Zachary Grin – physical therapist in New York shared this video of treatment on social media.

I have reproduced his summary below as I think it provides a good insight into successful elements of physio treatment for a functional movement disorder. Thank you Zachary for permission to post on this site as well.

I’m so excited to share this patient’s FND treatment plan & outcome! Background: Dog bite to the R thigh 3 yrs ago, R leg heaviness, severe R leg tremor & gait problems. She had some fluctuating improvement with “traditional” physical therapy but felt that her progress plateaued.

Treatment began with showing her the leg heaviness was due to significant muscle tension throughout the leg when walking.

Once aware, she learned how to relax the leg when she felt the heaviness by using her hands on the muscle for feedback.

Movement pattern changes with an external focus of attention: hopscotch, skipping, crab walk, agility ladder, obstacle courses, kicking a soccer ball to access automatic movements that were not “corrupted” by FND.

Dual-tasks: Learning to allocate less attention toward walking. Bop-It is my fav due to the high attentional demand. Gait may initially worsen but improve as they learn to balance attention allocation to the tasks!

Behavioral: Prevent reinforcement of motor symptom – If trunk hyperextension was triggered when stepping over an object she would repeat it until it stopped.

Sensory: Weighted vest – easier to relax her leg & raised her triggering threshold. Desensitizing the right leg to vibration allowed her to kick a firm soccer ball without triggering a leg tremor.

Autonomic: Diaphragmatic breathing with extended exhale – sympathetic activity to raise the triggering threshold.

Variability: People with FND may learn a motor skill very well but symptoms may reoccur by slight modification to the task. Variability helps to learn how to adapt motor responses to meet new task demands.

Outcome: After 4-months, she returned to work part-time (gradually increasing to full-time), rejoined her soccer league for the upcoming season, and could run without motor symptoms!!

FND is a complex condition. It demands clinicians be curious, creative, comprehensive, and comfortable with the grey. I hope this post provides clinicians with some out-of-the-box treatment ideas and provides patients with hope.