Cover Page

Occupational therapy and neurological conditions



Jenny Preston


Judi Edmans

on behalf of the College of Occupational Therapists Specialist Section – Neurological Practice









List of figures and tables


Figure 1.1Model of disability that is the basis for ICF
Figure 1.2Comparison of healthy and motor neurone affected by MND
Figure 1.3Healthy nerve cell and demyelination in MS
Figure 2.1Evidence-based practice applied to occupational therapy
Figure 2.2Model for improvement
Figure 4.1The relationship between occupational therapy knowledge and core skills
Figure 4.2The Model of Human Occupation (MOHO)
Figure 4.3Illustration of MOHO applied to neurological practice
Figure 4.4The Canadian Model of Occupational Performance and Enablement (CMOP-E)
Figure 4.5The Person-Environment-Occupation Performance (PEOP) model
Figure 4.6The Kawa (River) model; (a) The river; (b) Elements of the river; (c) Elements constricting water flow.
Figure 6.1Understanding the three factors involved in measuring in clinical practice
Figure 6.2Meaningful measurement in occupational therapy practice
Figure 6.3Client-centred decision-making: selecting the right measure at the right time
Figure 7.1Hand-over-hand technique
Figure 7.2Distal stabilisation technique
Figure 8.1Hierarchy of normal postural ability
Figure 8.2A step-by-step guide to building a stable seated posture
Figure 8.3Profiling bed
Figure 8.4Illustration of an environmental control system


Table 2.1Examples of neurological clinical questions and recommended levels of evidence
Table 2.2Key clinical guidelines for the management of long-term neurological conditions
Table 3.1The Canadian Practice Process Framework
Table 4.1Practical example of COPM applied to neurological practice
Table 4.2Practical application of PEOP personal factors to neurological practice
Table 4.3Practical application of PEOP performance enablers and components to neurological practice
Table 4.4Core values for neurological practice
Table 5.1Examples of occupational dysfunction applied to the ICF levels of disability
Table 6.1How to use measures in a meaningful way? Key questions and red flags
Table 6.2Occupational therapy-specific outcome measures
Table 6.3Commonly used activities of daily living indices
Table 6.4Functional Independence Measure and Functional Assessment Measure
Table 6.5Physical impairment measures
Table 6.6Cognitive impairment measures
Table 6.7Commonly used quality of life measures
Table 6.8Key measures for Huntington’s disease
Table 6.9Key measures for motor neurone disease
Table 6.10Key measures for multiple sclerosis
Table 6.11Key measures for Parkinson’s
Table 7.1Types of sexual dysfunction and potential solutions
Table 8.1Minor adaptations included in the guide

List of contributors

Ana Aragon Independent Occupational Therapist, Bath

Catherine Atkinson Royal Free Neurological Rehabilitation Centre, London

Jill Cooper Royal Marsden Hospital, London

Jane Duffy Formerly East Ayrshire Council, now a service user

Judi Edmans Division of Rehabilitation and Ageing, University of Nottingham, Nottingham

Jo Hurford National Hospital for Neurology and Neurosurgery, London

Fiona Kelly Royal Free Neurological Rehabilitation Centre, London

Jill Kings Neural Pathways, Gateshead, Tyne and Wear

Nicky McNair Regional Environmental Control Service, North East London Community Services, North East London

Freya Powell Royal Free Neurological Rehabilitation Centre, London

Jenny Preston Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, Irvine

Alison Wiesner Hertfordshire Neurological Service, Abbotts Langley, Hertfordshire

Academic foreword

Occupational Therapists working with people with neurological conditions will be delighted to learn of the publication of this book. The text has been written by members of the Specialist Section Neurological Practice (UK College of Occupational Therapists) who bring a wealth of knowledge, enthusiasm and clinical expertise to the topic.

Essentially this is a practical guide which provides an excellent reference manual for both those starting out in neurology and for established practitioners. For particular note is the use of case studies which illustrate facts in a way that factual text could not; the account by Jane Duffy of living with HD is particularly moving.

First and foremost this textbook underlines the unique role of occupational therapy in the treatment and care of people with a neurological condition. It incorporates theoretical, clinical and research perspectives to address the impact of neurological conditions from a person-centred viewpoint. The reader should develop an understanding of the impact of managing complex conditions in everyday life.

There are unique skills and contributions occupational therapists can make to improve quality of life in those with neurological conditions. This is an excellent book and I encourage occupational therapists to engage with it and dip into it regularly.

Professor Avril Drummond
Occupational Therapist and Professor of Healthcare Research
University of Nottingham

Service user foreword

It is a pleasure to be asked to write a ‘patients view’ of this new book regarding the usefulness of input from an occupational therapist with people with a long-term neurological condition. Living with such a condition can lead to many challenges in all aspects of everyday life, social, work and psychological.

This book is focused on assessments of each person as an individual rather than advising the exact same approach and interventions for all patients with a diagnosis; this patient centered approach is one I find reassuring. The emphasis on involving the person in every aspect of decision-making is something that a lot of patients will truly appreciate. To be involved in care decisions is the first step to empowerment for a person suffering from a long-term condition.

Whilst being a book focused on practical work, it pays attention to the importance of evidence-based practice, and the impact the decisions made by the therapist will have on the life of the patient. This offers reassurance to the patient that the interventions will be safe, effective and proved to have worked elsewhere.

As a layperson reading this it offers some enlightenment to the true meaning of occupation and the multiple facets of this rather than it just being simply about remaining at work through an illness. The interventions a therapist can use in all areas of a patient’s life become more valuable as each patient’s needs are different. I hope new and experienced therapists alike will find this book helpful in their ongoing learning and development as professionals and therefore more patients will benefit from the subsequent input from the therapists.

Tony Wilde
Service User


This book has been produced by members of the UK College of Occupational Therapists Specialist Section – Neurological Practice working with people with long-term conditions and has been developed to accompany the book titled Occupational Therapy and Stroke.

The book is intended for use by newly qualified occupational therapists and those new to the field of the management of people with long-term neurological conditions. It acknowledges ‘occupation’ as the foundation of occupational therapy, explaining how this combined with our core skills facilitates an understanding of the complexities of occupational therapy clinical practice with people with long-term neurological conditions.

We have tried to offer a guide from theory to clinical practice basing this around the four most common long-term neurological conditions: Huntington’s disease (HD), motor neurone disease (MND), multiple sclerosis (MS) and Parkinson’s. We hope that by providing guidance and explanations, new graduates will feel confident in the management of people with long-term neurological conditions.

Throughout the book we have included client quotes and case studies to provide real-life presentations to put the theory into context.

For ease of terminology throughout this book, the ‘client/patient’ is referred to as ‘the client’ where it is in reference to our own work, irrespective of whether he/she is being treated in the hospital or community. However, the term ‘patient’ is left unchanged where it is in reference to a national project/referenced document, etc. Similarly, we have used the term ‘Parkinson’s’ throughout this book, as this is currently the correct term for the condition previously known as ‘Parkinson’s disease’.

In the future, as new ideas are developed, this text should be viewed in the light of developing practice.

Dr Judi Edmans


We would like to give particular thanks to Dr Avril Drummond for providing Academic Foreword; Tony Wilde for providing Service User Foreword; all the contributors for their contributions; all those providing permission for the inclusion of photographs, figures and tables; the College of Occupational Therapists Specialist Section – Neurological Practice for funding to enable us to prepare this book; and last but not least our long-suffering husbands and families for their endless support and patience during the time taken to prepare this book.

Dr Jenny Preston and Dr Judi Edmans