NICE NG252: What high-quality OT looks like in complex and catastrophic neurorehabilitation
by Victoria Clark, Professional Head of Occupational Therapy
In October 2025, NICE published NG252: Rehabilitation for chronic neurological disorders including acquired brain injury, a NICE clinical guideline that sets out evidence-based expectations for how rehabilitation may be delivered for people with chronic neurological conditions. Central to the guidance is the recognition that rehabilitation is not a single episode of care, but an ongoing, coordinated and person-centred process that supports function, participation and quality of life over time.
For occupational therapists, NG252 speaks our language, providing a useful benchmark for quality. In complex and catastrophic cases, such as acquired brain injury or spinal cord injury, it reinforces the importance of occupational therapy input that is holistic, strategic and grounded in real-world function.
Rehabilitation focused on function and participation
NG252 frames rehabilitation as a means to support people to live their lives as fully as possible following neurological injury or illness. The guideline describes rehabilitation as care that aims to:
"maintain, improve or support function and independence in everyday activities"
and
"support participation in education, work, social and leisure activities, and independent living."
This emphasis moves beyond impairment-based recovery and aligns closely with occupational therapy’s core focus: understanding how neurological conditions affect daily routines, roles and environments, and identifying practical ways to support meaningful participation.
In complex and catastrophic cases, where recovery can be prolonged and unpredictable, this functional and participation-focused lens is particularly important. Progress may not be measured in rapid gains, but in improved safety, greater consistency, or increased engagement in everyday life, outcomes that are central to occupational therapy practice.
What NG252 signals about high-quality OT input
Rather than prescribing specific interventions, “NG252 helps to clarify the standards of rehabilitation input that people may reasonably expect. From an occupational therapy perspective, several themes are especially relevant when working on cases through a case manager.
1. Holistic assessment rooted in everyday life
NG252 highlights the importance of understanding the full impact of neurological conditions, stating that rehabilitation should be based on:
"a holistic assessment of the person's physical, cognitive, emotional and social needs, and the impact of these on everyday activities."
For the OT, this means assessments that clearly describe how cognitive, physical, sensory and emotional factors interact to affect daily living, from personal care and mobility to safety awareness, fatigue management and engagement with family or community life.
This holistic perspective supports a shared understanding of need and helps ensure rehabilitation planning remains grounded in lived experience, rather than isolated clinical observations.
2. Clear clinical reasoning linked to risk, independence and sustainability
NG252 emphasises that rehabilitation should be tailored and responsive, recognising that needs and priorities change over time. The guidance notes the importance of:
"individualised rehabilitation plans that are regularly reviewed and adapted as the person’s needs and goals change."
In complex cases, occupational therapy reports should therefore make clinical reasoning explicit, explaining not just what is recommended, but why, and how recommendations relate to risk, independence and longer-term sustainability.
This clarity is particularly valuable where decisions have significant implications, such as care models, funding prioritisation, environmental adaptations or equipment provision. Explicit clinical reasoning helps ensure recommendations remain proportionate, defensible and aligned with the individual’s stage of recovery.
Rehabilitation as an evolving, non-linear process
One of the most important messages within NG252 is its acknowledgement that rehabilitation is rarely linear. The guidance recognises that progress may fluctuate, plateau or shift as insight develops, circumstances change or new challenges emerge.
NG252 highlights the need for rehabilitation that is:
"responsive to changes in the person’s needs, goals and circumstances over time."
In catastrophic cases, early priorities often focus on safety, stabilisation and basic independence. As recovery progresses, however, new areas may come to the fore; such as executive functioning, emotional regulation, fatigue, changing family roles or questions around identity and meaningful occupation.
From an occupational therapy perspective, this reinforces the value of periodic re-assessment and reframing, rather than assuming early functional profiles will remain static. High-quality OT input should therefore articulate not only current function, but how needs may evolve — supporting rehabilitation planning that remains flexible and relevant over time.
3. Outcomes that reflect participation and quality of life
NG252 reinforces that meaningful outcomes extend beyond task performance or clinical measures alone. The guideline explicitly includes goals related to:
"participation, autonomy and quality of life."
For people with catastrophic injuries, occupational therapy outcomes often centre on enabling engagement in valued roles and routines, whether that is managing daily life at home, reconnecting with social networks, or exploring vocational possibilities where appropriate.
Focusing on participation-based outcomes helps ensure rehabilitation remains purposeful, even when progress is complex or gradual, and supports a broader understanding of what “success” looks like in long-term rehabilitation.
4. Contribution to coordinated, long-term rehabilitation pathways
NG252 recognises the importance of continuity and coordination, particularly for people with enduring and complex needs. It highlights the value of services that:
"support continuity of care across settings and over time."
Occupational therapy plays a key role in this by linking clinical recommendations with day-to-day living, supporting transitions between hospital, home and community environments, and aligning functional goals with broader life planning.
In catastrophic cases, where multiple professionals and services are often involved, this integrative contribution helps maintain coherence across the rehabilitation journey.
Occupational therapy and long-term planning
A further alignment between the ethos of OT and NG252 is its contribution to longer-term thinking. The guidance refers to rehabilitation that:
"supports people to adapt to long-term changes in function and participation."
In practice, OT assessments can help articulate not only current ability, but future sustainability, for example, how fatigue, cognition or behavioural change may affect independence over time, or how environmental demands interact with fluctuating capacity.
This forward-looking perspective is particularly valuable where decisions relate to housing, care arrangements or long-term support structures. By focusing on adaptability and participation, occupational therapy helps frame rehabilitation as a process of adjustment and optimisation, rather than a finite endpoint.
OT input aligned with NG252 expectations
Taken together, NG252 reinforces an OT’s role as both a clinical and strategic contributor within complex neuro-rehabilitation.
High-quality OT input in complex and catastrophic cases should:
- Be grounded in real-world function and participation
- Make clinical reasoning clear and defensible
- Recognise rehabilitation as an evolving process
- Support long-term sustainability and quality of life
- Contribute to coordinated rehabilitation pathways
At The OT Practice, we work closely with case managers to provide occupational therapy input that aligns with these principles, offering clinically robust assessments, clear reporting and a functional perspective that supports confident decision-making within complex cases.
What NG252-aligned occupational therapy looks like in practice
In complex and catastrophic neurorehabilitation, occupational therapy input that aligns strongly with the principles of NG252 will typically be characterised by a number of observable features.
From a practice perspective, this should include:
- Assessment and reporting that clearly connect function to daily life, rather than focusing solely on impairments or isolated tasks
- Explicit clinical reasoning, with recommendations linked to risk, independence, sustainability and participation
- Goals and outcomes that evolve over time, reflecting changes in capacity, insight and life context
- A forward-looking perspective, considering not just current ability but longer-term adaptability and quality of life
- Consistent communication across settings, helping maintain continuity as people move between hospital, home, community or vocational environments
When these elements are present, occupational therapy input is more likely to support coherent, long-term rehabilitation planning and to add meaningful value within complex case management pathways.
Looking ahead
As NG252 becomes embedded across rehabilitation services, case manager expectations around quality, coordination and long-term impact will / should rightly continue to elevate. For complex and catastrophic cases, occupational therapy has a central role in translating national guidance into meaningful, life-enhancing outcomes.
By maintaining a strong functional lens and a strategic, adaptive approach, OT input can continue to support rehabilitation pathways that are not only clinically sound, but responsive, sustainable and centred on what matters most to the individual.
