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Neuro Rehab 2 > Functional Neurologic Disorder (FND) > Flashcards

Functional Neurologic Disorder (FND) Flashcards

1
Q

how does Mayo Clinic define FND

A

neuro sx that can’t be explained by a neuro dz or other medical condition

pt demonstrates physical sx w/o organic cause

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2
Q

FND is considered a condition at the intersection of what 2 healthcare practices

A

neurology
psychiatry

“neuropsychiatric” disorder

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3
Q

what are risk factors for FND

A

females > males
anxiety disorders
possible psych trauma

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4
Q

what are the 3 main reasons to change the name from conversion disorder to FND

A

new dx criteria
dx of inclusion - tests to be used
look at fMRI evidence

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5
Q

conversion disorder vs FND

A

conversion disorder:
- dx of exclusion
- direct result of trauma (physical or psych)
- no physio theory or evidence behind dx

FND:
- dx of inclusion
- may have a “trigger”
- fMRI evidence
- “secondary gain” - pt gets something (+) out of being sick

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6
Q

what are 3 subsets of FND

A

nonepileptic sz
functional weakness
functional mvmt disorders

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7
Q

what are examples of the nonepileptic sz subset of FND

A

pseudo sz
functional

sz sx without any electrical correlate in EEG

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8
Q

what are 2 types seen in the functional weakness subset of FND

A

inconsistent weakness
paralysis

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9
Q

what are 3 types seen in the functional mvmt disorders subset of FND

A

functional tremor
- more common in adults
functional gait disorder
- more common in kids
functional coma

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10
Q

which 3 structures are altered in FND when viewed w an fMRI

A

insula
amygdala
dorsal prefrontal cortex

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11
Q

how does someone w FND’s insula look different on a fMRI and what does this mean

A

dec volume in R and L insula

R insula dec connectivity w:
- R temp/parietal junction
- R sensorimotor cortex
- (B) supplementary motor area
= dec connectivity to things that plan, execute, and monitor motor output

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12
Q

how does someone w FND’s amygdala look different on a fMRI and what does this mean

A

inc volume of amygdala
- amygdala = emotional stability, forming emotional memories

inc connectivity to motor cortex
- see motor output disturbances

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13
Q

how does someone w FND’s dorsal prefrontal cortex look different on a fMRI and what does this mean

A

dec dorsal prefrontal cortex when performing motor task

-> dec ability to respond flexibly to tasks and adjustments

-> dec agency

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14
Q

what is agency and why is it significant that this is dec in FND

A

agency is knowing you are the cause of whatever mvmts and consequences

d/t dec in dorsal prefrontal cortex activity, there is dec agency in FND
–> connectivity is missing
–> if moved passively, motor cortex tells them they did it themselves
–> when moved actively, brain tells them someone else did it

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15
Q

overall the changes seen on a fMRI lends to what physio characteristics of FND

A

regulating emotions
processing emotions
planning and acknowledging voluntary mvmts

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16
Q

what needs to be done first in the process of dx FND

A

r/o organic dx
- get some imaging!!

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17
Q

what steps are involved in r/o an organic dx

A

appropriate imaging
appropriate blood tests
possible spinal tap
EMG
EEG

18
Q

before going into the eval, what do you need to find out from the team

A

what they have told the pt and family
- did they hear the dx and how was it explained

what tests have been completed and which tests are currently ordered to be performed

19
Q

what are 4 steps to r/i a FND dx

A

hx
physical exam - impairments
functional skill assessment
specific test pertaining to hypothesis of FND dx

20
Q

what are components to their hx that you might start to r/i FND

A

abrupt onset

intermittent spontaneous cure or remission

secondary gain

psychiatric comorbidities

21
Q

what is an important thing to consider if someone has psychiatric comorbidities

A

this shouldn’t have more weight than anything else in their hx

22
Q

what are components looked at in a physical exam for FND

A

strength
sensory testing
coordination
gait
functional mobility
special tests

23
Q

how is motor control assessed in FND

A

MMT
observational analysis
Hoover’s sign

24
Q

how will MMT present in FND

A

give way weakness
- cuts off any motor engagement

25
Q

what will an observational analysis of motor control likely show in FND

A

can’t move limb confrontationally (on command)

can move limb observationally (unconsciously)

26
Q

what does a hoover’s sign tell us for FND

A

r/i test for this dx
- if (-), don’t have FND

27
Q

what is a consideration for pt ed while conducting the physical exam

A

verbally acknowledge what you are seeing

28
Q

what will a sensory exam in FND likely reveal

A

non-anatomical sensory changes
- sensory loss
- dec sensation
- inc sensation/perception of pain –> hyperalgesia on confrontation is common (often not as painful when they are distracted)

may vary throughout assessment or day or day to day

29
Q

what are characteristics of a functional tremor

A

distractible
variable
suggestible

able to be entrained

30
Q

what does it mean that a functional tremor could be entrained

A

any change in direction, frequency of tremor w distraction (cog, auditory, physical)

31
Q

what are characteristics of a functional gait pattern

A

variable step length
variable BOS
single leg being dragged
astasia-abasia (trunk mvmt)
slow, effortful
follows no neuro pattern

32
Q

what are 3 factors in determining a positive outcome

A

acceptance of dx
educating the pt
time b/w sx onset and FND dx

33
Q

what is a good way to deliver the results of your eval to pt w your dx of FND

A

verbally acknowledging all you saw throughout eval & recap it:
- these are (+) signs for FND
- share fMRI FND findings (validates it for them)
- share neuro and psych part

34
Q

what are 3 things our dx should contain

A

objective physical findings
physio to support dx
“trigger” events

35
Q

what are 3 things to avoid in our dx and why

A

life stress
emotional disorder
neurotic personality

avoid talking ab psych part of dx, not our scope, can muddy waters

psych support and hx not needed to effectively treat

36
Q

PT eval specific to FND: impairment testing, neuro screen, FND tests

A

impairment:
- strength
- ROM
- motor control

neuro screen/assessment
- somatosensation
- balance
- oculomotor
- CN testing

FND test/dx
- functional skills assessment
- functional gait assessment
- hoover’s sign
- entrainment, suggestibility, and distractibility of tremor

37
Q

what is the significance of pt ed in FND

A

pts who were told dx and outcomes, got better

38
Q

PT facilitation technique in FND

A

don’t touch them, no facilitation

have them do wildly hard, dual task, difficult thing, super distracting - and guard as best you can w/o touching them

39
Q

what are Nielson’s 4 core areas for PT intervention in FND

A
  1. education
  2. retraining mvmt
  3. demonstrating normal mvmt w/i therapy session (distraction)
  4. change maladaptive behaviors as it pertains to mvmt
40
Q

what are components that Nielson suggests to include in education for pt w FND

A

dx
physio behind dx
expectation of recovery
relative common dx for PTs
retraining normal mvmt

41
Q

what were Nielson’s 5 recommendations for rehab

A
  1. build trust before challenging
  2. repeat expectation of recovery in all convos
  3. limit “hands on” intervention and become more instructional
  4. avoid adaptive equipment (whenever possible/safe)
  5. goal directed rehab w focus on functional activities (pt goals to inc motivation)
42
Q

what are characteristics our PT interventions should have for FND (5)

A

activities to work towards pt goals
- daily
- weekly
- monthly

multi-tasking
distraction
high level
repetition

Neuro Rehab 2 (48 decks)

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