How we treat brain injury

Physiotherapy, occupational therapy, speech and language therapy and neuropsychology work to a single set of goals reviewed weekly. The alternative — three disciplines each running their own plan — is common and it produces progress in three directions that do not add up to a person going home.

Practically, that means the walking session is also an attention task, and the kitchen task is also a sequencing and memory task. The context is what makes the skill transfer.

Fatigue after brain injury is neurological, not motivational. A schedule that ignores it produces a worse result than a lighter one that respects it, because a tired brain does not lay down new learning.

So the day is built with breaks in it, and the intensity rises across the stay rather than starting at the top. Families sometimes read this as us going easy. It is the opposite.

Post-traumatic amnesia is measured daily with a validated scale until it resolves. Where consciousness is in question, a standardised repeated assessment is used rather than a bedside opinion — the error rate for the bedside opinion is too high to build a plan on.

The same applies to progress: goals are written so that they can be scored, which means we can tell you whether the programme worked rather than describing how it felt.

Upper-limb robotics and virtual reality deliver a volume of repetition that hands cannot sustain, and the virtual tasks can be graded precisely to an attention span that is still recovering.

They are tools inside the plan, not the reason for the plan. If a session with a therapist and a kitchen achieves the goal better, that is what is scheduled.