What is Functional Neurological Disorder (FND)?
Functional Neurological Disorder (FND) is a diagnosis of a collection of symptoms such as weakness, abnormal movements, sensation changes, cognitive changes and seizures that result from a problem with the functioning of the nervous system and how the brain and body send and receive signals. The Rehab Team’s monthly blog focuses on highlighting this common neurological condition. Our team of Neurological Physiotherapist’s based in Papamoa and Tauranga highlight what FND is, how it is diagnosed and what essential rehabilitation looks like.
Functional Neurological Disorder isa condition caused by alterations in the functioning of brain networks rather than abnormalities in brain structure (Hellet, 2022). It is the second most common neurological diagnosed made in neurology clinics in the states (Fobian & Elliott, 2019). FND is often described using the hardware vs software analogy. Imagine that your brain is a computer in which the physical components of your brain are the computer hardware and how different parts of your brain communicate with each other are the software (or an operating system i.e. Windows, Mac OSX). The hardware and software communicate and work together to help function and interact with the environment. FND is an issue with the software of the brain. This can cause a disruption in the way the hardware and software communicate with each other and can cause the hardware to function abnormally and react differently to the environment.
Why has this happened to me?
FND is caused by a complex interaction of physical, psychological, sensory, movement control (motor control), lifestyle factors and autonomic influences in the brain.
There can be several underlying biopsychosocial factors which play a role in the development of FND. Some of these factors contribute to making the brain vulnerable, triggering FND episodes and preventing people from getting better. Injury and pain can be a common trigger for FND flare-ups. Anxiety, depression and traumatic life experiences can also contribute to making brains more vulnerable to FND. However, it is possible to be diagnosed with FND and not have any of these underlying risk factors.
What are the symptoms of FND?
People living with FND can experience a wide variety of symptoms. These can include weakness, sensory changes, cognitive changes, dissociative attacks, involuntary movements, walking and balance disturbances, speech and visual changes to name a few.
FND symptoms can be described as appearing suddenly and progressing rapidly. Symptoms can also fluctuate, resulting in complete remission of symptoms followed by flare-ups and sudden recurrences.
How is Functional Neurological Disorder diagnosed?
FND is not a diagnosis of exclusion but is based on positive clinical findings like the Hoover Test and Entrainment Test. FND is most commonly diagnosed by a Neurologist following a referral from your GP. After diagnosis, immediate referral for rehabilitation is advised - the smaller the time between symptom onset and diagnosis, the better the rehab outcomes.
The Rehab Team’s Neurological Physiotherapists often assist in the referral process to Neurologists if this is required for our clients.
Functional Neurological Disorder treatment and rehabilitation
The evidence for FND treatment is small but rapidly growing as the international awareness of FND grows too. Current recommendations for FND treatment include:
-A clear diagnosis of FND is a timely manner with immediate referral for rehabilitation is best. It is now known that improvements in FND can occur, and at times recovery, with the correct rehabilitation.
-Gaining a good understanding of what FND is and your individual condition is important in optimising recovery.
-It is important to find your “'rehab team’’. This may have been completed by your Neurologist when you were diagnosed, however if no rehabilitation referrals were completed, it is important for you to find your own clinician that is experienced in FND. Depending on your symptoms, you may have a Neurological Physiotherapist, Psychologist, Occupational Therapist or Speech Therapist in your team. The Rehab Team works alongside a wider team of professional to assist clients in their FND rehab.
-In The Rehab Team’s Neurological Physiotherapy appointments, we often focus on:
A thorough assessment of your FND symptoms and any changes within the different areas that FND can impact - Physical, Motor control, Sensory, Lifestyle, Autonomic and Psychosocial. Based on what comes in the assessment will determine what your treatment will look like.
We work out how to encourage normal, automatic movement patterns - Afterall, FND is associated with an error in the way the brain’s neural networks communicate. If we can encourage automatic movement we can see a significant improvement in movement.
We determine if any FND triggers may be making your symtpoms worse.
If you are experiencing Functional Seizures - we set up an individualized pre-seizure plan to try to prevent seizures from starting. If this is not successful we give you strategies to use to get through your seizure in an easier and at times quicker way.
We slowly progress these exercises based on YOUR FND symptoms. This type of exercise is very different to the way you would progress exercises when trying to strengthen muscles (say after an ankle injury).
Before you leave our support, we provide you with a self-management plan so you have the skills to manage any potential FND flare ups you may have in the future.
Functional Neurological Disorder is a common neurological condition. It’s awareness and support within New Zealand is slowly growing. The Rehab Team is here to help support and provide rehabilitation to people diagnosed with FND - we see clients in our Papamoa Clinic or within their own homes within the Papamoa, Tauranga and Mount Maunganui regions. Please reach out to book an appointment - Here.
Want to read more?
Have a read of another FND blog - Seven myths in FND here.
Read our other blogs here.
References
Bennet et al., (2021). A practical review of functional neurological disorder (FND) for the general physician. doi: 10.7861/clinmed.2020-0987
Fobian & Elliott., (2019). A review of functional neurological symptom disorder etiology and the integrated etiological summary model. DOI: 10.1503/jpn.170190
Hallet et al., (2022). Functional neurological disorder: new subtypes and shared mechanisms. DOI: 10.1016/S1474-4422(21)00422-1
