NeuroRehabilitation - Volume 50, issue 2

Authors: Mark, Victor W.

Article Type: Introduction

DOI: 10.3233/NRE-228001

Citation: NeuroRehabilitation, vol. 50, no. 2, pp. 165-167, 2022

Authors: Kirkwood, Brian | Mark, Victor W.

Article Type: Review Article

Abstract: BACKGROUND: Functional movement disorders (FMDs) are a common cause of disability. With an increasing research interest in FMD, including the emergence of intervention trials, it is crucial that research methodology be examined, and standardized protocols be developed. OBJECTIVE: To characterize the current inclusion criteria used to select patients for FMD research studies and review the consistency and appropriateness of these criteria. METHODS: We identified studies of potential biomarkers for FMD that were published over the last two decades and performed a qualitative analysis on the finally included studies. RESULTS: We identified 79 articles and …found inconsistent inclusion criteria. The Fahn-Williams and DSM-IV criteria were the most commonly applied, but neither accounted for the majority (Fahn-Williams 46%, DSM-IV 32% of the total). The selection of the inclusion criteria depended in part on the phenotype of FMD under investigation. We also identified inclusion methodologies that were not appropriate, such as the inclusion of low-certainty diagnoses and diagnosing by excluding specific biomarkers rather than including patients based on clinical characteristics that commonly are thought to suggest FMD. CONCLUSIONS: Significant variability exists with the inclusion criteria for FMD research studies. This variability could limit reproducibility and the appropriate aggregation of data for meta-analysis. Advancing FMD rehabilitation research will need standardized inclusion criteria. We make some suggestions. Show more

Keywords: Functional neurological disorder, rehabilitation, MRI

DOI: 10.3233/NRE-228002

Citation: NeuroRehabilitation, vol. 50, no. 2, pp. 169-178, 2022

Authors: Mark, Victor W.

Article Type: Review Article

Abstract: BACKGROUND: The term “functional neurological disorder,” or “FND,” applies to disorders whose occurrence of neurological symptoms fluctuate with the patient’s attention to them. However, many other disorders that are not called “FND” nonetheless can also follow this pattern. Consequently, guidelines are unclear for diagnosing “FND.” OBJECTIVE: To review the neurological conditions that follow this pattern, but which have not so far been termed “FND,” to understand their overlap with conditions that have been termed “FND,” and to discuss the rationale for why FND has not been diagnosed for them. METHOD: A systematic review of the PubMed …literature registry using the terms “fluctuation,” “inconsistency,” or “attention” did not yield much in the way of these candidate disorders. Consequently, this review instead relied on the author’s personal library of peer-reviewed studies of disorders that have resembled FND but which were not termed this way, due to his longstanding interest in this problem. Consequently, this approach was not systematic and was subjective regarding disease inclusion. RESULTS: This review identified numerous, diverse conditions that generally involve fluctuating neurological symptoms that can vary with the person’s attention to them, but which have not been called “FND.” The literature was unclear for reasons for not referring to “FND” in these instances. CONCLUSION: Most likely because of historical biases, the use of the term “FND” has been unnecessarily restricted. Because at its core FND is an attentionally-influenced disorder that can respond well to behavioral treatments, the field of neurological rehabilitation could benefit by extending the range of conditions that could be considered as “FND” and referred for similar behavioral treatments. Because the term “FND” has been viewed unfavorably by some patients and clinical practitioners and whose treatment is not implied, the alternative term attentionally-modifiable disorder is proposed. Show more

Keywords: Functional neurological disorder, history of neuroscience, motor, physical therapy, occupational therapy, speech-language pathology, MRI, cognitive behavioral therapy

DOI: 10.3233/NRE-228003

Citation: NeuroRehabilitation, vol. 50, no. 2, pp. 179-207, 2022

Authors: Geary, Caitlin

Article Type: Case Report

Abstract: BACKGROUND: Patients with functional neurological disorder (FND) experience a variety of symptoms that affect their functional mobility and quality of life. Physical therapy can help promote normal movement patterns and restore independence. Although consensus recommendations have been published, choosing specific interventions can be a challenge due to the heterogeneity of symptom presentation. OBJECTIVE: This case series aims to detail specific interventions for three patients with FND who were admitted to an inpatient rehabilitation facility in Boston, MA, USA. CASE REPORT: Each presented with gait disturbances as his or her primary symptom and received physical therapy at …least five times per week during the inpatient stay, as well as treatment from a multidisciplinary team. CONCLUSION: As emerging literature continues and the diagnosis is more widely accepted, specific symptom interventions may become more generalized and lead to better outcomes with this patient population. Show more

Keywords: Functional neurological disorder, physical therapy, interventions, inpatient rehabilitation

DOI: 10.3233/NRE-228004

Citation: NeuroRehabilitation, vol. 50, no. 2, pp. 209-218, 2022

Authors: Hebb, Caitlin | Raynor, Geoffrey | Perez, David L. | Nappi-Kaehler, Jill | Polich, Ginger

Article Type: Case Report

Abstract: BACKGROUND: Functional gait disorders (FGD) are a common and disabling condition. Consensus-based rehabilitation techniques for treating FGD and other functional neurological disorder presentations at large utilize a variety of therapeutic strategies, including distraction, novel approaches to movement, entrainment, stress/hypervigilance modulation, and psychotherapy. CASE REPORT: Here we present a case of a 24-year-old woman with a complex history of anxiety, depression, left frontal astrocytoma, postural orthostatic tachycardia syndrome (POTS) and FGD. During a multidisciplinary inpatient rehabilitation stay for FGD, the patient underwent rhythmic auditory stimulation (RAS) delivered by a neurologic music therapist in conjunction with physical therapy, occupational therapy, …and psychotherapy. RESULTS: The RAS intervention appeared to play a significant role in symptom resolution for this patient. Improvement in the patient’s truncal displacement, foot dragging, and well as overall gait speed occurred following serial RAS trials performed over a single treatment session. Benefits persisted immediately following the intervention and upon subsequent reassessment. Although at four-year follow-up the patient’s FGD symptoms remained resolved, fatigue continued to limit her ambulatory capacity and overall endurance. CONCLUSION: RAS represents a unique therapeutic approach for treating FGD, complementary to existing consensus-based rehabilitation recommendations, and may warrant further consideration by the field. Show more

Keywords: Functional neurological disorder (FND), functional gait disorder, rhythmic auditory stimulation (RAS), neurologic music therapy (NMT), gait training

DOI: 10.3233/NRE-228005

Citation: NeuroRehabilitation, vol. 50, no. 2, pp. 219-229, 2022

Authors: Polich, Ginger | Zalanowski, Stacey | Maney, Julie | Perez, David L. | Baslet, Gaston | Maggio, Julie | O’Neal, Mary A. | Dworetzky, Barbara | Herman, Seth

Article Type: Research Article

Abstract: BACKGROUND: Emerging research supports a primary role for rehabilitation therapy alongside psychoeducation and psychotherapy in the treatment of functional neurological disorder (FND). OBJECTIVE: While consensus recommendations for physical therapists, occupational therapists, and speech and language pathologists treating FND have been published, specific recommendations for multidisciplinary FND care delivered on an inpatient rehabilitation unit are yet to be established. METHODS: This report describes one inpatient rehabilitation facility’s efforts to design and implement a clinical pathway for patients with acute-onset motor FND—patients recently hospitalized for work-up of new neurological symptoms subsequently deemed functional. RESULTS: Detailed descriptions …on defining admission criteria and delivering consensus- and evidence-based multidisciplinary inpatient rehabilitation are provided. CONCLUSIONS: In the context of prospective research studies, considerably more work is needed to delineate the optimal duration and intensity of inpatient rehabilitation treatment for the management of patients with motor FND. Show more

Keywords: Functional neurological disorder, inpatient rehabilitation, multidisciplinary

DOI: 10.3233/NRE-228006

Citation: NeuroRehabilitation, vol. 50, no. 2, pp. 231-243, 2022

Authors: Polich, Ginger | Thompson, Jeffrey | Molton, Ivan | Herman, Seth | LaFaver, Kathrin

Article Type: Review Article

Abstract: BACKGROUND: Higher levels of care in the form of intensive rehabilitation may be appropriate for select patients with a diagnosis of functional motor disorder (FMD). Intensive rehabilitation, as delivered through an outpatient day program or through admission to an inpatient rehabilitation facility, can offer a greater frequency and variety of integrated clinical services than most lower levels of care. OBJECTIVE: Higher levels of rehabilitation for FMD have not yet been well characterized in the literature. In this article, we will focus on the population of FMD patients who begin receiving care in the outpatient setting. METHOD: …In this review, we describe a range of options for higher levels of FMD care, evaluate the supporting literature, and weigh the pros and cons of each approach. Several specific examples of intensive rehabilitation programs in the United States will be described. Finally, we will consider existing health systems barriers to each of these outpatient and inpatient higher levels of care. RESULTS: Within a stepped model of care, intensive outpatient day-programs and inpatient rehabilitation may be considered for individuals who present with complex, refractory motor deficits from FMD. For appropriately selected patients, a growing body of literature suggests that time-limited, goal-oriented intensive rehabilitation may provide an effective treatment avenue. CONCLUSION: It remains to be determined whether treatment in intensive care settings, while more costly in the short term, could lead to greater cost savings in the long term. The prospect of telemedicine rehabilitation for FND in terms of efficacy and cost also remains to be determined. Show more

Keywords: Functional neurological disorder, rehabilitation, multidisciplinary

DOI: 10.3233/NRE-228007

Citation: NeuroRehabilitation, vol. 50, no. 2, pp. 245-254, 2022

Authors: Oral, Aydan

Article Type: Other

Abstract: BACKGROUND: Stroke is the leading cause of disability among neurological disorders. Evidence-based practices to reduce disability are presumed to be associated with more favorable outcomes. OBJECTIVE: To assess whether implementation interventions are effective at increasing uptake of evidence-based practices in stroke rehabilitation. METHODS: The Cochrane Review by Cahill et al. (2020) is summarized. RESULTS: The effectiveness of implementation interventions on health professionals’ use of evidence- based practices is uncertain. CONCLUSIONS: There is an urgent need for future research investigating the utility of implementation interventions to ensure the uptake of evidence by …health professionals for the benefit of stroke survivors. Show more

Keywords: Evidence-based medicine, rehabilitation, stroke

DOI: 10.3233/NRE-228008

Citation: NeuroRehabilitation, vol. 50, no. 2, pp. 255-258, 2022