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Neuromuscular PT II > Functional Neurological Disorders > Flashcards

Functional Neurological Disorders Flashcards

(52 cards)

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1
Q

FND Definition

A

Disorder of neural network communication

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2
Q

Neural Network Definition

A

Group of neurons working together across structural / anatomical boundaries

7-17 known neural networks in the brain

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3
Q

FND Demographics

A

Affects women more than men

Broad age range (4-94) with mean onset late 30s

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4
Q

The level of physical disability associated with FND is similar to what two pathologies?

A

MS

Epilepsy

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5
Q

T or F: FND involves structural abnormalities in the brain.

A

F

Involves functional changes (software vs. hardware problem)

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6
Q

Subtypes of FND

A

Functional Movement Disorder (most common)

Functional Seizures

Functional Cognitive Disorders

Persistent Perceptual Postural Dizziness (PPPD)

Persistent Post Concussion Symptoms (PPCS)

Complex Regional Pain Syndrome (CRPS)

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7
Q

Who is considered “the founder of modern neurology”?

A

Charcot

Described patterns of neurological symptoms / hypnosis becomes popular treatment strategy

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8
Q

FND is thought to overlap with what disorder commonly observed in military veterans?

A

PTSD (formerly known as “shell shock”)

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9
Q

In the 1980s, what term was abandoned to then consider FND as an existing pathology?

A

Hysteria

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10
Q

How does FND differ from that of an “imagined fear / condition” in terms of brain activity?

A

FND involves activity of more brain regions

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11
Q

FND is a ___ diagnosis. What does this mean?

A

positive

Rule-IN signs

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12
Q

What four characteristics compose the pattern of S&S related to FND?

A

Variable - type of presentation, location, duration

Distractible - improvement in performance with dual tasking

Entrainable - symptoms can be altered (with cueing from PT - “copy me”)

Suppressible - symptoms can be stopped

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13
Q

FND is NOT a diagnosis of ___.

A

exclusion

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14
Q

T or F: FND is NOT a purely psychiatric condition. It does not require a psychiatric history or comorbidity.

A

T

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15
Q

DSM-5 Criteria

A

> or = 1 symptom of altered voluntary motor or sensory function

Incompatibility between symptom and recognized neurological or medical conditions

Psych comorbidity or prior stressful life event NOT required or enough for diagnosis w/o “rule in” signs

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16
Q

What aspects of a patient’s history would clue you into FND?

A

Waxing / waning

Can have complete remission at times

Altered types of movements

Migration through body

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17
Q

What objective observations related to tremors are seen in a patient with FND?

A

“Whack-A-Mole” Sign - suppression of tremor in affected area will cause it to pop up in another area of the body

Varying frequency and / or direction of tremor

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18
Q

Hoover’s Sign

A

Weakness of hip extension / flexion that decreases with contralateral activation (resistance)

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19
Q

Prompting a patient to pay attention to their body ___ abnormal movement or weakness.

A

increases

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20
Q

Test Observations in FND Patients

A

Drift w/o pronation (hands held up in supination - affected arm will go straight down rather than doing so in combination with pronation)

Cocontraction around jt w/o spasticity

Collapsing weakness

Delayed / excessive startle

Changing pattern of sensory loss or midline splitting down sternum (loss on one side of the body)

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21
Q

What gait abnormality is associated with FND?

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A

“Walking on ice” / “dragging leg” without circumduction

22
Q

Speech Alterations Related to FND

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A

Over mouthing

Excessive / exaggerated eye blinking

Facial contortions

Effortful breathing

23
Q

FND vs. Non-FND: Onset

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A

FND - sudden

Non-FND - typically slow onset

24
Q

FND vs. Non-FND: Weakness Patterns

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A

FND - global weakness (no pattern)

Non-FND - CNS or PNS patterns of sensory or motor loss

25
FND vs. Non-FND: Suppressibility
FND - suppressible Non-FND - not truly suppressible (may change with medications)
26
Which category of diagnosis will sometimes present with periods of full remission, FND or Non-FND?
FND
27
What diagnoses often accompany criteria related to FND?
Autism EDS / Hypermobility Chronic Pain CRPS / Fibromyalgia (both triggered by peripheral nerve injury and present with hyperalgesia and allodynia)
28
FND Constructs and Neural Circuits
Agency - TPJ-Based Circuit Emotion Processing - Salience and Limbic Circuits Attention - Fronto-Parietal Circuits
29
What areas of the brain experience abnormal activation in the case of FND?
SMA (motor preplanning) R Temporo-Parietal Junction (rTPJ) - feedforward signaling and self agency (predictive brain) Increased activity in Cingulate Gyrus (self monitoring and motor inhibition)
30
What two things related to behavior are impaired in people with FND?
Agency and Attention
31
Agency Abnormalities
Agency Def - Being the one carrying out / controlling your own actions Predictions are abnormally strong and overpower contradictory sensory info (e.g., thinking your coffee cup is light and not initiating enough force) TPJ / prefrontal cortex / cerebellum
32
Attention Abnormalities
*Misdirected attention* is hallmark issue Increased awareness of symptoms / body parts with less to non-affected body parts
33
FND patients will experience a change in Interoception. What does this mean / what does this affect?
Interoception - the process by which NS interprets and integrates internal body signals (monitoring body's internal state)
34
FND patients will experience both __ and ___ awareness.
heightened - feeling blood running throughout brain reduced - forgetting to eat
35
FND patients will have lower accuracy with ___ and ___ recognition.
HR - feel like heart is racing postural sway - believe that they are losing their balance when they are not
36
How is sensory processing impaired in the case of patients with FND?
Altered perception, changes in how sensory signals are prioritized Sensory sensitivity and sensory avoiding behaviors Decreased sensory attenuation (inability to tune out or reduce info)
37
Patients with FND see an increase in ___ neuron activation.
*mirror* Brain cells that fire equally to task performance and watching someone else perform the same task
38
FND is associated with hyper-activation of the Amygdala. What are the implications of this?
Increased functional connections between salience / limbic areas and motor planning areas Heightened arousal and avoidance (w/o presence of a trigger)
39
Autonomic NS Symptoms of FND
Low HR variance Increased resting HR (decreased parasympathetic activity) Abnormal biomarkers (increased cortisol / c-reactive protein) Hyperactive startle Increased arousal
40
4 Core Areas of PT Intervention in Patients with FND
*Education* Retraining movement w/ diverted attention Demonstration that normal movement can occur Changing maladaptive behavior related to symptoms
41
The goal of rehab in patients with FND is to focus on ___, NOT ___.
task (function), self
42
Most Common Motor and Non-Motor Symptoms in Patients with FND
Motor - fatigue / weakness / decrease in balance Non-Motor - somatosensory and cognitive symptoms
43
When conducting a subjective assessment, what should you prioritize if you suspect / are aware of FND?
Most problematic symptom if there are multiple Overall pt goals Understand threats / danger signals for symptoms Beginning of story at onset
44
Predisposing Factors (Subjective Assessment)
Trauma Family / friends with neuro conditions Key life stressors Personality Repetitive tasks / requirements (time on task) Original injury - ortho issue / hypermobility (EDS)
45
Sensory Symptoms to Watch Out For
Numbness / tingling / sensitivity to certain sensations "I can't feel my ... " Body part disconnected from themselves or has a mind of it's own Symptoms aggravated or alleviated by sensory stimuli Difficulty moving body the way they want it to move Symptoms flare / fatigue in particular environment
46
COMPASS-31
Autonomic OM Composite Autonomic Symptom Score Especially HR variance and orthostatic hypotension
47
Patient Specific Functional Scale
OM related to patient goals
48
How can we "unlock" automatic movements?
Adding external focus (prompting achievement of goal through indirect prompting) and enhanced expectations Adding manual or cognitive dual task
49
Graded Exposure
Gradually exposing person from least to more provoking stimuli (keeping things goal oriented) Can be sensory input or motor tasks
50
Sensory Ladder
Red - freeze Orange - over alert (grouchy / irritable / defensive) Green - calm and alert (where we learn and remember best) Blue - under alert (awake but brain not fired up yet) Purple - asleep
51
Exercise program for patients with FND should be ___.
graded
52
How does aerobic exercise impact the brain?
Aerobic increases Brain-Derived Neurotrophic Factor (BDNF) - enhances motor learning - facilitates neuroplasticity

Neuromuscular PT II (9 decks)

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