Lecture Titles

1. Treatment Planning and Education

Lecture Description

This module sets the stage for the Rehab 101 course.  A brief introduction covers the rationale for the program and what to expect, followed by a dedicated talk on the crucial role of education in treating FND. We cover illness models, communicating how and why FND symptoms occur, and how important it is to have the treating team on the same page as the patient during the course of therapy.

1.1 Welcome and Introduction to FND Rehabilitation 101

Sarah Lidstone, MD, PhD
Director of the Integrated Movement Disorders Program
Toronto Rehabilitation Institute
Assistant Professor of Neurology, University of Toronto

Glenn Nielsen, PhD
Senior Lecturer in Neurological Physiotherapy
St George’s University of London
UK AHP FND Network Co-Lead

1.2. Education as a Rehabilitation Tool

Sarah Lidstone, MD, PhD
Director of the Integrated Movement Disorders Program
Toronto Rehabilitation Institute
Assistant Professor of Neurology, University of Toronto

Glenn Nielsen, PhD
Senior Lecturer in Neurological Physiotherapy
St George’s University of London
UK AHP FND Network Co-Lead

2. Rehabilitation Assessment, Common Themes Across Disciplines

Lecture Description

This module covers the common basics of an FND rehab assessment used by all disciplines. We explore structuring a history and building an understanding of the patient perspective that will form the basis for the therapy plan, both in the in-person and virtual settings.

2.1 Conducting a Patient Interview

Jennifer L. Freeburn, MS, CCC-SLP
Speech Language Pathologist
Functional Neurological Disorder Unit
Massachusetts General Hospital

Learning Objectives 2.1

• Identify key information that is important to gather during an initial patient interview
• Describe recommended interview strategies and questions
• Discuss methods that rehab professionals may use to consider biopsychosocial factors in case formulation and treatment planning​

2.2 Delivering an Effective Virtual Assessment

Haseel Bhatt, MSc, MScPT
Physiotherapy Lead
Integrated Movement Disorders Program
University Health Network

Learning Objectives 2.2

• Understand the evidence and feasibility of virtual assessments for FND
• Describe practical strategies for preparing and delivering an effective virtual FND assessment.
• Apply a 3-step framework for virtual FND assessments: before, during, and after the session.

3. Therapy Role and Techniques (including assessment when needed)

Lecture Description

Now we are getting to the meat of it! This module takes a tour through the specific tools and strategies used in FND rehab across all rehab specialties: physiotherapy, occupational therapy, and speech and language pathology (voice, speech, and swallow). We cover evidence-based techniques used in everyday practice in a series of practical, bite-sized talks. These are followed by a dedicated talk about dealing with pain, fatigue, and cognitive symptoms, the most common non-motor symptoms that arise in FND, and when present, can act as barriers to engagement. Rounding out the module, we cover the important roles of social work and nursing in the care of people with FND, and finish with a conversation exploring how to conclude therapy and prepare patients for self-management.

3.1 Therapeutic Neurobiological Mechanisms

David L. Perez MD, MMSc
Associate Professor of Neurology and Psychiatry
Mass General Brigham
Harvard Medical School

Learning Objectives 3.1

• Identify neuropsychological constructs implicated in the pathophysiology of functional neurological disorder
• Identify how functional neurological symptoms, neuropsychological constructs, and brain networks relate to one another in the pathophysiology of functional neurological disorder
• Identify primary resting state brain networks implicated in the pathophysiology of functional neurological disorder

3.2 Movement Retraining Physiotherapy

Julie Maggio, PT, DPT, NCS
Clinical Specialist
Massachusetts General Hospital Outpatient PT
MGH FND Unit Affiliated Researcher

Learning Objectives 3.2

• Participants will be able to assess movement patterns and recognize opportunities to enhance motor control utilizing external focus
• Participants will be able to identify key factors contributing to movement dysfunction, including altered attentional focus, fear, pain, and nervous system dysregulation
• Participants will develop a more comprehensive understanding of how FND impacts movement and motor control

3.3 Occupational Therapy, Including Provision of Aids and Adaptations

Clare Nicholson, OT
Clinical Specialist Occupational Therapist, Neurosciences / Functional Neurological Disorders Rehabilitation Team
The National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London
Doctoral Clinical Practitioner Academic Fellowship (DCAF) candidate
University College London (UCL), Centre for Behaviour Change

Learning Objectives 3.3

• To describe overarching principles of Occupational Therapy interventions for Functional Neurological Disorder
• To provide examples of Occupational Therapy interventions for specific functional neurological symptoms.
• To illustrate how symptom management strategies can be integrated into daily activities and routines.

3.4 Voice Disorders

Janet Baker, LACST, MsC, PhD
Speech Pathologist & Family Therapist
Clinical Consultant in Voice & Counselling
Supervision & Reflective Practice for Clinicians and Academics
Adjunct Associate Professor, Flinders University, SA
Honorary Clinical Fellow, UTS NSW

Learning Objectives 3.4

• Provide an overview of biopsychosocial conceptual understandings underpinning the nature and patterns of onset of FNVD
• Describe the positive clinical signs that contribute to the differential diagnosis of FNVD
• Present the general principles of management that include practical strategies to facilitate the resolution of vocal symptoms, and generalisation beyond the clinical setting
• Highlight ways in which counselling by the SLP is integral to this process, with attention to predisposing, precipitating, and perpetuating factors
• Identify possible ‘red flags’ that may indicate the need for deeper levels of counselling and/or collaboration with mental health professionals in the multidisciplinary team

3.5 Functional Speech Disorders

Jennifer L. Freeburn, MS, CCC-SLP
Speech Language Pathologist
Functional Neurological Disorder Unit
Massachusetts General Hospital

Learning Objectives 3.5

• Identify the common features and types of speech-language disruptions in FND​
• Describe methods for using assessment data to inform differential diagnosis of functional speech disorders
• Explain treatment principles and strategies as applicable to the clinical setting

3.6 Swallowing

Catherine Gregory, PhD, MSLP (Hons), BSc (Hons), CPSP
Lecturer and Clinical Educator
University of Technology, Sydney
Owner/Director of Resonate Speech Pathology

Learning Objectives 3.6

• Know the positive signs for functional neurological dysphagia
• Know the DEEEP principles of treatment of functional neurological dysphagia
• Understand how treatment for clients with chronic/complex FND differs

3.7 Pain, fatigue, and cognition

Cameron Moss
Principal Physiotherapist, Functional Movement Disorders
St George’s University Hospitals NHS Foundation Trust
Honorary Contract: City St George’s University of London

Learning Objectives 3.7

• To identify wider symptoms of pain, fatigue, and cognition that commonly co-exist with FND.
• To demonstrate examples of education regarding these complex, co-existing symptoms.
• To describe strategies that support self-management of these co-existing symptoms.

3.8 The Role of Social Work

Najda Robinson-Mayer, LMSW
Licensed Master Social Worker (LMSW)
University of Michigan Health System, Michigan Medicine
Adult Neurology Clinic, Department of Social Work
Social Worker MSW Senior

Learning Objectives 3.8

• Explain the multifaceted role of social work in treating patients who have functional neurologic disorders, including providing therapy, identifying needs, and collaborating with local agencies.
• Illustrate case management techniques to reduce barriers in access to healthcare and other resources.
• Demonstrate how prognostic signs are used to personalize psychotherapy treatment and maximize treatment success.

3.9 The Role of Nursing

Kate Kain, RN
Registered Nurse
Ambulatory Neurosciences
South Health Campus / Alberta Health Services (Calgary AB)

Learning Objectives 3.9

• Explain the RN role for patients with FND within various care settings.
• Explore the nursing role in the assessment of FND symptomology and patterns.
• Differentiate between the necessity of time spent with patients and setting boundaries to promote agency and avoid dependence.

3.10 Concluding treatment and supporting self-management

Glenn Nielsen, PhD
Senior Lecturer in Neurological Physiotherapy
St George’s University of London
UK AHP FND Network Co-Lead

Mark J Edwards, MBBS, BSc, FRCP, PhD
Professor of Neurology and Interface Disorders
Department of Basic and Clinical Neuroscience
Institute of Psychiatry, Psychology and Neuroscience
King’s College London

Learning Objectives 3.10

• To recognize the importance of planning for discharge from day one of treatment
• To be able to include strategies in your treatment that will help to create a good discharge experience
• To be able to approach treatment in ways that support the patient to develop self-management skills

4. Adapting Treatment for Paediatrics and Young People

Lecture Description

This module builds on the previous content to add the unique considerations when working with the pediatric population. Children and adolescents have unique predisposing, precipitating, and perpetuating factors associated with their symptoms, and can benefit from some special therapy strategies and care models, summarized over 3 brief talks.

4.1 Paediatric predisposing, precipitating, and perpetuating factors

Kristen Trott, PhD
Pediatric Psychologist
Nationwide Children's Hospital
Clinical Associate Professor
The Ohio State University in Columbus

Learning Objectives 4.1

• Identify typical FND symptomology in youth
• Define risk factors in the development of FND in youth
• Recognize complicating factors in recovery

4.2 Paediatric multidisciplinary teams

Dara Albert, DO, MEd, FAAN, FAES
Associate Professor
Department of Pediatrics
Division of Child Neurology
Nationwide Children’s Hospital/The Ohio State University

Learning Objectives 4.2

• Define why there is a need for multidisciplinary care for patients with FND
• Highlight the benefits of multidisciplinary care
• Provide an example of a multidisciplinary Pediatric Functional Seizure Clinic

4.3 Rehabilitation for Young People

Jason Kreuzman MOT, OTR/L
Occupational Therapist
St. Louis Children's Hospital
Therapy and Audiology Services

Learning Objectives 4.3

• Define the roles of OT, PT, and ST in the treatment of young people with FND
• Explain the importance of developmental skills in the FND treatment of young people
• Explain the Bio-Psycho-Social factors unique to young people with FND

5. Integrating Mind and Body

Lecture Description

This module begins with a moderated 30-minute panel discussion between an FND expert physiotherapist, occupational therapist, and psychotherapist that delves into the concept of “psychologically-informed therapy.”  We blur the boundaries between physical rehabilitation and psychotherapy and discuss the benefits and challenges in pulling together these different approaches. The following talk addresses psychological safety in rehab, covering practical tips about how to handle challenging mental health situations that sometimes may arise in therapy.

5.1 Unravelling psychologically-informed rehab: strategies and tools

Sarah Lidstone, MD, PhD
Director of the Integrated Movement Disorders Program
Toronto Rehabilitation Institute
Assistant Professor of Neurology, University of Toronto

Kate Holt
Clinical Physiotherapist
Research Physiotherapist
City St George's University of London

Sarah Cope, BSc, MSc, DClinPsy
Clinical Psychologist
Lishman Unit, South London
Maudsley NHS Foundation Trust

Helen Jinadu
Clinical Specialist Occupational Therapist
Lishman Unit
South London and Maudsley NHS Foundation Trust

5.2 Psychological safety in rehabilitation

Gaston Baslet, MD
Neuropsychiatrist
Bruce W Carter VA Medical Center, Miami, FL
Associate Professor of Psychiatry
Harvard Medical School, Boston, MA

Learning Objectives 5.2

• Identify the psychological safety concerns that may arise during rehabilitation therapy and have a plan on how to address them.
• Create a therapeutic, safe environment during rehabilitation therapy that will facilitate clinical progress of functional neurological symptoms and will allow psychological symptoms to be discussed.
• Recognize psychiatric and psychosocial factors that may interfere with rehabilitation therapy and may need to be prioritized.

6. The Lived Experience

Lecture Description

The final module of the course is a collection of the reflections and lived experiences shared by three people who received rehabilitation for FND. They discuss what was helpful and not helpful to their recovery, what made a difference, and their messages for health care providers.

6. The Lived Experience

Caoimhe McLoughlin
Research Fellow
University of Edinburgh
Consultant Liaison Psychiatrist
Sligo University Hospital, Ireland

Learning Objectives 6.1

• Hear advice (do and don’ts) for healthcare professionals from the patient perspective
• Use language that is helpful and non-stigmatising when working with patients
• Develop a more empathic understanding of what the patient goes through on their FND journey