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Neuro Dev/Control II > Functional Neurological Disorders > Flashcards

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
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2
Q

Describe functional gait

A
  • Incongruences between the gait pattern & functional strength tests
  • Functional gait: giving the impression of weakness
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3
Q

Describe antalgic functional gait disorder

A
  • It disappears when running for performing tandem gait
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4
Q

What was functional neurological disorder formerly known as

A
  • Conversion disorder
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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
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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
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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)
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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
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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
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10
Q

What contributes to functional movement disorders

A
  • Hypervigilance and internal focus
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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
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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
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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
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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
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15
Q

Characteristics of functional disorders

A
  • Variable
  • Changes with attention
  • Entrainable
  • Exacerbations & remissions
  • Suppressible
  • Sudden onset
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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

Neuro Dev/Control II (19 decks)

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