The Motor Reprogramming (MoRe) Program for Functional Movement Disorders
“MoRe” is an interdisciplinary, inpatient rehabilitation program for functional movement disorders (FMD) offered at the Frazier Rehab Institute in Louisville, KY, based on a program developed at the Mayo Clinic in Rochester, Minnesota. The rehabilitation team includes neurologists, physiatrists, physical, occupational and speech therapists and psychologists.
You were diagnosed with a functional movement disorder (FMD) by your neurologist. FMD are commonly encountered in neurologic practice and mimic symptoms of other neurologic disorders, but can be diagnosed based on a typical history and features on examination. Many patients have a variety of abnormal movements including tremor, jerking movements, abnormal posturing of limbs (dystonia) and difficulties walking. FMD symptoms can be variable over time and are often associated with additional complaints such as weakness, numbness, fatigue, pain, poor concentration or memory difficulties.
Diagnostic studies such as MRI of the brain and spine, nerve conduction studies, EEG and laboratory studies are typically normal and do not show brain lesions or other abnormal findings responsible for your disorder. The different parts of the nervous system (brain, spinal cord, nerve roots, peripheral nerves and muscles) are still in working order, but do not function well together. FMD can have a chronic course and lead to disability, however it is possible to retrain the nervous system and restore normal function. The sooner the treatment starts after onset of symptoms, the better the prognosis, but even patients who had symptoms for many years have the potential to get better.
Our program uses motor reprogramming (“MoRe”) strategies aimed at improving patients’ motor symptoms, gaining insight into disease mechanisms, regaining control over abnormal movements and learning better coping skills. The program is based on motor reprogramming strategies developed at the Mayo Clinic in Rochester, MN, and a previously validated guided self-help program for functional neurological disorders. Patients in the Mayo program had a >70% rate of significant symptom improvement after one week of therapy with continued success in over 60% after two years.
Pre-evaluation for treatment planning (Outpatient appointments):
- Neurologic evaluation in Movement disorder clinic: History and physical examination, review of previous medical records, confirmation of diagnosis/ rule out an alternative diagnosis, education.
- Physical therapy evaluation: Patient assessment, identification of deficits, explanation of inpatient program, expectation settings and development of a treatment plan. Based on your symptoms, treatment may include physical, occupational and speech therapy.
- Psychology evaluation: Clinical diagnostic interview, identification of problem areas and education in regards to the program. Administration of FMD Inventory and psychological questionnaires.
Overview of Treatment Week
Sunday afternoon: Inpatient admission, tour of therapy facilities. Monday-Friday: Daily therapy programs tailored to individual symptoms. Therapy may include physical, occupational, speech and psychological therapy. Saturday: Follow up planning and discharge.
Principles of therapy
- The principle of “motor reprogramming” (MoRe) is relearning of normal movements, similar to treatment of other neurological conditions (e.g. stroke, multiple sclerosis) with the goal of neurologic normality.
- Treatment begins with reestablishing elementary movements in the affected limb or body region, and building on those. More complex movements are only introduced after simple movements are performed successfully.
III. Mental practice is used to supports training efforts.
IV. Cognitive behavioral interventions are aimed at identifying triggers and other factors contributing to abnormal movements. You will learn ways on how to overcome obstacles that stand in the way of your symptoms getting better.
- Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR and Ahlskog JE. Functional movement disorders: Successful treatment with a physical therapy rehabilitation protocol. Parkinsonism and Related Disorders 2012;18(3):247-51.
- Williams C, Carson A, Smith S, Sharpe M, Cavanagh J, Kent C. Overcoming functional neurological symptoms: a five areas approach. CRC Press, 2011.
Information is also available on the following websites:
–www.neurosymptoms.org: Patient education site, includes links to handouts and related topics, written by Dr. Jon Stone from the UK.
–www.fndhope.org: Patient education and self-help site
Dr. Kathrin LaFaver, M.D.
University of Louisville, Department of Neurology Movement Disorder Clinic
220 Abraham Flexner Way, Suite 606
Louisville, KY, 40202
P: 502-582-7654, F: 502-587-4117