Nicole Muriel OTR/L, HSP, PCES: Think BIG!

An interview with Nicole Muriel OTR/L, HSP, PCES: Think BIG! on January 9, 2024 by George Ackerman, Ph.D, J.D.



Nicole Muriel is an Occupational Therapist who specializes in pelvic floor therapy and neurorehabilitation. In her 12-year career as an Occupational Therapist, she has found that her firm background in neurological rehabilitation and orthropedic conditions has set an unbreakable foundation LSVT-BIG. Nicole Muriel believes that the key to being a great OT is creating a space for her clients to be seen and heard. It is a fundamental part of true client success. In addition to managing her specialized occupational therapy practice, she participates in community/fundraising activities. She has been a proud Rockland County resident for 16 years now. Mark Twain said it best “To be great, truly great, you have to be the kind of person who makes the others around you feel great”. Thus, giving back to the community, and her clients is her top priority. She not only brings passion and empathy to her practice, But her own personal experience with pelvic floor dysfunction helped fuel the drive to create pivOTal Performance. She had graduated from Dominican College in Blauvelt, NY with her BS/MS in science. She holds quite a few certifications: sacroiliac joint practitioner, myofascial release cupping, corrective exercise specialist, and LSVT-BIG certified. Nicole loves enriching her mind with new and evidence-based treatments.

Please tell me a little about your background.

I am an occupational therapist who started my career in neuro Rehabilitation. I now have expanded my knowledge in the pelvic health specialty. Many clients who are affected by neurological conditions also suffer with constipation and urinary incontinence. So, it was really a no brainer for me to continue offering both services.

Can you tell me more about your organization?

I created PivOTal Performance with the mission of providing high-quality health & wellness services to all. PivOTal Performance is committed to empowering all our clients to ensure they reach their goals. My goal is to change the face of healthcare; by creating a space for all my clients to be seen and heard.

What is your passion and how did you get involved in Parkinson’s awareness and hope for a cure?

My passion has always been helping individuals get back to doing the things they love. This is the sole reason why I become an occupational therapist. Starting out I worked in a subacute rehab setting working with client’s who had neurological conditions.

What type of goals do individuals with Parkinson’s have when working with you?

The ultimate goal is improving their quality of life. Most go through an intense depression and elimination phase of life. This is at least what I call it. Most of my client’s withdraw from daily

tasks, enrichment activities, hobbies, socializing due to the overwhelming amount of doctor appointments in combination with depression and grieving that comes with receiving a diagnosis of Parkinson’s Disease.

What type of training and how long are the programs?

I have a MS in Occupational therapy.

Certified in LSVT-BIG In person, two-day training and certification course

Content delivered by LSVT Faculty using PowerPoint presentations, demonstrations, hands-on practice with people with PD and video examples

What effect can it have on an individual with Parkinson’s?

Honestly the program is amazing it can improve balance, gait, and divided attention skills. Most graduates are able to successfully perform ADL, IADLs and community mobility tasks and social engagements with improved balance and stability.

What would you like to see as a future goal for your programs?

To utilize LSVT-BIG programs are often. Most doctors are inward of this amazing program and everything it has to offer. The largest problem is if the MD is aware of LSVT-BIG the referral comes only when the client’s balance has become severe. This is not to say that LSVT-BIG can’t be beneficial to the client. But I would love a more proactive approach being used by an immediate referral.

What events do you participate in?

I have not participated in live events. Most of my time has been taking visceral Manipulation courses and studying all while running the practice.

How does this also assist the caregivers?

This program is great for caregivers. I have trained many family members and care staff regarding the program so they can increase daily engagement in LSVT-BIG long after the client is discharged from care. This is what makes the program so special. There is a long-term plan to help keep all skills long after discharge from rehab Services.

How can someone get in touch?  What is your website?

Instagram: @pivotal_performance_ot

How can others also become advocates for awareness?

Simples ways can be sharing social media posts regarding LSVT-BIG. Talking to your doctor about it. When it comes to doctors a primary care, neurologist, physicians can refer. Use the hashtag LSVT-BIG. I find word of mouth is another great way to advocate.

In your opinion what is the key to effective advocacy?

By keeping the conversation going this helps keep the importance of Parkinson awareness open in people minds.

How can we better fundraise to support a cure for Parkinson’s?

Events school fundraisers  music festivals tapping into any event where people plan to gather.

What other activities do you undertake to help improve and support your daily living Eg exercise and alternative remedies?

I am big on manual therapy and visceral Manipulation. I utilize these treatment to help increase range of motion and mobility. If a client has any pain I also will implement these treatments to help increase mobility and strength. Parkinson’s disease also affects digestion so visceral manipulation really helps to improve digestive problems.

Why should people who don’t have Parkinson’s care about this?

It affects all of us. We are a Community we have to strive to stick together. It’s also important because advances in Parkinson’s can benefit all other neurological conditions such as multiple sclerosis, stroke, and Huntington’s disease.

Have you had any family members or relatives affected by Parkinson’s disease?


If you had one song that would tell us more about you or represent your life which song would it be?

Ruelle feat. Fleurie Carry you

If you had one final statement or quote you could leave for the Parkinson’s community, what would it be?

“Nothing is impossible, the word itself says I’m possible”-Audrey Hepburn