Occupational Therapy for People with Progressive Neurological Disorders: Unpacking the Black Box

Progressive neurological disorders often present a challenge to occupational therapists owing to their variable presentation and relentlessly deteriorating course. The literature available to guide therapists either is process driven or describes key roles without detail of the specific therapeutic intervention used. This report describes an occupational therapy programme provided for eight people with multiple system atrophy as part of a randomised controlled trial. The framework given illustrates the three stages of the client-centred programme and provides a comprehensive account of the therapeutic interventions used to change occupational performance. The treatment included techniques to enhance skills, increase knowledge and change attitude. Upon completion of the 8-week programme, the clients reported benefit. Although it cannot be asserted that all these techniques are effective, the occupational therapy programme described constitutes a ‘black box’ and may be useful in formulating further research questions.