FND

Question 1

what is FND?

Answer 1

-functional neurological disorder
-patients will experience neurological symptoms such as weakness, sensory issues, movement problems etc that are not caused by structural damage to the nervous system but to do with how the brain and body communicate
-develops unconsciously

Question 2

what are common symptoms of FND?

Answer 2

-weakness or paralysis
-abnormal movement eg tremors
-swallowing problems
-seizures/ shaking
movements
-cognitive symptoms
-blackouts etc

Question 3

what is associated with a positive prognosis?

Answer 3

-most important is short duration of symptoms
-early diagnosis NB
-socio economic factors eg change in marital status
-good explanation of diagnosis
-patient confidence in clinician

Question 4

what is the cognitive contribution to FND?

Answer 4

-excessive attention to the body- brain may misinterpret symptoms or create symptoms based on learned patterns
-beliefs and prior experiences
-avoidance

Question 5

what are some challenges of HCPs working with patients who have FND?

Answer 5

-lack of confidence in communicating the diagnosis

Question 6

why is it so important to call it functional?

Answer 6

• as it avoids physical vs psychological
  -brreaks down functional / reversible vs structural / irreversible

Question 7

what does the physiotherapy Rx of FND involve?

Answer 7

-education regarding the condition & explaining it properly - functional, not psychological or structural
- address illness beliefs
-movement retraining
with distraction methods and diverting the patients attention
-non specific and graded exercise
-visualisation - form of distraction
-mirrors and video for providing feedback to patient about movement, also distraction method
-pain and fatigue management - common in FND

Question 8

what are some examples of clinical signs that can determine a diagnosis of FND?

Answer 8

-Hoovers sign - weakness of hip extension which returns to normal with contralateral hip flex against resistance (ie problem improves with distraction)
-hip abductor sign - similiar to hoover sign
-distraction or entrainment of a tremor- abolishing tremor by asking patient to copy movements

Question 9

what could movement retraining involve for FND?

Answer 9

-start by exploring movement and symptoms
-identify moments when movement normalises
-altering focus of attention
-try fast, unpredictable unfamiliar movements
-visual feedback and mirror
-repetitions!!

Question 10

what is recommended for leg weakness for FND?

Answer 10

-early WB: finger tip support
-side to side weight shifts
-crawling to 2 point kneel
-exercise in the centre of the room
-increase speed, slow down
-treadmill walking