Sensory Processing Difficulties in Patients with Functional Neurological Disorder: Occupational Therapy Management Strategies and Two Cases

2022 ◽  
pp. 100951
Author(s):  
Julie MacLean ◽  
Sara A. Finkelstein ◽  
Sara Paredes-Echeverri ◽  
David L. Perez ◽  
Jessica Ranford
Keyword(s):  
Occupational Therapy ◽  
Sensory Processing ◽  
Neurological Disorder ◽  
Management Strategies ◽  
Therapy Management ◽  
Functional Neurological Disorder

scholarly journals Occupational therapy consensus recommendations for functional neurological disorder

2020 ◽  
Vol 91 (10) ◽  
pp. 1037-1045 ◽  
Author(s):  
Clare Nicholson ◽  
Mark J Edwards ◽  
Alan J Carson ◽  
Paula Gardiner ◽  
Dawn Golder ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Neurological Disorder ◽  
Best Practice ◽  
Management Strategies ◽  
Occupational Therapists ◽  
Therapy Assessment ◽  
Consensus Recommendations ◽  
Starting Point ◽  
Stage 1 ◽  
Functional Neurological Disorder

BackgroundPeople with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention.MethodsThe recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved.ResultsWe recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document.ConclusionsOccupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.

20 International online survey of 1162 individuals with functional neurological disorder: demographics, symptom comorbidities, self- management strategies, and illness beliefs

2020 ◽  
Vol 91 (8) ◽  
pp. e16.1-e16
Author(s):  
Matthew Butler ◽  
Mathieu Seynaeve ◽  
Susannah Pick ◽  
James Rucker ◽  
Timothy Nicholson
Keyword(s):  
Neurological Disorder ◽  
Online Survey ◽  
Management Strategies ◽  
Self Management ◽  
Patient Questionnaire ◽  
Symptom Duration ◽  
Illness Beliefs ◽  
Alternative Treatments ◽  
Wide Range ◽  
Functional Neurological Disorder

AimsFunctional neurological disorder (FND) is common and often severe. It is poorly understood, and there have been no international large-scale studies of self- management and illness beliefs in FND. We created a patient questionnaire to assess FND demographics, symptom comorbidity, self-management strategies (particularly in relation to prohibited substances), views on novel treatments, and illness beliefs.MethodsThe questionnaire was shared open access over a three-week period.Participants were recruited internationally through social media and patient groups. RESULTS: In total, 1162 respondents from 16 countries took the survey. Of these, 98% reported a formal diagnosis of FND from a consultant neurologist or other suitably trained clinician. Females constituted 86% of respondents, with an average age of 41.7 years (SD=12.50). Mean symptom duration was 7.69 years (SD=9.37) and average time from diagnosis was 2.24 years (SD=3.35), indicating a diagnostic lag of over 5 years. Symptom comorbidity was very high, with respondents reporting current: seizures (50%), gait disturbance (76%), loss of balance (77%), tremors (61%), muscle jerks/spasms (65%), altered sensations (79%), speech difficulties (65%), memory problems (80%), fatigue (93%), and headache (70%). Current psychiatric comorbidities – depression (43%), anxiety (51%), panic (20%), and PTSD (22%) - were also common. Illness beliefs varied, with respondents agreeing most strongly that FND is a combination of physical and stress/trauma-related factors. Respondents rated FND as having a severe effect on their life, with little control felt over their symptoms. Respondents had received a wide range of medical interventions, and many had tried alternative treatments. Prohibited substances such as cannabis, ketamine, and psychedelics had been used by 15% of respondents, with the majority experiencing no or minimal physical (90%) and psychological (95%) sequelae. Many respondents reported that they would be willing to try medically supervised psychedelic therapy if it was found to be safe and effective.ConclusionsThis large international online survey of FND patients indicated a striking co-occurrence of multiple symptoms. As expected, respondents reported that FND severely impacted on their lives, and many had lived with symptoms, which are not well managed by current medical therapies, for years. There was interest in novel putative treatments, such as medically supervised psychedelic therapies, which indicates a strong need to investigate alternative treatments for this poorly served patient group.

scholarly journals Sensory Processing Difficulties in Functional Neurological Disorder: A Possible Predisposing Vulnerability?

2020 ◽  
Vol 61 (4) ◽  
pp. 343-352 ◽  
Author(s):  
Jessica Ranford ◽  
Julie MacLean ◽  
Priyanka R. Alluri ◽  
Olivia Comeau ◽  
Ellen Godena ◽  
...  
Keyword(s):  
Sensory Processing ◽  
Neurological Disorder ◽  
Functional Neurological Disorder

scholarly journals Barriers and enablers to providing community-based occupational therapy to people with functional neurological disorder: An interview study with occupational therapists in the United Kingdom

2021 ◽  
pp. 030802262110206
Author(s):  
Clare Nicholson ◽  
Jill Francis ◽  
Glenn Nielsen ◽  
Fabiana Lorencatto
Keyword(s):  
United Kingdom ◽  
Occupational Therapy ◽  
Service Provision ◽  
Neurological Disorder ◽  
Occupational Therapists ◽  
Community Settings ◽  
Community Based ◽  
Barriers And Enablers ◽  
The United Kingdom ◽  
Functional Neurological Disorder

Introduction Occupational therapists have an integral role in the treatment of people with functional neurological disorder, yet there is evidence of variable implementation of occupational therapy in community settings. This study explored the barriers and enablers to delivering community-based occupational therapy to people with functional neurological disorder in the United Kingdom. Methods Community-based neurological occupational therapists ( n = 10) with experience in functional neurological disorder were invited to complete semi-structured qualitative interviews. The interview schedule and analysis were based on the Theoretical Domains Framework, a behavioural science tool for investigating barriers and enablers to clinical practice. Data were analysed using a combined content and framework analysis approach. Findings Important barriers to treatment included limited published information to guide practice, lack of professional role clarity and restricted multidisciplinary team working. Enablers included occupational therapists’ dual training in physical and mental health and focus on activity engagement. Service provision, quality and access varied across geographical locations. Conclusion Occupational therapists are uniquely placed to help people with functional neurological disorder; however, findings suggest that existing community service structures in many regions in the United Kingdom are inadequate and limit the quality of treatment that can be provided. Additional resources are required to support occupational therapy service provision in community settings.

The relationship between psychosocial trauma type and conversion (functional neurological) disorder symptoms: a cross-sectional study

2021 ◽  
pp. 103985622110092
Author(s):  
Shimaa K. Morsy ◽  
Daniela Huepe-Artigas ◽  
Ahmed M. Kamal ◽  
Maha Ali Hassan ◽  
Nashaat Adel Abdel-Fadeel ◽  
...  
Keyword(s):  
Neurological Disorder ◽  
Conversion Disorder ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Trauma Symptom ◽  
Functional Symptoms ◽  
Neurology Clinic ◽  
The Relationship ◽  
Trauma Type ◽  
Functional Neurological Disorder

Objective: Psychosocial trauma was associated with developing conversion disorder (also known as functional neurological disorder) before Freud, though why a particular symptom should arise is unknown. We aimed to determine if there was a relationship between trauma type and symptom. Methods: We retrospectively reviewed the medical records of patients attending Australia’s first functional neurology clinic, including referral, clinic letters and a clinic questionnaire. Results: There were 106 females, 43 males and five transgender patients. Sensory (51%), motor (47%) and seizures (39%) were the commonest functional symptoms. Most patients (92%) reported stressors associated with symptom onset. Multiple trauma/symptom type associations were found: patients with in-law problems experienced more cognitive symptoms ( p = .036), for example, while expressive speech problems more commonly followed relationship difficulties ( p = .021). Conclusion: Associations were found between type of traumatic events and type of symptoms in conversion disorder. This will require verification in a larger sample.

Exploring the meaning of value-based occupational therapy services from the perspectives of managers, therapists and clients

2021 ◽  
pp. 030802262110300
Author(s):  
Su Ren Wong ◽  
Bi Xia Ngooi ◽  
Fang Yin Kwa ◽  
Xiang Ting Koh ◽  
Rachel J J Chua ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Goal Setting ◽  
Management Strategies ◽  
Perceived Value ◽  
Occupational Therapists ◽  
Therapeutic Relationships ◽  
Structured Interviews ◽  
Therapeutic Communication ◽  
Main Concept ◽  
Therapy Services

Introduction There is a worldwide trend towards value-based health care, which strives to control healthcare costs while maximising value for clients. The main concept of value has been defined as health outcomes achieved per US dollar spent. This research explored how clients of occupational therapy services, managers and occupational therapists perceived value in occupational therapy services. Method A qualitative design was used to explore the perspectives of clients ( n = 11), occupational therapists ( n = 7) and occupational therapy managers ( n = 7). Appreciative inquiry guided the two phases of semi-structured interviews ( n = 5) and focus groups ( n = 6). Inductive and deductive coding were used to establish themes. Findings Three themes encompassed the participants’ perceived value of occupational therapy services: (1) outcomes which are meaningful to daily life, (2) a constructive client–therapist relationship and (3) affordable, coordinated and understandable therapy. Conclusion Participants attributed value to occupational therapy services when they encountered personalised goal setting, focused on meaningful outcomes, managed personal costs and experienced positive therapeutic relationships. Enhancing services could focus on (1) developing skills in collaborative goal setting, (2) determining suitable outcome measures which are meaningful at personal- and service-level reporting, (3) encouraging self-management strategies, and (4) emphasising therapeutic relationships and supporting therapeutic communication skill development.

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