A guide for families: brain injury in adults
When someone close to you has a brain injury, the early days can feel overwhelming. The medical team is focused on keeping the person safe and stable. You are trying to take in information, manage fear about what comes next, and support someone you love who may have changed in ways you do not yet fully understand.
This guide is for families and carers navigating that journey. It aims to give you a clearer picture of what brain injury actually does, what rehabilitation involves, and how we work with families throughout the process.
What brain injury does
Brain injury affects people differently depending on which parts of the brain are damaged and the nature of the injury. There is no single picture.
What families often notice is that the physical recovery can be better than the inner one. The person may be mobile and look well, while experiencing real changes in how they think, feel, and behave. These are sometimes called the hidden effects of brain injury, and they are frequently the hardest part for families to manage.
Cognitive changes can include difficulty with memory, attention, processing speed, organisation, and problem-solving. Someone who was sharp and capable before their injury may now struggle to follow a conversation, retain information, or manage tasks they would previously have done without thinking.
Emotional and behavioural changes are also common. Irritability, anxiety, low mood, and impulsivity frequently follow brain injury. Personality can shift in ways that are difficult to explain and harder to live with day to day. This is not a choice on the part of the person affected. It is a consequence of damage to the parts of the brain that regulate emotion and behaviour.
Fatigue is one of the most underestimated effects. The brain works much harder to compensate for damaged areas, producing a deep neurological tiredness that is quite different from ordinary tiredness. Someone with a brain injury may need far more rest than either they or the people around them expect.
What rehabilitation involves
Rehabilitation after brain injury is not a single treatment. It is a coordinated process, delivered over time by a team of different professionals, with the aim of helping the person regain as much function and independence as possible.
A rehabilitation team might include a physiotherapist, occupational therapist, speech and language therapist, and neuropsychologist, among others, depending on what the person needs. These professionals work best when they are coordinated towards shared goals, with someone keeping an eye on the whole picture.
That is the role of the case manager. At Hawkley Rehab, Ken and Louise Hawkley manage all cases jointly. Both are qualified Occupational Therapists and members of BABICM, the British Association of Brain Injury and Complex Case Management. Our assessments are structured around the World Health Organisation’s International Classification of Functioning, Disability and Health, a framework that looks not just at the injury itself but at how it affects daily life and participation in the world.
Supporting families as well as clients
Case management is not only about the person with the injury. Families are affected deeply too. You may be adjusting to someone who seems different from who they were. You may have taken on responsibilities you did not have before. You may be carrying a mixture of grief, love, exhaustion, and uncertainty at the same time.
We aim to keep families informed and involved throughout. This means clear communication at every stage, involving families in planning where the client wishes it, and making sure you are not left managing questions without access to the people who can answer them.
Because Ken and Louise both carry every case in full, there is almost always someone available when something comes up. You do not have to wait for a single case manager to become free. And when both of us attend a meeting, only one case management fee is charged.
What to expect from working with us
Most cases begin with an Immediate Needs Assessment, a structured clinical evaluation covering the person’s physical, cognitive, emotional, and practical situation. This forms the foundation for everything that follows.
From there, we build and coordinate the right rehabilitation team for the individual, commission the appropriate services, and remain involved throughout to review progress and adapt the plan when things change.