Functional Neurological Disorders Flashcards
1
Q
Describe organic ataxia versus non-organic
A
- Patients with organic ataxia seek support as well, but typically avoid to stray far from their support & are much less likely to keep crossing the hallway
2
Q
Describe functional gait
A
- Incongruences between the gait pattern & functional strength tests
- Functional gait: giving the impression of weakness
3
Q
Describe antalgic functional gait disorder
A
- It disappears when running for performing tandem gait
4
Q
What was functional neurological disorder formerly known as
A
- Conversion disorder
5
Q
Define functional neurological disorder (FND)
A
- When someone has neurological symptoms which are real caused by a problem with the functioning of the nervous system not due to damage or structural disease of the nervous system causing difficulties fro the person who experiences them
- A problem of brain connectivity
- An involuntary but learned habitual movement pattern driven by abnormal self directed attention
6
Q
Describe a functional tremor
A
- Parkinson tremor: resting tremor, does I attenuate (stops) with holding hands steady or with attention movement (finger to nose to finger example), frequency of tremor stays relatively the same
- Functional tremor does not follow this characteristic pattern
7
Q
FND is an umbrella term that includes
A
- Functional movement disorders (FMD)
- Complex regional pain syndrome (CRPS)
- Persistent postural perceptual dizziness (3PD)
- Functional seizures
- Functional cognitive disorders
- Persistent post-concussion symptoms (PPCS)
8
Q
Incidence and prevalence of FND
A
- 2nd most common diagnosis in neurology clinics
- Accounts for 2-20% of new referrals to movement disorder clinics
9
Q
Describe the concept of software vs hardware problem
A
- It is NOT due to a focal neurological disease
- It is a problem with the brain network malfunction
- Commonly triggered by physical or emotional event but 40% of people do not have a psychiatric history
10
Q
What contributes to functional movement disorders
A
- Hypervigilance and internal focus
11
Q
Define agency
A
- The experience of being the cause of our own actions
- Depends on comparison of sensory feedback with what was predicted
12
Q
Describe impaired self agency
A
- Brain overawareness and attention without voluntary control
- Restore sensory feedback, autonomy & control
- Goal orientation & external focus drive restoration
13
Q
The critical outcomes of the explanation which appear to facilitate physiotherapy are
A
- An understanding by the patient that their treating health professionals accept that they have a genuine problem
- An understanding by the patient that they have a problem which has the potential for reversibility & thus is amendable to physiotherapy
14
Q
Clinical signs in selected functional neurological disorders
A
- Hoover sign in the weak leg: is present if a weak hip extension is corrected when the patient flexes the contralateral hip against resistance
- Drift without pronation of the weak arm: present when the affected outstretched arm, held in supination at the outset, fails to pronate when drifting
- Tonic contraction of the mouth with jaw & tongue deviation, fixed posturing of hand, & fixed posturing of foot
- Tubular vision defect: positive when the area of visual field defect remains unchanged despite moving away from the visual target
15
Q
Characteristics of functional disorders
A
- Variable
- Changes with attention
- Entrainable
- Exacerbations & remissions
- Suppressible
- Sudden onset
16
Q
Characteristics of nonfunctional disorders
A
- Regular rhythm or pattern
- Not distractible
- May change with sensory trick or medication
- Typically insidious & slow onset
17
Q
Describe the differences between task specific dystonia and functional dystonia
A
- Task specific: only with specific task, repetitive muscle contractions, responsive to sensory tricks
- Functional: fixed at onset, rapid progression to max severity, sensory tricks may not be present, variable position & posture
18
Q
Describe the differences between parkinsonian tremor versus functional tremor
A
- Parrkinsonian: low frequency, p resent at rest & diminishes with activity, usually involves fingers/hands/legs/lips & not voice or head
- Functional: may occur after a physical injury Orr panic attack, may occur with dissociation, variable speed & amplitude, entrainable, may get worse when someone holds the limb still, sudden onset with relapses & remissions, improves with autonomic movement
19
Q
Predictors of good prognosis for FND
A
- Early diagnosis
- Short duration of symptoms
- High satisfaction of care
20
Q
Predictors of poor prognosis
A
- Delayed diagnosis
- Longer duration of symptoms
- Personality disorder
21
Q
Criteria for determining if a patient with FMD is suitable for physical therapy
A
- 1) Pts should have received an unambiguous diagnosis of FMD by a physician preferably using the recommendations above
- 2) The pt should have some confidence in or openness to the diagnosis of FMD; physiotherapy is unlikely to be helpful to someone who believes the diagnosis is wrong
- 3) The pt desires improvement & can identify treatment goals
22
Q
Slide 32-33
A
23
Q
General treatment principles for FND
A
- Dx should be established prior to starting therapy & clearly communicated to the patient within a biopsychosocial framework
- Encourage transparency, especially regarding positive diagnostic features
- Explore & address unhelpful illness beliefs & behaviors
- Ensure that the pt understands potential for reversibility & is motivated to change
- Foster independence & self management during treatment
- Involve the family & caregivers in treatment
24
Q
What can the patient interview guide for FND
A
- Triggers
- Past medical successes/failures
- Expectations
- Tolerance for challenge, error, education
- The key to individual success
- The pt’s readiness to receive a diagnosis
- The pt’s life roles, goals, & responsibilities too frame
- And so much more
25
Q
Describe The Riverbanks Analogy
A
- The riverbank can only go so high
- The level can increase with trauma, fatigue, sleep deprivation, and/or stress leading to an overflow
- The overflow leads to tremor, jerks, pain, dystonia, and/or gait changes
- Rehabilitation though allows you to acquire & place sand bags to prevent flooding
26
Q
Benefits of generalized exercise for FND
A
- Externalizes the movement and becomes purposeful
- Changes the sensory signaling
- Brain chemistry
- Successful, normalizing
27
Q
Slide 40
A
28
Q
Describe the relationship between FMD and psychiatric comorbidity
A
- Pts with psychiatric comorbidity are generally more highly represented in a group of pts with FMD compared to the general population
- Psychotherapy is often more successful after some improvement has occurred during physiotherapy
29
Q
Optimal theory of motor learning includes
A
- Enhanced expectancies
- External focus of attention
- Autonomy
30
Q
Slide 49
A
31
Q
Describe optimal external focus in FND
A
- Using the autonomic nervous system
- Breathing
- Not allowing the movement to control you
- “Something that my brain already knew how to do…”
32
Q
The physiology of habituation/repetitions has effects on
A
- Neurotransmitters
- Action potential magnitude (potentiation)
- Connections/affinity
33
Q
What does MUST stand for
A
- Moments of Unexpected Success in Therapy
34
Q
Treatment techniques that are NOT recommended for FND patients
A
- Deception of the pt through any form
- Confining the pt to a wheelchair outside of therapy sessions while their gait pattern remains affected by functional symptoms
- Managing functional symptoms with surgery; surgical procedures are a commonly reported precipitant of FMDs
