Motor Retraining for Functional Movement Disorders

Motor Reprogramming (MoRe) for Functional Movement Disorders

Functional Movement Disorders (FMD) are commonly encountered in neurologic practice and mimic symptoms of other neurologic disorders, but can be diagnosed based on a typical history and features on examination. Many patients have a variety of abnormal movements including tremor, jerking movements, abnormal posturing of limbs, difficulties with walking and speech problems. FMD symptoms can be variable over time and are often associated with additional complaints such as weakness, numbness, fatigue, pain, poor concentration or memory difficulties (“brain fog”). 

Diagnostic studies such as MRI of the brain and spine, nerve conduction studies, EEG and laboratory studies are typically normal and do not show brain lesions or other abnormal findings responsible for your disorder. The different parts of the nervous system (brain, spinal cord, nerve roots, peripheral nerves and muscles) are still in working order, but do not function well together. FMD can have a chronic course and lead to disability, however it is possible to retrain the nervous system and restore normal function. The sooner the treatment starts after onset of symptoms, the better the prognosis, but even patients who experienced symptoms for many years have the potential to get better. 

We offer comprehensive, multidisciplinary evaluation and treatment for patients with FMD in our motor retraining (MoRe) program at Frazier Rehab Institute. MoRe uses strategies aimed at better understanding of the diagnosis, regaining control over abnormal movements and learning skills to cope with stress and prevent relapses. The program is based on motor reprogramming strategies developed at the Mayo Clinic in Rochester, Minn. [1], and a previously validated guided self-help program for functional neurological disorders using cognitive behavioral strategies [2]. 

Patients undergoing the MoRe program have shown improvement in their symptoms in >85% after one week of treatment, and self-reported improvement of symptoms was maintained in 69% after six months.

Read our patient success stories

References:

[1] Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR and Ahlskog JE. Functional movement disorders: Successful treatment with a physical therapy rehabilitation protocol. Parkinsonism and Related Disorders 2012;18(3):247-51.

[2] Williams C, Carson A, Smith S, Sharpe M, Cavanagh J, Kent C. Overcoming functional neurological symptoms: a five areas approach. CRC Press, 2011.

Pre-evaluation for treatment planning (Outpatient appointments):

  1. Neurologic evaluation in Movement disorder clinic: History and physical examination, review of previous medical records, confirmation of diagnosis/ rule out an alternative diagnosis, education.
  2. Physical therapy evaluation: Patient assessment, identification of deficits, explanation of inpatient program, expectation settings and development of a treatment plan. Based on your symptoms, treatment may include physical, occupational and speech therapy. 
  3. Psychology evaluation: Clinical diagnostic interview, identification of problem areas and education in regards to the program. Administration of FMD Inventory and psychological questionnaires. 

Motor Reprogramming (MoRe) for Functional Movement Disorders

Overview of treatment week

  • Sunday afternoon: Inpatient admission, tour of therapy facilities. 
  • Monday-Friday: Daily therapy programs tailored to individual symptoms. Therapy may include physical, occupational, speech and psychological therapy. We encourage participation of spouses/significant others during the treatment week. 
  • Saturday: Review of home exercises and relapse plan; discharge

Principals of therapy

  1. The principle of “motor retraining” (MoRe) is relearning of normal movements, similar to treatment of other neurological conditions (e.g. stroke, multiple sclerosis) with the goal of neurologic normality. 
  2. Treatment begins with reestablishing elementary movements in the affected limb or body region, and building on those. More complex movements are only introduced after simple movements are performed successfully. 
  3. Mental practice is used to supports training efforts. 
  4. Cognitive behavioral interventions are aimed at identifying triggers and other factors contributing to abnormal movements. You will learn ways on how to overcome obstacles that stand in the way of your symptoms getting better. 

If you think the MoRe Program may be of benefit to you, please ask your neurologist for a referral to our interdisciplinary FMD clinic

Research

There remain many open questions about functional neurologic disorders and few researchers have studied these conditions in the past. We are actively involved in FMD research to define risk factors, biomarkers and neuroimaging correlates of the disease. Our goal is to better understand underlying pathophysiologic mechanisms by studying brain changes occurring with therapy and help patients achieve best treatment outcomes.  During your stay at our center, you may have the opportunity to participate in research studies.

In 2017, we presented findings from our neuroimaging research at the 3rd International Conference on Functional Movement Disorders in Edinburgh, Scotland.

Faul L, Depue B, Jacob AE, Kaelin DL, Espay AJ, LaFaver K. Functional neuroimaging of functional movement disorders (FMD) before and after a rehabilitation program.  View our research poster. 

Make a gift

If you wish to make a difference for patients with FMD, consider making a gift to our center today. Your money will support FMD research and help to expand treatment services. To make a donation, contact Denise Nuehring (email: denise.nuehring@louisville.edu, Phone: 502-640-8663) or go online to our secure UofL School of Medicine giving form (FundForUofL.org/medicine) and select Neurology, Functional Movement Disorders (G2957) as designation for your gift.

Select Publications

  • Williams DT, LaFaver K, Carson A, Fahn S. Inpatient treatment for functional neurologic disorders. In: Hallett M, Stone J, Carson A, eds., Functional Neurologic Disorders, Volume 139 of the Handbook of Clinical Neurology series. Amsterdam: Elsevier, 2017: 631-641.
  • Abrol T and LaFaver K. Functional weakness and dysarthria in a 66-year-old man previously diagnosed with CIDP.  Practical Neurology. 2017(Jun): 42-44.
  • LaFaver K, Espay AJ. Diagnosis and Treatment of Functional (Psychogenic) Parkinsonism. Semin Neurol. 2017;37(2):228-232.
  • Jacob AE, Smith CA, Jablonski ME, Roach AR, Paper KM, Kaelin DL, Stetz-Thurmond D, LaFaver K. Multidisciplinary clinic for functional movement disorders (FMD): 1-year experience from a single centre. J Neurol Neurosurg Psychiatry. Epub 2017, Nov 15. 
  • BrainWaves: Movement Disorders Clinical Case and Podcast

Links

Further information about functional neurological disorders can be found at the following websites: www.neurosymptoms.org and www.fndhope.org.

MoRe Training Course for healthcare providers

A two-day training course targeting neurologists, physiatrists, physical, occupational, speech therapists, psychologists and other health care providers interested in the treatment of FMD took place on October 6-7, 2017, at the Brown Hotel in Louisville, Ky. Faculty from UofL Physicians, Frazier Rehab Institute and Mayo Clinic presented lectures and practical training opportunities to gain knowledge and skills on treatment of FMD patients. The videotaped lectures can be accessed for a fee online (CME/CE is no longer available) by emailing UofLPhysiciansMovement@ULP.org.