From the Guidelines
Physical therapy plays a crucial role in the management of Functional Neurological Disorder (FND) and should be a primary component of treatment, focusing on retraining normal movement patterns, improving posture, enhancing balance, and building core strength. A comprehensive physical therapy program typically includes education about the condition, graded exercise therapy, and specific movement retraining techniques, as supported by occupational therapy consensus recommendations 1. Patients should begin with gentle exercises that gradually increase in intensity over 8-12 weeks, attending sessions 2-3 times weekly. The therapy should also incorporate techniques such as visualization exercises, mirror therapy, and distraction strategies to help patients regain control over abnormal movements.
Key Components of Physical Therapy for FND
- Education about the condition to promote understanding and engagement
- Graded exercise therapy to gradually increase intensity and improve physical function
- Specific movement retraining techniques to address abnormal movement patterns
- Home exercises between sessions for reinforcement and consistent practice
- Establishment of clear, achievable goals with patients and tracking progress using functional assessments
According to the occupational therapy consensus recommendations 1, a biopsychosocial aetiological framework should guide physical therapy treatment for FND, with a focus on education, rehabilitation within functional activity, and the use of taught self-management strategies. This approach is distinct from therapy for other neurological conditions and is supported by expert consensus and limited evidence from multidisciplinary rehabilitation studies 1.
Benefits of Physical Therapy for FND
- Improvement in physical function and quality of life
- Reduction in symptom severity and frequency
- Enhancement of balance, posture, and core strength
- Promotion of neuroplasticity and rewiring of neural pathways
- Addressing the disconnect between intention and movement execution that characterizes FND
By prioritizing physical therapy as a primary component of treatment, patients with FND can experience significant improvements in symptoms, function, and quality of life, as supported by the limited but promising evidence from occupational therapy studies 1.
From the Research
Role of Physical Therapy in FND Management
- Physical therapy plays a crucial role in promoting normal movement patterns and restoring independence in patients with Functional Neurological Disorder (FND) 2.
- Physiotherapy has been shown to improve motor symptoms, activity, perceived health, and quality of life in patients with FMD, a type of FND 3.
- A multidisciplinary approach, including physical therapy, is essential for optimal outcomes in FND patients 2, 4.
Physical Therapy Interventions
- Physical therapy interventions can be tailored to address specific symptoms, such as gait disturbances, and can be delivered in various settings, including inpatient and outpatient facilities 2, 4.
- The use of the biopsychosocial model and neuroscience constructs can inform physical therapy interventions and guide care 4.
- Video telehealth services can be an effective way to deliver physical therapy to FND patients 4.
Benefits of Physical Rehabilitation
- Physical-based rehabilitation has shown promising results in improving outcomes for FND patients 5.
- Physical activity and exercise may have therapeutic potential in FND, particularly in regulating the autonomic nervous system (ANS) 6.
- Further research is needed to fully understand the role of physical therapy in FND management and to develop effective treatment protocols 3, 5, 6.