Improvement with rehabilitation is rarely straightforward. The process of recovery is different for everybody. It usually involves ups & downs with breakthroughs & setbacks. Some people can make big changes over a short period of time but perhaps for most, progress can feel frustratingly slow. Setbacks are usually more common than not and sometimes happen for no apparent reason. This usually does not mean the treatment is wrong, it just reflects that this is not a simple problem, but physiotherapy is one of many treatments that can make a real difference.
Is Physio/Physical Therapy Right for you?
Written by Glenn Nielson
Functional neurological symptoms (FNS) encompass a very wide range of problems, many of which can benefit from physiotherapy. A survey of physiotherapists specialising neurology, in the United Kingdom found that most saw people with FNS from time to time and a proportion saw people with this problem regularly .
Scientific evidence to support the use of physiotherapy has been limited but in the past few years a number of good quality scientific studies have been published. These show that physical rehabilitation based on an understanding of FND can result in improvement in symptoms in 60 to 70 percent of people (2-4). The physical rehabilitation described in the studies are active treatments that focus on retraining movement patterns. This can make real changes in the way the brain controls movement. You may have treatment from a physiotherapist alone, or as part of a rehabilitation package that can include occupational therapy, speech therapy, exercise therapy and psychology.
If physiotherapy didn’t work for you, you are not alone. If 60 to 70 percent of people improve with physiotherapy, it must also be true that 30 to 40 percent of people with FNS will get little or no benefit from physiotherapy. 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 physiotherapy a second (or third or fourth) chance and come back to it at a later date. Timing can be important. For example, physiotherapy is usually more effective when it starts after the diagnosis of FND is made as the treatment can be more specific. Also other health conditions, such as persistent pain can interfere with progress. In this case it may make sense to address other health conditions (for example optimize pain management) before starting or as a part of physical rehabilitation.
What You Can Do
Are you trying too hard?
As mentioned above it is common that the harder someone with FND tries to move normally, the worse their symptoms become. If you find yourself in a moment where your movement is getting worse and worse, stop, count to 5 or 10 (or take 3 deep breaths) then start again. You may find this helps. Also be kind to yourself during a bad day.
Do you have any bad habits that may make your symptoms a little worse?
For example, some people sit in a funny position that may feel comfortable but actually damages joints, increasing stiffness or overstretching tendons and ligaments. Improving your habitual sitting position can make a big difference, particularly when you have loss of range of movement (tight muscles or locked joints). Getting out of bad habits may minimise setbacks or speed up recovery with treatment.
Are you getting enough sleep?
Poor sleep and poor health tend to go hand in hand and optimising your sleep at night can have an enormous impact. Some simple tips include – minimise daytime sleeping; have a “wind down” routine in the evening and stick to a regular sleep and wake time. Your doctor can assess you for specific sleep related problems and direct you to more information.
Do you have a “boom and bust” activity pattern?
This is when you are very busy and you squeeze a lot of activity into a short period of time, only to hit a wall, leaving you “out of action” until you start to feel better. This is a common problem for people with persistent pain and or fatigue. Boom and bust activity patterns tend to result in a “negative spiral” which overtime can make you feel more fatigued or more pain for a given level of activity. Addressing boom and bust is an important part of rehabilitation and involves learning how to spread your activity over a week and take regular short breaks – easier said than done!
Can you increase the amount of exercise you do?
Often symptoms limit how much and the type of exercise that is possible. However if you are able to exercise moderately it can have many benefits. In fact a study has shown that regular walking exercise can improve FNS – particularly in people who have more mild physical disability . It is important that exercise is started slowly and increased by only small amounts at a time to avoid complications such as excessive fatigue or pain.
2. Short-term and long-term successful outcomes were documented in the treatment of patients with functional movement disorders by a rehabilitative, goal-oriented program with intense physical and occupational therapy. The rapid benefit, which was sustained in most patients, suggests substantial efficacy that should be further assessed in a prospective, controlled, clinical trial. (Czarnecki…2011)
3. Physiotherapists in general are interested in treating such patients and feel physiotherapy to be an appropriate treatment. However, inadequate service structures, knowledge and support from non-physiotherapy colleagues are judged to be barriers to provision of care. (Edwards., 2012)
4. There are specific interventions and approaches that seem to work, and are amenable to study e.g. unlearning maladaptive motor programs, ignoring negative movements, focusing on complex motor programs as a whole (i.e. not focusing on a paralysed leg, for example, that might be the case for a non-specialised physiotherapist) (Nielsen et al., 2013)
5. The most successful programs appear to do this by conceptualizing the FMD as a problem with abnormally learned “motor programs” in the brain that have to be “unlearned” (Nielsen et al., 2013)
6. Most physiotherapists questioned in a study felt that they could do more to help FND patients, but felt poorly supported by neurologists and existing service structure (Edwards et al., 2012b)