This Rehab Science Spotlight describes an interdisciplinary treatment model for functional neurological symptom disorder with illustration via case study.
CITATION
Hardin, A. S., & Carson, C. (2019). Interdisciplinary Treatment of Functional Neurological Symptom Disorder in an Inpatient Rehabilitation Setting: A Case Report. PM&R, 11(6), 661-664.
SUMMARY
Through illustration of a case study, this article concisely provides an evidence-based interdisciplinary treatment model for patients with functional neurological symptom disorder (FNSD or FND) completing inpatient rehabilitation. The article illustrates the critical role that rehabilitation psychologists play in helping the team understand this diagnosis, develop appropriate goals, and ensure consistent implementation of the treatment plan. In this case study, the psychologist scheduled a preliminary team meeting at the onset of treatment. Treatment guideline handouts were developed and provided to the team. As the authors point out, this meeting was essential, as the team’s expectations for the patient’s outcome would have been significantly reduced if this discussion had not occurred. During this meeting, the team was also educated on the rationale for utilizing an operant conditioning model, and scaffolded goals were developed collaboratively. Importantly, these goals were developed based on the patient’s identified values/interests. The psychologist also participated in co-treatment sessions with physical and occupational therapy to maximize adherence to the treatment plan and offer consultation as needed. Other principles of the treatment model included use of decisive language to promote expectations for progress, ensuring that the patient mastered each step prior to moving on to additional steps, and reinforcing adaptive behaviors while ignoring/avoiding excessive attention to maladaptive behaviors. The patient had a successful outcome as evidenced by improved physical functioning/independence, reduced frequency and intensity of FNSD symptoms, and increased confidence in her ability to self-manage future symptoms.
I chose this article because the efficacy of treatment approaches for FNSD is under-researched but much needed. Given the dearth of empirically-validated guidelines, I have found it challenging to provide effective interdisciplinary care for patients with FNSD. The interdisciplinary team in which I work has utilized this model with several patients with FNSD with good clinical outcomes. As the authors highlight, future studies should include randomized, controlled trials utilizing these principles. It would be interesting to examine efficacy of this model in both inpatient and outpatient rehabilitation settings.
THIS REHAB SCIENCE SPOTLIGHT was selected by Rose Dunn, PhD, Baylor Scott & White Institute for Rehabilitation in Dallas, TX