Written by: Clare Nicholson (Occupational Therapist)
The main aim of Occupational Therapy is to help people overcome the effect of health problems and disability using practical strategies and support. Occupational therapists can help people with movement problems (in a similar way to physiotherapy), but they can also help if you have fatigue, pain, functional seizures, cognitive difficulties, low confidence, anxiety and low mood to name just a few. The ‘occupation’ in occupational therapy does not only refer to paid work, but also to all other daily activities that you may want to complete in your day (getting washed and dressed, meal preparation, housework, childcare, leisure activities, shopping, using public transport etc). What you work on with your occupational therapist will be based on the goals that you set. Occupational therapists will work with you to identify the impact that your symptoms are having on your ability to carry out your daily activities. You will then work together to develop strategies to overcome barriers to participation, improve your abilities, independence and confidence.
Both physiotherapists and occupational therapists sometimes provide mobility equipment (such as crutches and wheelchairs), as well as other adaptive aids and environmental modifications (such as rails and ramps). Providing equipment is a complex issue. Many people with FND have the experience of being told they should not use adaptive equipment. The reason why clinicians tell people this is that it is widely believed that adaptive equipment changes the way we move in a way that could prevent or delay improvement. Also, equipment often causes secondary problems such as joint pain and muscle deconditioning. Therefore, in most cases, it is usually better to avoid unnecessary equipment use, especially early after symptoms have first started. It is a different situation if a person is in danger without equipment or if a person continues to experience disabling symptoms after they have completed treatment. In such cases, the right equipment can improve independence and quality of life. We recommend taking a common-sense approach when thinking about using equipment and getting advice from a physiotherapist or occupational therapist who understands FND.
If physiotherapy and occupational therapy didn’t work for you, you are not alone. If 60 to 70 percent of people improve with physical rehabilitation, it must also be true that 30 to 40 percent of people with FND will get little or no benefit. It is difficult to know why this is the case, it reflects the complexity of the diagnosis. If this is your experience, with the support of your doctor you may find more benefit from a different type of treatment or a different clinician. You may want to give physical therapies a second (or third or fourth) chance and come back to it at a later date. Timing is important to get the most out of rehabilitation. Physical therapies are usually more effective when they start after the diagnosis of FND is made as the treatment can be more specific and it is likely to involve a degree of education regarding FND, how it relates to you and your story and how your symptoms can be helped. Also, other health conditions, such as persistent pain and fatigue can interfere with progress. In this case, it may make sense to address other conditions (for example optimizing pain management) before starting or as part of physical rehabilitation.