Physical therapy for functional neurological disorder Flashcards
(25 cards)
stressful life events and fnd
people with fnd are 5.6 times more likely to have experienced childhood neglect
and
3.9 times more likely to have experienced childhood abuse
precipitating physical events
80% of pt report a physical event shortly preceding the onset of fmd
what is the neurobiological
understanding of FND
based on the theory of the brain working by predictive coding
sx are considered errors of predictive processing
Top-down expectations distort bottom-up
somatosensory experiences
this process is facilitated by excessive self-directed attention
what is the role of attention in FND
Attention exacerbates functional symptoms
Redirection of attention dampens or resolves the symptom
what interferes with intention
abnormal DLPFC connectivity
what interferes with movement planning
SMA abnormal connectivity
what interferes with movement generation
hypoactivity in the basal ganglia despite normal M1 (primary motor cortex)
what is the framework for understanding fnd pathophysiology
symptoms
constructs e.g. prediction, agency, emotional processing, attention
neural circuits e.g. TPJ based circuits (agency)
limbic circuits (emotional processing)
dx of fnd
rule in positive dx based on evidence from
- clinical hx
- validated neurological signs
- inconsistent or incongruent sx
what is the gold standard of tx
multidisciplinary care
recommendations for rehab tx for fnd
initial ax
education
movement and posture retraining
addressing secondary problems
supporting self mx
follow up
two elements of physical ax of fnd
subjective hx and clinical examination
parasympathetic division
the rest and digest response
sympathetic division
the fight or flight response
what is movement retraining
Motor symptoms can be considered as learnt patterns of movement driven by attention & expectation
what is the aim of movement retraining
Demonstrate and facilitate the experience of normal movement
steps of movement retraining
Automatic movement
Retrain activity not impairment
Redirect attention
Mirror feedback
Sequential motor learning approach
Guided exploration
which postures should be readdressed
maladaptive resting postures
name for functional dizziness
persistent postural perceptual disorder (pppd)w
what is CBT based rehab for PPPD
- CBT formulation for sx
- Exploring illness beliefs
- Exercises aimed at normalising maladaptive postural strategies
- Habituation
- Graded activity
- Relaxation
how do we support self mx of fnd post therapy
- FND Info
- Symptom formulation
- Treatment strategies
- Pain & fatigue management
- Treatment goals
- Progressions
- Plans for setbacks
tx principles
Avoid passive treatments
Avoid and wean adaptive aids where possible
Work on activities not impairments
Movement retraining with Redirection of attention
Maximise independence with activities and mobility
Agree to treatment terms at the beginning
Involve family
Address pain and fatigue
Self Management
One size does not fit all
treatment adjuncts
Non-specific exercise
Mirrors & Video
Pain & fatigue management
Functional Electrical Stimulation
TENS
EMG Biofeedback
Therapeutic sedation / EUA
TMS
Hypnosis
Group interventions
evaluation of splinting and mobility aids
avoid splints where possible
- Change patterns of movement patterns
- Can cause secondary sources of pain
- Can draw attention to an area → sx exacerbation
- May limit progress
