Functional Movement Disorders Unit

Functional movement disorders are one of the most frequent causes of neurological assessment in a movement disorders consultation (up to 18% in some studies). These disorders are also known by other names such as “conversive disorders”, “psychogenic disorders”, “medically unexplained symptoms or symptoms of non-organic origin”.

Patients with functional movement disorders may present with tremor, abnormal postures or walking problems that can lead to significant disability. Typically the tests performed are normal and have classically been related to stress or an underlying emotional difficulty.

The absence of alterations in the tests requested and the difficulty in finding a firmer diagnosis generates understandable distress in patients and their families, who are often involved in a spiral of tests and second opinions, with the consequent feeling of uncertainty regarding the diagnosis and with persistence or worsening of the physical symptoms they present.

Functional Movement Disorders Unit, a pioneer unit in Spain.

There are a limited number of multidisciplinary units dedicated to the care of these patients internationally. The Functional Movement Disorders Unit, within the Neurology Service of the Ruber Internacional Hospital, is a pioneer in Spain in the diagnosis and comprehensive treatment of patients suffering from these movement problems.

In our unit we perform a complete assessment of the patient, confirm the diagnosis and explain it in detail. Depending on each patient, a customized treatment plan is designed according to their individual characteristics.

The therapeutic approach is based on a transdisciplinary rehabilitation program that may include physiotherapy, occupational therapy and/or speech therapy with therapists with extensive experience in functional movement disorders and whose work is based on international recommendations published in recent years, as well as assessment and coordinated work with neuropsychiatry and psychotherapy.

Referrals for physical therapy recommendations:

(Nielsen G et al, Physiotherapy for functional motor disorders: a consensus recommendation. 2015. J Neurol Neurosurg Psychiatry).

Referrals for occupational therapy recommendations:

(Nicholson C, Edwards MJ, Carson AJ, Gardiner P, Golder D, Hayward K, Humblestone S, Jinadu H, Lumsden C, MacLean J, Main L, Macgregor L, Nielsen G, Oakley L, Price J, Ranford J, Ranu J, Sum E, Stone J. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry. 2020 Oct;91(10):1037-1045).

Referrals for speech therapy recommendations:

(Baker J, Barnett C, Cavalli L, et alManagement of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapyJournal of Neurology, Neurosurgery & Psychiatry 2021;92:1112-1125).

OBJECTIVES

Actively explore with the patient strategies to improve movement control through:

Education about symptoms and the mechanisms thatmay be involved in the generation of symptoms.
Retraining with different physicaland/or cognitive techniquesspecific to each type of movement disorder, using mainly the alteration of the focus of motor attention on the symptom.
Developing together with the patient an individualized symptom management plan to implement the work done during the week at home.

This multidisciplinary and individualized management in each patient is in line with current evidence published in recent years in the scientific literature (Espay AJ et al, Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. 2018. JAMA Neurology) whose main objective is to improve the quality of life of our patients.