Brett Gottman, OT, is highly respected by his peers and shares his insights on working with people recovering from brain injury.

Brett Gottman, OT, has been a member of Bacharach’s brain injury team for years, and is currently co-coordinator.  He offers the following strategies and insights to fellow clinicians working with patients recovering from brain injury but notes that these approaches are equally important to family and friends.


It’s not about controlling the patient, it’s about controlling yourself.


Create an environment that allows the patient to better manage actions and responses. Goal should be to minimize problematic behavior.




Changing how you approach or speak to a patient by remaining calm and inviting.


-Always greet the patient with an introduction of your name, department, and role. This may be ongoing depending on the patient’s recall.

-Speak slowly and directly.

-Redirect rather than correct.

-Explain a procedure or an intention in simple concrete terms prior to action.

-Announce the end of an interaction or transitional period as unspoken social cues may be missed.




-Create a consistent environment where participation is wanted.

-If a task is refused, offer flexible arrangements to meet sensory needs or to make the patient comfortable.

-Attempt to understand what may be uncomfortable and leading to the refusal.

-Be direct with instruction. Often asking the patient if they want to get out of bed may result in a no.

-Create a visual schedule to aide with transitions and expectations of activity throughout the day.

-Flexibility is key, activities can be approached at a later time.

-Provide a sense of control with two choices that lead to the same therapeutic outcome or goal.

-Leverage known interests or leisure activities by incorporating them into task.

-Checklists towards goal completion (higher level patients) may increase participation and expectations.

-Utilize positive reinforcement with compliments towards progress to task completion.




Remain calm and identify the stimulus to be removed.

-Do not attempt to argue or reason, focus on redirection.

-Pay attention to environmental context as a contributing factor.




-Do not take things personally.

-Redirect and utilize non-verbal cues such as moving past stimulus, removing from environment, signaling.

-Do not embarrass, attempt to address patient politely in a one on one setting.

-Crowds or over stimulating environments can lead to inappropriate behavior.

-Be a model for appropriate behavior.

-Leverage easy topics for conversation such as leisure interests, sports, family and weather.


Diminished Insight into Impairment


-If there is a safety issue such as weight bearing on a non-weight bearing (NWB) extremity, confront the issue directly in sensitive manner.

-Explain concretely why it is unsafe or an activity cannot be performed, explain that it may not be permanent.

-Do not argue, remain flexible, change topic if necessary.

-Awareness generally increases with time, approach topic or situation at a later point if needed.


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