Connect with us
  • Elysium

Neurophysiotherapy news

Functional Neurological Disorder and physiotherapy

PhysioFunction look at the impact of the condition and how specialist therapy can assist



What is FND and how can can specialist physiotherapy-led interventions help? The team at PhysioFunction share their insight and expertise with NR Times

Functional Neurological Disorder (FND) is a condition that affects the how the nervous system functions and how the brain sends and receives signals to and from the body. Symptoms are caused by alterations to the brain’s networks rather than abnormalities or injuries to the structures.

FND has been reported across the entire lifespan from  four to 94, with a significantly greater prevalence observed in women (60-80 per cent). The overall prevalence of FND has been reported at 50-100 cases per 100,000 of the population, relating to between 33,665 and 67,330 cases in the UK.

FND can be stratified into different subtypes. Functional seizures occur when individuals experience seizures which resemble epilepsy or syncope. Functional movement disorders (FMD) can manifest with any abnormal movement.

Positive diagnostic factors may include tremor, dystonia, gait and balance dysfunction, jerks or myoclonus, and limb weakness or generic motor dysfunction (Hallet et al., 2022). FND may be differentiated from structural neurological disorders by variation in symptom presentation and task completion. Other subtypes of FND include Persistent Postural Perceptual Dizziness and Functional Cognitive Disorder. 

Hallet et al. (2022) highlighted that functional disorders have been defined in other medical specialities, including irritable bowel syndrome in gastroenterology, fibromyalgia in rheumatology, and painful bladder syndrome in urology, and there is commonly comorbidity of functional disorders with each other.

Causation of FND is complex and multifactorial. Various risk factors have been proposed and include exposure to psychological stressors and a history of childhood adversity, particularly neglect, although in published evidence such events were not present in around half of FND diagnoses (Hallet et al., 2022). FND commonly occurs with diagnosed psychological health conditions including depression, anxiety and post-traumatic stress disorder, as well as the presence of cluster B personality traits, including dramatic or overly emotional behaviour, trouble maintaining relationships, and significant distress.

Diagnostic criteria have been established in partnership by neurologists, psychiatrists and other health professionals, and treatment is recommended to be multidisciplinary, treating the presenting symptoms and begins with establishing a two-way communication between clinician and patient to improve understanding and engage patients in their own treatment (Hallet et al., 2022).

Explore psychology internship opportunities to contribute your skills to the multidisciplinary field and make a positive impact on patients’ well-being.

How PhysioFunction can help 

Physiotherapy is one of the primary therapies in the management of functional movement disorders and a consensus for physiotherapy treatment of functional movement disorders was developed by Neilsen et al. in 2015. In the consensus document they highlight that physiotherapy intervention should be delivered within a biopsychosocial aetiological framework, addressing beliefs, self-directed attention and abnormal habitual movement patterns, movement retraining and self-management strategies within a positive and non-judgemental context.

At PhysioFunction we combine traditional Physiotherapy techniques with exercise and Technology for Rehabilitation to support and enhance the nervous system’s ability to recover movement and function in the treatment of FMD. 

In FND, active, independent movement is a priority so treatment will involve exercise both in clinic and at home, with hands on facilitation used sparingly when required. We employ the use of technologies to add safety, support and the creation of an environment to provide progressive, graded rehabilitation. Devices such as the AlterG anti-gravity treadmill, Functional Electrical Stimulation (FES) assisted cycle (FES Cycling) , Litegait body weight support system, MindMotion GO and, in some cases, robotic exoskeletons such as the Rex, FREEWalk and ReWalk can be used to improve muscle function, facilitate weight bearing, redirect attention and/or re-educate movement. 

Additionally, our Hydrotherapy service is used to provide therapeutic exercise and movement in water. Using the buoyancy and resistive properties of water alongside heat, can aid movement, reduce pain, improve balance, increase strength and promote function in functional movement disorders. 


Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J. (2022). Functional neurological disorder: new subtypes and shared mechanisms. The Lancet Neurology, 21(6), 537-550.

Nielsen, G., Stone, J., Matthews, A., Brown, M., Sparkes, C., Farmer, R., … & Edwards, M. (2015). Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry, 86(10), 1113-1119.