When someone returns home after a stroke or acquired brain injury (ABI), the instinct — for clinicians, families, and often the person themselves — is to focus on what feels most urgent. Walking safely. Managing meals independently. Getting dressed without assistance. These are real and important goals. But there is a category of recovery that quietly gets left behind —Leisure. The garden that hasn't been tended. The weekend makan sessions that stopped. The Sunday morning walk with a neighbour that disappeared from the calendar without anyone deciding it should.
A scoping review published in the OTJR: Occupational Therapy Journal of Research synthesised 17 studies on leisure engagement among community-dwelling adults living with ABI. Its findings are clear — and they carry direct implications for how rehabilitation in the community ought to be structured.
Leisure Is Not a Luxury in Recovery
Leisure occupations — activities that are freely chosen, intrinsically motivated, and done for pleasure — carry a protective function for the brain and body. Research consistently links sustained leisure engagement with better cognitive health, improved physical function, and meaningfully reduced risk of depression across all adult age groups.
For someone navigating life after a stroke or traumatic brain injury (TBI), those benefits are not incidental. They are part of what recovery actually means.
Yet the scoping review confirms what occupational therapists see in practice: rehabilitation tends to concentrate on self-care and productivity, with leisure addressed — if at all — only after discharge from inpatient services. By that point, patterns of disengagement have often already formed, and re-engagement becomes harder to initiate without deliberate clinical support.
What the Research Shows Happens to Leisure After Brain Injury
Across all 17 studies reviewed, the pattern was consistent: leisure participation decreased following ABI, and the activities that remained tended to be sedentary, home-based, cognitively passive, and solitary.
Before injury, people were gardening, cycling, attending concerts, visiting friends, playing sport, and traveling. After injury, the most commonly retained activities were watching television, resting, and sitting quietly. Studies from Korea, Sweden, Nigeria, Ireland, and Australia all documented the same shift — regardless of cultural context or geography.
The magnitude of change was not modest. One study found that participants went from an average of 4.9 different leisure activities before their stroke to just 1.9 afterwards. Another found that 92% of TBI participants reduced their leisure participation after injury. A third documented that engagement in social and recreational activity remained significantly lower than peers without disability even a decade after injury.
Critically, this reduction persisted long after the acute phase of recovery. Studies tracked participants for periods ranging from less than six months post-injury to fifteen years — and the pattern of reduced, simplified leisure engagement held throughout.
What Gets in the Way
The review identified three overlapping categories of factors shaping leisure engagement post-hospitalisation.
Physical and cognitive factors are the most intuitive barriers. Fatigue, reduced mobility, impaired balance and coordination, and difficulties with memory or processing all affect whether someone can sustain meaningful participation. The ability to walk a few hundred metres independently, and to drive, were among the strongest predictors of retained leisure engagement in one cohort study.
Environmental and social factors were equally significant — and arguably more amenable to change. Access to appropriate transport appeared as a barrier across multiple studies, as did architectural constraints at home, the availability of supportive companions, and the nature of community spaces themselves. Physical and structural barriers — crowded hawker centres, poorly lit venues, uneven footpaths, noise — were reported as the most frequently encountered and largest in magnitude for community-dwelling ABI survivors.
Psychological and attitudinal factors added another dimension. Fear of risk, reduced confidence, and a tendency to wait for functional capacity to improve before attempting activities all contributed to sustained disengagement. One qualitative study identified that accepting one’s current capacity — rather than waiting to return to how things were — was itself a meaningful enabler of re-engagement. Waiting for the old version of oneself to return, rather than rebuilding around who one is now, cost people years of participation.
This matters because the interventions that address each category look quite different. Treating leisure disengagement as a purely physical problem misses the environmental and psychological dimensions that are often more tractable.
What Is Actually Being Lost
There is a deeper question about what leisure represents beyond enjoyment. Multiple studies in the review linked leisure engagement to a sense of meaning and purpose. When people stopped participating in activities that had previously defined them — as a cook, a sportsperson, a community member, a traveler — they lost more than pastimes. They lost a sense of who they were.
Most studies reported that people were dissatisfied with their reduced leisure participation, with some expressing frustration and genuine distress. The correlation between degree of leisure limitation and the level of distress was statistically significant — meaning the more restricted someone’s leisure became, the more it bothered them. That is not a peripheral finding. For clients managing the psychological impact of stroke or brain injury, the erosion of occupational identity is clinically significant and worth addressing directly.
One study linked leisure engagement to a sense of purpose. Another found that satisfaction with leisure participation increased over time when the right conditions were present — lower stroke severity, greater independence, stronger cognitive function, and meaningful social support. These are not fixed variables. Many are modifiable with the right clinical input.
The Case for Occupational Therapy
This is precisely where occupational therapy adds a dimension that other disciplines do not typically address. OT does not only ask: “Can you button your shirt?” It asks: “What does a meaningful day look like for you — and what is standing between you and that?”
The scoping review concluded that a complex, individually tailored intervention is likely required to meaningfully support leisure re-engagement for neuro rehab. That complexity reflects the reality that leisure is shaped by personality, culture, environment, physical capacity, and personal priority — none of which are uniform across individuals.
At Lifeweavers, our occupational therapists bring experience from acute hospital settings into community practice, which means they understand both the clinical picture and the very different demands of real life at home. Goal-setting includes what the client actually wants to do — not only what the clinical checklist requires. That might mean working with a stroke survivor who wants to return to cooking for their family, a stroke client in their 30s aiming to get back to recreational football, or an older adult who simply wants to sit in a park without fatigue cutting the outing short. Our care coordination model also means that for clients managing multiple disciplines, leisure goals are not siloed within a single therapy session but carried across the whole plan.
Age Is Not the Full Story
One limitation the review authors themselves acknowledge is a bias toward older adult populations in the existing research. Stroke has historically been associated with older age, but the incidence of stroke in younger adults is rising — 25% of first-time strokes now occur in people under 65, and the average age of stroke presentation has been shifting younger across the Asia-Pacific region.
For a younger person managing a career, family responsibilities, and an active social life, the leisure disruption from a medical condition is qualitatively different. The activities at stake — competitive sport, travel, parenting young children, social evenings — carry different weight. The psychological impact of losing them is different. And the intervention needs to reflect that distinction rather than apply frameworks built around retirement-age participants.
A Note on What the Research Is Still Missing
The review noted a significant geographical gap: the overwhelming majority of studies were conducted in Western contexts, with only two studies from Asia. Given that leisure occupations are profoundly shaped by cultural context — what constitutes meaningful recreation, how family and community participation is structured, how disability is perceived socially — this is a gap worth naming directly.
For clients in Singapore and across the region, the leisure activities that carry the most meaning may look quite different from those that dominate Western research. Hawker centre visits, family gatherings, temple observances, community gardening, festive celebrations — these are the activities that matter, and they are the activities that deserve to be addressed in culturally informed rehabilitation plans.
Leisure Before and After Acquired Brain Injury: What the Evidence Shows
| Activity Type | Typical Pre-ABI Pattern | Typical Post-ABI Pattern |
|---|---|---|
| Outdoor activities | Frequent — walking, cycling, sport, nature | Significantly reduced across all studies |
| Social activities | Active — visits, community events, group gatherings | Reduced; often replaced by solitary alternatives |
| Travel and outings | Common — tourism, day trips, family excursions | Largely discontinued; transport barriers prominent |
| Creative and cultural pursuits | Varied — arts, music, cinema, reading | Reduced; receptive activities better retained than participative |
| Home-based passive leisure | Present but not dominant | Becomes the primary mode of engagement |
| Cognitively active leisure | Regular — games, learning, meaningful work | Reduced; passive watching and resting increase |
Frequently Asked Questions
Why is returning to leisure activities important after stroke or brain injury? Leisure engagement is linked to better physical health, reduced risk of depression, and improved cognitive functioning. Beyond clinical outcomes, leisure activities carry a sense of identity, meaning, and social connection — all of which are directly affected by acquired brain injury. Recovery that does not address leisure is leaving a meaningful part of the picture incomplete.
What leisure activities are realistic after a stroke? This is highly individual and depends on personal goals, current functional capacity, and what was meaningful before injury. Many people return to adapted versions of previous activities. A stroke survivor who loved cooking may return to the kitchen with modifications; a keen walker may begin with shorter, supported routes. An occupational therapist will assess what is achievable now and work progressively toward longer-term goals.
How can occupational therapy help me return to my hobbies after a brain injury? An occupational therapist will assess which activities you want to return to, identify the barriers — physical, environmental, or psychological — and work with you on practical strategies to re-engage. This may include adapting the activity itself, developing fatigue management strategies, problem-solving transport or environmental access, and building confidence progressively over time.
What are the most common barriers to leisure after acquired brain injury? Transport is consistently cited across the research as a primary barrier. So are fatigue, reduced physical mobility, cognitive changes affecting planning and initiation, dependence on others, and environmental factors such as noise, crowds, and inaccessible spaces. Addressing these barriers requires both clinical expertise and practical problem-solving — which is why a community-based OT model is particularly well-suited to this work.
When should leisure goals be introduced during stroke or brain injury rehabilitation? The evidence suggests leisure should be considered from the outset of rehabilitation — not deferred until after discharge. Patterns of disengagement form quickly, and the longer leisure occupations remain absent, the harder re-engagement becomes. If you have been discharged from inpatient care and leisure has not yet been addressed, it is not too late to raise it with your therapist or care coordinator.
Why choose Lifeweavers for private rehab therapy in Singapore?
Lifeweavers is Singapore’s most comprehensive private rehab therapy team, consisting of:
Occupational Therapists
Physiotherapists
Speech Therapists
Hand Therapists
Dieticians
Stretch Therapists
Specialised Massage Therapists
Collaborative Acupuncture & TCM
Our team holds joint case reviews, works from a single unified therapy plan, and adapts that plan together as you progress.
This is what gold-standard, coordinated rehabilitation looks like — and it is available at home, at our clinic, or both.