawal (Bedard et al., 2020).

4. Work or school and visual distractibility: Heightened visual sensitivity and difficulty filtering distractions lead to fatigue and errors. The combination of cognitive load and sensory bombardment ramps up stress and anxiety, making sustained work difficult (Oliva et al., 2024).

What the research says about prevalence and impact

Recent literature reports high rates of sensory changes after acquired brain injury and links those changes to anxiety, pain, sleep disturbance, and reduced quality of life. More than a third of people report persistent sensory symptoms and many describe these as drivers of emotional dysregulation and functional limitation (de Sain et al., 2024; Martindale et al., 2023).

Evidence-based neuroprotective and recovery promoting factors

1) Aerobic and task based exercise

Aerobic exercise engages molecular and systems level mechanisms that support neuroplasticity, improve cognition, and reduce mood symptoms. Regular aerobic activity can upregulate neurotrophic factors, support synaptic plasticity, and improve executive function and mood after brain injury (Herrera et al., 2024; López et al., 2024).

2) Sleep optimization

Sleep quality is tightly linked to recovery. Poor sleep after brain injury worsens cognitive symptoms, heightens emotional reactivity, and may impair healing (Wickwire et al., 2016; Bell et al., 2023).

3) Cognitive reserve and stimulation

Higher cognitive reserve and ongoing cognitive engagement are associated with better cognitive and motor outcomes after brain injury (Pettigrew et al., 2019; Oliva et al., 2024).

4) Social support and psychosocial engagement

Strong social networks and structured social participation buffer cognitive decline and reduce emotional distress (Bedard et al., 2020).

5) Sensory based occupational therapy interventions

Occupational therapists use sensory assessments such as the sensory profile and modulation strategies to reduce overwhelm and improve coping. Techniques include environmental modification, sensory diets, graded exposure, and teaching self regulation skills. Reviews support sensory and psychosocial occupational therapy interventions in brain injury rehabilitation (Torregrossa et al., 2023; Scoping Review, 2025).

Translating evidence into practical OT strategies at Neuroplastic Rehab

• Screen sensory profile early: Identify problematic sensory domains using structured tools (de Sain et al., 2024).

• Start with environmental and routine adjustments: Use sunglasses, noise reducing headphones, or modified shopping times.

• Build a graded exposure plan paired with regulation tools: Controlled exposure plus breathing or proprioceptive input reduces arousal (Hoffman et al., 2019).

• Integrate aerobic exercise and sleep hygiene into goals: Prescribe safe, progressive exercise and coach sleep routines (Herrera et al., 2024; Wickwire et al., 2016).

• Leverage social supports and meaningful activity: Use peer or caregiver supports to maintain connection and confidence (Bedard et al., 2020).

  
  

Bottom line

Sensory changes after brain injury are common and can directly fuel anxiety and emotional dysregulation. Addressing sensory needs is central to restoring daily function. A multimodal, evidence informed approach that combines sensory based occupational therapy, neuroprotective lifestyle factors such as aerobic exercise and sleep optimization, and strengthening social and cognitive reserve offers the best chance to reduce anxiety and improve quality of life. Neuroplastic Rehab uses these principles to create individualized, practical plans that help clients reengage with life.

References

1. Bedard, M., Felteau, M., Mazmanian, D., & Fedyk, K. (2020). Social support as a protective factor against cognitive decline after TBI. NeuroRehabilitation, 46(3), 311–322.

2. Bell, A., Hughes, R., & Mathias, J. (2023). Traumatic brain injury, sleep, and melatonin: A review. Journal of Neurotrauma, 40(5), 515–527.

3. de Sain, A. M., van den Berg-Emons, H., Ribbers, G. M., & Bussmann, J. B. (2024). Sensory hypersensitivity after acquired brain injury. Disability and Rehabilitation, 46(2), 211–221.

4. Herrera, S. G. R., Ramos, V. M., & Cuenca, J. M. (2024). The effect of aerobic exercise on neuroplasticity, learning, and cognition: A systematic review. NeuroRehabilitation, 54(1), 85–100.

5. Hoffman, A. N., Lam, M., & Faden, A. I. (2019). Sensory sensitivity as a link between concussive traumatic brain injury and enhanced fear conditioning. Scientific Reports, 9, 13762.

6. López, L. P., Guzmán, A., & Calderón, A. (2024). Aerobic exercise and cognitive function in chronic severe brain injury. BMC Sports Science, Medicine and Rehabilitation, 16(44), 1–10.

7. Martindale, C., McClure, L., & Hanes, K. (2023). Sensory hypersensitivities and their association with post-traumatic headache and emotional symptoms. Frontiers in Neurology, 14, 1167542.

8. Oliva, G., Parente, F., & Costa, A. (2024). Cognitive reserve and rehabilitation outcomes in acquired brain injury. Frontiers in Human Neuroscience, 18, 1123441.

9. Pettigrew, C., & Soldan, A. (2019). Defining cognitive reserve and implications for cognitive aging and recovery. Current Neurology and Neuroscience Reports, 19(1), 1.

10. Torregrossa, W., Varghese, M., & McAllister, T. (2023). Behavioral and psychiatric symptoms following traumatic brain injury: Implications for treatment. Journal of Neuropsychiatry and Clinical Neurosciences, 35(1), 45–58.

11. Wickwire, E. M., Schnyer, D. M., & Germain, A. (2016). Sleep, sleep disorders, and mild traumatic brain injury: Review and research agenda. Current Opinion in Neurology, 29(6), 674–682.

12. Scoping Review. (2025). Psychosocial occupational therapy interventions for pediatric traumatic brain injury: A scoping review. OccupationalTherapy.com.