ArticleFND3 min read
How occupational therapy helps with FND
Functional neurological disorder is common, real and treatable. Occupational therapy has a central role, and the approach is different from other neurological conditions.
What is FND?
Functional neurological disorder is a problem with how the nervous system works, rather than damage to its structure. Symptoms can include weakness, tremor, walking difficulties, seizure-like episodes (dissociative seizures), sensory changes, fatigue, pain and difficulties with concentration. The symptoms are real and can be very disabling, even though scans and tests are often normal.
The OT consensus recommendations
In 2020 an international group of clinicians, led by Clare Nicholson at the National Hospital for Neurology and Neurosurgery, published consensus recommendations for occupational therapy in FND.1 They recognised that OTs commonly see people with FND, but that there had been little guidance on what helps.
The recommendations say that OT for FND should be based on a biopsychosocial framework: understanding how biological, psychological and social factors interact. Three things sit at the centre of treatment:
- Education: helping people understand FND, and that improvement is possible.
- Rehabilitation within functional activity: retraining movement and routines through real, everyday tasks, often with attention directed away from the symptom.
- Taught self-management strategies: for symptoms like fatigue, pain, dissociation and setbacks.
The paper also highlights that several aspects of OT for FND are distinct from therapy for other neurological conditions. For example, some approaches that help after stroke, such as relying on equipment or compensatory techniques, may be unhelpful in FND if they reinforce abnormal movement patterns.
What OT for FND looks like in practice
- A shared understanding of your symptoms and what keeps them going
- Goals based on activities that matter to you
- Graded practice of everyday tasks, at home and in the community
- Routines that balance activity, rest and recovery
- Strategies for managing triggers, setbacks and fatigue
- Careful review of equipment, keeping what genuinely helps
- Working with your wider team, such as neurology, physiotherapy and psychology
How NexGen can help
We provide specialist OT for FND at home and in the community, following the principles of the consensus recommendations, and work alongside your neurologist, physiotherapist and psychologist where they’re involved.
Questions
Can FND get better?
Yes. Many people improve with the right understanding and specialist rehabilitation, although recovery can take time and may include setbacks.
Why might an OT reduce my equipment?
Some equipment helps with safety and independence. But in FND, relying on aids can sometimes reinforce symptoms. An OT will review this carefully with you and never remove something you need to stay safe.
Do I need a diagnosis of FND before seeing an OT?
A diagnosis from a neurologist is important for FND-specific rehabilitation. If you’re still waiting, an OT can still help with everyday difficulties in the meantime.
References
- Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry 2020;91:1037–1045. Link
- neurosymptoms.org: information about FND for patients and families. Link
This article is general information, not a substitute for individual clinical advice. If you have new or worsening symptoms, speak to your GP or NHS 111.
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