The evidence behind our practice

Stroke · upper limb

Arm and hand recovery can continue long after stroke

Persistent difficulty using the arm is a major cause of disability after stroke, and it’s often assumed that little changes after the first few months. The Queen Square Upper Limb Neurorehabilitation programme, an NHS service at the National Hospital for Neurology and Neurosurgery, delivers a high-intensity three-week programme (90 hours) focused on personal functional goals.

In a study of 224 people who completed the programme, with a median of 18 months since their stroke, participants made clinically important improvements in arm impairment and activity, and gains continued after treatment ended.

What it means for you: it’s rarely “too late” to work on arm and hand function. Practice that is frequent, meaningful and built into daily tasks matters.

Ward NS, Brander F, Kelly K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry 2019. Read the paper

Functional neurological disorder

Occupational therapy has a central role in FND

People with FND are commonly seen by occupational therapists, but until recently there was little guidance on what helps. An international group of clinicians, led from the National Hospital for Neurology and Neurosurgery, published consensus recommendations for OT in FND.

They recommend that OT is based on a biopsychosocial framework, with education, rehabilitation within everyday functional activity and taught self-management strategies at its core. Several aspects of OT for FND are distinct from therapy for other neurological conditions.

What it means for you: FND needs specialist, function-focused rehabilitation, not just equipment.

Nicholson C, et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry 2020;91:1037–1045. Read the paper

FND · community support

Why FND support at home matters

Ongoing research at UCL notes that people with FND often report receiving equipment only, rather than rehabilitation, from community services, and that gains from rehabilitation can be hard to sustain without the right support. Better community-based OT could improve independence and quality of life.

What it means for you: rehabilitation delivered at home, in your real routines, is a key part of FND recovery.

UCL Centre for Behaviour Change: Improving engagement in community-based OT and self-management for people with FND (NIHR-funded doctoral research). Read more

Brain injury · cognition

Structured strategies for planning and organising

Difficulties with planning, organising and keeping track of tasks are among the most common causes of disability after brain injury. Goal Management Training teaches people to pause, check their goal and break tasks into steps.

In early trials with people after traumatic brain injury, Goal Management Training led to significant gains on everyday tasks compared with a control training, and a separate case showed better meal preparation after training. Later trials with stroke and acquired brain injury support its use for executive difficulties.

What it means for you: cognitive rehabilitation works best when strategies are practised on real tasks, such as cooking, work or appointments.

Levine B, Robertson IH, Clare L, et al. Rehabilitation of executive functioning: an experimental–clinical validation of Goal Management Training. J Int Neuropsychol Soc 2000;6:299–312.