The Novel Use of Robot-Assisted Gait Training in the Treatment of Functional Neurological Disorder: A Case Report

Functional neurological disorder (FND) is a condition defined by neurological symptoms that may be motor, sensory or cognitive in nature and can result in significant functional impairment, including total loss of mobility. There is evidence supporting the use of robotics in other neurological conditions such as stroke and spinal cord injury, but there is currently no published evidence for its use in the treatment of FND. This case using the Hocoma Lokomat robotic exoskeleton device represents the first known case of robot-assisted gait training in the treatment of FND. The aim of this case study was to determine if robot-assisted gait training (RAGT) could be a viable treatment option to improve mobility for patients with FND. Over 9 weeks, the 34-year-old patient completed 15 RAGT sessions. Outcome measures included the functional ambulation category (FAC), functional independence measure (FIM), 10-m walk test (10MWT) and Oxford manual muscle strength testing (MMT). At the conclusion of the RAGT programme, the patient had achieved independent walking: FAC improved from 0/5 to 5/5, FIM Locomotion improved from 1/7 to 7/7, FIM Total improved from 56 to 123 and the 10 MWT was completed in 37.45 s. The patient's muscle strength improved from 0/5 to 5/5 in all lower limb muscle groups (MMT). At 6 months postintervention, the patient reported zero FND relapses or functional impairments. RAGT can be considered a potential intervention option in FND, specifically in cases with gait impairments, and can be associated with dramatic improvements in strength and mobility. This is the first case of a patient with FND successfully completing RAGT in the treatment of gait-related impairments. Studies exploring feasibility and patient acceptability of this novel therapy in FND are now warranted.