![]() ![]() In the present retrospective, naturalistic cohort study, we reviewed the medical records of 50 individuals with motor FND who were referred to outpatient physical therapy from a subspecialty FND clinical program. While promising, this treatment is generally not available in U.S.-based physical therapy clinics, where patients are typically seen on a weekly basis. Intensive outpatient physical therapy programs (eight sessions over 5 consecutive days) have also been studied, particularly in the United Kingdom, with 65%−72% of patients reporting symptom improvement ( 12, 15). institutions restrict this approach from being widely adopted. From a practical perspective, insurance coverage difficulties and limited inpatient rehabilitation hospital expertise in FND within U.S. However, enrollment criteria included failure to respond to outpatient treatment, and individuals with comorbid psychogenic nonepileptic seizures (PNES also referred to as dissociative seizures) were excluded. ![]() In a retrospective study of an inpatient 1-week multidisciplinary program that included 3 hours of physical therapy, occupational therapy, and/or speech-language pathology in addition to cognitive-behavioral therapy (CBT) ( 14), more than 80% of participants reported being at least “much improved” posttreatment. In the hospital, 1- to 4-week stays with daily physical therapy (frequently coupled with other treatments) have demonstrated promising outcomes. Physical therapy for FND has been studied across several clinical settings. Unlike conventional forms of neurological physical therapy that focus on impairment-level treatment strategies (e.g., bed-level strengthening exercises), physical therapy for FND emphasizes task-based interventions (e.g., climbing stairs) and self-efficacy. Four core guiding principles included education on FND, demonstration that normal movement can occur, retraining movement with diverted attention, and challenging maladaptive behaviors ( 2). The 2014 consensus recommendations for physical therapy in motor FND further standardized approaches ( 2). Despite these factors, physical therapy proved to be successful for more than half of the patients, as demonstrated by a variety of outcome measures, including patient- and clinician-reported measures ( 1). The therapeutic approaches used were diverse, and many studies had small sample sizes. Treatment duration varied from days to months and was performed in distinct settings (inpatient versus day versus outpatient treatment). A systematic review identified 29 studies performed between 19 that evaluated the effectiveness of physical therapy ( 1). Physical therapy is a first-line treatment for individuals with functional limb weakness, gait disturbances, tremor, and dystonia, among other functional motor symptoms ( 8, 12, 13). To date, little is known about the feasibility of implementing an evidence-based outpatient physical therapy intervention for FND in the United States. Recent advancements in the assessment and management of FND emphasize specific examination signs that guide diagnosis, as well as therapeutic roles for education, physical therapy, occupational therapy, and psychotherapy ( 2, 7– 11). Patients with FND represent 10%−16% of referrals to neurology clinics ( 3, 4) and have impaired health-related quality of life similar to patients with other major neurological conditions ( 5, 6). Physical therapy is a major therapeutic modality for individuals with motor functional neurological disorder (FND)/conversion disorder ( 1, 2). ![]()
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