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Home / Rehab Mantras
The rehab mantras summarise important principles of neurorehabilitation in short, memorable and repeatable nuggets. Find out what they mean, the research behind them, and discover to what extent they can contribute to best practices.
Every interaction is important for recovery. Going shopping, playing a game, making a cup of coffee… Everything we do is an opportunity for rehabilitation.
Recovery after a brain injury is a journey and takes time. With the right support, it is possible to be healthy and live well.
Rehabilitation is key to recovery and can lead to improvements even many years after a brain injury.
After a brain injury, learning happens “by doing”. In the beginning this takes effort. With practice it becomes easier. Consistency helps with this learning.
Movement can have powerful benefits on the body and mind. It can increase overall health, improve flexibility and strengthen muscles. Exercise has been shown to reduce stress and anxiety, improve mood, and boost self-esteem
Research allows us to understand the needs, difficulties, and strengths that people have after brain injury, We are then able to develop more effective interventions to help people achieve their long-term goals.
We communicate in more ways than words. Everything we do, or not do, as well as what we say, expresses our needs, wants, and emotions.
Therapy can be hard and tiresome. Working towards specific goals gives direction and purpose, providing a roadmap to achievement. The journey may not always be easy. Keeping our goals in mind helps to overcome the challenges and obstacles that we may face along the way.
Rehab does not only happen in therapy sessions. It happens all day long and at night. Every time a skill is practiced in daily routines, that can be rehab.
These three things can help a recovering brain. Repetition helps (re)build and strengthen neural connections. Routines provide regular opportunities to practice skills in everyday situations. Positive relationships have been described as the ‘most important vehicle for change’ in brain injury rehabilitation through their influence on brain functioning.
After a brain injury, we may help people by doing things for them that they cannot do on their own. But rehab is about helping people regain their independence through training and therapy. It requires active participation from the person. The best help sometimes is to step back, and do things with the person, not for the person.
Rehab at Brainkind is transdisciplinary. This means that everyone is involved: the person with the brain injury, their family and friends, staff and people in the community. We all contribute to help people with brain injury live lives well lived.
The rehab mantras are short, repeatable and memorable statements aimed at helping anyone to understand and apply key principles of the neurobehavioural therapy model, which is the approach to rehabilitation of acquired brain injury used at Brainkind.
Rehabilitation after an acquired brain injury is a complex process. It is not always easy to understand why some things should happen in a particular way. The rehab mantras were created to demystify some of the more complex aspects of rehabilitation, help anyone involved in rehabilitation to understand, remember and apply the principles of our neurobehavioural model.
The rehab mantras are all about raising awareness and understanding of how rehabilitation after brain injury works. Communicating them is key. We start by sharing them through various means, including webinars, articles, quizzes, interactive polls, and activities. We ask services to use these materials to discuss each mantra, not only with staff, but also with the people we support. We want to understand what each mantra means to them, while also sharing why it is important
The short answer is yes! Research underpins the rehab mantras in two ways. On the one hand, the mantras themselves are developed from evidenced-based principles of brain injury rehabilitation. For example, “it’s never too late to rehab” is about neuroplasticity – the ability of neural networks in the brain to change through growth and reorganization - and it reminds us to stay up-to-date with scientific advances, as new interventions to help people, even many years after brain injury, are continuously evolving. On the other hand, we have been evaluating the rehab mantras initiative itself, how it changes knowledge about brain injury rehabilitation, and the practical implementation of that knowledge. You can read more about the science behind the mantras in our reading list and on the research behind the rehab mantras section.
So far, it’s a little bit early to say. The feedback we’ve had has been positive. People are enthusiastic about the mantras, and many find them meaningful and inspiring. Initial results suggest that it may help retain knowledge about certain concepts, but the jury is still out in terms of whether it has a significant impact on day-to-day practice. We also want to learn more about what the people we support think about it, and whether these statements have helped them in any way.
While the specific mantras used in different settings may vary, some apply to many situations beyond the rehabilitation of people with acquired brain injury. In addition, the method we used to identify the core values and principles that need to be translated and communicated through simple, accessible means, could be applied across a range of settings and situations where the concepts are complex, but we want to focus on the “take home message”.
Updates and new information about the rehab mantras will be posted on this page. But readers can always subscribe to our mailing list, or email research@brainkind.org with any questions or feedback. We’d love to hear from you!
We have been evaluating the rehab mantras initiative as we develop and implement it. To date we have carried out two evaluation studies.
To learn more about the science that inspired each of our rehab mantras, refer to our suggested readings.
This book chapter provides a very good overview of the neurobehavioural approach to rehabilitation, and of the importance of practicing skills outside of the rehab centre, in real life settings:
Wood RL, Worthington AD. (2001) Neurobehavioural rehabilitation: a conceptual paradigm. In R. Ll. Wood & T. M. McMillan (Eds.) Neurobehavioural Disability and Social Handicap Following Traumatic Brain Injury. Hove: Psychology Press.
The mantra “things take time” was inspired by Piet Hein’s poem “T. T. T.” and first applied by Pamela Klonoff in the context of brain injury rehabilitation:
Hein, P. (2004). T. T. T.. Retrieved March 5, 2024, from https://allpoetry.com/T.T.T.Klonoff P. S. (2010). Psychotherapy After Brain Injury: Principles and Techniques. New York, NY: Guilford Press.
Hein, P. (2004). T. T. T.. Retrieved March 5, 2024, from https://allpoetry.com/T.T.T.
Klonoff P. S. (2010). Psychotherapy After Brain Injury: Principles and Techniques. New York, NY: Guilford Press.
The studies below provide some evidence of improvements achieved many years after a brain injury. The Parish and Oddy study (2007) was conducted in Brainkind services:
Hammond, F. M., Malec, J. F., Corrigan, J. D., Whiteneck, G. G., Hart, T., Dams-O’Connor, K., … & Ketchum, J. M. (2021). Patterns of functional change five to ten years after moderate-severe traumatic brain injury. Journal of Neurotrauma, 38(11), 1526-1534. Parish, L., & Oddy, M. (2007). Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury. Neuropsychological Rehabilitation, 17(2), 230-243 Schiff, N. D., Giacino, J. T., Butson, C. R., Choi, E. Y., Baker, J. L., O’Sullivan, K. P., … & Henderson, J. M. (2023). Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized feasibility study. Nature Medicine, 29(12), 3162-3174.
Hammond, F. M., Malec, J. F., Corrigan, J. D., Whiteneck, G. G., Hart, T., Dams-O’Connor, K., … & Ketchum, J. M. (2021). Patterns of functional change five to ten years after moderate-severe traumatic brain injury. Journal of Neurotrauma, 38(11), 1526-1534.
Parish, L., & Oddy, M. (2007). Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury. Neuropsychological Rehabilitation, 17(2), 230-243
Schiff, N. D., Giacino, J. T., Butson, C. R., Choi, E. Y., Baker, J. L., O’Sullivan, K. P., … & Henderson, J. M. (2023). Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized feasibility study. Nature Medicine, 29(12), 3162-3174.
The article below describes the science behind the processes involved in learning new skills and how these can be applied to brain injury rehabilitation:
Schmitter-Edgecombe, M. (2006). Implications of basic science research for brain injury rehabilitation: A focus on intact learning mechanisms. The Journal of Head Trauma Rehabilitation, 21(2), 131-141.
Here are some selected examples of the growing body of evidence suggesting that movement is related to positive health outcomes:
Bergouignan, A., Legget, K. T., De Jong, N., Kealey, E., Nikolovski, J., Groppel, J. L., … & Bessesen, D. H. (2016). Effect of frequent interruptions of prolonged sitting on self-perceived levels of energy, mood, food cravings and cognitive function. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 1-12. De Sousa Fernandes, M. S., Ordônio, T. F., Santos, G. C. J., Santos, L. E. R., Calazans, C. T., Gomes, D. A., & Santos, T. M. (2020). Effects of physical exercise on neuroplasticity and brain function: a systematic review in human and animal studies. Neural Plasticity. Dimitrov, S., Hulteng, E., & Hong, S. (2017). Inflammation and exercise: Inhibition of monocytic intracellular TNF production by acute exercise via β2-adrenergic activation. Brain, Behavior, and Immunity, 61, 60-68.Xing, Y., & Bai, Y. (2020). A review of exercise-induced neuroplasticity in ischemic stroke: pathology and mechanisms. Molecular Neurobiology, 57(10), 4218-4231.
Bergouignan, A., Legget, K. T., De Jong, N., Kealey, E., Nikolovski, J., Groppel, J. L., … & Bessesen, D. H. (2016). Effect of frequent interruptions of prolonged sitting on self-perceived levels of energy, mood, food cravings and cognitive function. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 1-12.
De Sousa Fernandes, M. S., Ordônio, T. F., Santos, G. C. J., Santos, L. E. R., Calazans, C. T., Gomes, D. A., & Santos, T. M. (2020). Effects of physical exercise on neuroplasticity and brain function: a systematic review in human and animal studies. Neural Plasticity.
Dimitrov, S., Hulteng, E., & Hong, S. (2017). Inflammation and exercise: Inhibition of monocytic intracellular TNF production by acute exercise via β2-adrenergic activation. Brain, Behavior, and Immunity, 61, 60-68.
Xing, Y., & Bai, Y. (2020). A review of exercise-induced neuroplasticity in ischemic stroke: pathology and mechanisms. Molecular Neurobiology, 57(10), 4218-4231.
This article reviews the evidence behind the claim that research improves healthcare performance:
Boaz, A., Hanney, S., Jones, T., & Soper, B. (2015). Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ open, 5(12), e009415.
The readings below help better understand behaviour after a brain injury and what can be done to help:
Alderman, N., & Worthington, A. (Eds.) (2024). Managing Challenging Behaviour Following Acquired Brain Injury: Assessment, Intervention and Measuring Outcomes. Taylor & Francis. Feeney, T. J. (2010, August). There’s always something that works: principles and practices of positive support for individuals with traumatic brain injury and problem behaviors. In Seminars in speech and language (Vol. 31, No. 03, pp. 145-161). Thieme Medical Publishers.Rahman, B., Oliver, C., & Alderman, N. (2010). Descriptive analysis of challenging behaviours shown by adults with acquired brain injury. Neuropsychological Rehabilitation, 20(2), 212-238.
Alderman, N., & Worthington, A. (Eds.) (2024). Managing Challenging Behaviour Following Acquired Brain Injury: Assessment, Intervention and Measuring Outcomes. Taylor & Francis.
Feeney, T. J. (2010, August). There’s always something that works: principles and practices of positive support for individuals with traumatic brain injury and problem behaviors. In Seminars in speech and language (Vol. 31, No. 03, pp. 145-161). Thieme Medical Publishers.
Rahman, B., Oliver, C., & Alderman, N. (2010). Descriptive analysis of challenging behaviours shown by adults with acquired brain injury. Neuropsychological Rehabilitation, 20(2), 212-238.
The articles below discuss the importance of goal setting in rehabilitation and its impact on outcomes:
Playford, E.D., Siegert, R., Levack, W., & Freeman, J. (2009). Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clinical Rehabilitation, 23, 334-344 Turner-Stokes, L., Rose, H., Ashford, S., & Singer, B. (2015). Patient engagement and satisfaction with goal planning: Impact on outcome from rehabilitation. International Journal of Therapy & Rehabilitation, 22(5), 210-216.
Playford, E.D., Siegert, R., Levack, W., & Freeman, J. (2009). Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clinical Rehabilitation, 23, 334-344
Turner-Stokes, L., Rose, H., Ashford, S., & Singer, B. (2015). Patient engagement and satisfaction with goal planning: Impact on outcome from rehabilitation. International Journal of Therapy & Rehabilitation, 22(5), 210-216.
This mantra reminds us about the importance of repetition and practice to consolidate new learning, which are described in the readings below.
Schmitter-Edgecombe, M. (2006). Implications of basic science research for brain injury rehabilitation: A focus on intact learning mechanisms. The Journal of Head Trauma Rehabilitation, 21(2), 131-141. Wood, R. Ll. & McMillan, T. M. (2001) (Eds.) Neurobehavioural Disability and Social Handicap Following Traumatic Brain Injury. Hove: Psychology Press.
Wood, R. Ll. & McMillan, T. M. (2001) (Eds.) Neurobehavioural Disability and Social Handicap Following Traumatic Brain Injury. Hove: Psychology Press.
The articles below both talk about the importance of the three Rs on brain function:
Christensen, A-L. (2018), Foreword. In C. Bowen, S. Palmer, & G. Yeates, G. (Eds.). A Relational Approach to Rehabilitation: Thinking About Relationships After Brain Injury. London: Routledge Snyder, P. (2017, March). Relationships, repetitions, and routines: The ‘new’ 3Rs of early childhood development and learning. Invited presentation to the Retired Faculty of the University of Florida. Gainesville, FL, United States.
Christensen, A-L. (2018), Foreword. In C. Bowen, S. Palmer, & G. Yeates, G. (Eds.). A Relational Approach to Rehabilitation: Thinking About Relationships After Brain Injury. London: Routledge
Snyder, P. (2017, March). Relationships, repetitions, and routines: The ‘new’ 3Rs of early childhood development and learning. Invited presentation to the Retired Faculty of the University of Florida. Gainesville, FL, United States.
The background to this mantra is described in the article by Professor Mike Barnes suggested below.
Barnes, M. P. (2003). Principles of neurological rehabilitation. Journal of Neurology, Neurosurgery & Psychiatry, 74(Suppl. 4), iv3-iv7.
The readings below describe how we are all ultimately working together towards a shared goal. In some way, they also come full circle to the first mantra “Every interaction is rehab”:
Littooij, E., Doodeman, S., Holla, J., Ouwerkerk, M., Post, L., Satink, T., … & de Groot, V. (2022). Setting meaningful goals in rehabilitation: A qualitative study on the experiences of clients and clinicians in working with a practical tool. Clinical Rehabilitation, 36(3), 415-428. Wood, R. L., Alderman, N., & Worthington, A. (2020). Neurobehavioural rehabilitation. In N. Agrawal, R. Faruqui, and M. Bodani, Oxford Textbook of Neuropsychiatry. Oxford University Press.
Littooij, E., Doodeman, S., Holla, J., Ouwerkerk, M., Post, L., Satink, T., … & de Groot, V. (2022). Setting meaningful goals in rehabilitation: A qualitative study on the experiences of clients and clinicians in working with a practical tool. Clinical Rehabilitation, 36(3), 415-428.
Wood, R. L., Alderman, N., & Worthington, A. (2020). Neurobehavioural rehabilitation. In N. Agrawal, R. Faruqui, and M. Bodani, Oxford Textbook of Neuropsychiatry. Oxford University Press.
