Expert opinion: Balancing hope and realism in neuro rehab

One of the most delicate conversations in neurorehabilitation happens early and often: setting recovery goals. How do clinicians inspire hope and motivation while being honest about what’s possible?

How do clinicians support a patient’s aspirations without setting them up for crushing disappointment? And perhaps most importantly, how do they balance what they think they know from past experience with the reality that every brain injury is unique?

Here, NR Times members share their thoughts on the question:

How should we talk about recovery goals with patients while balancing hope and realism?

Natalie Mackenzie, director, BIS Services

Recovery after brain injury is often a long and challenging journey, where a sense of hope can naturally fluctuate over time.

It’s essential to set realistic, client-centered goals with the client that are both measurable and meaningful, while acknowledging the emotional and psychological complexities of the process.

A strong multidisciplinary team is vital in maintaining motivation and engagement, providing consistent support, and adapting goals as needed.

Peer support groups can also play a key role, offering clients the opportunity to connect with others who have faced similar challenges and see what’s possible.

Balancing hope and realism requires skilled clinicians who can navigate the nuances of insight and awareness, involve families in the process, and ensure that clients feel supported every step of the way.

This collaborative approach helps sustain motivation and progress, even when the road to recovery feels uncertain and long.

Helen Shakespeare, partner and principle serious injury lawyer, Thompsons Solicitors

At Thompsons, we strive for our client’s to feel heard, not managed. We should listen and keep an open mind. Recovery goals should reflect a clients values and aspirations.

Our role is to work with highly skilled clinical professionals to support that journey with purpose and with care.

People can achieve unbelievable things through well managed and imaginative rehabilitation.

Sometimes that means having difficult conversations, but these should focus around providing all available options and an informed choice being made by the client.

Pieter du Toit, director of clinical services, Brainkind

When we talk about recovery goals, the key is to make them living conversations, not fixed promises.

Recovery goals are not just milestones to tick off, but conversations that help people rediscover who they are becoming.

At Brainkind, we see every day how realistic, collaboratively set goals anchor people in what is achievable while keeping alive the motivation to try.

Families, therapists, and the person themselves all bring perspectives that shape this shared understanding of progress.

Rehabilitation is rarely linear; there are setbacks, challenges, and feedback loops through which realism deepens and new possibilities emerge.

People need that realism; it provides safety, clarity, and direction.

But it must be offered with warmth and imagination, so that hope becomes not false optimism, but the steady energy that sustains effort, learning, and meaning over time.

Nick Berners-Price, The National Register of Parkinson’s Specialist Personal Trainers

Parkinson’s offers such an interesting perspective when looking at this question.

Experience of diagnosis of Parkinson’s is understandably traumatic and invariably entirely negative.

Recovery is unfortunately currently not one of the options, but delivering the message that exercise not only slows progression, but has the potential to rewind some of the symptoms in the early stages, could and should be part of balancing the trauma of the diagnosis experience.

Life can be lived well, even with a degenerative neurological condition, but covering the full range of management options, from medication to exercise, nutrition to relaxation, is the key.

Patients need information and support to be in a position to do this, so that hope and realism can be delivered in equal measure.

Dr Anita Rose, clinical director, Cognivate

In reality, hope in rehabilitation is a double-edged sword.

On one hand, as clinicians, we want to instil hope, support hope in our clients, and help them see there is hope in recovery. However, on the other hand, we need to remain realistic, transparent and honest.

One thing I talk about with my clients is what Hope can be seen as.

Using an acronym, I explain that Hope = Healing Outcomes Progress and Empowerment.

Life is full of paradoxes, it can be beautiful or sad, it can bring hope or despair, but in reality, to live life we have to allow ourselves to experience the full spectrum of what life has to offer, and I see my role as empowering my clients to live the best life they can.

To have hope means to build resilience with our clients.

Resilience is about positive adaptation, realistic optimism – to be hopeful about the future while making plans that empower coping with actual reality and that require courage and hope.

In the words of my clients: .

“HOPE” is the little voice you hear whispering “maybe” when it seems the entire world is shouting “no.”

“Hope for me goes hand in hand with help. Help in a cure, help in being independent, help in living my best life”.

“My hope is always a better tomorrow. And then another, and another. It’s not always easy, I know, but I’m sure it’s worth it and more importantly I know I am worth it.”

Joe Dooley, assistant psychologist, TRU

When talking about recovery goals, it’s important to keep the patient right at the centre of the conversation.

Being open and honest, while taking a gradual and realistic approach, helps strike the right balance between hope and practicality.

Patients should always understand their overall goal, but it’s often the smaller, more achievable steps that make the journey feel possible.

Breaking big goals into manageable milestones can make progress feel less daunting and give patients a chance to recognise their achievements along the way.

These small wins not only boost motivation but also help them see how far they’ve come.

Over time, this approach keeps hope alive while helping patients maintain a clear and realistic sense of what is possible.

Elizabeth Nightingale, neurologic music therapist, Chiltern Music Therapy

In neurorehabilitation, every conversation about recovery has the potential to carry enormous emotional weight.

As a Neurologic Music Therapy Therapist, I’ve learned that talking about goals isn’t just about setting targets, it’s about building a relationship grounded in trust, honesty, and hope.

We’re often walking alongside people who are reimagining their lives after something life-changing, and that takes as much emotional care as clinical skill.

There’s always this fine balance – we want to nurture hope, because hope fuels engagement and motivation, but we also have a responsibility to be truthful and realistic about what’s possible.

Too much optimism can feel dismissive; too much realism can feel defeating.

I think the art lies in staying alongside the person, holding both the reality of the injury and the possibility of adaptation and growth.

Paula Hansen, World Accessible Holidays

Holidays, rest and travel are an important part of rehabilitation and respite for everyone, and this is no different for individuals in recovery.

There’s too much negativity about disability and the limitations people believe it can bring.

Hope and realism aren’t opposites, they work together. Realism means acknowledging that yes, things will be different and require more planning, more support and more thinking.

But it also means knowing things are absolutely achievable with the right support.

We work with clients competing in sailing competitions across Oslo, Oman and Switzerland, or send them on African safaris in accessible vehicles.

Our clients take sit ski holidays or simply go on a family holiday in the sun. That’s realism in action, not pretending the journey’s easy, but proving it’s completely doable.

If you skied before your injury, you can still ski in a sit ski. The dream doesn’t change; the method does. That’s where real hope lives.