When every day is different: Adapting mobility support after a stroke or aneurysm
When every day is different: Adapting mobility support after a stroke or aneurysm
Supporting someone after a stroke or aneurysm requires more than addressing physical symptoms - it demands a comprehensive, person-centred approach. Clinicians working in neurorehabilitation understand that recovery isn’t linear; abilities can shift from one day to the next, influenced by factors such as fatigue, cognitive load, emotional state and environmental demands.
That’s why holistic assessment is essential. Frameworks like the Person-Environment-Occupation (PEO) model and the International Classification of Functioning, Disability and Health (ICF) help to structure our understanding of these complex interactions.
The PEO model, for example, highlights how a person’s occupational performance emerges from the dynamic relationship between their abilities, the environments they engage with, and the tasks that hold meaning in their lives. A good fit between these elements leads to better function; a poor fit can quickly undermine independence.
Similarly, the ICF model takes a broad view of health and disability, recognising that functional ability is shaped not only by medical conditions, but by environmental and social factors, from accessibility and support networks to societal attitudes. It moves away from diagnosis as the only perspective, instead focusing on real-world participation and barriers to inclusion – elements that a purely diagnosis-led assessment might miss.
With these frameworks in mind, assessments must go beyond checklists. They should involve understanding the client’s goals, roles, supports, and environment. By approaching mobility planning through a biopsychosocial lens, clinicians can recommend supports that flex with the client's changing needs - not just on their best days, but throughout the full spectrum of function.
Adaptability is key. Whether it's evaluating the home for barriers, trialling assistive tech, or adjusting plans in response to feedback, the goal is sustainable, confidence-building mobility. For people living with brain injury, and the teams supporting them, responsive, tailored equipment can help maintain independence and engagement - even when every day brings something different.
‘On a Good Day’ - This Year's ABI Week Theme
Headway's Action for Brain Injury (ABI) Week 2025, 19-25 May, is focused on the theme of ‘On a Good Day’, highlighting the unpredictable nature of brain injury recovery. This powerful theme acknowledges that brain injury survivors often experience significant variations in their capabilities and symptoms from one day to the next.
‘On a Good Day’ recognises the gaps between what someone can accomplish when they're feeling their best versus when they're facing more challenging symptoms. For many survivors, this unpredictability affects their ability to work, maintain relationships, and engage in everyday activities.
Through this campaign, Headway aims to increase public understanding of these fluctuations, encouraging greater empathy and appropriate support for those having ‘bad days’ while celebrating the achievements possible on ‘good days’.
Understanding the fluctuating nature of brain injury
For many people living with the effects of a stroke or aneurysm, the concept of ‘on a good day’ versus ‘on a bad day’ becomes central to daily life. These fluctuations can affect:
• Energy levels - where fatigue may strike suddenly or build gradually, turning a promising morning into an afternoon where even basic tasks feel overwhelming
• Physical abilities - such as strength, coordination, and balance, which might allow for independent walking one day but require significant support the next
• Cognitive function - including concentration, memory, and processing speed, where the ability to follow conversations or remember instructions can vary dramatically
• Emotional wellbeing - with mood changes that can feel beyond one's control, affecting interactions with loved ones and the ability to cope with daily challenges
These variations aren't simply a matter of willpower or effort. They reflect the complex neurological changes following brain injury and can be influenced by numerous factors including sleep quality, stress levels, and even environmental conditions like temperature or noise. Understanding this can help both survivors and their support networks approach difficult days with compassion rather than frustration.
The challenge of unpredictability
The unpredictability of symptoms can be one of the most challenging aspects of brain injury recovery. Activities that were manageable yesterday might seem impossible today, leading to feelings of frustration or inadequacy.
This variability can also be confusing for family members and friends who may struggle to understand why capabilities seem to change without warning. Well-intentioned comments like "but you could do this yesterday"can add to the emotional burden, making it essential for everyone involved to understand that these fluctuations are a legitimate part of the condition, not a lack of effort or determination.
Adapting mobility support for changing needs
When considering mobility solutions after a brain injury, it's essential to account for this variability. The right equipment doesn't just work on good days – it adapts to provide appropriate support when things are more challenging.
Effective mobility equipment for brain injury survivors often incorporates:
· Adjustable settings that can be easily modified based on daily needs
· Modular components that can be added or removed as required
· Versatile designs that support different positioning requirements
· Ease of use features that reduce the need to exert energy on more difficult days
For example, a wheelchair with adjustable back support can provide more stability on days when core strength and balance are compromised, while allowing for more freedom of movement when the user feels stronger.
Similarly, a lightweight, foldable wheelchair can be an ideal solution for individuals whose challenging days are less frequent but still impactful. On good days, it can remain stored away, allowing for independent mobility, while being readily available when fatigue sets in, or balance requires a little extra support.
The goal of mobility support isn't just about moving from place to place – it's about maintaining independence and confidence, and engagement in meaningful tasks and activities.
The right mobility and postural support can make a meaningful difference in day-to-day function - especially when energy, focus, or balance are in short supply. On days when fatigue limits physical stamina, power-assist features help conserve energy for essential tasks, rather than depleting it through mobility alone. When cognitive overload makes complex operations difficult, intuitive controls reduce the mental load, supporting autonomy without adding frustration.
From a clinical perspective, effective equipment supports energy conservation by minimising the effort required to maintain posture or stability. This allows clients to redirect their limited energy toward higher-value activities — whether that’s self-care, therapy goals, or engaging in meaningful routines. Adjustable support features can be dialled up or down depending on the client’s condition that day, providing the flexibility needed to support independence across fluctuating levels of function.
The Importance of ABI Week
ABI Week plays a crucial role in reducing stigma, promoting understanding, and driving support for those living with brain injury. Through education and awareness campaigns, events like ABI Week help bridge the knowledge gap about the complex and often invisible challenges that brain injury survivors face.
By highlighting these experiences, Headway and supporting organisations help create more inclusive communities where people understand that someone with a brain injury might have vastly different capabilities from one day to the next – and that this is a normal part of their condition, not a reflection of effort or motivation.
This increased awareness leads to more appropriate support systems, better workplace accommodations, and greater empathy from the public, all of which are essential for brain injury survivors to achieve their full potential.
While the unpredictability of life after a stroke or aneurysm can't be eliminated, appropriate support can help manage its impact. Recovery is often a long and non-linear journey – it can take up to two years for neutral pathways to be re-established or for a new baseline to emerge. Working with mobility specialists who understand the fluctuating nature of brain injury, and the unpredictable trajectories, ensures solutions can flex and adapt with changing needs – providing stability on difficult days and freedom on better ones.
