Neuro occupational therapy in action: striding for strength after brain injury
Introducing Esther, the brain injury survivor who stepped up her rehabilitation game.
Business professional Esther was used to living life at 150 miles per hour.
Her work life included international trips, long workdays, client meetings, and managing large programmes.
Her social life was no slower.
"I loved being constantly on the go, multiple things going on at the same time - going out to gigs, as well as sorting work and completely living in the fast lane." Esther recalls.
This is how life was for Esther when she suffered a traumatic brain injury during a trip abroad in June 2023.
While in Poland, Esther was heading back to her hotel on an electric scooter when it flipped on a brick, causing her to fall and hit her head.
Unaware that anything was wrong, Esther continued her day. However, the next day she had a seizure.
I didn't even know occupational therapy, this kind of service, existed or was even provided. You don't know about these things until you need them. 
Esther
She was taken to the hospital, where it was confirmed that she had suffered a concussion and a fractured skull, causing brain damage. She remained in hospital for eight days while being monitored.
"That's when they said what had actually happened, that I'd had a traumatic brain injury." Esther says, "So eventually, after I was in the Polish intensive care equivalent for a little while, I was allowed to fly home."
Post-injury steps
"I felt really poorly after the accident and, not having experienced anything like that before, it was very difficult physically." Esther recalls, "I was in a lot of pain, and I was very tired, constantly feeling unwell. I couldn't do basic things.
"I always say to people, I was in the shower one day and couldn't remember how to turn it on." Esther says, "I'm a massive cook, I cook a lot, but I couldn't measure ingredients. None of it made any sense to me. There was a lot of memory missing, a lot of patches."
All of this caused Esther to halt the career she had loved for 24 years.
Months after Esther's injury, and after a period of sick leave, Esther returned to work at minimal hours after seeing two separate neurologists.
"I went back to part time work in November 2023, I started on three and a half, four hours a day. It wasn't a role, per se, it was to get used to being on the computer again, taking my time."
Soon after, Esther went for a scan. She was diagnosed with hydrocephalus and went through a process of tests.
Hydrocephalus is a condition where there is too much fluid on the brain, a direct result from Esther's brain injury. It occurs when the cerebrospinal fluid (CSF) is blocked, or when ventricles (the chambers of the brain) enlarge.
Luckily for Esther, her hydrocephalus eventually improved, and she continues to be monitored.
"I managed to stay in my role as an extra pair of hands because I'm an expert in what I do." Esther recalls, "But the biggest challenge I was having was remembering how to do things and building my confidence to take client calls. I was irritable, and constantly drained.
"The fatigue held me back in terms of taking on more hours, I would do five hours of work and then go to bed for three hours because I couldn't cope. I couldn't figure out what was going on and how I could get through."
Luckily, Esther was connected to Krysalis neurological occupational therapist, Anna, through her Income Protection claim. The symptoms Esther was experiencing - neuro fatigue, memory issues, mood changes - could finally be understood and managed.
I thought it was really interesting to understand what sits beneath - the 'whys'. Like why was something happening that had never been an issue before, and understanding why it was happening now, and how it was linked to memory.
Esther
Anna started working with Esther in July 2024, a year after the injury, to help Esther return to her fast-paced, full-time position.
But Esther needed to understand the importance of the differences between life before and after injury. The 150 miles per hour lifestyle she had been living was no longer obtainable in the same way it had been before.
"The early assessments at the start when we covered what neuro fatigue is, and what was happening to me, was so important. I learned which activities really burned out my internal battery, and then tyring to figure out how to build the day around that."
"Before, I would never take breaks or eat lunch or breakfast most days. For years." Esther adds, "I lived on four- or five-hours sleep. I can't do that now, which is a good thing."
The teaching, the tools, the techniques. Around boundaries, balancing the day, taking breaks, and really understanding what was going on. That was important to me.
Esther
Anna focused on how to adapt Esther's working environment - both externally such as the type of lighting in a room, and internally such as Esther's frame of mind. They worked together on how to create a less overbearing schedule, including:
- Resheduling meetings to allow for breaks
- Building daily practices
- Creating relaxing routines
"Making more space for things like gratitude and meditation journaling, even just taking five minutes to do some breathing exercises in the day just to reset has been really helpful. Because I do it now, properly and consistently, which I didn't do before."
Esther already had a love for nature and exercise, so as a strategy to help reduce anxiety and manage mood changes, Anna also encouraged the importance of being out in nature.
There's a study that if you can get out into natural light, even if it's ten minutes in the morning and at night, it boosts your neuro energy.
Krysalis neuro occupational therapist, Anna
Striding for strength
As Esther's rehabilitation went on, she decided she wanted to give back to the brain injury community, and applied to do a 14-day sponsored walking challenge held by the brain injury charity Same You.
Anna encouraged the challenge, knowing that the importance of nature and exercise as a work hardening activity would help with Esther's fatigue, anxiety, and build confidence and resilience.
Anna says, "Esther embraced everything fantastically well. She really leaned into the rehab process and has empowered herself."
Esther completed the challenge with her mother, where they walked 27.2 miles in 14 days, and smashed their fundraising target of £500.
The walk was themed "Connection", so Esther and her mother walked through their local community: through woods and parks, around a museum, art gallery, and a disused railway, discovered local monuments, and walked to the home of Esther's football team.
"It wasn't massive," Esther says, "But it was still a big one for me at the time...to do all of that in two weeks."
Anna was also proud of Esther, who says, "All credit to Esther, she really picked up on everything we worked on and went with it."
'Connection' in Esther's community
And as Esther's confidence and resilience grew, she began to feel as though she could take on more hours at work, and Anna encouraged it.
"The biggest challenge at work, and one of the things that was helpful, was that I was able to share some of the material that Anna and I worked through with my work colleagues."
Because I look the same, and I turn up pretty much the same, they didn't understand what was going on.
Esther
Moving forward...
By the end of February 2025, Esther returned to full-time work, and she now has a better balance of hybrid working to suit her needs.
Esther says, "It's been really difficult. I have to be strict with my boundaries because the culture is fast paced with a fast turnaround; that's the culture I work in."
"It's the ability to switch off that then means I can do the hours and the requirements. The time I've spent with Anna, the support, has been hugely differentiated in terms of actually making me human again.
"Having someone to regularly talk to throughout, very openly, about how I was feeling - talking about what wasn't working and what was happening when I was having a dip, and being able to reflect on it together. Figuring out my triggers and how we do something differently next time."
Helping me return to work. Helping me to full-time hours, and helping me to understand, and change, my pace is different now - I'm good with it.
Esther
Recently on talking heads...
