Physical Rehabilitation of Motor Functional Neurological Disorders: A Narrative Review

Functional Neurological Disorders (FNDs) are one of the most common and disabling neurological disorders, affecting approximately 10–30% of patients in neurology clinics. FNDs manifest as a range of motor, sensory, and cognitive symptoms that are not explained by organic disease. This narrative review aims to assess the current state of knowledge in physical-based rehabilitation for motor/movement FNDs in the adult population, with the goal of improving research and medical care for this patient population. To ensure optimal outcomes for patients, it is critical to consider several domains pertaining to FNDs, including which field of discipline they should belong to, how to investigate and test, methods for rating outcome measures, and optimal courses of treatment. In the past, FNDs were primarily treated with psychiatric and psychological interventions. However, recent literature supports the inclusion of physical rehabilitation in the treatment of FNDs. Specifically, physical-based approaches tailored to FNDs have shown promising results. This review utilized a comprehensive search of multiple databases and inclusion criteria to identify relevant studies.

[1]  N. Smania,et al.  Improvement in motor symptoms, physical fatigue, and self-rated change perception in functional motor disorders: a prospective cohort study of a 12-week telemedicine program , 2022, Journal of Neurology.

[2]  M. Hallett,et al.  Functional neurological disorder: new subtypes and shared mechanisms , 2022, The Lancet Neurology.

[3]  B. Dworetzky,et al.  Development of an inpatient rehabilitation pathway for motor functional neurological disorders: Initial reflections. , 2022, NeuroRehabilitation.

[4]  Caitlin Geary Physical therapy interventions in an inpatient rehabilitation setting for functional neurological disorder: A case series. , 2022, NeuroRehabilitation.

[5]  G. Baslet,et al.  A historical review of functional neurological disorder and comparison to contemporary models , 2021, Epilepsy & behavior reports.

[6]  J. Muhrer Functional Neurological Disorder: Overview and a Case Study , 2021, The Journal for Nurse Practitioners.

[7]  Francesco Brigo Jean-Martin Charcot (1825-1893) and his second thoughts about hysteria. , 2021, Arquivos de neuro-psiquiatria.

[8]  A. Carson,et al.  A practical review of functional neurological disorder (FND) for the general physician. , 2021, Clinical medicine.

[9]  Jay M. Behel,et al.  Multidisciplinary inpatient rehabilitation for Functional Movement Disorders: A prospective study with long term follow up. , 2020, Parkinsonism & related disorders.

[10]  C. Lungu,et al.  Assessment of Emergency Department and Inpatient Use and Costs in Adult and Pediatric Functional Neurological Disorders. , 2020, JAMA neurology.

[11]  M. Tinazzi,et al.  A physical therapy programme for functional motor symptoms: A telemedicine pilot study. , 2020, Parkinsonism & related disorders.

[12]  M. Hallett,et al.  Outcome Measures for Functional Neurological Disorder: A Review of the Theoretical Complexities. , 2019, The Journal of neuropsychiatry and clinical neurosciences.

[13]  A. Hardin,et al.  Interdisciplinary Treatment of Functional Neurological Symptom Disorder in an Inpatient Rehabilitation Setting: A Case Report , 2019, PM & R : the journal of injury, function, and rehabilitation.

[14]  L. Goldstein,et al.  Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda , 2018, Journal of Neurology, Neurosurgery, and Psychiatry.

[15]  Mark Hallett,et al.  Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders , 2018, JAMA neurology.

[16]  Tazvin Ijaz,et al.  Psychometric properties of Conversion Disorder Scale- Revised (CDS) for children. , 2017, JPMA. The Journal of the Pakistan Medical Association.

[17]  M. Edwards,et al.  A Simplified Version of the Psychogenic Movement Disorders Rating Scale: The Simplified Functional Movement Disorders Rating Scale (S‐FMDRS) , 2017, Movement disorders clinical practice.

[18]  A. Carson,et al.  Chapter 5 - Epidemiology , 2016 .

[19]  M. Edwards,et al.  Randomised feasibility study of physiotherapy for patients with functional motor symptoms , 2016, Journal of Neurology, Neurosurgery & Psychiatry.

[20]  A. Carson,et al.  Functional neurological disorders: mechanisms and treatment , 2016, Journal of Neurology.

[21]  M. Hallett,et al.  Functional disorders in the Neurology section of ICD-11 , 2014, Neurology.

[22]  A. David,et al.  Physiotherapy for functional motor disorders: a consensus recommendation , 2014, Journal of Neurology, Neurosurgery & Psychiatry.

[23]  J. Guérit Neurophysiology of conversive disorders , 2014, Neurophysiologie Clinique/Clinical Neurophysiology.

[24]  Karl J. Friston,et al.  Loss of sensory attenuation in patients with functional (psychogenic) movement disorders. , 2014, Brain : a journal of neurology.

[25]  Rachel Davis,et al.  DSM-5 Handbook of Differential Diagnosis , 2014 .

[26]  O. Klungsøyr,et al.  Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up. , 2014, Journal of rehabilitation medicine.

[27]  J. Rowe,et al.  Imaging Psychogenic Movement Disorders , 2013, Current Neurology and Neuroscience Reports.

[28]  M. Edwards,et al.  The prognosis of functional (psychogenic) motor symptoms: a systematic review , 2013, Journal of Neurology, Neurosurgery & Psychiatry.

[29]  Richard S. J. Frackowiak,et al.  The functional neuroimaging correlates of psychogenic versus organic dystonia , 2013, Brain : a journal of neurology.

[30]  M. Tijssen,et al.  The bereitschaftspotential in jerky movement disorders , 2012, Journal of Neurology, Neurosurgery & Psychiatry.

[31]  P. Mortensen EPIDEMIOLOGY , 2012, Schizophrenia Research.

[32]  M. Hallett,et al.  Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder , 2011, Movement disorders : official journal of the Movement Disorder Society.

[33]  R. Renken,et al.  Abnormal Parietal Function in Conversion Paresis , 2011, PloS one.

[34]  P. Haggard,et al.  Abnormal sense of intention preceding voluntary movement in patients with psychogenic tremor , 2011, Neuropsychologia.

[35]  David T. Jones,et al.  SPECT perfusion patterns distinguish psychogenic from essential tremor. , 2011, Parkinsonism & related disorders.

[36]  Antonio Gambardella,et al.  Rating scale for psychogenic nonepileptic seizures: Scale development and clinimetric testing , 2011, Epilepsy & Behavior.

[37]  M. Hallett,et al.  The involuntary nature of conversion disorder , 2010, Neurology.

[38]  Sue Leurgans,et al.  Rating scale for psychogenic movement disorders: Scale development and clinimetric testing , 2005, Movement disorders : official journal of the Movement Disorder Society.

[39]  R. Heruti,et al.  Conversion motor paralysis disorder: overview and rehabilitation model , 2002, Spinal Cord.

[40]  M. Delargy,et al.  Successful rehabilitation in conversion paralysis. , 1986, British medical journal.

[41]  C. W. Wynn Parry,et al.  Rehabilitation of conversion paralysis. , 1985, The Journal of bone and joint surgery. British volume.

[42]  H. Hafeiz Hysterical Conversion: a Prognostic Study , 1980, British Journal of Psychiatry.

[43]  M. Trimble,et al.  A brief history of hysteria: From the ancient to the modern. , 2016, Handbook of clinical neurology.

[44]  A. David,et al.  Emotion-Motion Interactions in Conversion Disorder: An fMRI Study , 2015 .

[45]  P. Calabrese,et al.  Hysteria around the world. , 2014, Frontiers of neurology and neuroscience.

[46]  Tazvin Ijaz,et al.  Development of Conversion Disorder Scale for Children , 2014 .

[47]  A. David,et al.  Neural correlates of recall of life events in conversion disorder. , 2014, JAMA psychiatry.

[48]  T. D. Stewart Hysterical conversion reactions: some patient characteristics and treatment team reactions. , 1983, Archives of physical medicine and rehabilitation.

[49]  J. Stone Functional Disorders , 2022 .