Functional neurological disorder (FND) -

Functional neurological disorder (FND)

July 24, 2024

Common understanding on FND.

Symptoms are diverse and can include weakness, movement disorders (tremor, jerks and dystonia), sensory symptoms, cognitive deficits, Fatigue and persistent pain. Symptoms can present acutely and resolve quickly or can be long lasting. Regardless of duration, those affected frequently experience high levels of distress, disability, unemployment, and reduced quality of life.

The symptoms of FND are caused by a potentially reversible miscommunication between the brain and the body. FND is diagnosed by a neurologist using ‘positive clinical signs’ (eg, Hoover’s sign, distractibility, entrainment of tremor and variability in symptoms during function) and is not a diagnosis of exclusion. It can be diagnosed alongside other neurological conditions.

For better outcome, the below points need to be considered at the point of seeking rehabilitation.

People diagnosed with FND have some degree of understanding and agreement with the diagnosis
Can identify rehabilitation goals or areas of need and are motivated to make changes.
Has an understanding that the initial focus of therapy is to improve function rather than provision of aids and adaptations

Good practise recommendations and Principles used by our specialist therapy team.

Acknowledge that FND is a real, common and disabling condition that causes neurological symptoms that are outside the person’s control.
Help the person understand the relevance of triggering events if they report them.
Provide education on how the body’s stress response can influence functioning of the nervous system and therefore FND.
Discuss how self-directed attention can make symptoms worse and conversely redirecting attention (distraction) can temporarily reduce symptoms.
Discuss how symptom focus and chronic health conditions can exacerbate or cause cognitive difficulties, fatigue, anxiety, low mood and pain.
Discuss the importance of a 24-hour approach to therapy; that is, implementing rehabilitation strategies throughout the daily routine as part of self-management.
Education, rehabilitation within functional activity and the use of taught self-management strategies
Recognise that aids and equipment can cause new secondary problems such as joint pain (eg, shoulder pain from walking with crutches) and deconditioning of muscles.
Where possible avoid use of compensatory aids and techniques in the acute phase or when undergoing active rehabilitation.
Recognise and sensitively challenge unhelpful thoughts, beliefs and behaviours.
Multi-disciplinary interventions are beneficial.

Understanding the right time for rehabilitation.

There will be some people who do not gain benefit from rehabilitation and remain symptomatic. If the person has had adequate access to specialist intervention for FND then a focus on disability management may be appropriate. However, given the fluctuating nature of FND, it is important to consider that gains may still be possible in the future. Re-engaging in rehabilitation at a later date may be advantageous for some.