(Adapted from a presentation given at a study day entitled 'Progressive Neurological Conditions', held at Nottingham Disabilities Living Centre on 16th May 2001)

Progressive neurological conditions are characterised by a diversity of clinical symptoms, each arising from the effects of the different disease processes on the central nervous system. Individuals with Parkinsons disease, Motor Neurone disease, Huntingdons disease, Multiple Sclerosis or other acquired neurological condition present differing clinical pictures.

Parkinsons disease tends to affect clients over 60 years of age, having a slow onset and process. This may include gradual deterioration of mental as well as physical faculties over many years. Motor Neurone disease tends to affect younger people over the age of 40, with a rapid onset and deterioration of physical functions, but rarely affecting intellect. Huntingdons disease also affects a younger age group, becoming apparent after the age of 30. It is an inherited brain disorder causing clumsiness and involuntary movements as well as pre-senile dementia, personality and behavioral changes. Multiple Sclerosis (MS) tends to have an early onset between the ages of 20-40 and has a varied presentation of loss of sensation, balance problems, movement difficulties and visual problems sometimes over many years. Some clients with MS have a remitting condition with occasional relapses lasting weeks or months whereas others have a chronic condition with no periods of remission.

The progressive nature of these disease processes means that the clinical picture will change over time, affecting the clients' abilities, functioning and needs. In some instances, the clinical picture may also change within a day, a client's abilities being affected by medical or physical treatments, tiredness or illness. These conditions place huge demands on clients and their carers within both institutional and domestic environments. The diversity of the client group presents practitioners with a number of challenges in the area of moving and handling, a selection of which will be discussed here.

When addressing moving and handling issues with a client that has a progressive neurological condition, consideration needs to be given first to their present functional abilities, especially with regard to mobility. During the early stages of a disease, or in periods of remission, a client may remain relatively mobile and able to move about independently. In the interests of their general well being and dignity, it is important that clients continue to mobilise and transfer independently as long as they are able, provided that they are safe and the activity is not contraindicated.

It may be, however, that a client's mobility skills fluctuate or start to deteriorate. If a client needs assistance with their mobility, it is possible that some equipment to help with moving and handling may also be called for. The provision of such equipment to this client group requires accurate assessment and selection. It will be necessary for both the current disease presentation and its prognosis to be acknowledged. It may also be a requirement for practitioners to complete a risk assessment of an individual client's moving and handling needs, to identify difficulties and hazards and to specify potential solutions. Although smaller pieces of moving and handling equipment such as transfer boards, sliding sheets and standing aids may provide sufficient assistance in the short term, it is wise for the assessor to be mindful of likely future needs. It may be appropriate at the outset to consider the provision of equipment and techniques that will continue to benefit the client and their carer(s) as needs change in the longer term. Such an approach may prove less disruptive to a client than the frequent revision of smaller equipment in response to changing abilities and needs.

The provision of any equipment, including moving and handling equipment, must take into account the environment in which it will be used. Equipment that has proved effective in an institutional setting may seem cumbersome in a smaller, domestic environment. Space in a domestic environment may be utilised for several purposes - for example, a sitting room may also have to serve as a sleeping area if a client is unable to manage stairs. The same room may also be the main living area for other members of the household.

Assessing the environment in which a client spends their time involves more than simply looking at the physical components, space and structure. The social and cultural aspects of an environment are equally important and these may generate other elements that will need to be included when moving and handling is addressed. A living space shared by an extended family may dictate that equipment is portable and can be stored away, so as to limit its 'interference' with normal family life. Equipment that is to be used by a carer who is frail or disabled will need to be easily accessible and manageable. If equipment is required in an environment within which illness or disability are 'played down', it will need to be discrete and socially acceptable.

A key consideration for practitioners who work with individuals who have a progressive neurological condition is the client's understanding of the diagnosis, its course and consequences, together with their awareness of the possible impact upon their own and other's lives. The practitioner will also need to ascertain the response of family members and significant others. The manner in which clients or carers deal with the condition will inevitably influence their acceptance of advice concerning its management. A client who believes that they are experiencing 'a rough patch' as oppose to long term difficulties, is less likely to want to explore their future needs. A client who is aware of their condition, but currently minimally affected by it or in remission, may wish to maintain a style of living that does not appear overtly 'disabled' for as long they are able. In both these instances, any moving and handling advice will need to be approached with due regard to the client's perspective.

Given that moving and handling usually involves demonstrating practical techniques and/or equipment, the way in which these are presented to the client will be especially important. Care must be taken not to overwhelm a client or carer with information, but at the same time clients should not be left bereft of sources of information that may benefit them in future. It should be recognised that many clients will need time to adjust to changed circumstances and may wish to exert some control over areas of their lives in which they still have some choice or influence.

In summary, the provision of moving and handling advice and equipment to the client with a Progressive Neurological Condition demands thorough, skilled assessment and intervention. Practitioners need to be aware of the disease process and forever mindful of at what stage the client and their carer(s) are with the condition, both physically and emotionally. The challenge lies in delivering timely and sensitive moving and handling input in a manner that is responsive to the needs of clients, carers, practitioners and organisations.

Debra Hall
Moving and Handling Specialist

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