A Physical Therapy Guide to Functional Neurologic Disorder
Functional Neurologic Disorder (FND) is an an increasingly diagnosed condition that typically affects young and middle aged people. It occurs when pathways from the brain which help you with actions such as moving, talking, or speaking, get disrupted. Every person presents differently, but typically they have experienced trauma or distress.
Functional Neurologic Disorder is one of the most commonly diagnosed conditions in neurology clinics.1
Continue reading to learn more about Functional Neurologic Disorder and how CityPT physical therapists and occupational therapists can assist in promoting healing and return to function.
- Understanding Functional Neurologic Disorder
- Symptoms of Functional Neurologic Disorder
- What Causes Functional Neurologic Disorder?
- Diagnosing Functional Neurologic Disorder
- What to Expect from Rehab Therapy
- Is It Time to Seek Treatment?
Functional Neurologic Disorder (FND) is a very complex condition.
It's commonly described as a condition with symptoms which include: a loss of strength or sensation, abnormal movements, or epileptic movements. These symptoms are not caused by any structural damage to the brain — instead they are related to psychological or emotional factors.2
Even though there is no structural damage to the brain, it is not able to send and receive information to certain parts of the body to do their job correctly. Emotions, memory, and the way the brain processes new information can all be affected as well.3
You may be wondering, if there is no structural damage, why is the condition considered a neurologic one? It is because the person presents with neurologic symptoms that interfere with daily life and limit their ability to function.
Similar to other neurologic conditions, symptoms vary from person to person and include areas of motor (voluntary movement), sensory (feelings/sensations), and cognitive function. One important factor to note is that symptoms may fluctuate (sometimes hourly) or can be present continuously. One day the patient may have significant improvement in their mobility, with complete loss of function the next day.4
Impairments in motor function include:
- Limb weakness or complete loss of function (paralysis)
- Tremors and spasms
- Difficulty walking
- Difficulty speaking or swallowing
Impairments in sensory function include:
- Numbness, tingling, or pain in various parts of the body (typically on one side)
- Various impairments in vision
Impairments in cognitive function include:
- Poor memory
- Difficulty with problem solving
Symptoms of FND also include psycho-social factors that the patient might have such as: anxiety, depression, post traumatic stress disorder (PTSD), poor family support, chronic pain, and fatigue.
There is no single or clear cause for FND. It can be triggered with a diagnosis of a neurologic condition. FND can also be caused by a reaction to a stressful situation or psychological or physical trauma.5
Certain characteristics do put people at a higher risk for being diagnosed with FND, such as:5
- Recent stress or trauma
- A pre-existing neurological diagnosis (epilepsy, migraines, and movement disorders are the most common)
- A pre-existing mental health condition
- Having a history of stress or trauma in childhood
Unlike other conditions, diagnosing FND does not involve standard testing. Imaging is used to rule out other neurological medical conditions; and a complete assessment of symptoms is performed. Typically, an MRI or EEG will show no abnormalities while the patient is presenting with neurologic symptoms, which leads medical professionals to consider FND as a diagnosis.
The DSM-5 states the following as criteria for diagnosing a person with FND:5
- One or more symptoms that affect body movement or senses
- Symptoms which cannot be explained by a medical condition or any mental health disorder
- Symptoms cause significant enough distress or problems in social or work areas which require medical evaluation
Providing patients with a clear FND diagnosis as early as possible and establishing rehab care is essential in allowing patients to manage this condition.
Treating Functional Neurologic Disorder requires a more psycho-behavioral approach, with multi-disciplinary team members such as physical, occupational, and behavioral therapists. CityPT physical and occupational therapists work together to create a unique plan that's fit for each individual.
Similar to other neurologic conditions, physical and occupational therapy is essential in helping patients return to their prior level of activity and function.
They assist in:
- Exploring useful assistive devices to guide recovery
- Physical training
- Strategies to cope with symptoms related to pain, fatigue, anxiety, depression, and fear
- Cognitive exercise to help with return to functional activities such as paying bills and working
It's essential to have a holistic plan of care, which involves education, movement training (specifically with distraction), and behavioral change strategies. It's important to note that all of these strategies should be utilized with a positive and non-judgmental approach from therapists — which you can expect from a CityPT clinician. This helps the person diagnosed with FND to accept their diagnosis as well as understand that it is a treatable condition.6
If you or someone you know has been diagnosed with Functional Neurologic Disorder, or are dealing with changes in overall function for unknown reasons, it's important to seek a consultation as soon as possible. CityPT therapists can assist in identifying signs of FND and refer you to a neurologist as well as help address functional impairments at an early stage to optimize recovery.
Consulting with a CityPT physical and/or occupational therapist, over telehealth or in-person, will help you develop and establish a multi-disciplinary program and facilitate long term recovery to prevent relapse.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Stone J, Carson A, Duncan R, et al. Who is referred to neurology clinics?--the diagnoses made in 3781 new patients. Clin Neurol Neurosurg. 2010;112(9):747-751. doi:10.1016/j.clineuro.2010.05.011. https://pubmed.ncbi.nlm.nih.gov/20646830/ ↩
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. American Psychiatric Association, Arlington, VA2000 ↩
Functional neurologic disorder. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/functional-neurologic-disorder. Accessed November 23, 2022. 15 September 2013. Spine, 38(20): 1715–1722 ↩
Functional neurologic disorder/conversion disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/conversion-disorder/diagnosis-treatment/drc-20355202. Published January 11, 2022. Accessed November 23, 2022. ↩ ↩2 ↩3
Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: A consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry. 2014;86(10):1113-1119. doi:10.1136/jnnp-2014-309255. https://pubmed.ncbi.nlm.nih.gov/25433033/ ↩