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.

Ask episode

Chapters

Transcript

Episode notes

Intro

00:00 • 6min

Understanding Functional Neurological Disorders

05:40 • 11min

Navigating Functional Neurological Disorders

16:21 • 10min

Understanding Patient Histories in Physical Therapy

26:00 • 2min

The Essential Multidisciplinary Approach in FND Treatment

28:16 • 4min

Understanding Dystonia: Functional vs Non-Functional

32:38 • 13min

Realistic Expectations in FND Treatment

45:36 • 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