Thank you to SUE HUMBLESTONE and CLARE NICHOLSON, OCCUPATIONAL THERAPISTS from the NATIONAL HOSPITAL for NEUROLOGY and NEUROSURGERY, LONDON for contributing this page to the site. They explain how they use Occupational therapy in the multidisciplinary treatment of patients with functional neurological disorders.
Occupational Therapist’s are concerned with how people function in their daily lives and so we are particularly interested in the impact of functional symptoms on a persons ability to engage in their life. We do this by looking at your daily activities and completing an activity analysis (breakdown of the components of an activity). In doing this we can identify what problems you may be having in completing a task, these tasks could be as simple as getting washed and dressed, feeding yourself or even returning to work.
Getting from where you are now to where you want to be can often seem overwhelming, your therapist’s can help you in this journey by helping you to set achievable goals using the scheme below.
Using this scheme "I want to be able to make my own breakfast" becomes..
"I will be able to make my own breakfast standing at the kitchen bench and carry it to the kitchen table using only one elbow crutch within four weeks".
It is often helpful to include your significant others (and other health professionals involved in your care if applicable) in the goal setting process so that they understand what you are working towards.
Equipment and Aids
In most cases Occupational Therapy for people attempting rehabilitation with functional neurological disorders tends to steer away from the use of equipment and aids (compensatory approach) to achieve your goals. We do this because we feel that the use of compensatory approaches assists people to complete a task in spite of difficulties however they do not always assist with rehabilitation of these difficulties.
The use of equipment, splints, aids etc can cause:
- New reasons for pain – often see patients that are using crutches to walk then develop chronic pain in the shoulders, wrists etc which can then lead to wheelchair use.
- Can cause a decrease in fitness levels – this can then lead to an exacerbation in fatigue levels which in turn reduces involvement in daily activities (as outlined in the Physiotherapy section)
- Can draw attention to an area → increase self focus → symptom exacerbation
In patients who are not attempting to get better with rehabilitation or where nothing has helped, equipment such as wheelchairs can improve independence but its important to understand that they also make recovery more difficult.
Although we appreciate that the use of carers may be essential in some cases to support you within your home, the prolonged use of carers can:
- reduce confidence in your own abilities
- decrease your fitness levels
- decrease your independence
- if your family are caring for you this may adversely affect your relationships
- when you do try and engage in an activity independently after a period of care the increased demands on your thinking (planning and problem solving) may have slowed down and therefore be harder. Things will then feel like more of an effort and may impact upon your motivation to do things yourself the next time.
Gaining independence through rehabilitation
We therefore encourage people to work on completing daily occupations in a normal movement pattern with reduced reliance on equipment and input from others. This serves to promote independence, as well as opportunities for rehabilitation and recovery. In this way we encourage people to view participation in all daily activities as a form of rehabilitation as participation acts to build functional strength and endurance.
If you have been having difficulty getting through each day involvement in leisure activities can be difficult. We can help you to identify your hobbies and interests and re-engage with these activities.
Learning to smooth out good days and bad days
You will probably notice that some of our approaches may overlap with Physiotherapy and Psychology particularly in regards to the use of fatigue and pain management strategies. This is a core feature of our treatment for patient’s with functional symptoms as we aim to break the unhelpful cycle that many patient’s experience where on your ‘good days’ you tend to do too much which inevitably leads to ‘bad days’, disengagement in activities, increase in frustration and dip in mood. Click on the links below for some Occupational Therapy Worksheets for Functional Motor Disorders (FMD) (ie those causing mobility or movement problems)
Working with Psychology
Occupational Therapist’s work alongside psychologists and cognitive behavioural therapist’s to assist you to identify sources of anxiety of stress and develop management strategies. Sessions may include:
- helping you to identify how you feel when you are stressed or anxious through improved self awareness (e.g sweaty, increased heart rate).
- identification of what situations / activities you may find stressful and why this might be.
- exploration of relaxation and stress management techniques
- graded exposure to stressful situations in a supported environment e.g using public transport whilst using anxiety management techniques.
- Gaining a healthy balance within your daily life to manage stresses.
- Recapturing your occupational identity – gaining back a sense of ‘I can’, breaking down avoidance and encouraging positive risk taking.
Managing or Returning to Work
When you have FNS staying in work or returning to work after a period of illness can be very difficult. The people that you work with or work for are likely to have a limited understanding of your problems and in fact some of your symptoms may be ‘hidden’ e.g fatigue and are often hard to explain. Occupational therapists are well placed to assist you with these issues, we can do this by:
- identifying with you the main difficulties that you are having
- practically problem solving these issues
- liaising with your employer with you or on your behalf
- offering advice on reasonable adjustments e.g alternate working patterns, assertive communication within your work place.
- preparing you to return to work by ‘work hardening’
- implementing environmental changes
- making appropriate referrals e.g Access To Work.