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Occupational therapy and neurological conditions Occupational therapy and neurological conditions EDITED BY Jenny Preston Judi Edmans on behalf of the College of Occupational Therapists Specialist Section – Neurological Practice This edition first published 2016 © 2016 by John Wiley & Sons, Ltd Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030‐5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley‐blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. 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No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging‐in‐Publication Data Names: Edmans, Judi, editor. | Preston, Jenny, 1963– , editor. | College of Occupational Therapists. Specialist Section Neurological Practice, issuing body. Title: Occupational therapy and neurological conditions / edited by Judi Edmans, Jenny Preston on behalf of the College of Occupational Therapists Specialist Section Neurological Practice. Description: Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons, Inc, 2016. | “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 ‘Occupational therapy and stroke’ book.” –Preface. | Includes bibliographical references and index. Identifiers: LCCN 2015047747 (print) | LCCN 2015048300 (ebook) | ISBN 9781118936115 (pbk.) | ISBN 9781118936122 (pdf) | ISBN 9781118936139 (epub) Subjects: | MESH: Nervous System Diseases–therapy | Occupational Therapy–methods | Case Reports Classification: LCC RM735 (print) | LCC RM735 (ebook) | NLM WL 140 | DDC 615.8/515–dc23 LC record available at http://lccn.loc.gov/2015047747 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover image: [Production Editor to insert] Set in 9.5/13pt Meridien by SPi Global, Pondicherry, India 1 2016 Contents List of figures and tables, viii List of contributors, x Academic foreword, xi Service user foreword, xii Preface, xiii Acknowledgements, xiv 1 Introduction, 1 1.1 Economic impact of long‐term neurological conditions, 1 1.2 Definition of long‐term neurological conditions, 2 1.3 International Classification of Functioning, Disability and Health, 2 1.4 Huntington’s disease, 4 1.5 Motor neurone disease, 9 1.6 Multiple sclerosis, 13 1.7 Parkinson’s, 18 1.8 Self‐evaluation questions, 22 References, 22 2 Delivering good quality, safe and effective care, 24 2.1 Introduction, 24 2.2 The strategic context, 24 2.3 Evidence‐based practice, 27 2.4 Clinical guidelines, 33 2.5 Practice guidance, 33 2.6 Client expertise in evidence‐based practice, 35 2.7 Quality improvement, 36 2.8 Health economic evaluation, 39 2.9 Professional standards of practice, 40 2.10 CPD and lifelong learning, 40 2.11 Self‐evaluation questions, 42 References, 43 3 Person‐centredness and long‐term neurological conditions, 46 3.1 Introduction, 46 3.2 Person‐centredness, 46 3.3 Client‐centred practice, 48 v vi Contents 3.4 Self‐management, 55 3.5 Co-production, 57 3.6 Evaluating your practice, 58 3.7 Self-evaluation questions, 59 References, 60 4 Theoretical basis, 63 4.1 Introduction, 63 4.2 Definitions of occupational therapy, 63 4.3 Central philosophy of occupational therapy, 65 4.4 Core professional reasoning skills, 65 4.5 Conceptual models of occupational therapy practice, 69 4.6 Frames of reference, 78 4.7 Context‐dependent practice skills, 81 4.8 Self‐evaluation questions, 83 References, 83 5 Occupation and long‐term neurological conditions, 86 5.1 Introduction, 86 5.2 Defining occupation, 86 5.3 Occupational patterns, 87 5.4 Doing, being, becoming and belonging, 88 5.5 Occupational dysfunction, 93 5.6 Occupational adaptation, 96 5.7 Defining occupational goals, 98 5.8 Self‐evaluation questions, 99 References, 99 6 Identifying occupational performance enablers and deficits, 101 6.1 Introduction, 101 6.2 What is measurement?, 101 6.3 What are occupational therapy outcomes?, 102 6.4 Selecting the right measure, 103 6.5 Commonly used measures in neurological rehabilitation, 106 6.6 Disease‐specific measures, 111 6.7 Self‐evaluation questions, 118 References, 118 7 Occupational therapy intervention, 122 7.1 Introduction, 122 7.2 Activities of daily living, 123 7.3 Fatigue management, 124 7.4 Cognitive rehabilitation, 126 7.5 Anxiety management, 129 7.6 Falls management, 135 7.7 Pain management, 137 7.8 Managing tremor, 140 Contents vii 7.9 Sleep, 143 7.10 Sexual relationships and intimacy, 144 7.11 Self evaluation questions, 147 References, 147 8 Using technology to support participation, 150 8.1 Introduction, 150 8.2 Environmental characteristics and occupational performance, 150 8.3 Environmental adaptations, 151 8.4 Assistive technology, 152 8.5 Assistive devices, 152 8.6 Housing adaptations, 154 8.7 Seating and postural management, 156 8.8 Management of posture and positioning in sitting, 158 8.9 Management of posture and positioning in lying, 160 8.10 Splinting, 162 8.11 Electronic assistive technology, 163 8.12 Self‐evaluation questions, 168 References, 168 9 Living with a long‐term neurological condition, 171 9.1 Introduction, 171 9.2 Transitions theory, 171 9.3 Illness experiences, 172 9.4 Rehabilitation and recovery, 173 9.5 Lifespan transitions, 174 9.6 Social and cultural transitions, 175 9.7 Caregiving, 183 9.8 Psychosocial adjustment, 185 9.9 Self‐evaluation questions, 189 References, 189 10 Planning for the future, 194 10.1 Introduction, 194 10.2 Disease progression, 194 10.3 The nature of occupation in death and dying, 197 10.4 Facilitation of meaning, quality of life and well‐being, 198 10.5 Spirituality, 198 10.6 Therapeutic use of self, 199 10.7 Advance care planning, 200 10.8 Conclusion, 209 10.9 Self‐evaluation questions, 209 References, 210 Index, 212 List of figures and tables Figures Figure 1.1 Model of disability that is the basis for ICF 3 Figure 1.2 Comparison of healthy and motor neurone affected by MND 10 Figure 1.3 Healthy nerve cell and demyelination in MS 14 Figure 2.1 Evidence‐based practice applied to occupational therapy 27 Figure 2.2 Model for improvement 37 Figure 4.1 The relationship between occupational therapy knowledge and core skills 64 Figure 4.2 The Model of Human Occupation (MOHO) 69 Figure 4.3 Illustration of MOHO applied to neurological practice 71 Figure 4.4 The Canadian Model of Occupational Performance and Enablement (CMOP‐E) 72 Figure 4.5 The Person‐Environment‐Occupation Performance (PEOP) model 73 Figure 4.6 The Kawa (River) model; (a) The river; (b) Elements of the river; (c) Elements constricting water flow. 77 Figure 6.1 Understanding the three factors involved in measuring in clinical practice 102 Figure 6.2 Meaningful measurement in occupational therapy practice 103 Figure 6.3 Client-centred decision-making: selecting the right measure at the right time 106 Figure 7.1 Hand‐over‐hand technique 141 Figure 7.2 Distal stabilisation technique 141 Figure 8.1 Hierarchy of normal postural ability 157 Figure 8.2 A step‐by‐step guide to building a stable seated posture 158 Figure 8.3 Profiling bed 161 Figure 8.4 Illustration of an environmental control system 165 Tables Table 2.1 Examples of neurological clinical questions and recommended levels of evidence 32 Table 2.2 Key clinical guidelines for the management of long-term neurological conditions 33 Table 3.1 The Canadian Practice Process Framework 50 Table 4.1 Practical example of COPM applied to neurological practice 72 Table 4.2 Practical application of PEOP personal factors to neurological practice 74 viii