Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-24T11:00:23.316Z Has data issue: false hasContentIssue false
  • English
  • Français

Occupational therapy for functional neurological disorders: a scoping review and agenda for research

Published online by Cambridge University Press:  27 November 2017

Paula Gardiner ,
Lindsey MacGregor ,
Alan Carson  and
Jon Stone
Paula Gardiner
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
Lindsey MacGregor
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
Alan Carson
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
Jon Stone*
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
*
*Address for correspondence: Dr Jon Stone, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crew Road, Edinburgh EH4 2 XU, United Kingdom. (Email: Jon.Stone@ed.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Functional neurological disorders (FND)—also called psychogenic, nonorganic, conversion, and dissociative disorders—constitute one of the commonest problems in neurological practice. An occupational therapist (OT) is commonly involved in management, but there is no specific literature or guidance for these professionals. Classification now emphasizes the importance of positive diagnosis of FND based on physical signs, more than psychological features. Studies of mechanism have produced new clinical and neurobiological ways of thinking about these disorders. Evidence has emerged to support the use of physiotherapy and occupational therapy as part of a multidisciplinary team for functional movement disorders (FMD) and psychotherapy for dissociative (nonepileptic) attacks. The diagnosis and management of FND has entered a new evidence-based era and deserves a standard place in the OT neurological curriculum. We discuss specific management areas relevant to occupational therapy and propose a research agenda.

Keywords

Functional neurological disordersoccupational therapypsychogenicconversion disordernonorganicfunctional disordersnonepilepticseizuresfunctional movement disorders
Type
Review Articles
Information
CNS Spectrums , Volume 23 , Special Issue 3: Theme: Neuropsychiatry , June 2018 , pp. 205 - 212
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Stone, J, Carson, A, Duncan, R, et al. Who is referred to neurology clinics? The diagnoses made in 3,781 new patients. Clin Neurol Neurosurg. 2010; 112(9): 747–751.Google Scholar
2. Gelauff, J, Stone, J, Edwards, M, Carson, A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry. 2014; 85(2): 220–226.Google Scholar
3. Durrant, J, Rickards, H, Cavanna, AE. Prognosis and outcome predictors in psychogenic nonepileptic seizures. Epilepsy Res Treat. 2011; 2011: 1–7.Google Scholar
4. Demartini, B, Batla, A, Petrochilos, P, Fisher, L, Edwards, MJ, Joyce, E. Multidisciplinary treatment for functional neurological symptoms: a prospective study. J Neurol. 2014; 261(12): 2370–2377.Google Scholar
5. McCormack, R, Moriarty, J, Mellers, JD, et al. Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study. J Neurol Neurosurg Psychiatry. 2014; 85(8): 895–900.Google Scholar
6. Jordbru, AA, Smedstad, LM, Klungsøyr, O, Martinsen, EW. Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up. J Rehabil Med. 2014; 46(2): 181–187.Google Scholar
7. Czarnecki, K, Thompson, JM, Seime, R, Geda, YE, Duffy, JR, Ahlskog, JE. Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol. Parkinsonism Relat Disord. 2012; 18(3): 247–251.Google Scholar
8. Nielsen, G, Buszewicz, M, Stevenson, F, et al. Randomised feasibility study of physiotherapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatry. 2016; 88(6): 484–490.Google Scholar
9. Nielsen, G, Ricciardi, L, Demartini, B, Hunter, R, Joyce, E, Edwards, MJ. Outcomes of a 5-day physiotherapy programme for functional (psychogenic) motor disorders. J Neurol. 2015; 262(3): 674–681.Google Scholar
10. Stone, J, LaFrance, WC, Brown, R, Spiegel, D, Levenson, JL, Sharpe, M. Conversion disorder: current problems and potential solutions for DSM–5. J Psychosom Res. 2011; 71(6): 369–376.Google Scholar
11. Rawlings, GH, Reuber, M. What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies. Seizure. 2016; 41: 100–111.Google Scholar
12. Stone, J, Warlow, C, Sharpe, M. The symptom of functional weakness: a controlled study of 107 patients. Brain. 2010; 133(Pt 5): 1537–1551.Google Scholar
13. Angus-Leppan, H. Diagnosing epilepsy in neurology clinics: a prospective study. Seizure. 2008; 17(5): 431–436.Google Scholar
14. Carson, A, Lehn, A. Epidemiology, Chapter 15. In: Handbook of Clinical Neurology, Vol. 139: Functional Neurologic Disorders. 2016: 47–60.Google Scholar
15. Carson, A, Stone, J, Hibberd, C, et al. Disability, distress and unemployment in neurology outpatients with symptoms “unexplained by organic disease. J Neurol Neurosurg Psychiatry. 2011; 82(7): 810–813.Google Scholar
16. Anderson, KE, Gruber-Baldini, AL, Vaughan, CG, et al. Impact of psychogenic movement disorders versus Parkinson’s on disability, quality of life, and psychopathology. Mov Disord. 2007; 22(15): 2204–2209.Google Scholar
17. Reuber, M. The etiology of psychogenic non-epileptic seizures: toward a biopsychosocial model. Neurol Clin. 2009; 27(4): 909–924.Google Scholar
18. Stone, J, Carson, A, Hallett, M. Explanation as treatment for functional neurologic disorders, Chapter 44. In: Handbook of Clinical Neurology, Vol. 139: Functional Neurologic Disorders. 2016: 543–553.Google Scholar
19. Pareés, I, Kojovic, M, Pires, C, et al. Physical precipitating factors in functional movement disorders. J Neurol Sci. 2014; 338(1): 174–177.Google Scholar
20. Hendrickson, R, Popescu, A, Dixit, R, Ghearing, G, Bagic, A. Panic attack symptoms differentiate patients with epilepsy from those with psychogenic nonepileptic spells (PNES). Epilepsy Behav. 2014; 37: 210–214.Google Scholar
21. Reuber, M, Brown, RJ. Understanding psychogenic nonepileptic seizures: phenomenology, semiology and the Integrative Cognitive Model. Seizure. 2016; 44: 199–205.Google Scholar
22. Aybek, S, Vuilleumier, P. Imaging studies of functional neurologic disorders, Chapter 7, In: Handbook of Clinical Neurology, Vol. 139: Functional Neurologic Disorders. 2016: 73–84.Google Scholar
23. Hallett, M. Neurophysiologic studies of functional neurologic disorders, Chapter 6. In: Handbook of Clinical Neurology, Vol. 139: Functional Neurologic Disorders. 2016: 61–71.Google Scholar
24. Stone, J. Functional neurological disorders: the neurological assessment as treatment. Pract Neurol. 2016; 16(1): 7–17.Google Scholar
25. McWhirter, L, Stone, J, Sandercock, P, Whiteley, W. Hoover’s sign for the diagnosis of functional weakness: a prospective unblinded cohort study in patients with suspected stroke. J Psychosom Res. 2011; 71(6): 384–386.Google Scholar
26. Schmerler, DA, Espay, AJ. Functional dystonia. Chapter 20. In: Handbook of Clinical Neurology, Vol. 139: Functional Neurologic Disorders. 2016: 235–245.Google Scholar
27. Daum, C, Hubschmid, M, Aybek, S. The value of “positive” clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry. 2014; 85(2): 180–290.Google Scholar
28. Schwingenschuh, P, Saifee, TA, Katschnig-Winter, P, et al. Validation of “laboratory-supported” criteria for functional (psychogenic) tremor. Mov Disord. 2016; 31(4): 555–562.Google Scholar
29. Avbersek, A, Sisodiya, S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry. 2010; 81(7): 719–725.Google Scholar
30. Goldstein, LH, Mellers, JDC. Psychologic treatment of functional neurologic disorders. Chapter 46. In: Handbook of Clinical Neurology, Vol. 139: Functional Neurologic Disorders. 2016: 571–583.Google Scholar
31. Goldstein, LH, Chalder, T, Chigwedere, C, et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology. 2010; 74(24): 1986–1994.Google Scholar
32. LaFrance, WC, Baird, GL, Barry, JJ, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014; 71(9): 997–1005.Google Scholar
33. Stone, J, Edwards, M. Trick or treat? Showing patients with functional (psychogenic) motor symptoms their physical signs. Neurology. 2012; 79(3): 282–284.Google Scholar
34. Nielsen, G, Stone, J, Edwards, MJ. Physiotherapy for functional (psychogenic) motor symptoms: A systematic review. J Psychosom Res. 2013; 75(2): 93–102.Google Scholar
35. Nielsen, G, Stone, J, Matthews, A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015; 86(10): 1113–1119.Google Scholar
36. White, PD, Goldsmith, KA, Johnson, AL, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011; 377(9768): 823–836.Google Scholar
37. Saifee, TA, Kassavetis, P, Pareés, I, et al. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol. 2012; 259(9): 1958–1963.Google Scholar
38. Sharpe, M, Walker, J, Williams, C, et al. Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology. 2011; 77(6): 564–572.Google Scholar
39. Hubschmid, M, Aybek, S, Maccaferri, GE, et al. Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks. Gen Hosp Psychiatry. 2015; 37(5): 448–545.Google Scholar
40. Goldstein, LH, Mellers, JD, Landau, S, et al. Cognitive behavioural therapy vs. standardised medical care for adults with dissociative non-epileptic seizures (CODES): a multicentre randomised controlled trial protocol. BMC Neurol. 2015; 15(1): 98.Google Scholar
41. Saifee, TA, Kassavetis, P, Pareés, I, et al. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol. 2012; 259(9): 1958–1963.Google Scholar
42. Gutman, SA, Schindler, VP. The neurological basis of occupation. Occup Ther Int. 2007; 13(2): 71–85.Google Scholar
43. Dallocchio, C, Arbasino, C, Klersy, C, Marchioni, E. The effects of physical activity on psychogenic movement disorders. Mov Disord. 2010; 25(4): 421–425.Google Scholar
44. Moene, FC, Spinhoven, P, Hoogduin, KA, van Dyck, R. A randomised controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for inpatients with conversion disorder of the motor type. Psychother Psychosom. 2002; 71(2): 66–76.Google Scholar
45. Heruti, RJ, Reznik, J, Adunski, A, Levy, A, Weingarden, H, Ohry, A. Conversion motor paralysis disorder: analysis of 34 consecutive referrals. Spinal Cord. 2002; 40(7): 335–340.Google Scholar