Occupational therapy
Occupational therapists help individuals with mental and physical disabilities to participate in everyday activities. They are recognised as part of the multidisciplinary treatment of patients with FND, but there is little published research confirming the effectiveness of occupational therapy.
The aim of occupational therapy is physical rehabilitation based on guided activity training, practical pain and fatigue management, support for mental distress and building independence. Particularly important is the independent management of symptoms and the establishment of an internal locus of control. This is achieved through a good understanding of the diagnosis and interventions, and through progressive goal-setting.
Setting goals is important, but it is crucial that occupational therapists are flexible in doing so, as FND treatment is not linear. Because of the many perpetuating factors, patients often experience alternating periods of improvement and periods of deterioration. Goals should be set by the patients themselves and do not have to be time-limited.
The principles of vocational rehabilitation for patients with FND, are no different from those of vocational rehabilitation for other neurological disorders. It is crucial that employers and teachers understand that patients have real symptoms, with possible periods of remission and exacerbation. Occupational therapists can be involved in developing work adjustments for patients, such as changes in job roles, reduced working hours, regular breaks, etc. An important aspect is support for a graduated return to work or school after a period of absence. When patients are unable to return to work, occupational therapists are responsible for supporting them to find other paid and/or unpaid roles.
Because of the frequent alternations between deterioration and improvement during treatment, you can regularly have a reflection session with the patient to explore the answers to the following questions together:
What have you learned about your condition and diagnosis?
Can you identify the factors that make your symptoms worse? Can you identify the warning signs that lead to a worsening of your symptoms?
What are the most useful symptom management strategies you have learned?
What are the least helpful symptom management strategies you have learned?
What can you do if you notice your symptoms getting worse?
Do you recognise coping strategies that make the healing process difficult for you in the long term?
What are your goals for the next three months? (Then for 6, 9 and 12 - progressive goal setting.)
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Nicholson, C., Edwards, M. J., Carson, A. J., Gardiner, P., Golder, D., Hayward, K., ... and Stone, J. (2020). Occupational therapy consensus recommendations for functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry, 91(10), 1037-1045.