Physiotherapy for functional motor disorders: a consensus recommendation

Abstract

BackgroundPatients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment.MethodsA meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience.ResultsWe recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms.ConclusionsPhysiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package.

Clinical briefing: functional neurological symptom disorder

“…Given that neuroscience nurses have much more contact with patients than other professionals they are in a good position to reinforce management plans and knowledge of FNSD, such as that recommended by Nielsen et al (2015). Moreover, approaching the care of people with FNSD with the same mind-set afforded to people with other neurological illness and adopting a goal setting approach to management may go some way in improving the patients' experience.…”

“…Effective communication skills are inherent in nursing care and nurses could very easily adopt the strategies advocated by Stone (2005Stone ( , 2014 and Nielsen et al (2015) when caring for patients diagnosed with FNSD. Nurses are seen as trustworthy, an essential attribute in caring for patients who distrust others and suffer with the symptoms associated with abuse or trauma.…”

“…Indeed, the key aims of the guidance is to educate health care workers, guide treatment and management, and thereby improving overall care for people suffering from FNSD. Furthermore, Nielsen et al (2015) have produced a set of recommendations for Functional Motor Symptoms that may go some way in also helping neuroscience nurses when caring for patients with FNSD. Whilst the guidance is aimed primarily at physiotherapists the recommendations can easily be extrapolated to nursing care as well as promoting inter-professional working.…”

Functional neurological disorders: The neurological assessment as treatment

“…Describing further treatment with physiotherapy [43][44][45] and/or psychological treatments [46][47][48] is beyond the scope of this article. In brief though, there are now detailed recommendations regarding the content of physiotherapy 45 and there is good evidence emerging for its role in treating patients with functional movement and gait disorder.…”

“…In brief though, there are now detailed recommendations regarding the content of physiotherapy 45 and there is good evidence emerging for its role in treating patients with functional movement and gait disorder. For example, a recent randomised trial of 3 weeks of inpatient physical rehabilitation for patients with functional gait disorder of 9 months duration showed a mean 7-point change in a 15-point functional mobility scale compared with controls.…”