…..One of the things that patients with functional weakness often notice is that the severity of the weakness can vary over time…..

This section is based mainly on the author’s own experience in trying to assist many hundreds of patients with functional weakness to get better.

If you haven’t read them yet, have a look at these sections before you read on:

1. Functional Limb Weakness: It’s really important to understand that this symptom is common, does not mean you are going mad or ‘losing it’, and is potentially reversible without medication.
2. Understanding FND: It’s essential that you feel the doctor has looked into your case properly and come to the correct diagnosis.
3. Physiotherapy and exercise: This explains some basic principles behind rehabilitation and exercise for functional symptoms including weakness, pain and fatigue.
4. Psychological Therapy: If your doctor has referred you to a psychologist or psychiatrist you may be wondering why. Read this section to help you understand this.

Learning to overcome functional limb weakness …

We are still learning more about what kinds of treatment work best for patients with functional weakness.

Understanding it

It can be surprising how much impact simply receiving a clear and understandable explanation for the symptom can have. Often patients with functional weakness may have gone months or even years without a diagnosis (or sometimes with an alternative diagnosis like MS).

It can take a long time to ‘get your head’ around a problem like functional limb weakness. For patients that do start to feel better, doing this seems to be an important part of it.

Seeing how it fits in with all your other symptoms can also be an important part of understanding it. It can help to understand that your weakness is one symptom among many (usually pain, fatigue and sleep disturbance) and that you have one illness with many symptoms, not many symptoms caused by different diseases.

For this reason, it is probably the case that some of the treatments that are proven to be effective for patients with chronic fatigue syndrome/ME and chronic pain are also helpful for patients with functional weakness.

These include

1. Physiotherapy

2. Psychological Therapy

3. Medication to help pain and sleep

Specific things that come up in relation to functional limb weakness

…Try, as much as possible, to think about other things when you walk….

One of the things that patients with functional limb weakness often notice is that the severity of the weakness can vary in time. So on Tuesday you may feel that your leg is really heavy and dragging but on Wednesday the symptom is much more in the background. Variability is a common feature of many functional symptoms. If you think about it, its one reason why the diagnosis of FND makes sense. If there was structural damage to the nervous system, the symptom might fluctuate a bit but not dramatically as it can do with functional limb weakness.

There are several reasons why functional limb weakness can vary in severity:

1. At times of greater fatigue
2. At times of greater pain
3. When you are thinking consciously about movement

This last one is worth some thought. You may have noticed that the more you think about moving your limbs the heavier and more difficult it can be to move them.

This is because movement works best when it is automatic. You don’t normally think about walking when you’re climbing the stairs or walking to the shops. In fact if healthy people do think about walking it often starts to go wrong.

Recognising this can help with FND treatment.

Try, as much as possible, not to think about your movements when you walk. Physiotherapists are not always sure what to do to help people with FND. Usually, automatic movements that use both legs or both arms at the same time are better than exercises that really focus on the limb that’s weak.

Remember that with FND you are trying to regain control of a limb that may not feel completely like ‘yours’. You may have got used to holding it in a certain way

People with functional arm weakness tend to cradle it on their lap, especially if it’s painful as well

People with functional leg weakness sometimes find that they sit with the ankle turned in.

These positions may feel ‘natural’ but they are not. Your brain thinks they are normal positions to be in. Your brain may have got used to the idea that one side of your body doesn’t feel the same as the other side.

The aim of treatment is to try to get your brain to experience normal natural movement again.

Other treatments

If you’re feeling really stuck with your weak limbs then it may be worth trying hypnosis. Sometimes under hypnosis, normal movements can start to occur again.

Occasionally patients with severe functional limb weakness have improved during a procedure called therapeutic sedation with a general anaesthetic. This should only be carried out if there is paralysis and your doctor has experience with this technique. It is usually only helpful as a last resort when it’s not possible to give someone a demonstration of reversibility any other way (for example with physical examination techniques). It is definitely not a ‘cure-all’ for functional limb weakness, unfortunately.