Goal setting after a brain injury

Setting goals for rehabilitation helps target what’s important to the child and family. Gemma Kelly, physiotherapist at The Children’s Trust, explains more.

It’s really important to set goals for rehabilitation after a brain injury. Every child, young person and family is different, and they need to do, want to do, and enjoy different things. Setting goals allows the child, family and all the professionals working with them to aim towards the things that are most important to that child and family at that time. We need to look at the outcome of the services we provide, through using what we call ‘outcome measures’. One type of outcome measure uses family-set goals, and this is thought to be relevant to all the children and is more meaningful than some of the other types of measures.  The goals set by families are taken, and the child’s clinical team set a level which we expect them to achieve during their rehabilitation placement. We measure whether we have achieved these goals in a measure known as Goal Attainment Scaling (GAS).

Setting goals for children following a severe brain injury

Our recently published research paper looked at all the goals that were set by children and their families who came for residential rehabilitation following a severe brain injury over a three-year period (860 goals set by 122 children and families). The highest number of these goals were set in activities related to:
  • mobility eg walking, using their arm;
  • self-care eg washing, dressing or using the toilet; and
  • communication – talking, gesturing, using communication aids.
These areas are different to those found in other studies that had looked at goal setting with children with other disabilities who were at home, and more often prioritise school and leisure activities. However, this is not surprising given that this study looked at the goals of children/young people with severe and new brain injuries, therefore these key areas that are important to being able to look after themselves are prioritised.

Levels of goals achieved

The research looked at whether the therapist-set expected level for each goal was achieved, overachieved or underachieved. Overall 75% of the expected levels were achieved, with 46% of them at the expected level. So this shows that therapists set the level that they expect children/young people to reach exactly right less than half the time. Although this seems low, it reflects that not only is every child/young person different, but also every brain injury is different. This makes predicting outcomes very difficult. Other studies that looked at goal setting with adults who have had strokes have shown that therapists (much more than individuals or families), fear that not achieving goals may be upsetting for children/young people and their families. Therefore, they may set cautious goals that are easier to achieve. This may not always be the best thing because goals are often linked to hopes and ambitions, and so they can provide a strong motivator to keep going with rehabilitation. However, more work is needed to understand families and clinicians experiences of the goal setting process better.

Using goals to target what’s important to the child and family

The take home messages from this study are that:
  • Goal setting is extremely useful so that rehabilitation can target what’s important to the child and family, and to ensure that everyone is working towards the same thing. Soon after a severe brain injury priorities often involve moving, communicating and looking after yourself. 
  • Having conversations about the expected outcomes of rehabilitation is important, but it’s very difficult to predict what the outcomes will be, and therapists will only get it exactly right less than half the time. It’s important that everyone is aware of this during these discussions.
  • More research into this area is needed to make sure that process is the best it can be, and meets the needs of the children and young people during rehabilitation.
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