Acquired Brain Injury: How Occupational Therapy and Exercise Physiology Help Under the NDIS

What is an acquired brain injury?

An acquired brain injury (ABI) is any damage to the brain that happens after birth. Common causes include traumatic brain injury from falls, car accidents or assaults, stroke, hypoxic injury (lack of oxygen, for example after a cardiac arrest or near-drowning), infections such as encephalitis, tumours and alcohol or drug-related injury.

No two brain injuries are the same. Depending on which part of the brain is affected, a person may experience:

• Physical changes such as weakness on one side, poor balance, spasticity, reduced coordination and low fitness
• Fatigue that is out of proportion to activity and slow to recover
• Cognitive changes affecting memory, attention, planning, problem-solving and processing speed
• Changes to mood, motivation, emotional control and behaviour
• Difficulty returning to work, study, driving and community roles

These changes interact. Poor fitness makes fatigue worse, fatigue makes concentration harder and trouble concentrating makes it harder to stick with an exercise program. Breaking that cycle needs both the body and the day-to-day routine addressed together.

Why ABI rehabilitation needs both OT and EP

Research on people with moderate to severe traumatic brain injury shows cardiorespiratory fitness is often well below that of the general population. A Cochrane review of fitness training after TBI found participants improved their exercise capacity by roughly 36 per cent from baseline, with no adverse events reported. The same review found the evidence was not yet strong enough to say fitness training alone improves fatigue, mood or return to daily activities.

That gap is exactly where occupational therapy comes in. Fitness gives a person more capacity. OT helps them use that capacity in the tasks that matter to them: getting ready in the morning, cooking a meal, catching public transport, going back to work or managing a household.

Fatigue: the shared problem

Post-injury fatigue is one of the most common and disabling effects of ABI. It is also where coordinated OT and EP make the biggest difference.

The OT maps out where energy goes across a typical week and helps the person plan high-demand tasks for their best time of day, build in rest breaks and simplify tasks that drain them. The EP then fits exercise into that plan at the right time and the right dose. Over time, as fitness improves, the energy budget grows and the OT can gradually add more activity back into the week.

Cognition and exercise sessions

Cognitive changes affect how a person learns and remembers an exercise program. Your EP will adapt sessions using the strategies your OT has already put in place, such as written or photo-based exercise cards, consistent session times, phone reminders and involving support workers or family so the program carries on between visits. When both clinicians use the same strategies, the person is not juggling two different systems.

Driving after a brain injury

In Victoria, many people need a medical review before returning to driving after an ABI. An OT driving assessment is often part of that process. It looks at vision, cognition, reaction time and physical skills off-road, then an on-road assessment in a dual-control vehicle. Exercare doesn't currently offer driving assessments, but we can point you to accredited OT driving assessors and help you prepare. Your EP can support this by working on neck rotation, reaction speed, upper limb strength and the endurance needed for longer drives.

NDIS funding for ABI therapy

ABI is one of the more common primary disabilities in the NDIS. Where a brain injury causes permanent and significant disability and the person applied before age 65, the NDIS can fund both occupational therapy and exercise physiology. Both are usually funded from your Capacity Building budget, most often under Improved Daily Living Skills (Category 15). Exercise physiology can also be funded under Improved Health and Wellbeing (Category 12). Equipment and home modification recommendations from your OT are funded from your Capital budget.

Clear, goal-linked reports make a big difference at plan reassessment. Because our OT and EP work together, reports can show progress across both physical and functional areas, which helps build a consistent case for ongoing funding. If you were injured in a transport accident, some or all of your supports may be funded by the TAC instead of the NDIS. It is worth checking with your support coordinator.

What to expect when you start

1. Intake: complete our NDIS intake form and select EP, OT or both. We confirm funding and goals with you or your support coordinator.
2. Initial assessments: the OT looks at daily function, cognition and your home. The EP assesses fitness, strength, balance and safety considerations such as seizure history, blood pressure and medications.
3. Shared goals: both clinicians agree on priorities so sessions build towards the same outcomes.
4. Ongoing sessions: delivered at home, in your local park or at a nearby gym.
5. Reviews and reports: progress is measured and written up in time for your plan reassessment.

Evidence referenced in this article

• Hassett L, et al. Fitness training for cardiorespiratory conditioning after traumatic brain injury. Cochrane Database of Systematic Reviews, 2017.
• The definition, incidence and prevalence of acquired brain injury in Australia. Australian Institute of Health and Welfare.
• NDIS participant dashboard: acquired brain injury. NDIA.

Written by the Exercare allied health team. This article is general information only and is not a substitute for individual medical advice. Exercare provides mobile exercise physiology and NDIS occupational therapy across south-east and eastern Melbourne.

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