This section is based mainly on the author’s own experience in trying to assist many patients with functional movement disorders to get better.

If you haven’t read them yet, have a look at these sections before you read on:

1. Tremor, Spasms and Walking Problems: It is really important to understand that these symptoms are common, do not mean you are going mad or ‘losing it’, and are potentially reversible without medication.
2. Understanding FND: It is essential that you feel the doctor has looked into your case properly and come to the correct diagnosis.
3. Physiotherapy and exercise: This explains some basic principles behind rehabilitation and exercise for functional symptoms including weakness, pain and fatigue
4. Psychological therapy: If your doctor has referred you to a psychologist or psychiatrist you may be wondering why. Read this section to help you understand this.

Learning to overcome functional movement disorders …

We are still learning more about what kinds of treatments work best for patients with functional movement disorders.

Understanding it

It can be surprising how much impact simply receiving a clear and understandable explanation for the symptom can have. Often patients with functional movement disorder may have gone months or even years without a diagnosis (or sometimes with an alternative diagnosis like Parkinson’s disease).

It can take a long time to ‘get your head’ around being diagnosed with a functional movement disorder. For patients who do start to feel better, doing this seems to be an important part of it.

Seeing how it fits in with all your other symptoms can also be an important part of understanding it. It can help to understand that your weakness is one symptom among many (usually pain, fatigue and sleep disturbance) and that you have one illness with many symptoms, not many symptoms caused by different diseases. Read more about FND and other functional disorders if this applies to you.

These include

1. Physiotherapy
2. Psychological therapy
3. Medication to help pain and sleep

Specific things that come up in relation to functional movement disorder

Intermittent movement disorder
Some patients with tremor experience ’bouts’ of tremor. These episodes may be preceded by dissociative symptoms. Although patients with this do not black out, the advice on treatment and learning to avert attacks may be similar to that for dissociative seizures. Have a look at the treatment of functional seizures and see if anything applies to you.

Think about how variable it is
Variability is a common feature of many functional symptoms. If you think about it, it’s one reason why the diagnosis of FND makes sense. If there was structural damage to the nervous system, the symptoms might fluctuate a bit but not dramatically as they can do with functional movement disorders.

There are several reasons why functional movement disorders can vary in severity:

1. At times of greater fatigue
2. At times of greater pain
3. When you are thinking consciously about movement. For example, this may be especially the case when you are sitting resting and not doing very much or lying in bed and more aware of your body

This last one is worth some thought. You may have noticed that the more attention you pay to your movements the worse they get.

Try, as much as possible, not to think about your movements. Remember that with functional movement disorder, you are trying to regain control of a limb that may not feel completely like ‘yours’.

Sometimes patients report that having their tremor or abnormal posture feels ‘natural’ whereas having a limb that is in the normal position, or still, feels unnatural.

You may need to train your brain so that the normal position starts to feel natural again. Read Anna’s Story on the Cases page for an example of this.

Try these specific things for individual symptoms.

Functional Tremor

(with thanks to Glenn Nielsen, Physiotherapist at St George’s Hospital, London)

Physiotherapy
All of these need to be practised repeatedly, and many will seem impossible or difficult to begin with. You are trying to break a ‘habit’ in your brain, that is not easy to do. If you are trying these on your own and they arent working don’t give up on physical movement as a treatment. Sometimes you need someone to show you what to do. I’ve put these here just to give you an idea of some of the things that might help

1. Attempt to make a voluntary tremor ‘on top’ of your existing tremor, perhaps with a sweeping arm movement like the conductor of an orchestra. then change the movements to wider and slower movements eventually bringing it to a standstill. Does your functional tremor stop briefly when you do this? Keep practising to see if this helps you get better control.
2. See if you can ‘interfere’ with the rhythm of your functional tremor by making a rhythmical movement with your “good” arm or leg. Ask a friend to make a tapping movement that you have to copy. The friend should start off with a steady rhythm but then speed up and slow it down which will make it harder for you to keep up. If the rhythm of the functional tremor changes depending on this ‘external’ rhythm, you could see if it’s possible to slow the external rhythm right down until perhaps it stops.
3. Learning to contract and relax muscles. Functional tremor often comes about because the person is contracting all the muscles of their arm or leg at once. Learning a technique called progressive muscular relaxation can help you get more control back over muscle contraction.
4. Look in a mirror when trying to do this. This may help your brain learn where it’s going wrong. Have a look at Max’s mirror video.

It may be worth trying hypnosis. Sometimes under hypnosis, tremor may improve and you may be able to learn self-hypnosis to practice at home.

Link with anxiety
Functional tremor, can in some patients, be especially linked to anxiety.

Commonly, feelings of anxiety link to the tremor itself, what will people think about me? Am I going to start shaking all over? Will that be embarrassing? But these are still feelings of anxiety.

Many patients with functional tremor don’t have anxiety, but if you do, it may be important to face up to that and seek specific treatment directed at controlling excessive worry. This can sometimes help.

Some patients report that episodes of tremor appear to ‘get rid’ of a build-up of “hard-to-describe”, tense, dizzy symptoms. They don’t want the tremor to happen, but recognise that when it does (if it happens as ‘episodes’) that it does seem to lessen those feelings. If this applies to you then it may be useful to discuss that with your treating health professional. This can be similar to what happens to people having functional seizures. Have a read of that treatment page too if your movement disorder symptoms are episodic like this.

Functional Dystonia

We are still learning what specific techniques are most helpful for functional dystonia. As a general principal, trying to move the affected part is really important, although if it’s fixed this may not be possible.

Some of the following may be helpful.

1. Changing sitting and standing postures
2. Desensitise the limb using techniques learned for complex regional pain syndrome
3. Looking in a mirror gives your brain feedback that the limb is not in the right position. For example, some patients report that they feel as if the foot is straight even when it’s actually bent.
4. Using a mirror to ‘trick’ your brain into thinking that the abnormal foot or hand is normal. This is the same technique used in patients with Phantom Limb Pain and is also used in CRPS.
5. Practising ‘imagining your foot or hand in a normal position again.

Additional treatments that are sometimes used in functional dystonia include:

Hypnosis . In a state of hypnosis some people become aware that the dystonia improves or even disappears temporarily. Learning to experience the altered state of being in hypnosis or carrying out ‘self-hypnosis’ can be helpful for some people.

Therapeutic Sedation. This is only potentially useful in patients with ‘fixed’ dystonia who are unable to experience their limbs in a normal position at any other time. This also allows examination for any contractures. If this is handled correctly it can encourage normal movements which the patient has not experienced for a long time. This should only be carried out if your doctor has experience with this technique. It is not a ‘cure-all’ for fixed dystonia.

Walking problems (Functional Gait Disorder)

1. Try humming a tune or singing a song (in your head if you need to!) while walking. Has this made it easier to walk?
2. Try walking backwards if you have difficulty walking. Walking backwards is a different ‘program’ in the brain and you may be surprised to find that it’s easier than walking forwards. If you can walk backwards more easily use that to experience more automatic movements. Im not suggesting you walk everywhere backwards!
3. Try sliding along the ground as if you are ice skating,
4. Running. For patients that are able, sometimes a slight jog makes it easier to move. This is a bit like someone with a stutter who has problems speaking but can sing normally. Have a look at Miranda’s video to see this in action.
5. Dancing. If you like dancing or have been good at it, see if you can bring some of the natural movement of dance to your normal walk. You might feel a bit silly – but practice on your own or with someone you trust and see what happens!
6. Try bouncing a balloon or throwing or kicking a ball. Your brains attention on the ball or balloon may have the effect of improving your automatic movements and squashing down the abnormal FND movements.