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New Guidance for Occupational Therapists on Acquired Brain Injury

Posted in Special Feature on 20th Sep 2013


The College of Occupational Therapists (COT) has published new guidance for occupational therapists working with adults with acquired brain injury. Developed by experts from the Brain Injury Forum of the COT Specialist Section – Neurological Practice, this new book covers specifically ‘acquired brain injury’ and supports the implementation of two national documents, which aim to improve the delivery of acquired brain injury rehabilitation services: Rehabilitation following acquired brain injury: national clinical guidelines1 and the National service framework for long-term conditions.2


The effects of brain injury are varied in terms of the severity and causes; no two cases are the same. Lives may be turned completely upside down following the injury, not just for the individual but for those around them. Various functions and/or activities may have to be relearned and, for some, a shift in perspective on life and expectations for the future is required.

The first priority following a brain injury is medical intervention to preserve life and reduce further damage occurring through secondary complications. This, in itself, can be a lengthy process, with many challenges along the way. This may mean that the stay in hospital following a brain injury can be a long one, which can, in turn, lead to further practical issues. The occupational therapist may be involved as part of the multidisciplinary team throughout the hospital admission, from involvement in coma stimulation programmes through acute rehabilitation intervention and discharge planning.

For many people, however, discharge from hospital is just the beginning of a long and challenging journey to rebuild their life. This is where the role of the occupational therapist becomes vital.

What is the occupational therapist’s role?

Occupational therapy ‘aims to enable and empower people to be competent and confident in their daily lives, and thereby enhance wellbeing and minimise the effects of dysfunction or environmental barriers’.3 Occupational therapists address such dysfunction ‘using a range of interventions that often include environment, teaching clients a new repertoire of skills or helping them to re-establish ones they have lost’.3 This is particularly important for people recovering from acquired brain injury. A wide range of ‘physical and neuropsychological impairments can impact on activities and meaningful occupations, while reducing a person’s level of social participation, including their ability to participate in educational and vocational activities’.4

Occupational therapists will work with a person, in collaboration with family and friends, to help them make sense of their injury and achieve personal goals through participation in a range of meaningful and purposeful activities.4

How will the guidance help?

This new publication has been developed as a practical resource. It outlines the key recommendations from the national guidelines1,2 in a range of different areas, including: principles and organisation of services, approaches to rehabilitation, carers and families, early discharge and transition to rehabilitation services, inpatient clinical care, rehabilitation setting and transition phases, rehabilitation interventions and continuing care and support. These recommendations have been  used to develop a series of key reflections for occupational therapists that can be used on a practical, day-to-day basis to support clinical decision making when working with adults with acquired brain injury.

In addition to this, each section has an audit tool to evaluate current practice against the recommendations, giving the opportunity to identify how this practice can be evidenced. A checklist and action plan is also provided to encourage occupational therapists to ask themselves if they are meeting criteria in all the appropriate areas.

The publication also signposts the reader towards further resources: useful organisations, publications, websites and relevant legislation.

 A service user’s perspective

Nick sustained a serious head injury following an accident whilst at work in March 2003. The next six months were spent in hospital, during which time, following initial surgery, a long recovery process started. He was then looked after for a further six months by his father at the family home.  After an unsuccessful supported return to work he was referred for occupational therapy.  Now approaching a decade after the accident he still feels a realistic general improvement every six months; and believes an important element of this is the support and guidance he gets from the occupational therapists and the resulting increased independence it gives him.

“In my experience, the most important factor in recovery is your determination. To sustain this determination and get positive results, it has to be assisted and directed. For me, the input of occupational therapists at various times has been very important. This has come in activities of various types, from gardening to latterly cooking, leaving me with useful skills which I can use everyday and thus increase my self-confidence.”

How can the guidance be used?

As well as being a valuable resource for occupational therapists, this publication will also be of interest to other health and social care professionals. It is important, especially within multidisciplinary teams, to be aware of a patient’s care throughout the recovery process. This publication will give an insight into the targets and goals occupational therapy services are working towards. It can also be used by the patient, family and carers to learn more about the service and ensure they are receiving the best possible care.

This publication can be purchased from the College of Occupational Therapists website


1. Royal College of Physicians and British Society of Rehabilitation medicine (Turner Stokes ed) (2003) Rehabilitation following acquired brain injury: national clinical guidelines. London: RCP/BRSM.

2. Department of Health (2005) National service framework for long-term conditions. London: DH.

3. Duncan EAS ed (2006) Foundations for practice in occupational therapy. 4th ed. Edinburgh: Elsevier Churchill Livingstone.

4. College of Occupational Therapists (2013) Acquired brain injury: a guide for occupational therapists. London: COT.

ACNR 2013;13:5:13


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