Functional Neurological Disorder (FND) is a complex neurological condition with multifactorial symptoms that can be debilitating, including seizures, paralysis, hearing loss, double vision, memory problems, chronic pain and fatigue.
The most effective way to adequately address the needs of people with FND is through a multidisciplinary therapy strategy that includes psychotherapy, physiotherapy and occupational therapy.
In this blog, we take a closer look at the role of occupational therapy in FND rehabilitation, which addresses challenging and often debilitating cognitive deficits.
Table of Contents
- What is FND
- What causes FND
- Most common symptoms of FND
- The multidisciplinary treatment approach
- The role of occupational therapy in FND rehabilitation
- The holistic impact of occupational therapy
What is FND?
For many years, FND was misdiagnosed as hysteria, conversion disorder, or somatization. This led to a great deal of irritation and disbelief among FND patients, as well as the medical community, which was ill-prepared to understand this condition.
FND is a disruption of the signals between the brain and the body but the structures of the brain and nervous system are intact. It is a disorder of how the brain and body communicate and some of its symptoms don’t fit the pattern of a recognized neurological condition or show up naturally in test findings.[i][ii] Although these symptoms are not related to other diagnoses, it is very debilitating to a person’s quality of life.
The incidence of FND is equivalent to the prevalence of Multiple Sclerosis in the general population in Canada.
What causes FND?
Only after 2019, FND was validated as a multifactorial condition expressed by various symptoms that do not necessarily follow the same pattern. However, to reach a diagnosis of FND, the individual needs to present with one or more symptoms that alter motor or sensory function. This can be caused by a physical or psychological insult that had happened any time across the lifespan and was precipitated causing a functional disorder between the brain and the body.
Patients frequently describe a triggering event, such as a stressor, accident, or disease, following which they develop long-term neurological impairments. However, it is important to note that although FND is sometimes referred to as “stress-induced” or “psychosomatic,” many of its sufferers do not have a single, identifiable stressor or underlying mental illness.[iii]
Some predisposing factors may include being female, having a pre-existing neurological or psychiatric disease, and a history of trauma.
Most common symptoms of FND
The most common symptoms observed in the FND clients can be divided into [iv]
- Motor Symptoms:
- Weakness or paralysis in one or more limbs.
- Tremors, spasms, or jerky movements.
- Difficulty with coordination or balance.
- Sensory Symptoms:
- Numbness or tingling sensations.
- Vision changes, double vision
- Loss of hearing or hypersensitivity
- Seizures or Episodes:
- Non-epileptic seizures (sometimes called psychogenic seizures), which look similar to epileptic seizures but do not have the same electrical brain activity.
- Cognitive Symptoms:
- Cognitive issues, such as memory problems or difficulty concentrating.
- Memory problems
- Mental fatigue
- Brain fog
- Other Symptoms:
- Chronic pain, fatigue, or headaches.
- Speech difficulties, such as slurred or stuttered speech, increased effort with speech.
The cognitive deficits are often the most challenging and debilitating during the rehabilitation process due to the impact in multiple areas of the daily routine including personal care, work related activities, social and recreational life.
The Multidisciplinary Treatment Approach
The evidence of best practice to treat FND is a multidisciplinary approach addressing mind – body, brain health function with the context of the individual. It is designed after an individualized assessment of the client’s function and understanding of the motor/sensory symptoms experienced by the client.
A physiotherapist, occupational therapist, and psychologist are frequently required to provide the most comprehensive treatment approach due to the complexity and multifactorial symptoms.
It is important to provide a safe, and comfortable environment for the treatment where the client can participate with reduced stress, feeling heard by clinicians that are curious about the symptoms and not judgmental. The literature demonstrated that the validation of the symptoms and the understanding of the rehabilitation process is a big part of the recovery process.
The Occupational Therapy Approach to FND
Occupational therapists play an important role when treating FND addressing cognitive challenges such as memory, focus, or organization issues with the intention to restore independence.
Key elements of the OT approach include:
- Pacing and Activity Analysis Fatigue and pain are common in FND and can exacerbate cognitive and physical symptoms. Occupational therapists work with clients to analyze daily routines, identify stressors, and implement pacing strategies. These techniques help clients:
- Balance activity and rest.
- Reduce the nervous system’s load.
- Prevent symptom flare-ups.
- Memory and Organizational Aids Cognitive deficits, such as memory loss and poor focus, are often significant barriers to daily functioning. Therapists introduce practical tools and strategies, such as:
- Memory aids (e.g., planners or smartphone reminders).
- Step-by-step routines for complex tasks.
These interventions help reduce frustration, enhance confidence, and support clients in managing daily demands.
- Sensory and Emotional Regulation Sensory and emotional triggers can interfere with cognitive and physical abilities. Occupational therapists collaborate with psychologists or psychiatrists to:
- Identify and address triggers.
- Develop coping mechanisms for stress and sensory overload.
- Foster emotional resilience.
The Holistic Impact of Occupational Therapy
Functional Neurological Disorder (FND) can be a complex and life-altering disorder, but it responds well to the correct treatment approach. A thoughtful, multidisciplinary approach, with occupational therapy playing a pivotal role can address the interconnected nature of physical, cognitive, and emotional challenges. By focusing on individual needs and fostering a supportive environment, OT empowers clients to:
- Gain greater control over their symptoms.
- Reclaim independence in daily activities.
- Improve their quality of life.
Through tailored interventions that address the root functional disconnects, individuals with FND can achieve meaningful recovery and regain confidence in their abilities to live fulfilling lives.
References
[i] Roelofs JJ, Teodoro T, Edwards MJ. Neuroimaging in Functional Movement Disorders. Current Neurology and Neuroscience Reports. 2019;19(3):12.
[ii] Perez DL, Edwards MJ, Nielsen G, Kozlowska K, Hallett M, W Curt LaFrance J. Decade of progress in motor functional neurological disorder: continuing the momentum. Journal of Neurology, Neurosurgery & Psychiatry. 2021 Jun 1;92(6):668–77.
[iii] Peeling JL, Muzio MR. Conversion Disorder [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020.
[iv] Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., … & Morgante, F. (2018). Current concepts in diagnosis and treatment of functional neurological disorders. JAMA neurology, 75(9), 1132-1141.
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