Adaptive Recreation, Skill Development, and Vocational Exploration after TBI: Adaptive Machine Knitting for Veterans and Adults with TBI

Adaptive Textile Skills & TBI Pilot

Accessible creativity. Meaningful participation. New pathways to skill development.

The Adaptive Textile Skills & TBI Pilot is a developing initiative through Brinda Inc. and Uglier Than Homemade Sin exploring how knitting machines and other textile-production methods can be adapted for people with traumatic brain injury and other disabilities.

The project is being designed with a simple question in mind:

If the traditional way of making something creates a barrier, what other pathway can we create?

For some people, traditional knitting needles or craft tools may be difficult to use because of changes in vision, hearing, dexterity, grip strength, fine or gross motor coordination, balance, endurance, cognition, or upper-extremity function.

Others may have additional disabilities or injuries, including limb loss, spinal cord injury, orthopedic injuries, sensory loss, chronic pain, or other effects of polytrauma.

The goal is not to identify one craft that is universally accessible.

The goal is to develop multiple ways to participate.

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Beyond Traditional Knitting

Machine knitting is the first major modality being explored through this project, but the long-term concept is broader.

Potential areas of adaptive textile exploration include:

• machine knitting;
• loom knitting;
• hand knitting;
• adaptive crochet;
• weaving;
• embroidery and needle arts;
• sewing;
• net making;
• fishing-net fabrication and repair;
• cast-net construction and repair;
• rope and cordage work;
• technical textile production; and
• textile-based independence aids and adaptive products.

Different tools create different physical, visual, cognitive, and sensory demands.

A knitting machine may remove some fine-motor barriers while creating challenges involving reach, carriage resistance, yarn loading, visual monitoring, or task sequencing.

A loom may work better for one person.

A weaving setup, embroidery stand, adapted workstation, or net-making jig may work better for another.

The program is being developed around the principle that the activity should be adapted to the individual—not the other way around.

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Designed With TBI in Mind

Traumatic brain injury can affect far more than memory.

People with TBI may experience combinations of:

• visual impairment or visual-processing changes;
• double vision or difficulty visually tracking;
• hearing loss or auditory-processing challenges;
• vestibular and balance problems;
• reduced grip strength;
• impaired fine-motor control;
• impaired gross-motor coordination;
• weakness or reduced bilateral hand use;
• tremor, spasticity, or altered motor control;
• fatigue and reduced endurance;
• attention and memory difficulties;
• executive-function and sequencing challenges;
• sensory-processing differences;
• mobility limitations; and
• communication changes.

For veterans and others who have experienced polytrauma, TBI may also coexist with limb loss, orthopedic injury, spinal cord injury, nerve injury, chronic pain, or other disabilities.

Because those combinations vary greatly from person to person, accessibility cannot be reduced to a single modification.

The pilot will examine combinations of tools, positioning, instructions, environment, pacing, and adaptive equipment to determine what supports successful participation.

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Potential Adaptations

Accessibility strategies may include:

• seated and wheelchair-accessible workstations;
• adjustable working heights;
• stabilization and clamping systems;
• enlarged or modified handles;
• one-handed techniques;
• reduced-force tools;
• high-contrast markings;
• tactile indicators;
• magnification and improved lighting;
• large-print instructions;
• simplified visual step cards;
• written instructions to supplement spoken instruction;
• captioned instructional content;
• task segmentation;
• repetition and guided practice;
• simplified yarn-management systems; and
• structured rest breaks and pacing.

The project will also examine where an adaptation does not work and when a different textile method may be more appropriate.

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Purposeful Community Participation

One proposed service component of the pilot is the production of Knitted Knockers, soft handmade breast prostheses provided to people following mastectomy and other breast surgeries.

An approved machine-knitting pattern is available through Knitted Knockers, and the organization maintains a list of approved yarns selected for qualities such as softness, washability, breathability, and suitability for sensitive skin.

The project is exploring partnerships with fiber-industry companies whose products appear on that approved list.

Participation in any service project would be voluntary.

The larger goal is to create opportunities for participants to develop skills while also having the option to produce something useful for another person.

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Veteran-Allied Programming

A major focus of the developing pilot is the possibility of offering adaptive textile programming within Alabama’s expanding TBI service system, including programming that is welcoming and relevant to veterans living with TBI.

The proposed model combines:

• accessible recreation;
• skill development;
• community participation;
• volunteer service;
• peer connection;
• adaptive technology;
• vocational exploration; and
• opportunities for purposeful activity.

The project is not intended to represent knitting or crafting as a treatment for TBI.

Instead, it explores how accessible creative and production activities might support participation, skill development, confidence, connection, and individualized rehabilitation goals.

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Vocational Exploration & Employment Pathways

Adaptive textile skills may also provide opportunities to explore work-related abilities, accommodations, vocational interests, and employment pathways.

Participants may have opportunities to practice skills such as:

• following multi-step instructions;
• task sequencing;
• equipment operation;
• quality control;
• problem solving;
• error correction;
• materials management;
• work pacing;
• attention to detail;
• production consistency;
• inventory management;
• collaboration; and
• completion of a product from beginning to end.

Fiber and textile work also includes many roles beyond physically creating an item.

Potential pathways may include:

• machine operation;
• textile production;
• sewing and assembly;
• embroidery;
• net fabrication and repair;
• fishing and marine textile work;
• weaving;
• quality assurance;
• finishing;
• packaging and fulfillment;
• computerized pattern work;
• inventory and materials management;
• instruction;
• peer support;
• retail;
• small-business development; and
• creative self-employment.

The purpose is not to direct participants toward a predetermined occupation.

Instead, the program can help explore the question:

What parts of this process match this person’s strengths, interests, accommodations, and employment goals?

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From Recreation to Employment

The program is being developed around a continuum of possibilities:

Recreation → Skill Development → Volunteer Service → Vocational Exploration → Work-Based Learning → Employment or Self-Employment

A participant may simply discover a meaningful leisure activity.

Another may enjoy producing items for community service.

Someone else may discover an interest in equipment operation, textile fabrication, net repair, production work, teaching, or entrepreneurship.

All of those are valid outcomes.

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Evidence-Informed Development

The project is being informed by recent peer-reviewed research examining:

• meaningful occupational participation after TBI;
• recreation and social participation following brain injury;
• craft and needlework participation;
• well-being and social connection through meaningful activity;
• vocational rehabilitation following TBI;
• supported employment;
• individualized accommodation; and
• rehabilitation approaches that emphasize participation in meaningful activities.

Current research does not establish machine knitting as a treatment for TBI.

That is not the premise of this project.

Instead, the research supports the importance of meaningful participation, individualized adaptation, recreation, skill development, social engagement, and vocational rehabilitation following injury.

The unanswered question is whether adaptive machine knitting and related textile-production methods can provide another accessible pathway into those opportunities.

That is what this pilot is designed to explore.

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Pilot Evaluation

Initial pilot development will examine:

• physical accessibility;
• visual accessibility;
• cognitive accessibility;
• fatigue and endurance;
• usability;
• instructional needs;
• adaptations required;
• participant satisfaction;
• task completion;
• confidence;
• social participation;
• vocational interest; and
• continued interest in textile activities.

The project may also generate accessibility feedback for manufacturers regarding equipment design, controls, visual contrast, instruction design, grip requirements, positioning, and other barriers identified by disabled users.

Future development may include collaboration with rehabilitation or university researchers for more formal program evaluation.

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Partnership Opportunities

The Adaptive Textile Skills & TBI Pilot is currently in development and seeking collaborative partners.

Potential partners include:

Rehabilitation & Disability Organizations

TBI programs, vocational rehabilitation agencies, independent-living organizations, veteran programs, assistive-technology programs, and community rehabilitation providers.

Fiber & Textile Companies

Knitting-machine manufacturers, yarn companies, loom manufacturers, embroidery and sewing companies, weaving suppliers, adaptive-tool manufacturers, and textile producers.

Employers & Industry Partners

Marine and fishing-equipment companies, net manufacturers and repair businesses, textile manufacturers, embroidery businesses, apparel companies, maker businesses, and other employers interested in accessible workforce development.

Community Partners

Libraries, art centers, makerspaces, fiber guilds, yarn shops, community organizations, and other accessible gathering spaces.

Research Partners

Universities and researchers interested in TBI, rehabilitation, disability, assistive technology, occupational participation, vocational rehabilitation, or accessible design.

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Evidence-Informed Development

The Adaptive Textile Skills & TBI Pilot is being developed using recent peer-reviewed research from traumatic brain injury rehabilitation, occupational participation, recreation and leisure, vocational rehabilitation, and craft-based activity.

The existing research does not establish knitting or machine knitting as a treatment for traumatic brain injury. Instead, it provides evidence for the broader principles behind this project: meaningful participation, individualized adaptation, social connection, purposeful activity, skill development, and supported vocational engagement.

Meaningful Occupation After TBI

A 2022 systematic review by Klepo, Sangster Jokić, and Tršinski examined the role of occupational participation for people with traumatic brain injury. The review found that participation in meaningful occupations can help individuals understand and adapt to changes in their abilities, reconstruct identity, fulfill personal needs, and develop a renewed sense of meaning after injury.

This supports a central principle of the pilot:

Rehabilitation should create pathways into meaningful activity rather than require everyone to participate in the same way.

For adaptive textile work, that may mean changing the tool, task, environment, positioning, instructional method, or production process to better match the individual.

Recreation, Leisure & Social Participation

A 2024 scoping review by Leeson, Collins, and Douglas examined recreation- and leisure-based interventions intended to increase social participation among adults with moderate-to-severe TBI.

The authors found that socially interactive leisure activities may provide opportunities for increased social participation and may positively influence factors such as enjoyment, confidence, and well-being. The review also emphasized the importance of understanding the individual barriers and facilitators that determine whether a person can participate successfully.

That question is directly relevant to this pilot.

A participant may be highly interested in knitting, weaving, sewing, embroidery, or another textile activity but encounter barriers involving:

• hand strength;
• fine or gross motor coordination;
• vision;
• hearing;
• fatigue;
• balance;
• cognition;
• sequencing;
• mobility; or
• inaccessible equipment.

Removing those barriers may create access to an activity that was previously unavailable.

Needlecraft, Purpose & Well-Being

Recent research has also examined the role of needlecraft and other crafts in well-being.

A 2024 scoping review by Le Lagadec and colleagues reviewed 25 studies involving activities such as knitting, crochet, sewing, embroidery, and quilting.

Four major themes emerged across the literature:

• mental well-being;
• social connection, value, and belonging;
• purpose, achievement, and satisfaction; and
• identity, culture, family, and legacy.

A 2025 systematic review by Bukhave and colleagues examined 19 studies of craft-based interventions. Studies reported improvements in various outcomes including mood, self-efficacy, social skills, well-being, life satisfaction, anxiety, stress, and depression.

However, the researchers also identified significant limitations in the quality and consistency of the existing evidence.

For that reason, this project does not describe fiber arts as a proven clinical intervention.

Instead, the research suggests that craft participation may provide meaningful experiences worthy of further study—particularly when accessibility determines whether someone can participate at all.

Knitting as Meaningful Occupation

Knitting-specific research also provides useful insight.

In a 2019 qualitative study, Brooks and colleagues examined the experiences of avid knitters. Participants described benefits related to:

• enjoyment;
• mental challenge;
• social connection;
• skill development;
• creative expression; and
• occupational identity.

Those findings are particularly relevant to a project that examines not simply whether a participant can physically produce a textile item, but whether the activity provides opportunities for mastery, identity, connection, and continued participation.

Vocational Rehabilitation After TBI

Employment is another important component of recovery and community reintegration.

A 2022 scoping review by Nguyen, Hackman, and Truitt examined vocational outcomes among U.S. service members and veterans following TBI. The review included 48 studies and found that vocational interventions commonly addressed cognitive and functional barriers and included approaches such as supported employment.

The researchers also concluded that vocational rehabilitation following military TBI remains an area in need of additional research and interdisciplinary approaches.

A randomized controlled trial published in 2021 by Fure and colleagues examined combined cognitive and vocational rehabilitation following mild-to-moderate TBI.

At three months, 81% of participants receiving the intervention had returned to stable employment compared with 60% receiving treatment as usual. At 12 months, employment rates were high in both groups and the difference was no longer statistically significant.

The findings suggest that individualized cognitive supports and vocational rehabilitation may help some individuals return to work sooner.

This is why the Adaptive Textile Skills & TBI Pilot includes vocational exploration rather than treating textile participation solely as recreation.

Participants may have opportunities to explore:

• equipment operation;
• task sequencing;
• production planning;
• quality control;
• work pacing;
• problem solving;
• materials management;
• adaptive equipment;
• work tolerance;
• transferable skills; and
• possible employment or self-employment pathways.

The Research Gap

The existing evidence supports meaningful occupation, accessible recreation, individualized rehabilitation, social participation, craft engagement, and vocational rehabilitation following TBI.

What appears to be largely missing from the literature is research specifically examining:

• machine knitting as an adaptive activity for adults with TBI;
• machine knitting as an alternative to conventional hand knitting for people with physical or sensory disabilities;
• adaptive textile production as vocational exploration following TBI;
• comparisons among hand knitting, loom knitting, machine knitting, weaving, embroidery, net making, and other textile methods;
• accessible textile-production programs for veterans with TBI; and
• textile activities that intentionally connect recreation, volunteer service, vocational exploration, and employment.

That gap is part of the reason this pilot is being developed.

The research question is not:

“Does knitting treat TBI?”

The more useful question is:

“Can adaptive textile-production activities provide accessible, meaningful, and potentially vocationally relevant opportunities for people with TBI and other disabilities—and what adaptations are necessary to make participation possible?”

The initial pilot will help begin answering that question.

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Selected Peer-Reviewed Research

Brooks, L., Ta, K.-H. N., Townsend, A. F., & Backman, C. L. (2019). “I just love it”: Avid knitters describe health and well-being through occupation. Canadian Journal of Occupational Therapy, 86(2), 114–124.

Bukhave, E. B., Creek, J., Linstad, A. K., & Frandsen, T. F. (2025). The effects of crafts-based interventions on mental health and well-being: A systematic review. Australian Occupational Therapy Journal, 72(1).

Fure, S. C. R., et al. (2021). Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial. Annals of Physical and Rehabilitation Medicine, 64(5).

Klepo, I., Sangster Jokić, C., & Tršinski, D. (2022). The role of occupational participation for people with traumatic brain injury: A systematic review of the literature. Disability and Rehabilitation, 44(13), 2988–3001.

Le Lagadec, D., Kornhaber, R., Johnston-Devin, C., & Cleary, M. (2024). Healing stitches: A scoping review on the impact of needlecraft on mental health and well-being. Issues in Mental Health Nursing, 45(10), 1097–1110.

Leeson, R., Collins, M., & Douglas, J. (2024). Interventions that aim to increase social participation through recreation or leisure activity for adults with moderate to severe traumatic brain injury: A scoping review. Disability and Rehabilitation, 46(15), 3286–3302.

Nguyen, M. V., Hackman, D. E., & Truitt, A. R. (2022). Vocational outcomes of service members and veterans after traumatic brain injury: A scoping review. Journal of Head Trauma Rehabilitation, 37(6), E467–E487.