Physical rehabilitation for Functional Neurological Disorder- 1 Flashcards
What does FND stand for?
Functional Neurological Disorder
What does FMD stand for?
Functional Movement/Motor Disorder
What FND used to describe?
-Used to describe when there is a problem with the function of the nervous system while the structure nervous system is still intact
What does DSM 5 and ICD 11 stand for?
- Conversion Disorder
- Dissociative Neurological Symptom Disorder
How are FND usually described?
-Using their phenomenology
What are the 4 phenomenological symptoms?
- Motor
- Sensory
- Functional
- Cognitive
What are examples of motor symptoms?
-Tremors, weakness
What are examples of sensory symptoms?
- Somatosensation- numbness or complete absence of sensation
- Persistent Perceptual Postural Dizziness
- Visual symptoms- functional blindness
What are functional seizures also known as?
-dissociative seizures / non-epileptic attacks
What are typical presentations of FMD?
▪ Weakness/paralysis ▪ Tremor ▪ Gait Disturbance ▪ Jerks ▪ Dystonia ▪ Fixed Dystonia
What is the criteria for stroke?
- Facial asymmetry
- Arm weakness
- Speech problems
What is facial asymmetry due to in stroke?
- Due to hypertonia
- Loss of muscle tone
- Weakness in facial muscle
Most patients have a combination of neurological and what functional systems?
- fatigue
- persistent pain bladder
- bowel problems
What is the epidemiology of FND?
- Incidence of FND 4-12 per 100,000 per year
- Prevalence approx. 50 per 100,000
- 60-75% female
What is prognosis of FND?
- Poor
- 40% same or worse at 7 years follow up
- Most patients remain symptomatic
What about FND is unknown?
-The impact of appropriate treatment on prognosis is unknown
What is FMD?
- Disorder of sensorimotor processing
- Top-down expectations distort bottom-up somatosensory experiences
What is FMD facilitated by?
-Facilitated by excessive attention directed towards the body
What do functional motor symptoms require to manifest?
-Attention
What drive functional symptoms?
-Expectations
What are the biological risk factors?
- History of illness
- Disease
- Hypermobility
What are the psychological risk factors?
- Adverse life events
- Personality traits
- Emotional disorder
What are the social risk factors?
- Neglect
- Family dynamics
- Illness models
What are the biological triggering factors?
- Injury or illness
- Physiological event
What are the psychological triggering factors?
- Acute panic attack
- Dissociative episode
What are the social triggering factors?
- Live events
- Social stressors
What are the biological maintaining factors?
- Neuroplasticity
- Deconditioning
- Neuroendocrine & immune changes
What are the psychological maintaining factors?
- Illness beliefs
- Avoidance behaviour
- Fear / anxiety
What are the social maintaining factors?
- Financial pressures
- Employment issues
- Excessive support
What are the five Multidisciplinary care units in the UK?
- Neurology and Neuropsychiatry
- Psychology
- Physiotherapy
- Occupational Therapy
- Speech & Language Therapy
What are some of the outcomes of Multidisciplinary rehab?
- Patients reported significant benfit that lasts up to a year
- Many patients still symptomatic
What the 6 components of physical rehab?
▪ Education ▪ Movement retraining ▪ Address secondary problems e.g. pain, fatigue, etc ▪ Self management ▪ Vocational rehabilitation ▪ Follow up
What are some of the outcomes of physical rehab?
- Proportion with a “good” outcome 55 – 70%
- Moderate to large effect size
- Scores of mental health often do not change
- Cost effective
- Benefits sustained at follow up (1-2 years)
What model does CBT utilise?
- Use the model that involves an understanding of the thoughts, behaviour, bodily sensations and emotions in order to help patients understand their condition
What are some examples of experimental treatments?
- Transcranial Magnetic Stimulation
- Biofeedback / EMG Biofeedback
- Hypnosis
- Therapeutic Sedation
- Virtual Reality
What is the purpose of movement and posture retraining?
- To address maladaptive habitual postures
- To retrain movement patterns / tasks
