Physiotherapy for functional motor disorders: a consensus recommendation

Glenn Nielsen, Jon Stone, Audrey Matthews, Melanie Brown, Chris Sparkes, Ross Farmer, Lindsay Masterton, Linsey Duncan, Alisa Winters, Laura Daniell, Carrie Lumsden, Alan Carson, Anthony S David, Mark Edwards, Glenn Nielsen, Jon Stone, Audrey Matthews, Melanie Brown, Chris Sparkes, Ross Farmer, Lindsay Masterton, Linsey Duncan, Alisa Winters, Laura Daniell, Carrie Lumsden, Alan Carson, Anthony S David, Mark Edwards

Abstract

Background: Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment.

Methods: A meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience.

Results: We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms.

Conclusions: Physiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package.

Keywords: NEUROPSYCHIATRY; REHABILITATION; SOMATISATION DISORDER.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

References

    1. Jordbru AA, Smedstad LM, Klungsøyr O, et al. . Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up. J Rehabil Med 2014;46:181–7.
    1. Czarnecki K, Thompson JM, Seime R, et al. . Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol. Parkinsonism Relat Disord 2012;18:247–51.
    1. Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res 2013;75:93–102.
    1. Stone J, Carson A, Duncan R, et al. . Who is referred to neurology clinics? The diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010;112:747–51.
    1. Carson A, Stone J, Hibberd C, et al. . Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease’. J Neurol Neurosurg Psychiatry 2011;82:810–13.
    1. Gelauff J, Stone J, Edwards M, et al. . The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 2014;85:220–6.
    1. Bermingham SL, Cohen A, Hague J, et al. . The cost of somatisation among the working-age population in England for the year 2008–2009. Ment Health Fam Med 2010;7:71.
    1. Edwards MJ, Stone J, Nielsen G. Physiotherapists and patients with functional (psychogenic) motor symptoms: a survey of attitudes and interest. J Neurol Neurosurg Psychiatry 2012;83:655–8.
    1. Edwards MJ, Adams RA, Brown H, et al. . A Bayesian account of ‘hysteria’. Brain 2012;135:3495–512.
    1. Pareés I, Kojovic M, Pires C, et al. . Physical precipitating factors in functional movement disorders. J Neurol Sci 2014;338:174–7.
    1. Stone J, Warlow C, Sharpe M. Functional weakness: clues to mechanism from the nature of onset. J Neurol Neurosurg Psychiatry 2012;83:67–9.
    1. Stone J, LaFrance WC Jr, Brown R, et al. . Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res 2011;71:369–76.
    1. Stone J, Carson A. Functional and dissociative (psychogenic) neurological symptoms. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta J eds. Bradley's neurology in clinical practice. Philadelphia: Elsevier, 2012. 2147–62.
    1. Edwards MJ, Bhatia KP. Functional (psychogenic) movement disorders: merging mind and brain. Lancet Neurol 2012;11:250–60.
    1. Stone J. The bare essentials: functional symptoms in neurology. Pract Neurol 2009;9:179–89.
    1. Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 2011;20:308–11.
    1. Espay AJ, Goldenhar LM, Voon V, et al. . Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: an international survey of movement disorder society members. Mov Disord 2009;24:1366–74.
    1. McKenzie P, Oto M, Russell A, et al. . Early outcomes and predictors in 260 patients with psychogenic nonepileptic attacks. Neurology 2010;74:64–9.
    1. Edwards MJ, Stone J, Lang AE. From psychogenic movement disorder to functional movement disorder: it's time to change the name. Mov Disord 2013;29:849–52.
    1. Stone J, Edwards M. Trick or treat? Showing patients with functional (psychogenic) motor symptoms their physical signs. Neurology 2012;79:282–4.
    1. Dallocchio C, Arbasino C, Klersy C, et al. . The effects of physical activity on psychogenic movement disorders. Mov Disord 2010;25:421–5.
    1. White P, Goldsmith K, Johnson A, et al. . Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011;377:823–36.
    1. Stone J, Gelauff J, Carson A. A “twist in the tale”: altered perception of ankle position in psychogenic dystonia. Mov Disord 2012;27:585–6.
    1. Butler DS, Moseley GL. Explain pain. Adelaide: Noigroup Publications, 2003.
    1. Nijs J, Paul van Wilgen C, Van Oosterwijck J, et al. . How to explain central sensitization to patients with ‘unexplained'chronic musculoskeletal pain: practice guidelines. Man Ther 2011;16:413–18.
    1. Schrag A, Trimble M, Quinn N, et al. . The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004;127:2360–72.
    1. Adrian E, Yealland LR. The treatment of some common war neuroses. Lancet 1917;189:867–72.
    1. Tatu L, Bogousslavsky J, Moulin T, et al. . The “torpillage” neurologists of World War I electric therapy to send hysterics back to the front. Neurology 2010;75:279–83.
    1. Khalil T, Abdel-Moty E, Asfour S, et al. . Functional electric stimulation in the reversal of conversion disorder paralysis. Arch Phys Med Rehabil 1988;69:545–7.
    1. Fishbain D, Goldberg M, Khalil T, et al. . The utility of electromyographic biofeedback in the treatment of conversion paralysis. Am J Psychiatry 1988;145:1572.
    1. Pollak TA, Nicholson TR, Edwards MJ, et al. . A systematic review of transcranial magnetic stimulation in the treatment of functional (conversion) neurological symptoms. J Neurol Neurosurg Psychiatry 2014;85:191–7.
    1. Moene FC, Spinhoven P, Hoogduin KA, et al. . A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn 2003;51:29–50.
    1. Stone J, Hoeritzauer I, Brown K, et al. . Therapeutic sedation for functional (psychogenic) neurological symptoms. J Psychosom Res 2014;76:165–8.
    1. Garcin B, Roze E, Mesrati F, et al. . Transcranial magnetic stimulation as an efficient treatment for psychogenic movement disorders. J Neurol Neurosurg Psychiatry 2013;84:1043–6.
    1. Ferrara J, Stamey W, Strutt AM, et al. . Transcutaneous electrical stimulation (TENS) for psychogenic movement disorders. J Neuropsychiatry Clin Neurosci 2011;23:141–8.
    1. Shapiro AP, Teasell RW. Behavioural interventions in the rehabilitation of acute v. chronic non-organic (conversion/factitious) motor disorders. Br J Psychiatry 2004;185:140–6.
    1. Trieschmann R, Stolov W, Montgomery E. An approach to the treatment of abnormal ambulation resulting from conversion reaction. Arch Phys Med Rehabil 1970;51:198–206.
    1. Edwards MJ, Alonso-Canovas A, Schrag A, et al. . Limb amputations in fixed dystonia: a form of body integrity identity disorder? Mov Disord 2011;26:1410–14.
    1. Health Improvement Scotland. Stepped care for functional neurological symptoms. Edinburgh, 2012. (accessed 17 Jul 2014).
    1. Deaton AV. Treating conversion disorders: Is a pediatric rehabilitation hospital the place? Rehabil Psychol 1998;43:56.
    1. Ness D. Physical therapy management for conversion disorder: case series. J Neurol Phys Ther 2007;31:30–9.
    1. Speed J. Behavioral management of conversion disorder: retrospective study. Arch Phys Med Rehabil 1996;77:147–54.
    1. Watanabe TK, O'Dell MW, Togliatti TJ. Diagnosis and rehabilitation strategies for patients with hysterical hemiparesis: a report of four cases. Arch Phys Med Rehabil 1998;79:709–14.
    1. Sharpe M, Walker J, Williams C, et al. . Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology 2011;77:564–72.
    1. Hinson VK, Cubo E, Comella CL, et al. . Rating scale for psychogenic movement disorders: scale development and clinimetric testing. Mov Disord 2005;20:1592–7.

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