What is Functional Neurological Disorder?
Functional Neurological Disorder (FND) is a medical condition affecting the functioning of the nervous system and how the brain and body send, receive and interpret signals. Although it presents with similar characteristics as a stroke there is no structural disease, such as dead brain tissue. FND was neglected by researches and clinicians for a significant amount of time, as it debatably involves both psychiatry and neurology. Some physical/psychological risk factors can cause FND, such as significant trauma or stressful life events both recent and in early childhood. Physical signs of FND could include; paralysis, fatigue, reduce balance, pain, seizures, significant weakness, seizures and paraesthesia. In recent MRI studies it was found that patients with FND have reduced functional connectivity in areas of their brain in comparison to other active healthy parts of their brain. Although these studies don’t determine predisposing factors to developing the disorder, they propose an inability in function between voluntary and automatic motor function.
With limited evidence and high incidence of this condition, how can physiotherapist guide their treatment? Experts of the disorder advocate a multidisciplinary approach to treatment due to the wide variety of presentations of the disorder. A multidisciplinary team is a group of healthcare professionals from difference disciplines which guide the activities of the team through a care plan e.g. Physiotherapists, Psychiatrists, Occupational Therapists, Speech Pathologists, etc. This enables a patient-centred approach towards each individual’s presenting symptoms. Treatment is based upon retraining neural pathways through training of repetitive normal movements to replace abnormal patterns of movements. Treatment can also include pharmacological options to treat other symptoms, such as seizures or cognitive behavioural therapy. Although it is essential for further research to guide treatment and explain the origin of this disorder, as Physiotherapists treatment should be tailored to patient’s specific needs and goals.