CHARITIES: Neurological conditions and functional rehabilitation
by Nikki Thompson, Founder & Executive Director
In this article we will explore some of the most common neurological conditions that you are likely to read about or see in your beneficiaries. We will cover some top-level clinical explanations of the conditions and the functional impact that they may have on your beneficiaries daily life. Once we understand more about the mechanics and impact of the conditions then we will cover how, together, we can help.
What is a neurological condition?
According to Brain Research UK there are approximately 11 million people in the UK living with a neurological condition of some form. A neurological condition is one that affects the brain, spinal cord and / or nervous system. Some neurological conditions can occur suddenly such as stroke or traumatic brain injury and are often referred to as a ‘neurological event’ whereas others will progress over time such as Multiple Sclerosis or Parkinson’s Disease. There are lots of neurological conditions that your beneficiaries may experience, below are just a few examples of some of the most common neurological conditions that you are likely to come across in a professional capacity.
Stroke
There are 2 types of stroke, both very different in the physiological mechanism and therefore early medical treatments however the resulting impairments are the same.
- Haemorrhagic – this happens when a blood vessel in the brain ruptures resulting in a bleed into the brain damaging the localised brain cells.
- Ischaemic – this happens when an artery supplying blood to the brain is blocked by a blood clot and the brain is deprived of oxygen. This is the most common (85%) type of stroke.
Depending on where the damage to the brain is will determine the likely impact, the most common challenges post stroke include impaired speech and swallow, weakness on one side of the body (the opposite one to the damage) resulting in reduced mobility or ability to grip items, balance, swallow or speak.
Multiple Sclerosis
Multiple Sclerosis (MS) is an auto immune condition which means that the immune system mistakes part of the body as a foreign substance and attacks it. Our nerves are surrounded by a protective myelin sheath to ensure that instructional messages created by the brain can smoothly travel to the rest of the body. In MS, it is the sheath that is attacked by the body causing scars or ‘plaques’, these then interrupt the smooth passage of these messages. This can cause a range of neurological symptoms such as fatigue, blurred vision and altered balance and reduced mobility.
Motor Neurone Disease
We have included this condition due to its rapid deterioration and the need for timely interventions post diagnosis to maximise quality of life for the person diagnosed and their families. Often charities are a relatively swift way for beneficiaries to access some of this support. Thankfully the condition is relatively rare with approx. 1,100 new diagnoses per year (compared to over 100,000 strokes per year). Mainly affecting the 50-65 age bracket, some people can die from the condition as early as 6 months from symptom onset. Most people sadly die within 2-3 years with 15% alive at 5 and 10% alive at 10 years from first symptoms.
There are 4 different types of MND the most common being Amyotrophic Lateral Sclerosis (ALS). This is where the specialist nerve cells in the brain and spinal cord called motor neurones stop working properly and die prematurely. This is known as neurodegeneration. The motor neurones control muscle activity such as: gripping, swallowing, breathing, speaking and walking and so as these cells die, so the persons ability to control these activates will also cease.
Functional impact
As you will see from the 3 examples above, although the biological manifestation of the condition may alter, often the symptoms are similar. MND is an exception to this due to its rapid deterioration. The functional impact of a neurological condition on a beneficiary's everyday life can be divided into 2 categories, physical and cognitive.
Physical
| Symptom or residual effect | Impact on beneficiary's daily life |
|---|---|
| Reduced mobility | • Being able to walk from room to room in their home. • Being able to stand for long enough to make a meal or snack • Being able to walk outdoors i.e. around a supermarket. |
| Unable to climb the stairs | • Having to remain on the ground floor of their property. • Unable to access the bathroom so having to strip wash at a sink. • Unable to sleep in the same bed as their partner. |
| Getting in and out of their property | • Unable to access the garden or social activities. • Risk of social isolation and loneliness. |
| Reduced fine motor skills which could be due to a tremor, reduced muscle strength or ability to initiate the movement. | Challenges with: • Preparing meals and drinks and then feeding or drinking. • Dressing and fastenings such as buttons, laces or zips. • Personal care such as shaving or teeth cleaning. • Writing. • Accessing and bringing medication to mouth. |
| Fatigue | This is the most common symptom across all neurological conditions and has a significant impact on daily life both physically and from a mental health perspective. Examples include: • Reduced social interactions leading to loneliness. • Reduced ability to engage in family life, hobbies. |
Cognitive
| Symptom or residual effect | Impact on beneficiary's daily life |
|---|---|
| Reduced memory | • Missing appointments • Losing items • Forgetting to take medication |
| Increased tendency to aggression | This can have a significant impact on relationships and self-esteem. |
| Reduced problem solving ability | • Ability to plan routes and journeys affecting driving and access to public transport. • Ability to be left alone incase of emergencies. |
| Reduced word finding | Ability to effectively communicate leading to a reduction in desire and engagement in social activities due to embarrassment or frustration. |
Functional Rehabilitation
Some neurological conditions such as a stroke can mean that the beneficiary can improve with specialist rehabilitation input and time, others such as MND or MS are progressive i.e. the beneficiary will over time deteriorate. Either way rehabilitation is available with the following aims depending on the condition:
- To improve function to the maximum level possible. This maybe back to the same level or the 'best possible' level post neurological event.
- To maintain and prolong the current level of function for as long as possible.
A description of both approaches is captured brilliantly in the following paragraphs available from 'A Professionals Guide to Functional Rehabilitation' by Rachael Hargreaves.
"The two main treatment approaches used in functional rehabilitation are the compensatory and restorative approaches. These approaches belong to corresponding frames of reference which are used to guide occupational therapy practice. The restorative approach forms part of the biomechanical frame of reference which places emphasis on restoring previous function via participation in activity. The grading of activities is often used with in this approach and by gradually increasing the task demand, a client may gradually return to their prior level of functioning. For example, a client with reduced balance may first be able to sit and practise washing their upper body each morning before progressing to standing up to don their lower half garments. In concordance with this may be balance exercises at intervals throughout the day in order to further promote improvement. The compensatory approach forms the basis of the rehabilitative frame of reference in which the aim is to modify the demand a task places on the person. This may be achieved by teaching different techniques and strategies or may include the provision of assistive equipment and aids. Both approaches may be used in conjunction, for example, the client may require the use of a handrail to stand when donning their lower half garments to compensate for loss of balance if it is not fully restored."
The aim of this article was to provide insight into the day-to-day challenges that your beneficiaries may experience and how occupational therapy may support them. We are proud to support charities both large and small and would be delighted to discuss in more detail if you offer support to your beneficiaries after an acute neurological episode or diagnoses of a neurological condition. Call us on 0330 024 9910 or email enquiries@theotpractice.com.
References and further sources of information
British Heart Foundation https://www.bhf.org.uk/informationsupport/conditions/stroke
The Stroke Association https://www.stroke.org.uk/what-is-stroke/types-of-stroke
The MS Society https://www.mssociety.org.uk/about-ms/what-is-ms
Brain Research UK https://www.brainresearchuk.org.uk/info/neuro-facts
The OT Practice A Professionals Guide to Rehabilitation by Rachal Hargreaves https://www.theotpractice.co.uk/news/our-experts-blog/a-professionals-guide-to-functional-rehabilitation
