Making a pot of coffee, getting dressed, changing a baby’s diaper — these are everyday tasks that many people don’t give a second thought. But seemingly ordinary activities can quickly become difficult and demoralizing for patients with a neurological condition that impairs their fine motor skills, such as Parkinson’s disease, or those who are recovering from a stroke or brain injury.

Helping these patients regain function and independence is occupational therapist Nicole Mannion, MA, OTR/L, whose newly established role is bringing more complex, specialized care to the Greater Boston area.

Part of a multidisciplinary team delivering outpatient neurological rehabilitation in Foxborough, Mannion said patients with neurological conditions often have multiple concerns that become closely intertwined with their rehabilitation work.

“It’s atypical that you’re only treating motor issues from a stroke,” she explained. “As you start to care for a patient, you realize they have problems with their vision, executive functioning or ability to problem-solve, or they may have post-stroke depression. Then you add challenges with transportation and navigating the health care system, which can be especially difficult for someone with a cognitive impairment. Those are some of the things that make treatment more complex.”

Part of Rehabilitation Services, the Brigham’s Occupational Therapy team consists of 15 inpatient occupational therapists (OTs) and eight outpatient OTs who support clinics at the main campus, 850 Boylston St. and Foxborough. Mannion is the first and only neuro-focused outpatient OT.

Helping patients find alternative ways to comfortably perform everyday activities and tasks, OTs assist patients in adapting to challenges with their movement and coordination due to an illness, injury or disability. For the patient population Mannion cares for, this can include helping someone recovering from a stroke to use the bathroom by themselves. Recently, she cared for a young mother who was struggling to change her baby’s diaper after a brain injury caused uncontrollable movements in her hands.

A large part of her job is helping patients feel comfortable discussing their goals and limitations, Mannion explained.

“You get down to talking about things that are very personal, and that can sometimes be hard for patients,” she said. “In addition to building rapport with patients, I try to validate their experiences. These patients are living with major issues, and well-meaning family members often say things like, ‘You’re going to be fine,’ but sometimes that’s not what people need to hear. They want validation that this is extremely hard and life-changing.”

Celebrating the progress that her patients make is the best part of her day, Mannion said.

“When they say, ‘Oh, my gosh! I can do this now,’ it’s a really good feeling,” she said. “Being part of these bigger, life-changing events has always been of interest to me. I feel better when I can do things to help.”

Multidisciplinary Care in a Community Setting

In addition to Mannion, the specialized Neuro Rehab team at the Brigham and Women’s/Mass General Health Care Center in Foxborough includes physical therapists (PTs) and speech language pathologist. Adding an OT to the team has enhanced the quality of care across the spectrum of rehabilitation services, explained Beth Regan, MS, CCC-SLP, the team’s senior speech language pathologist.

“We tend to share patients within our caseloads and frequently engage in discussion about goals we are working on, as well as the patient’s strengths and areas for improvement,” Regan said. “This can really be helpful in treatment planning, especially with more challenging neurological diagnoses.”

Mannion noted that making this kind of specialized OT care available in an outpatient, community-based setting is not only about convenience. For patients with neurological conditions, it can make a difference in whether they access care at all.

“For patients who live outside of the city, it’s easier to get here. While that’s important for everyone, it’s especially important for these patients because they often rely on someone else for transportation,” she explained. “And because this site has a comprehensive program, patients can come here and see Speech Therapy, PT and me all in the same place. It makes the care so much more fluid, and for neurologic issues it’s pretty rare to find a clinic that has all three specialties.”

Nancy Kelly, MS, OTR/L, clinical supervisor of Occupational Therapy, described Mannion as “the perfect person to lead the way” in elevating care, especially where the need is so great.

“Expanding our outpatient expertise to include intervention for people who have neurological conditions has been a long-term goal of mine,” Kelly said. “Nicole brings excellence and enthusiasm to her role, and her patients receive outstanding care.”

Occupational Therapy Month is held every April to honor occupational therapists’ substantial role in improving patients’ health and quality of life. In celebration of Brigham OTs, Brigham Bulletin is highlighting one of the many exceptional OTs who play a critical role in our delivery of high-quality, patient-centered care.