Power mobility for independence when energy is limited

For individuals living with brain injury, energy can be a precious and finite resource. As Action for Brain Injury Week 2025 highlights with its theme "On a good day," the fluctuating nature of post-injury recovery means that physical capabilities, cognitive function, and energy levels can vary dramatically - often within the same day.

Research consistently demonstrates that fatigue is one of the most prevalent and persistent symptoms following brain injury. Studies report that that up to 73% ^[1] of individuals experience significant fatigue after injury, and can be common, burdensome, and long-lasting.

This fatigue changes how energy must be managed and allocated. For clinicians working with brain injury survivors, understanding this "energy budget" becomes a critical part of rehabilitation planning.

For many individuals after brain injury, this creates a catch-22 situation: the very effort required to move independently can deplete the energy needed for meaningful engagement in daily activities. When a significant portion of one's energy budget is consumed by the physical exertion of mobility itself, little remains for cognitive tasks, social interaction, or therapeutic exercises.

Power mobility solutions offer a clinically sound approach to resolving this paradox. By reducing the physical demand of movement, they allow individuals to strategically conserve and redirect their limited energy toward higher-value activities.

Understanding fluctuating energy levels

For individuals living with the effects of a brain injury, the concept of 'on a good day' versus 'on a bad day' becomes central to daily life. Energy levels may fluctuate unexpectedly, turning a promising morning into an afternoon where even basic tasks feel overwhelming. Physical abilities such as strength, coordination, and balance might allow for independent mobility one day, but require significant support the next.

These variations reflect the complex neurological changes following brain injury and can be influenced by numerous factors including sleep quality, stress levels, and even environmental conditions. From a clinical perspective, appropriate power mobility solutions provide several key benefits for individuals with fluctuating energy levels. By reducing the physical exertion required for mobility, power systems help preserve energy for meaningful activities and therapeutic engagement.

Mollayeva et al. found that fatigue severity at baseline was a significant predictor of Glasgow Outcome Scale-Extended scores across all injury severities. By reducing fatigue through power mobility, clinicians may help improve overall functional outcomes and long-term quality of life.

By reducing the cognitive load associated with navigating physical barriers, power mobility helps preserve cognitive resources for other tasks - particularly important on days when cognitive fatigue is prominent. This conservation of cognitive energy can make the difference between successful engagement in meaningful activities and withdrawal due to overwhelming fatigue.

Clinical considerations for varying presentation

For healthcare professionals supporting individuals with brain injury, selecting appropriate power mobility requires careful consideration of how symptoms fluctuate across days. Control interfaces must accommodate the full spectrum of cognitive function - from "good days" when complex operations are manageable to challenging days when processing speed and attention may be significantly diminished.
Power bases that integrate with adjustable seating systems allow postural support to be modified based on daily presentation. On days when tone increases or core stability decreases, additional supports can be engaged while maintaining the same mobility base.

The ideal power mobility solution must perform consistently across all environments the individual needs to access - from the controlled setting of home to more challenging outdoor environments. This can also include power add-ons for manual chairs, which can support energy conservation. There are various powered options available that can cater to different cognitive presentations, which address different demands from individuals. This approach ensures that participation isn't limited by location, even on days when physical capabilities are reduced.

The therapeutic value of power mobility

Beyond simple transportation, clinicians increasingly recognise[2],[3] power mobility as a therapeutic intervention that supports rehabilitation goals. It enables consistent participation in therapy sessions, even when fatigue would otherwise limit attendance. It provides opportunities for controlled and safe exploration that builds confidence and executive cognitive functions, that can be transferable skills to many different situations.

For therapists supporting brain injury rehabilitation, power mobility represents a tool for maximising function and independence within the reality of fluctuating capabilities. Used alongside therapeutic positioning, strength training and cognitive rehabilitation, it can form part of a multimodal approach, tailer to individual goals. By preserving energy for therapeutic activities and meaningful engagement, power mobility becomes an enabler of rehabilitation rather than simply a compensatory approach.

Perhaps most importantly, power mobility solutions acknowledge and respect the unpredictable nature of brain injury recovery. Rather than expecting individuals to conform to the demands of static equipment, adaptive power systems flex to meet changing needs. This supports dignity and autonomy regardless of whether it's a "good day" or a challenging one, as well as taking cognitive skills presentation into account.

The AJM Choice approach

At AJM Choice, we understand the complex relationship between energy management and independence for individuals with brain injury. Drawing on over 40 years of NHS-trusted expertise through our parent company AJM Healthcare, our clinical team applies a person-centred approach to power mobility assessment and recommendation.

As specialists in providing power mobility solutions, we've seen firsthand how appropriate powerchair technology can transform daily life for individuals with fluctuating energy levels after brain injury. We focus on matching technological features to specific clinical presentations, ensuring that controls are accessible even on days when cognitive or physical resources are limited. Our range of power mobility options includes features specifically designed to accommodate the varying presentation common after brain injury, from programmable control interfaces to adaptable seating systems.

What sets our approach apart is our commitment to adapting solutions as recovery progresses. Brain injury rehabilitation is rarely linear, and power mobility needs often evolve over time. Our clinically led follow-up ensures that equipment continues to meet changing needs, whether that means adjusting interfaces for improved cognitive access or modifying seating systems to accommodate changes in tone or posture.

For individuals travelling the unpredictable path of brain injury rehabilitation, consistency provides something invaluable: the freedom to engage with life on their own terms, regardless of the day's challenges. The recovery journey can be marked by uncertainty, but the reliability of appropriate power mobility offers both practical support and psychological reassurance - the foundation upon which autonomy and confidence can be rebuilt.

[1] https://www.sciencedirect.com/science/article/pii/S0149763414002772
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7681349/
[3] https://pubmed.ncbi.nlm.nih.gov/27910723/