FND Flashcards
What is FND
Functional neurological disorders is a medical condition in which there is a problem with the functioning of the NS and how the brain/body sends and/or receives signals rather than a structural disease process. Conventional tests such as MRI brain scans and EEGs are usually normal in patients with FND.
Cause of FND
Many different predisposing factors can make patients more susceptible to FND such as having another neurological condition, experiencing chronic pain, fatigue or stress. However, some people with FND have none of these risk factors. At the time FND begins, studies have shown that there may be triggering factors like a physical injury, infectious illness, panic attack or migraine which can give someone the first experience of the symptoms. Psychological disorders and stressful life events, both recent and in childhood, may be risk factors for developing the condition in some patients
Diagnosis
There is emerging literature on structural imaging and functional MRI’s of the brain in people with conversion disorder. Studies have shown that those with conversion disorder tend to have reduced volumes of right and left basal ganglia and right thalamus compared to others without conversion disorder
DSM-V diagnostic criteria for FND
A. One or more symptoms or deficits affecting voluntary motor or sensory function suggest neurological or other general medical condition.
B. Physical findings provide evidence of incompatibility between the symptoms and recognized neurological or medical conditions.
C. The patient is not feigning or intentionally producing his or her symptoms or deficits.
D. The symptom or deficit causes clinically significant distress or impairment in the social, occupational, or other important areas of functioning or warrants medical evaluations
Hoovers sign- diagnostic test
involuntary extension of the unaffected leg occurs when flexing the contralateral leg against manual resistance. However, if the physiotherapist does not feel the unaffected leg’s heel pushing down as the patient flexes the hip of the affected limb, then this suggests functional weakness
S and S FND- Cardiac and gastrointestinal
Cardiac- SOB, palpitations, chest pain
Gastrointestinal= vomiting, abdominal pain, difficulty swallowing, nausea, bloating, diarrhoea
S and S FND- MSK and neuro
MSK- pain in legs, back/joint pain
Neurological- headaches, dizziness, amnesia, vision changes, paralysis
FND- Medical management- other
hypnosis, psychotherapy, pharmacotherapy, transcranial magnetic stimulation
physical therapy management- FND
The aim of physiotherapy is to prevent secondary complications, it may help the process of remission. Examples of treatment: for a patient presenting with paralysis or weakness, consider working on pre-gait activities such as sit-to-stands, weight-shifting in multiple planes, mini-squats, lunge matrices, balance activities, etc. Gait activities should include stair management, dual-task activities, adjustment of gait mechanics, etc. Next, it is important to incorporate activities that will help the patient with participation, especially with activities of daily living.§
What is complex regional pain syndrome
A term for a variety of clinical conditions characterised by chronic persistent pain and are subdivided into type I and type II. It is a condition that can develop after a limb trauma and appears mostly in one or more limbs.
CRPS- causes
Can affect any part of the body- occurs most in wrist post distal radial fracture. Central sensitisation is most common cause. Onset is mostly associated with trauma, immobilisation, injections, or surgery. No relationship between the severity of the injury and the following syndrome. A stressful life and other psychological factors may be potential risk factors,
Etiology
Sprains and strains, surgeries, fractures, contusions, crush injuries, nerve lesions, stroke.
CPRS- Clinical presentation- sensory disturbances
Allodynia and hyperalgesia, hypoesthesia and hypoalgesia, hypersensitivity of the skin
CPRS- Clinical presentation- autonomic disorders
swelling and oedema, changes of sweating, abnormal skin BF, colour/temp changes, swelling,
Clinical presentation- motor dysfunction
weakness of muscles, inability to move the extremity, stiffness, tremor, decreased ROM, severe impairment of complex movement, atropgy, inability to intiate movement, dystonia
