NDIS I-CAN v6 and Acquired Brain Injury

What ABI participants, families, and supporters need to know

Disclaimer: This article reflects publicly available information about the NDIS I-CAN v6 assessment framework as at June 2026. It does not constitute professional disability support, medical, or legal advice. For personalised guidance, contact the NDIA on 1800 800 110, your Support Coordinator, or a disability advocacy organisation.

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Acquired brain injury (ABI) encompasses any damage to the brain that occurs after birth — from stroke, traumatic brain injury (TBI), hypoxic brain injury, encephalitis, or other causes. In Australia, ABI is one of the leading causes of disability in people under 65, and a significant group within the NDIS.

ABI is among the most complex disability types to assess accurately, for a specific reason: many of its most significant functional impacts are invisible.

Cognitive fatigue, memory impairment, executive function difficulties, emotional dysregulation, reduced insight, and changed personality are not apparent from looking at someone. They may not be apparent in a 90-minute structured assessment session with an unfamiliar person. They are, however, profoundly present in daily life — and if the I-CAN v6 assessment does not capture them, the plan that results will not reflect genuine needs.

This guide covers the hidden impacts of ABI and how to document them accurately.

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The Core Challenge: Invisible Impacts and Variable Functioning

ABI participants face two specific assessment challenges that require deliberate preparation:

1. Hidden functional impacts

Many ABI impacts are not visible to an outside observer — particularly in a structured, one-on-one setting where the participant may be at their most cognitively organised, before fatigue sets in. Cognitive fatigue, memory impairment, word-finding difficulties, reduced processing speed, and executive dysfunction all fall into this category.

2. Variable functioning

ABI functioning often varies significantly depending on time of day, cognitive load, environmental demands (noise, visual complexity), social demands, and physical state. An assessor who sees a participant at 10am after a good night's sleep in a quiet room may see a very different person from the one who attempts to manage a grocery shop at 3pm after a morning of appointments.

Both of these challenges have the same solution: thorough, specific, written documentation that gives the assessor an accurate picture of daily functioning rather than what they observe in the session alone.

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Understanding Cognitive Fatigue

Cognitive fatigue deserves special attention because it is one of the most significant and most under-documented impacts of ABI.

Following brain injury, the brain often has to work much harder than before to perform tasks that were previously automatic. Over time, this additional cognitive effort accumulates into a profound, neurologically-based fatigue that is qualitatively different from ordinary tiredness.

What it looks like in practice:

• A person may function reasonably well in the morning but be completely unable to manage complex tasks, conversation, or decisions by early afternoon
• After any demanding activity — a phone call, an appointment, a shopping trip — the person may need to rest for hours before attempting anything else
• On high-demand days, the following day or two may also be significantly impaired
• Cognitive fatigue is not resolved by simply sitting down; it requires genuine cognitive rest

How to document it:

• What activities trigger cognitive fatigue?
• How severe does it become? (A 0–10 scale can be useful)
• How long does recovery take after a demanding activity?
• What is the "capacity" for cognitive activity in a day — and how does exceeding it affect the following day?
• What activities are impossible when cognitive fatigue is present?

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Domain-by-Domain Guidance

Self Care

Physical self-care abilities vary significantly depending on the nature and location of the brain injury. Many ABI participants have no physical mobility limitations but struggle with self-care due to executive function, sequencing, or cognitive fatigue.

What to document: Whether physical assistance is required; whether prompting or step-by-step instruction is needed to sequence tasks; whether cognitive fatigue after self-care affects the rest of the day; any sensory changes (pain, hypersensitivity) that complicate self-care.

Example: "Can shower independently when prompted to begin, but requires a checklist to sequence the steps reliably. After morning self-care, typically needs 30–40 minutes of rest before being able to manage any further demands."

General Tasks and Demands

ABI commonly disrupts the executive function abilities underlying daily routine management — the ability to initiate tasks, sequence steps, manage time, and adapt to change.

What to document: Whether the person can follow a daily routine reliably or requires prompting and external structure; the role of reminders, checklists, or support workers in maintaining routines; ability to manage medications reliably given memory and sequencing difficulties; any safety concerns or vulnerability to exploitation arising from impaired judgement or reduced insight.

Example: "Cannot initiate or manage the day's activities without a structured schedule and prompting from a support worker. Has missed multiple medical appointments due to memory difficulties. Takes medications but has on several occasions taken double doses due to forgetting the first. Requires reminders and supervision for all time-sensitive activities."

Domestic Life

Executive function and memory impairments from ABI significantly affect the ability to manage a household — particularly tasks that require planning, sequencing, or sustained effort.

What to document: Ability to shop for food and household items (memory, executive function, and fatigue all affect grocery shopping); ability to plan and safely cook meals (fire safety, sequencing of cooking steps, forgetting items on the stove); ability to manage cleaning and household tasks (initiation difficulties, fatigue cost); what support or aids are used to compensate.

Example: "Cooking has become unsafe since the injury — has left the stove unattended and forgotten to turn it off on multiple occasions. Uses a slow cooker as a safer alternative but can only manage very simple meals. Cannot independently plan a weekly grocery shop. Household cleaning requires prompting and is done significantly less frequently than needed without support worker assistance."

Communication

ABI commonly affects communication in ways that are not obvious in casual conversation but become apparent under demand.

What to document:

• Word-finding difficulties (tip-of-the-tongue failures, substitutions)
• Processing speed — difficulty keeping up with fast conversation or complex verbal instructions
• Fatigue-related communication breakdown — fluent early in the day, significantly impaired later
• Reading and writing difficulties
• Difficulty with abstract language, inference, or complex instructions

Mobility

What to document: Any physical mobility limitations from the injury; balance and coordination difficulties; fatigue-related mobility limits (can walk 500 metres in the morning, cannot walk 100 metres in the afternoon); any assistive technology in use.

Interpersonal Interactions & Relationships

ABI frequently affects interpersonal relationships through personality change, emotional dysregulation, reduced social cognition, impulsivity, and difficulty reading social cues.

What to document: Changes to personality or emotional regulation since the injury; impact on relationships (family, friends, work); ability to manage conflict; vulnerability in social situations due to impaired social cognition.

Example: "Has significant difficulty managing frustration, which frequently escalates quickly. This has placed considerable strain on family relationships and has led to the loss of several friendships since the injury. Now avoids most social situations to manage this."

Learning & Applying Knowledge

What to document: Current capacity for learning new information; memory and retention difficulties; any return-to-education attempts and the supports required; vocational rehabilitation history.

Life Long Learning

ABI often dramatically disrupts a person's vocational trajectory. Many ABI participants had careers and employment goals before their injury that are no longer achievable in the same form.

What to document: Pre-injury employment and vocational goals; what the person's current employment aspirations are (even if different from before); the cognitive and physical barriers ABI creates to pursuing any form of employment or vocational training; what support would be needed to pursue vocational goals (job coaching, reduced hours, cognitive accommodations); whether the person has attempted return to work and what happened.

Example: "Was employed full-time as an accountant before the injury. Attempted to return to the same role after 12 months but could not manage the cognitive demands reliably — errors and fatigue led to resignation after 6 weeks. Now aspires to work in a low-demand administrative role, 10 hours per week maximum, with structured tasks and minimal multi-tasking, but has not yet found a suitable placement."

Mental & Emotional Health

Depression and anxiety are extremely common after acquired brain injury — both as direct neurological consequences and as responses to the profound life changes that ABI brings. Emotional dysregulation is also common in some types of ABI.

What to document: Diagnosed mental health conditions following the injury; changes in emotional regulation since the injury (irritability, emotional lability, reduced frustration tolerance); how mental health difficulties affect daily functioning; current mental health treatment; risk of self-harm or crisis.

Example: "Has been diagnosed with major depression since the injury. Also experiences significant emotional dysregulation — becomes verbally aggressive with very little provocation, which has affected family relationships significantly. Sees a psychologist and psychiatrist but mental health management remains difficult. Two crisis presentations to hospital in the past year."

Community, Social & Civic Life

What to document: Actual current participation (not aspirational); barriers to participation including cognitive fatigue, transport, sensory sensitivity, and social anxiety; what participation requires in terms of support.

Domestic Life

ABI can affect the ability to manage a household — see the General Tasks and Demands section for how executive function and routine management affect the domestic environment specifically.

What to document: Ability to plan and execute grocery shopping; ability to cook safely (fire safety concerns are common post-ABI); ability to manage cleaning, laundry, and household maintenance reliably; whether domestic tasks have become unsafe or are no longer completed without support.

Behaviours of Concern

What to document: Any behaviours arising from emotional dysregulation, impulsivity, or frustration post-ABI — in context, with frequency, and with current management approaches.

Physical Health

ABI often involves significant ongoing physical health management — neurological conditions, pain, medication, and specialist monitoring all add to the daily health burden.

What to document: Ongoing neurological management requirements; medications and their functional side effects (many ABI medications affect alertness, fatigue, or cognition); chronic pain; any physical health conditions arising from or worsened by the injury; the frequency and complexity of specialist appointments and what support is needed to attend them.

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Variable Recovery Trajectories: Why They Matter for Your Assessment

ABI is unusual as a disability in that recovery trajectories vary enormously between individuals and across time. Some people make significant functional gains in the first two years post-injury. Others plateau relatively quickly. Some experience slow progressive improvement over many years. Some experience later deterioration — particularly in older adults with TBI, where long-term neurological consequences can emerge years after the initial injury.

This variability creates a specific preparation challenge: the assessor needs to understand where you are in your trajectory, not just what your current functioning looks like.

What to describe about your recovery trajectory:

• When did the injury occur?
• What was your acute presentation and what were you told about your prognosis?
• What gains have you made since — and by when did improvement plateau?
• Is your current functioning stable, or are you still noticing changes (positive or negative)?
• Have there been any secondary changes — medical complications, additional health events — that have affected your recovery?

For participants whose ABI occurred many years ago: describe the stable plateau you have reached — make clear that this is not continued recovery but an established, ongoing disability presentation.

For participants with recent ABI: describe both current functioning AND expected trajectory, and note that current capacity may understate eventual stable needs (or vice versa if early recovery gains are expected to persist).

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Describing Before and After the Injury

For participants with acquired brain injury, describing what you could do before the injury versus what you can do now is one of the most powerful forms of preparation documentation.

This is not about dwelling on loss. It is about providing the assessor with a functional baseline that contextualises current support needs.

A simple before/after structure for each relevant domain:

• Before the injury: "I worked full-time as a [occupation], drove independently, managed all household tasks, and socialised regularly."
• After the injury: "I have not returned to work in [X] years. I cannot drive due to [specific reason]. I require support worker assistance for cooking and all household management. I rarely socialise because [specific barrier]."

This before/after structure is particularly powerful for:

• Demonstrating that current support needs represent a genuine functional change, not a lifelong presentation
• Establishing the contrast that makes the support needs comprehensible in context
• Addressing assessors who may assume that current capacity is the person's baseline rather than a significant decline from it

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The Role of Carers and Family Members in ABI Preparation

Carers of people with ABI often possess the most accurate picture of daily functioning — particularly when reduced insight means the participant themselves cannot accurately self-assess.

What carers can contribute:

Domain-by-domain daily observations. A carer who lives with or regularly supports an ABI participant can describe specifically: what the participant can and cannot do in each domain, how long things take, what assistance is provided, and what the consequences are when support is not available.

Documentation of the full day. ABI participants often function best in the morning, deteriorating through the day. Carers who see the participant across the full day can document this trajectory in a way that a morning assessment session cannot capture.

Insight into reduced insight. If the participant's injury has affected their ability to accurately perceive their own deficits, the carer can explicitly flag this to the assessor and provide their own observations as a counter-balance to potentially understated self-report.

Safety documentation. Many ABI-related safety incidents — near-misses, burns from leaving appliances on, falls, medication errors — are only witnessed by carers. These incidents are important evidence and should be documented specifically, with dates where possible.

If you are a carer supporting an ABI participant through their I-CAN v6 assessment, preparing a detailed, domain-by-domain written statement is one of the most valuable things you can do. See our dedicated guide: NDIS I-CAN v6 for Carers and Families.

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A Note on Insight Limitations

A specific challenge for some ABI participants is reduced insight — difficulty accurately perceiving their own functional limitations as a result of the injury. This is a neurological consequence of some types of brain damage, not a choice or denial.

If the person with ABI has reduced insight into their own deficits:

• A family member or carer's written observations become even more critical
• The preparation document should be completed primarily by the supporter, with the participant's involvement where possible
• The assessor should be informed in advance about the insight limitation so they can weight information sources appropriately

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Using the Pre-Assessment Period Well

With the new framework starting from April 2027 and a staged transition, most ABI participants have time to prepare. Here is how to use it:

1. Commission a current OT assessment. An occupational therapist's functional assessment, framed in I-CAN domain terms, is among the most valuable documents you can bring to your assessment.
2. Keep a daily functioning log. Brief daily notes — including cognitive fatigue levels, what was and was not manageable — build a specific picture over weeks and months.
3. Document the full day, not just the morning. For ABI participants, functioning often deteriorates significantly through the day. Ensure your preparation reflects afternoon and evening capacity, not only morning performance.
4. Include a supporter statement. A family member or carer who provides a specific, domain-by-domain description of what they observe every day adds information the participant may not be able to self-report accurately.

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Sources: NDIA — Support needs assessment framework, Brain Injury Australia, Synapse — Brain Injury Information and Support, NDIS Amendment (Getting the NDIS Back on Track No. 1) Act 2024, Disability Advocacy Network Australia (DANA)