From the Guidelines
Physical therapy for functional neurological disorder (FND) should prioritize techniques that encourage normal movement patterns and resting postures, such as graded activity, relaxation techniques, and sensory grounding, as outlined in the 2020 occupational therapy consensus recommendations 1. When treating FND, physical therapists can use various strategies to address specific symptoms, including:
- Functional tremor: superimposing alternative rhythms, using the unaffected limb to dictate a new rhythm, and assisting the person to relax the muscles in the limb to prevent cocontraction 1
- Functional jerks: addressing unhelpful prejerk cognitions and movement, using general relaxation techniques, and encouraging learning of slow movement activities such as yoga or tai chi 1
- Dystonia: encouraging optimal postural alignment, even distribution of weight, and grading activity to increase the time that the affected limb is used within functional activities 1
- Functional limb weakness: engaging the person in tasks that promote normal movement, good alignment, and even weight-bearing, such as transfers, sit to stand, and standing with the aid of a standing frame 1 It is essential to employ anxiety management and distraction techniques when undertaking a task, and video recording interventions can be useful to demonstrate changeability and highlight successes 1. Additionally, splinting should be used with caution, as it may prevent restoration of normal movement and function, and removable splints may have an overall positive effect in some cases, but benefits should be balanced against potential harm 1.
From the Research
Physical Therapy Techniques for Functional Neurological Disorder
- The use of the biopsychosocial model and neuroscience constructs can inform physical therapy interventions for functional neurological disorder, as highlighted in the study by 2.
- Physical therapy can help promote normal movement patterns and restore independence in patients with functional neurological disorder, with interventions tailored to individual patient needs 3.
- Physiotherapy has been shown to improve motor symptoms, activity, perceived health, and quality of life in patients with functional movement disorder, a type of functional neurological disorder 4.
Specific Interventions
- Gait training and balance exercises may be beneficial for patients with functional neurological disorder who present with gait disturbances 3.
- Physical activity and exercise may have therapeutic potential for patients with functional neurological disorder, particularly in regulating the autonomic nervous system 5.
- A multidisciplinary approach to treatment, including physiotherapy, cognitive behavioral therapy, and neuromodulation, may be effective in managing functional neurological disorder 6.
Treatment Approaches
- Patient-centered care and a strong therapeutic alliance are important for improving outcomes in patients with functional neurological disorder 6.
- The use of video telehealth services may be a useful adjunct to traditional physical therapy interventions for functional neurological disorder 2.
- Individualized treatment plans, taking into account the unique needs and symptoms of each patient, are essential for effective management of functional neurological disorder 6.