Functional Movement Disorder (FMD).pdf

FUNCTIONAL MOVEMENT DISORDER DPT 6410 J.J. Mowder-Tinney PT, PhD, NCS Identify the diagnostic criteria and differential diagnosis of Functional Movement Disorders (FMD). Learning Objectives Review strategies to assess FMD Describe the optimal approach to provide a comprehensive intervention Problem...

FUNCTIONAL MOVEMENT DISORDER DPT 6410 J.J. Mowder-Tinney PT, PhD, NCS Identify the diagnostic criteria and differential diagnosis of Functional Movement Disorders (FMD). Learning Objectives Review strategies to assess FMD Describe the optimal approach to provide a comprehensive intervention Problem with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process such as multiple sclerosis or stroke. A condition interacting between the specialties of neurology and psychiatry. These symptoms become ‘stuck’ in a ‘pattern’ in the nervous system resulting in altered brain functioning. – fMRI scans show changes in patients with FND which look different from healthy patients Functional Neurological Disorder What is Functional Neurological Disorder FMD CRPS PNES (psychogenic nonepileptic seizures) 3PD (persistent posturalperceptual dizziness) Fobian AD, Elliott L. A review of functional neurological symptom disorder etiology and the integrated etiological summary model. Journal of psychiatry & neuroscience: JPN. 2019 Jan;44(1):8. Functional Movement Disorder (FMD) Examples have been given to consider this a software problem while the hardware is intact. – Examples of potential triggering factors include physical injury, infectious illness, panic attack Is an involuntary habitual movement pattern that is learned and driven by abnormal self-directed attention. Treatment focuses on retraining movements and redirecting from unhelpful illness beliefs and behaviors. – Consider the larger biopsychosocial framework Nielsen G. Physical treatment of functional neurologic disorders. Handbook of Clinical neurology. 2016 Jan 1;139:555-69. How can I explain this to my patient? This article includes two videos – Video 1: Looks at common pitfalls of explanation of FMD, including failure to make a positive diagnosis and jumping to conclusions about psychological factors. It helps name the condition and explain how the physical signs, such as the tremor entrainment test, lead to the diagnosis. – Video S2: Uses clips from patients with FMD to explore how it is possible to explain functional limb weakness and functional dystonia to a patient. We discuss the follow-up visit, and the importance of assessing patient's confidence in the diagnosis and readiness for further treatment referral. Prognosis is improving as understanding the condition is improving It is important to – Accurately and timely diagnose – Decrease stigma of a psychological or conversion disorder – Improve educated and accurately focus treatments. LaFaver K. Treatment of functional movement disorders. Neurologic clinics. 2020 May 1;38(2):469-80. Clinical Signs and Options to Assess Hoover’s Sign Hip Abductor Sign Entrainment of a Tremor The patient may have difficulty pushing their “bad” leg down (hip extension), but when they are asked to lift up their “good” leg. Movement in the “bad” leg returns transiently to normal. Weakness of hip abduction which returns to normal with contralateral hip abduction against resistance. This is when the shaking of an arm or leg becomes momentarily better when the person concentrates on copying a movement that the examiner makes Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. Journal of psychosomatic research. 2013 Aug 1;75(2):93-102. Nielsen G, Stone J, Matthews A, Brown M, Sparkes C, Farmer R, Masterton L, Duncan L, Winters A, Daniell L, Lumsden C. Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry. 2015 Oct 1;86(10):1113-9. WHAT IS THE GOAL? Retrain the brain A systematic review utilizing 28 case series or reports with 373 patients describing interventions. Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. Journal of psychosomatic research. 2013 Aug 1;75(2):93-102. Summary of Optimal Activities Motivational Interviewing – Review the cueing used with patients OPTIMAL theory – Enhanced Expectancy – Autonomy – External Focus Neuroplasticity Sleep Biopsychological understanding and intervention Wellness and Fitness