Functional Neurological Disorder (FND) is a diagnostic label given to somebody suffering functional problems (ie physical symptoms) which appear neurological in origin, but where there is no identifiable structural damage to their brain and nervous system. Rather, the problem is with how their brain and body sends, receives and interprets signals. To use a computer analogy, it’s a software problem rather than a hardware problem.
Traditionally, people with FND were told their problem was psychological and they were referred to a psychiatrist. As FND can in some cases be completely physically debilitating, it’s not surprising that many sufferers found it difficult to accept that was their only treatment option; easily interpreted as “it’s all in your mind”.
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More recently, however, the way that FND is viewed by the medical profession has evolved considerably and this has resulted in a significant re-think in the approach to treatment. In essence, in addition to (and separate from) dealing with the psychological aspects of FND, doctors are now emphasising and explaining to patients the mechanism of their motor symptoms, ie actually demonstrating to them their clinical signs. In so doing, it is hoped that patients can better understand how and why the disorder has occurred.
Equipped with that understanding, they can be helped to focus on correcting over-attention on those symptoms and their generally poor expectation in relation to the extent of movement.
One physiotherapy-based feasibility study at University College, London, has recently demonstrated the potential benefits of adopting this approach to the treatment of FND. 60 patients were recruited to the study and divided between an intervention group and a control group. According to the authors of the study, “At 6 months, 72% of the intervention group rated their symptoms as improved, compared to 18% in the control group.” In fact, 32% of those in the control group reported a worsening of their symptoms compared to just 3% in the intervention group.
This is a startling difference and reflected the results achieved in an earlier study involving people suffering a functional gait disorder. In this earlier case the treatment was provided on a more intense inpatient basis.
Specialist therapy for FND can still be extremely difficult to find in the UK; a genuine postcode lottery. But this new research should really be changing the way that solicitors representing people with FND compensation claims approach the issue of treatment.
“There really is a persuasive case here to see whether funding can be arranged for private and ideally inpatient rehabilitation at a specialist centre” says Andrew Atkinson, Head of Personal Injury at BLB Solicitors. “If therapy can improve symptoms to the extent that a claimant is able to do more for themselves or consider a return to work, that modest investment in funding the treatment could end up saving the insurance company tens of thousands of pounds. Claimants should discuss this with their solicitor.”