Occupational therapist working within neurological rehab? A forum to explore assessment and intervention recommendations!
Dear all,
I have largely worked within brain injury and neurorehabilitation since 2020 and find this specialism fascinating. Neurology is a complex, challenging - but highly interesting and rewarding - area of practice. There is constantly something new to learn and I know practitioners around the world have valuable insights to share. So I am keen for OTs to contribute to this knowledge bank - particularly if you work with any of the following:
Traumatic brain injury (TBI)
Anoxic brain injury
Brain tumour
Complex stroke
Spinal cord injury (SCI)
Infection (e.g. encephalitis)
Congenital or progressive neurological conditions
All ideas and suggestions are welcome, including:
Motor, sensory, visual or cognitive assessments
Structured upper limb programmes
Tried-and-tested outcome measurement
Relevant research and general reading recommendations
With a person-centred approach, clearly no one assessment, intervention or outcome measure fits all. But what has worked well in your practice experience?
N.B. Be mindful of patient confidentiality
This such an interesting thread - thank you for posting.
My experience has been a mixed bag of inpatient and community neuro-rehab and I'd agree that communication and getting the client on board is key. Motivational interviewing is really helpful and I'm now interested in looking at the Empowerment behavioural management approach.
I use MOHO, COPM and GAS goals to guide intervention. We don't use a standardised upper limb assessment Jamie but have a general form to record relevant physical, sensory and medical information, ROM, different grips and then how thos translates into functional issues, then a plan.
I'm really interested in the use of VR in upper limb rehab having recently attended a presentation about this. It was based around pain management but has so many applications.
Love OT . Worked as a an OTA State Hospital Mental Health Provider, (1993.-2002) . as well as many other areas such as Easter Seals, In patient hospital , group homes My education was provided by the best OT Instructors - they taught us more/ above what was required/ educational experiences fieldwork! Best tumes un my kife as an older 30 yr old qst time college / as a single parent!! And my favorite courses were rehan/neurology. Then ironicly, I sustained a SCI at age 53...c5-c7 incimplete SCI / freak Accident! I was beginning another OTA position in nursing home Physical ADL'S therapy, and made it only 4 days before i collapsed on the job! Apparently when i initially stubbed/ broke my left little toe, and rather than just fall down, i struggled to remain upright and 'whipplashed my neck/head. Not discovered for 3 months when i needed emergency surgery March of 2011!!! So I try to look at now having real lufe neuro training/experiences bc had i not been OTA Trained/ Educated, I wouldnt have known what i was up against in needing to keep moving every body part i could. The information told to me, " dont expect youll ever walk again!" Thats all i kept hearing, and i tokd the drs and nurses, No not me! Im an OT provider, i have to finish my lifes work! And I did@ thos time itcwas/still is, for me!!!
Such a cool and visual pictorial! Summarizes up what we assess and the complexity of cognition!
I'm currently struggling a bit with being able to measure "initiation" - can only do it functionally and based on observation at the current time and exploring with my patient into what motivates and will cue her to get "up and going" especially when she goes home!
Otherwise today I've used the COGNISTAT and the Rivermead Behavioural Memory test. All used alongside functional tasks to see how my patients would be affected with their goals for rehab :)
Executive Function
A branch of cognition I assess daily, here's a handy graphic I recently came across, summarising elements of executive function:
Full image credit to Pepper Kids Therapy. If you have insights or tools related to executive function, I'd love to hear about them. If so, comment below! Jamie
'How to Manage Spasticity After a Stroke'
Summary:
Post-stroke spasticity can make it difficult to stretch, move, and accomplish everyday tasks.
Modifying your home, working with an occupational therapist, practicing daily exercises, and using mobility aids can help you manage spasticity.
Treatments, such as injections and medications, can help reduce long-term damage from spasticity.
Hi Jamie,
I am an independent OT who works with adults in the community who have had suffered a TBI. Before this I worked in both acute and inpatient neurorehab in London.
I mostly work in cognitive-behavioural rehabilitation and from my perspective, it is important to know about the impairment stuff and pathology of injuries however, in my experience, the medical model is not so useful for guiding OT in long term neuro rehab. If you see people who are 1 -2 years post injury, understanding the biopsychosocial model will guide your rehab much better and help you formulate treatment plans.
I would advise you go back to the routes of OT as discipline. I would recommend reading some of Karen Hammells work on the limitations of using the ICF and OT client centred practice. Neuro-rehab in the community is as much about mental health and coping with changes to identify, as it is to do with 'cognitive rehab'. Compensation strategies rarely work unless the individual is ready in themselves to start using them. The complexity as of rehab is supporting them to get to that point.
The MOHO provides some good grounding for thinking about the individual as an occupational being. Also useful is theories such as Occupational identity, occupational justice and deprivation.
You should also consider about your communication skills and how you interact with the client. Motivational interviewing has good elements to it. Be aware of its limitations though. Mark Holloway wrote a good article discussing this (2016 I think.
A recent model that is being used in the community is the Empowerment behavioural management approach. There is chapter about this is Neuropsychological rehabilitation (2017). This considers the system around the client and is about empowering them rather than others making choices for them. This is particularly relevant for OT when considering goal development and how you communicate to clients. Its also a framework to guide support workers and families.
Fatigue management is another area if real importance that OTs are involved in. Donna Malley has done some really good articles about this. Her research paper 'Fatigue after ABI: A model for clinical management' is great.
I hope this is helpful. Let me know if you have any questions about the above!
BW
Alex
I work in the only secure NHS acquired brain injury unit in the north west....we use MOHO assessments & outcomes ....our main focus is risk ...we’re looking to add to our range of assessments
@Shawn Phipps could you share a few ideas, links or resources here? We loved your TED talk!
Case Study: Stroke Rehabilitation - Assessment and Upper Limb Intervention
I first met 'Mr. M' on a stroke ward, when I assisted another occupational therapist with the patient’s self care (wet shaving). On discharge to the stroke discharge team, I led and co-facilitated Mr. M’s upper limb assessments, with regular visits to his home. I was then able to lead a home exercise programme (HEP) and shaving intervention, both of which were meaningful to him and focused on key skill deficits following his stroke.