Physical therapy evaluation and treatment of functional movement disorders: A case series

Functional neurological disorder (FND) is prevalent in neurologic clinics. FND includes subtypes, such as Functional Movement Disorder (FMD), which involves movement-related symptoms. There is a lack of reproducible FMD treatment guidelines, especially in outpatient physical therapy (PT). This case series aims to describe detailed interventions and outcomes for individuals with FMD in outpatient clinics.

Four patients with FMD, presenting with functional gait abnormality and tremors, participated in PT. Sessions lasted 45 min, once a week, with total number of visits based on individual progress. Interventions included mindfulness, gait training, tremor reduction strategies, motor retraining, and mirror feedback.

Our findings indicated meaningful improvements in objective measures. The Nine-Hole Peg Test improved by greater than 10 s on average, meeting or exceeding the minimal detectable change (MDC). Two patients improved on the Box and Blocks Test, exceeding the MDC of 5.5 blocks/minute. The Five Times Sit to Stand test showed an average improvement of 28.7 s, with all patients completing the test within the balance dysfunction cutoff. The change in gait speed for each patient exceeded the MCID of 0.1 to 0.2 m/s. Patient-reported outcomes, particularly in fatigue and pain (PROMIS-29®), demonstrated substantial improvements, with fatigue scores improving an average of 9.3 points.

This case series highlights potential benefits of outpatient PT interventions in treating FMD. Detailed interventions can assist with treatment planning. The observed improvements in patients underscore the importance of intervention selection, paving the way for research to expand upon these promising outcomes.