I Love Neuro

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

Oct 7, 2024

In this engaging discussion, Heather Salon and Julie Maggio, both clinical specialists in outpatient physical therapy at Massachusetts General Hospital, share their expertise on Functional Neurological Disorders (FND). They explain the shift towards recognizing FND as a 'rule-in' diagnosis, making it crucial for healthcare professionals to identify specific diagnostic signs. Highlighting multidisciplinary care, they emphasize the collaboration of various therapists and specialists. Sensory-based interventions and setting realistic patient expectations are also key topics, providing practical insights for effective treatment.

54:27

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Episode guests

Heather Salon

Julie Maggio

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Quick takeaways

The podcast highlights a shift towards recognizing Functional Neurological Disorders (FND) as a 'rule-in' diagnosis rather than a diagnosis of exclusion.

Key assessments for diagnosing FND include specific 'rule-in' signs like Hoover's sign and give-way weakness, emphasizing clinical evaluation over imaging.

Effective management of FND requires a multidisciplinary approach involving multiple professionals to address both the neurological and psychological aspects of the disorder.

Deep dives

The Emergence of Functional Neurologic Disorders (FND)

Functional neurologic disorders (FND) have gained significant attention over recent years, reflecting a marked increase in awareness and understanding among clinicians. FND encompasses a diverse range of symptoms and has evolved from being underrecognized and poorly understood to becoming a topic of discussion in neurologic rehabilitation. Professionals like Heather Salon and Julie Maggio, both experienced physical therapists, highlighted their journeys of discovering FND during their careers, particularly noting that the term conversion disorder is increasingly being replaced by FND. The growth of interest is attributed to ongoing research, presentations in major conferences, and improved diagnostic clarity following years of confusion about the condition.

Intro

6min

Understanding Functional Neurological Disorders

11min

Navigating Functional Neurological Disorders

10min

Understanding Patient Histories in Physical Therapy

2min

The Essential Multidisciplinary Approach in FND Treatment

4min

Understanding Dystonia: Functional vs Non-Functional

13min

Realistic Expectations in FND Treatment

9min

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