Physical rehabilitation for Functional Neurological Disorder- 1

Question 1

What does FND stand for?

Answer 1

Functional Neurological Disorder

Question 2

What does FMD stand for?

Answer 2

Functional Movement/Motor Disorder

Question 3

What FND used to describe?

Answer 3

-Used to describe when there is a problem with the function of the nervous system while the structure nervous system is still intact

Question 4

What does DSM 5 and ICD 11 stand for?

Answer 4

• Conversion Disorder

- Dissociative Neurological Symptom Disorder

Question 5

How are FND usually described?

Answer 5

-Using their phenomenology

Question 6

What are the 4 phenomenological symptoms?

Answer 6

• Motor
• Sensory
• Functional
• Cognitive

Question 7

What are examples of motor symptoms?

Answer 7

-Tremors, weakness

Question 8

What are examples of sensory symptoms?

Answer 8

• Somatosensation- numbness or complete absence of sensation
• Persistent Perceptual Postural Dizziness
• Visual symptoms- functional blindness

Question 9

What are functional seizures also known as?

Answer 9

-dissociative seizures / non-epileptic attacks

Question 10

What are typical presentations of FMD?

Answer 10

▪ Weakness/paralysis 
▪ Tremor
▪ Gait Disturbance
▪ Jerks
▪ Dystonia
▪ Fixed Dystonia

Question 11

What is the criteria for stroke?

Answer 11

• Facial asymmetry
• Arm weakness
• Speech problems

Question 12

What is facial asymmetry due to in stroke?

Answer 12

• Due to hypertonia
• Loss of muscle tone
• Weakness in facial muscle

Question 13

Most patients have a combination of neurological and what functional systems?

Answer 13

• fatigue
• persistent pain bladder
• bowel problems

Question 14

What is the epidemiology of FND?

Answer 14

• Incidence of FND 4-12 per 100,000 per year
• Prevalence approx. 50 per 100,000
• 60-75% female

Question 15

What is prognosis of FND?

Answer 15

• Poor
• 40% same or worse at 7 years follow up
• Most patients remain symptomatic

Question 16

What about FND is unknown?

Answer 16

-The impact of appropriate treatment on prognosis is unknown

Question 17

What is FMD?

Answer 17

• Disorder of sensorimotor processing

- Top-down expectations distort bottom-up somatosensory experiences

Question 18

What is FMD facilitated by?

Answer 18

-Facilitated by excessive attention directed towards the body

Question 19

What do functional motor symptoms require to manifest?

Answer 19

-Attention

Question 20

What drive functional symptoms?

Answer 20

-Expectations

Question 21

What are the biological risk factors?

Answer 21

• History of illness
• Disease
• Hypermobility

Question 22

What are the psychological risk factors?

Answer 22

• Adverse life events
• Personality traits
• Emotional disorder

Question 23

What are the social risk factors?

Answer 23

• Neglect
• Family dynamics
• Illness models

Question 24

What are the biological triggering factors?

Answer 24

• Injury or illness

- Physiological event

Question 25

What are the psychological triggering factors?

Answer 25

- Acute panic attack | - Dissociative episode

Question 26

What are the social triggering factors?

Answer 26

- Live events | - Social stressors

Question 27

What are the biological maintaining factors?

Answer 27

- Neuroplasticity - Deconditioning - Neuroendocrine & immune changes

Question 28

What are the psychological maintaining factors?

Answer 28

- Illness beliefs - Avoidance behaviour - Fear / anxiety

Question 29

What are the social maintaining factors?

Answer 29

- Financial pressures - Employment issues - Excessive support

Question 30

What are the five Multidisciplinary care units in the UK?

Answer 30

- Neurology and Neuropsychiatry - Psychology - Physiotherapy - Occupational Therapy - Speech & Language Therapy

Question 31

What are some of the outcomes of Multidisciplinary rehab?

Answer 31

- Patients reported significant benfit that lasts up to a year - Many patients still symptomatic

Question 32

What the 6 components of physical rehab?

Answer 32

``` ▪ Education ▪ Movement retraining ▪ Address secondary problems e.g. pain, fatigue, etc ▪ Self management ▪ Vocational rehabilitation ▪ Follow up ```

Question 33

What are some of the outcomes of physical rehab?

Answer 33

- 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)

Question 34

What model does CBT utilise?

Answer 34

- Use the model that involves an understanding of the thoughts, behaviour, bodily sensations and emotions in order to help patients understand their condition

Question 35

What are some examples of experimental treatments?

Answer 35

- Transcranial Magnetic Stimulation - Biofeedback / EMG Biofeedback - Hypnosis - Therapeutic Sedation - Virtual Reality

Question 36

What is the purpose of movement and posture retraining?

Answer 36

- To address maladaptive habitual postures | - To retrain movement patterns / tasks