Goal setting after brain injury: how it works and why it matters

When someone starts rehabilitation after a brain injury, one of the first things a case manager will do is talk about goals. For families who have just been through something traumatic, this can feel premature. The person is still adjusting. The future is still uncertain. What is the point of setting goals now?

The point is that rehabilitation without goals is not rehabilitation. It is activity. Goals are what give the activity direction, allow progress to be measured, and make it possible to change course when something is not working.

What NICE says about goal setting

NICE guideline NG252 (Rehabilitation for chronic neurological disorders including acquired brain injury, 2025) sets out clear expectations for how goals should be agreed and managed in brain injury rehabilitation.

The starting point is that goals must be set collaboratively. Not by the clinician alone, not by the family, and not by default. The person with the brain injury should be at the centre of the process, and their own priorities should shape what is being worked towards. If the person has difficulty communicating or lacks insight into their own difficulties, NG252 is clear that this does not remove them from the process. The approach should adapt to include them, not exclude them.

Goals should reflect what matters most to the person in their own life. That might mean being able to return to work, look after a child, manage a journey independently, or take part in a hobby they loved. Clinical goals about physical function or cognitive performance are the means to those ends, not ends in themselves.

Short-term steps toward longer-term outcomes

NG252 recommends that goals be broken into shorter-term steps. This matters for two reasons. First, a long-term goal that feels distant and abstract gives very little day-to-day guidance. A goal that is achievable in the next two to four weeks is something to work towards, something to measure against, and something that provides a genuine sense of progress when it is reached.

Second, the path from where someone is now to where they want to be is rarely straight. Shorter goals allow the team to adapt as circumstances change, as new difficulties emerge, or as something that looked achievable turns out to need more groundwork than expected.

Regular review

Goals should not be set and forgotten. NG252 is explicit that they should be reviewed regularly and updated as the person progresses. A goal that was appropriate six months ago may have been achieved, may need adjusting, or may no longer reflect what the person wants. Keeping goals current is not an administrative task — it is how rehabilitation stays relevant.

Reviews should involve the person and, where appropriate, their family. The case manager’s role includes making sure the rehabilitation team is working to goals that still reflect the person’s actual priorities.

The link between goals and the holistic assessment

Goals do not emerge from nowhere. They come directly from the holistic rehabilitation needs assessment, which establishes what is affecting the person across every area of their life. A goal that is not grounded in that assessment is guesswork.

This is why the sequence matters. Assessment first, then goals, then a rehabilitation plan that is built around those goals. Our article What is a holistic rehabilitation needs assessment? explains what that assessment covers and why it needs to be broad.

What this means in practice

At Hawkley Rehab, goal setting is built into our case management process from the initial assessment. We use the WHO ICF framework to understand what areas of a person’s life are being affected, and we use that picture to work with the client to identify what rehabilitation should be aiming for.

Goals are documented clearly, shared with the rehabilitation team, and reviewed regularly. When we report to solicitors or at case conferences, the goals provide the framework for explaining what has been achieved and what the plan is going forward.

If you would like to discuss how we approach goal setting in our case management work, please get in touch.