Background
Trevor, aged 68, was diagnosed with Bulbar Motor Neurone Disease (MND). He lived with his wife in a three‑bedroom, owner‑occupied property where they had raised their family. Early symptoms included difficulty projecting his voice and reduced fine motor control, particularly in his hands, leading to challenges with gripping everyday items. Following assessment by his GP and subsequent investigations, he received a formal diagnosis of MND.
As his condition progressed, Trevor experienced increased breathlessness, fatigue, and reduced mobility. Previously very active, he soon found accessing the stairs and the downstairs toilet challenging. These changes began to affect his ability to engage in the occupations that were meaningful to him.
Application of MOHO
The Model of Human Occupation (MOHO) emphasises the interaction between a person’s volition, habituation, performance capacities, and their environment. Using this model supported a holistic assessment of Trevor’s changing needs and guided interventions that protected his autonomy, dignity, and quality of life.
Volition: Personal Causation, Values, Interests
Trevor was highly motivated by two core interests: gardening and supporting his football team, Everton. These occupations were central to his identity and wellbeing. As his mobility and respiratory function deteriorated, accessing the garden and maintaining his usual leisure routines became increasingly difficult.
Understanding what mattered most to Trevor enabled the team to prioritise interventions that preserved his sense of purpose and motivation despite the progressive nature of MND.
Habituation: Roles and Routines
A review of Trevor’s daily routines highlighted opportunities to support energy conservation. Although he was able to manage the stairs in the morning, multiple trips up and down became unsustainable as his breathlessness increased.
To support Trevor’s independence:
- His routine was adapted so he completed all morning activities upstairs before coming down for the day.
- This reduced stair transfers to one descent per day, conserving energy while maintaining safety.
- A stair lift was later installed as his mobility declined further.
Toileting was also identified as an area of risk. The downstairs WC was adapted with a Closomat wash and dry toilet, enabling Trevor to maintain dignity and independence even as his physical function changed.
Performance Capacities: Processing, Communication, Motor and Respiratory Function
Early in his diagnosis, Trevor’s communication abilities began to deteriorate. It was therefore essential to understand his wishes and preferences before further decline occurred.
To support communication:
- Trevor used his iPad with pre‑recorded messages and accessible communication apps to interact with family and friends.
- Alternative access methods and simplified interfaces enabled him to remain socially connected.
As his motor skills reduced, the Closomat toilet was further adapted with proximity sensors, allowing hands‑free activation of the wash and dry functions. This preserved independence and dignity as his abilities changed.
Environment: Physical and Social Environment
Trevor’s built environment presented several barriers. His home was situated at the bottom of a steep hill, and the driveway limited safe access as his mobility declined. Because accessing the garden remained a core occupation, environmental modifications were essential to maintain his wellbeing.
Interventions included:
- Ramping to the front of the property to ensure safe access.
- Anticipatory planning informed by prognosis, leading to early development of a ground‑floor living space.
- A ground‑floor extension was created with a bedroom and fully equipped bathroom to support single‑level living as his condition progressed.
These changes reduced risk, supported energy conservation, and enabled Trevor to remain at home—his strongly expressed wish.
Summary
Using MOHO guided a holistic and person‑centred assessment of Trevor’s needs and priorities. By understanding the occupations that held meaning for him and recognising how disease progression would impact his volition, habits, and performance capacities, the team was able to plan proactively and sensitively.
Key adaptations included:
- Closomat Palma Vita toilet with proximity switch
- Front‑of‑property ramping
- Stair lift provision
- Ground‑floor bedroom and bathroom extension
These interventions allowed Trevor to live at home throughout his MND journey, without requiring a formal package of care until end‑of‑life support from District Nurses. They protected his dignity, respected his wishes, and ensured he remained connected to the occupations and environments that mattered most.