Management of Functional Neurological Disorder
Functional Neurological Disorder (FND) is a disruption of brain processing, where symptoms arise from abnormal functional signalling rather than structural damage. It is one of the most common conditions seen in general neurology clinics and the second most frequent reason for neurologist referral after migraine.
Clients may present with dissociative attacks, functional movement symptoms (including tremor, dystonia, gait disturbance, and limb weakness), sensory disturbances, cognitive changes, chronic pain, and fatigue. Symptom intensity is strongly influenced by attention; focusing on symptoms can worsen them, while external focus or distraction often reduces them.
FND is not progressive, and outcomes improve with early diagnosis, effective education, and structured rehabilitation.
Rehabilitation and Exercise in FND
Education is one of the most therapeutic interventions in FND care. Helping clients understand the nature of functional symptoms reduces fear, increases engagement, and lays the foundation for rehabilitation.
Key principles include:
Restoring automatic movement by encouraging movement patterns supported by external cues or dual-tasking, helping reduce excessive conscious control and improving fluidity.
Using graded progression in both aerobic and functional strengthening to build tolerance and confidence while avoiding boom–bust patterns that reinforce symptom fluctuation.
Incorporating pacing and autonomic regulation through structured activity, planned rest, and breathing or grounding techniques to manage fatigue, improve stability, and support consistent participation.
Scope and Clinical Considerations
Diagnosis must be made by a neurologist or neuropsychiatrist. When clients present with functional-type symptoms without a confirmed diagnosis, clinicians should validate their experience, document symptoms objectively, and provide education within their scope while prompting appropriate medical review.
Allied health professionals play a crucial role in early support, safe movement guidance, and pacing reinforcement, provided practice remains within professional boundaries.
Note: Always consult your healthcare provider before starting any new exercise or treatment program, particularly if you have concerns related to bone health or other medical conditions.