The Clinical Reasoning and Multi-Modal Rehabilitation Approach in Treating a Patient with Functional Neurological Disorder

Background: Functional Neurological Disorder (FND) presents with a variety of abnormal motor and sensory symptoms. Physical therapy (PT) is a key discipline in a care team including neurology, physiatry, clinical psychology, and other rehabilitative therapies for treating individuals with this condition. However, FND has been regarded as difficult to treat due to negative provider perceptions, comorbid diagnoses, heterogeneity of patient presentation, and chronicity of symptoms. Purpose: The purpose of this case study is to evaluate the multi-modal, evidence-based care in rehabilitating a patient with FND, considering the key complexities of the diagnosis, and establishing PT’s role in treatment. Case Description: A 39-year-old female was referred to a hospital-based outpatient neurological rehabilitation clinic by her physiatrist for balance impairments due to five years of FND symptoms. She experienced right upper- and lower-extremity tremors, dystonia, and sensory deficits which contributed to limitations in gait, balance, and activity tolerance. She attended 20, 45-minute sessions where interventions included functional activity, neuromuscular re-education, sensory integration, patient education, and therapeutic exercise. Outcome Measures: The Functional Gait Assessment (FGA), Six-Minute Walk Test (6MWT), Sensory Organization Test (SOT), and Comfortable and Fast Gait Speeds (CGS, FGS) were utilized as outcome measures. The patient improved from 18 to 26/30 on the FGA, increased her 6MWT distance by 85 meters, performed above age-predicted values on the SOT, and demonstrated improved gait quality. Discussion: The patient achieved significant improvements in dynamic gait, functional activity tolerance, balance, and gait quality. She also received care from psychology and physiatry, demonstrating an effective multi-disciplinary approach to rehabilitation. This case illustrates the effective elements contributing to symptom resolution in a patient who sustained a long, disabling experience of FND.