Neuro Occupational Therapy - reflecting on the complexities of the Christmas period
Seeing Christmas through the occupational therapy lens...
I must begin by saying I have had a busy week! With Christmas just around the corner, the run up to the main event has been anything but routine.
End of term Christmas madness has been followed by late night wrapping marathons, last minute present shopping, and baking sessions - to name a few.
Whilst the festive period offers little in the way of a consistent routine, for many of us Christmas brings family traditions and, for some, numerous activities throughout the season of advent as we approach the big day.
The predictability of these traditions offer meaning; a feeling of shared unity within family and community networks which are, in general, thought to be good for our physical and emotional well-being.
But it is important to consider how this period impacts on families and individuals living with brain injury, neurological conditions, and neurodivergent diagnoses. As clinicians we must ensure we are, at all times, cognisant of the pressures these individuals experience at this time of year.
The toasting of chestnuts on our woodburning stove, leaving mince pies out on the mantle, or soaking a whole turkey in a bucket of seasoned water is not something that is done in our house every day! 
Christmas is a time when our roles and responsibilities change. Whilst working over the festive period is accepted for some, many of us will stop work to spend time with family and friends.
The activities we choose to do, or must do, for ourselves and other people over this period are guided in many ways by those familiy traditions. It is these activities and responsibilities that give us a sense of purpose, define who we are, and influence the way we live our lives and interact with others.
Each one of us is unique, and this uniqueness impacts on our choices and, in turn, influences how we think, act, and behave.
For our beneficiaries, and the families of those affected by brain injury, neurological conditions or neurodivergent diagnoses, Christmas can be a difficult time.
For individuals with cognitive and executive limitations, or families juggling the additional responsibility of supporting a loved one, festive tasks can feel overwhelming.
The unpredictability of the festive season and the perceived pressures around delivering a 'perfect' Christmas can make it hard.
Social events and the party season can be challenging for some individuals with social communication disorders or physical communication challenges.
Families supporting individuals with behavioural or sensory needs may have issues with adapting quickly enough to the dramatic changes in the shared physical environments in the wider community, leading to exclusion and isolation.
All these challenges will impact greatly on how an individual perceives themselves. What they are capable of doing and how they spend their time may have shifted radically.
Moreover, the opportunities available to them to engage in activities may have shrunk, and the impact can be more keenly felt at Christmas time.
Neurological occupational therapists are unique in that they have a comprehensive understanding of the impact of disability in relation to daily activities.
A neurological occupational therapist considers an individual's ability to participate in activities, alongside environmental and community elements.
In addition to this, there has to be an awareness of the significant sociocultural, temporal, and client-centred elements that are guiding and influencing participation in activities during the festive period.
Let's explore these - including how these elements influence occupation specifically relating to neurological and neurodivergent conditions at Christmas time.
Living with brain injury: past, present, and future
The temporal elements of occupation and an individual's experience of participation relating to the past, present, and future is an essential consideration for neurological occupational therapists.
Our performance and participation in activities is affected by our own view of the world; the expected and familiar patterns, sequences, and rhythms and experiences that are unique to us. Our experiences, of course, are a combination of thoughts and feelings that emerge while completing an activity, and our interpretation of that event afterwards.
Our profession is truly holistic; the client-centred nature of the role is guided by the aspirations and goals of the individuals we serve.
At Christmas especially, our performance and participation is also affected and influenced by our feelings of anticipation prior to completing an activity - the advent calendar is just one example of this.
These elements, ultimately, influence our participation in activities, the activities we choose, and our behaviour towards them.
But, although routines and rituals unique to an individual and their family may well have 'always been done' at Christmas, that does not mean that they should be considered as a fixed entity.
Great expectations
Sociocultural norms are sets of rules and regulations - unspoken or written - that guide a group, people, or society regarding what is appropriate or inappropriate behaviour. These include attitudes and expectations which arguably play a significant role at Christmas in influencing how we behave and act.
Many of us over the festive period have our minds on an often unrealistic expectation of the big day itself.
For families living with the consequences of a brain injury, neurological condition, or neurodivergent diagnosis, the self-imposed expectations or attitudes of others sometimes magnify the daily challenges that may be more keenly felt at this time of year.
Unique intervention
Every beneficiary I have ever met has wanted to engage and participate in activities, and they hold a clear sense of purpose. Each of them is unique to their personality, likes, dislikes, and motivators.
These unique parameters, combined with clinical observations of functional ability, environment, routines, values and beliefs, enable Krysalis neurological occupational therapists to provide advice and therapeutic intervention to help our beneficiaries achieve their goals.
We all participate in activities with which we have the functional ability, interest and desire to engage. Equally as important, however, are the situational elements that promote successful performance and participation.
It is the shared values and morals in the occupational therapy community that shine the brightest at this time of year.
Regardless of disability, everyone has a right to live a full, active and fulfilled life not only on one day, but throughout the rest of the year.
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About the Author
Jo Throp
Jo Throp is a neurological occupational therapist and Founder and CEO at Krysalis Consultancy - an established nationwide specialist neurological occupational therapy consultancy which provides community-based rehabilitation and vocational rehabilitation services.
Jo is a practicing clinician with a passion for occupational therapy. Since qualifying in 1997 she has worked within the specialist field of neurology and has extensive experience of setting up and managing both community and inpatient multi-disciplinary neurological rehabilitation services, within both the NHS and independent sector.