By Ronda Boswell, Occupational Therapist, Cognivate Rehabilitation.
The way we perceive and process the world around us is fundamental to how we navigate our lives. Our sensory experiences – the sound of a busy office, the brightness of the sky or the feel of a familiar tool in our hands – form the backdrop of our daily occupations. When these sensory systems are functioning well, they allow us to engage with our environment and reinforce our sense of self. However, following a brain injury, many individuals face a profound yet frequently unseen challenge: significant changes in sensory processing that can fundamentally alter their function and identity.
For example, a person may find that sounds once considered background noise now feel physically painful or that ordinary fluorescent lighting triggers intense fatigue and migraines. Conversely, some may experience sensory dulling, where they feel disconnected from their bodies or their surroundings. These changes are not isolated; they directly impact a person’s ability to participate in their daily activities. When the world becomes overwhelming or distressing, the simple act of grocery shopping, attending a child’s school play or returning to a workplace can become a source of profound anxiety and exhaustion.
As a result, a person’s sense of identity can also become increasingly fragile. If a person can no longer tolerate the sensory demands of a busy restaurant, they may stop meeting friends and lose their role as a friend. If the tactile demands of a hobby like gardening or woodworking become distressing, they may lose a vital source of stress relief and achievement. This sensory-driven withdrawal is often misunderstood by others as a lack of motivation or a change in personality, when it is actually a protective response to a world that has become sensory-intense and unpredictable.
Understanding these hidden sensory barriers is a vital responsibility of the interdisciplinary team. As these symptoms are subjective and often difficult for the individual to articulate, the team must be proactive in screening for sensory dysregulation. Neuropsychologists, physiotherapists, and speech and language therapists all play a role in identifying how sensory overload may be, for example, contributing to cognitive fatigue, balance issues and communication frustrations. Validating that these experiences are a direct result of the brain injury is a crucial first step in helping the individual move from a place of confusion and shame to one of adaptation and self-compassion.
Occupational therapists are uniquely positioned within the neurorehabilitation team to bridge the gap between sensory challenges and meaningful engagement. Our role involves a deep dive into the sensory ergonomics of a person’s life. By assessing both the individual’s sensory profile and the environments in which they live and work, occupational therapists can implement tailored strategies that restore agency. This might include environmental modifications, such as adjusting lighting or acoustics at home, or introducing assistive technology like noise-canceling headphones or tinted lenses to manage visual stress.
Furthermore, we work to develop sensory diets and pacing strategies that allow individuals to engage in valued occupations without hitting a wall of exhaustion. This might mean breaking down a cooking task into smaller steps to reduce sensory input or finding new, quieter ways to engage in social roles. For some, it may involve sensory retraining or finding entirely new occupations that align with their current sensory needs; perhaps switching from a loud gym for a quiet walk, ensuring that the pursuit of health and connection remains possible.
To truly support an individual, neurorehabilitation must focus on addressing often overlooked sensory changes. The interdisciplinary team assists the individual in deciphering their new reality by recognising the influence of these new changes following brain injury. Our role as occupational therapists is to ensure that sensory changes do not become a permanent barrier to a fulfilling life. We aim to empower individuals recovering from a brain injury to confidently engage with the world again. By modifying the environment and/or the task, we enable them to reclaim their lives, restore their key roles and continue to express their identity through their actions.