Can a patient with a functional neurological disorder (FND) work safely?

Can Patients with FND Work?

Yes, patients with FND can and should work, with appropriate vocational rehabilitation support including workplace accommodations, graded return-to-work plans, and flexible scheduling arrangements. 1

Core Principle: Work as Therapeutic Intervention

• Occupational therapists have a key role in supporting people with FND to manage their condition in the context of work and study, applying vocational rehabilitation principles from neurological rehabilitation. 1
• Vocational rehabilitation should begin early in treatment, not deferred until "full recovery," as meaningful occupation is therapeutic and prevents deconditioning. 2
• The goal is sustained employment through structured support addressing biopsychosocial factors, not simply job placement. 2

Essential Workplace Accommodations

Employers and educators must understand that FND patients have genuine symptoms that may vary in severity, with possible periods of remission and exacerbation. 1

Key accommodations include:

• Role modifications and reduced hours initially 1
• Regular rest breaks throughout the workday 1
• Flexible working options (remote work, hybrid arrangements) 1, 2
• Graded return to work following sick leave, with incremental increases in hours and responsibilities 1, 2

Optimal Job Characteristics During Recovery

• Jobs with predictable routines and structured schedules are preferable, as reestablishment of structure and routine is central to FND intervention and relapse prevention. 2
• Administrative roles with flexible scheduling, data entry, customer service (non-phone based), library work, or positions allowing seated work with regular breaks accommodate common FND symptoms. 2
• Initially target roles with minimal physical demands if motor symptoms predominate, avoiding jobs requiring sustained standing, repetitive movements, or fine motor precision until movement retraining is consolidated. 2
• Creative or craft-based work can provide meaningful occupation while allowing self-paced activity and integration of anxiety management strategies. 2

Critical Implementation Strategy

Occupational therapists should work jointly with occupational health departments to identify and advocate for reasonable adjustments to improve work performance and symptom management. 1

The vocational rehabilitation process should include:

• Helping employers understand the diagnosis using clear language (symptoms are real, potentially reversible, caused by brain-body miscommunication) 1, 2
• Developing written plans for graded activity increases 1
• Teaching self-management strategies applicable to the workplace (attention redirection, anxiety management, pacing) 1, 2
• Regular follow-up to troubleshoot issues and adjust accommodations as symptoms fluctuate 1

Common Pitfalls to Avoid

• Do not wait for complete symptom resolution before discussing return to work - this delays therapeutic occupation and promotes deconditioning. 2
• Avoid treating FND like degenerative neurological conditions - FND symptoms are potentially reversible and do not cause permanent structural damage. 2
• Do not focus solely on symptom elimination - functional goals (returning to meaningful activities including work) should drive rehabilitation. 1, 2
• Avoid premature use of disability accommodations that reinforce sick role - balance support with promotion of independence and normal function. 1

Prognosis for Work Capacity

• Recovery in FND often follows a pattern of symptom remission and exacerbation rather than linear improvement, requiring flexible workplace expectations. 1
• 60-96% of patients report improvement after intervention, with most falling in the minimally to much improved range. 2
• Patient confidence in treatment and understanding of the diagnosis predict better outcomes, including successful return to work. 2
• Multidisciplinary studies demonstrate improvements in physical function and quality of life at 12-25 month follow-up, supporting long-term work capacity. 2