Physiotherapy
Physiotherapy plays a crucial role in the comprehensive treatment of patients with functional neurological disorders. Various studies (e.g. Czarnecki et al., 2012; Edwards et al., 2012; Nielsen et al., 2013), demonstrate the positive effects of physiotherapy by focusing on understanding FND. Approximately 60-70% of FND patients have reported an improvement in symptoms due to physiotherapy.
The main aim of physiotherapy at FND is to inhibit (suppress) abnormal patterns and facilitate (encourage) normal movement patterns, thus helping the patient to be as independent as possible in activities of daily living. This is a long-term process with a good outcome if the exercise programme is sufficiently intensive, specific and focused on functional goals. Distraction is the key to managing this group of patients. We try to prevent the patient from controlling his/her movement by using different techniques to stimulate automatic or automatically generated movement.
The exercise programme includes a variety of movement tasks with elements such as:
weight transfers,
change in walking speed,
walking on a treadmill,
walking back,
walking up the stairs,
Walking on a reduced support surface,
walking to the beat (in time with the music, counting),
sitting on an unstable surface - a therapy ball,
crossing an obstacle,
reaching/touching,
applause,
moving objects,...
Other physiotherapy techniques that have been shown to be effective include:
Mirror therapy,
camera recording (as feedback on correct posture and walking pattern),
keeping a rehabilitation diary,
sensory stimulation,
visualisation,
progressive muscle relaxation,
pain-relieving electrotherapy (TENS).
A key component of a successful treatment programme for patients with FND is to educate patients and relatives to carry out the exercises in the home environment. Particular attention should be paid to the psychophysical state of the individual, providing information without a sense of stigma and increasing motivation to persist with long-term treatment programmes despite the fluctuating nature of the disease.
Some examples of communication (Nielson et al., 2014).
Techniques and strategies to avoid
Avoid misleading the patient or accusing them of having symptoms 'in their head'.
Encouraging the patient to continue to use walking equipment or aids after physiotherapy if the quality of walking is worse without them. This will prevent the patient from 'fixing' abnormal walking patterns in the brain.
Managing symptoms with surgery. Surgery is a common trigger for motor subtype FND, but repeated surgery can only worsen symptoms.
For more practical tips and strategies when working with patients from FND, click here.
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Gilmour, G. S., in Jenkins, J. D. (2021). Inpatient treatment of functional neurological disorder: a scoping review. Canadian Journal of Neurological Sciences, 48(2), 204-217.
Kim, Y. N., Gray, N., Jones, A., Scher, S., in Kozlowska, K. (2022). The role of physiotherapy in the management of functional neurological disorder in children and adolescents. In Seminars in pediatric neurology (Vol. 41, p. 100947). WB Saunders.
Nielsen, G. (2016). Physical treatment of functional neurologic disorders. Handbook of clinical neurology, 139, 555-569.
Nicholson, T. R., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., Mildon, B., ... in FND-COM (Functional Neurological Disorders Core Outcome Measures) Group. (2020). Outcome measures for functional neurological disorder: a review of the theoretical complexities. The Journal of neuropsychiatry and clinical neurosciences, 32(1), 33-42.
Perez, D. L., Edwards, M. J., Nielsen, G., Kozlowska, K., Hallett, M., in LaFrance Jr, W. C. (2021). Decade of progress in motor functional neurological disorder: continuing the momentum. Journal of Neurology, Neurosurgery & Psychiatry, 92(6), 668-677.