Mater Hospital Neuroscience Centre
The FND service at the Mater Hospital sees 100-150 new patients per year suffering from a variety of functional symptoms. The ever-growing team currently consists of one neurologist, one neuropsychiatrist, two neuropsychologists, four neurophysiotherapists and two speech pathologists. A particular strength of the service provided at the Mater Hospital is a strong team approach giving the best possible chance for a good treatment outcome.
In early 2015 the Mater Centre for Neurosciences in Brisbane, Australia, opened a dedicated clinic for Functional Neurological Disorders. This is one of only two such clinics in Australia offering an evidence-based approach to FND by a keen multi-disciplinary team.
The treatment of patients with FND at the Mater Centre for Neurosciences follows a stepped care approach. Patients are initially assessed by our neurologist. If the diagnosis of FND is confirmed based on positive clinical signs, the patient receives an initial explanation on the positive nature of the diagnosis (i.e. not a diagnosis of exclusion) and the positive signs are demonstrated/explained to the patient. This is followed by an initial explanation of underlying mechanisms leading to FND and provision of written information about the diagnosis as well as basic information about our treatment approach. The patient is then assessed by other members of our multi-disciplinary team and an individual treatment plan is developed. We hold fortnightly multidisciplinary team meetings where all patients currently receiving treatment are discussed to ensure that treatment plans are well co-ordinated, can be adapted and the best possible outcomes for patients can be achieved.
Principals of Therapy
Principles of neuropsychological interventions
- Supportive counselling and psychoeducation regarding the diagnosis of FND
- Homework to record the main features of the main symptom (chart topography: e.g. where, when, triggers, duration)
- Psychoeducation regarding physiological arousal and mind-body connection (basic neurobiology)
- Introduction of strategies to regulate physiological arousal, e.g. grounding exercises, progressive muscle relaxation, mindfulness
- Cognitive Behavioural Therapy for any comorbid depression and anxiety
- Re-prioritisation of life and its meaningful activities as a primary focus, with focus on symptoms being a second/ later priority
Principles of neurophysiotherapy interventions
- Development of patient centered goal setting. Motivational interviewing is being used when appropriate
- Implementation of graduated exercise program incorporating normal movement patterns with specific de-emphasis on dysfunction
- Exercise program addressing any secondary impairments such as
- disuse weakness
- reduced balance
- cardiovascular endurance
- Development and prescription of home (or ward) exercise program with corresponding exercise log/diary
- Education and advice highlighting the benefits of exercise on central sensitivity and chronic fatigue as appropriate
- Liaising with neuropsychologist regarding sleep hygiene and incorporating rest periods through the day as appropriate
A major aim in our therapy is not just short term improvement, but to equip patients with the necessary knowledge and skills they need in the long term (including a longer term self-management and relapse plan.
- Nielsen, G., Stone, J., Matthews, A., Brown, M., Sparkes, C., Farmer, R., et al. (2014). Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery, and Psychiatry, jnnp–2014–309255. http://doi.org/10.1136/jnnp-2014-309255
- Lehn, A., Gelauff, J., Hoeritzauer, I., Ludwig, L., McWhirter, L., Williams, S., et al. (2015). Functional neurological disorders: mechanisms and treatment. Journal of Neurology, 263(3), 1–10. http://doi.org/10.1007/s00415-015-7893-2