234: Advancing the Understanding and Treatment of Functional Neurological Disorders With Heather Salon, PT, DPT, NCS and Julie Maggio, PT, DPT, NCS

I Love Neuro

Feel confused about how to assess and treat someone with Functional Neurological Disorder (FND)? We got your back! In this episode host Erin Gallardo interviews FND experts Heather Salon, PT, DPT, NCS and Julie Maggio, PT, DPT, NCS on this range of neurological symptoms that includes functional movement disorders, seizures, and speech/communication issues. FND is characterized by abnormal brain connectivity and network dysfunction, often presenting with mixed symptoms. A key shift in recent years has been the recognition of FND as a "rule-in" diagnosis, rather than a diagnosis of exclusion. Learn what to expect during the subjective evaluation and how to approach it with best practice.

Heather and Julie highlight the importance of identifying specific "rule-in" signs, such as Hoover sign, give-way weakness, and symptom variability, to confidently diagnose FND. They also emphasize the need for a comprehensive assessment, including evaluations of the motor, sensory, and autonomic systems. Also discussed are differential diagnoses like dystonia.

The conversation underscored the multidisciplinary nature of FND care, with physical therapists, occupational therapists, psychologists, and neurologists working collaboratively to provide optimal treatment. Sensory-based interventions, such as the use of Kinesio tape, abdominal binders, and visual feedback, were discussed as valuable tools in the PT's toolbox.

Importantly, Heather and Julie stress the need to manage patient expectations and set realistic goals, focusing on improving function and reducing symptoms rather than aiming for complete symptom resolution. They also highlighted the importance of ongoing education and resources for clinicians interested in advancing their knowledge and skills in the FND field.

Check out these resources mentioned in the episode:

https://www.fndsociety.org/fnd-education FND society education resources

26.08.2023-Information-guideance-sheet-for-medical-professionals.pdf (fndaction.org.uk) Inform the doctor fact sheet

Diagnosis and Management of FND

A framework for understanding the pathophysiology of functional neurological disorders

A practical review of FN for the general physician