Neurological Rehabilitation for Functional Neurological Disorder

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About this Research Topic

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Background

Functional Neurological Disorder (FND) can be recognized as diverse non-epileptic neurological symptoms of usually abrupt onset that alternate with normal or improved voluntary control. The symptoms are aggravated by either self-directed attention or emotional upset and improved with distraction. Although FND has been described for centuries, scientific research for FND has surged only in the 21st century when it was widely recognized as a medical disorder. Emerging research associates FND with multiple objective biomarkers, including structural and physiological anomalies in brain imaging, genetic characteristics, and comorbid findings in cardiovascular, gastrointestinal, immunological, and musculoskeletal systems. Because it is a persisting and common disabling illness, FND has been subject to numerous and successful rehabilitation trials in recent years. It is now important to review the distinguishing features of rehabilitation trials for FND when compared to other physically or cognitively disabling neurological disorders. By doing so, it should be possible to clarify what approaches for FND appear to have the most promise for clinical efficacy, as well as to propose future directions for rehabilitation research.



Despite more than 30 clinical trials by now of neurological rehabilitation for FND, there has been little advance toward evaluating the benefits of treatment for everyday function beyond self-reported general clinical condition, neurological examination, and within-laboratory performance measures. To improve understanding the potential benefits of neurological rehabilitation for FND, it will be necessary to examine more specifically how everyday activities can be affected and improved by therapy, including using instrumented objective activity measures in the community. In addition, research will be needed to understand the long-term retention of gains on everyday activities. Diagnostic and inclusion criteria for rehabilitation trials also must become more specific and standardized, as opposed to enrolling participants for general functional motor deficits.



We welcome the submission of a variety of article types, including original research, systematic reviews and meta-analyses, narrative reviews, research or technical reports, and opinion pieces. We encourage manuscript submissions which cover any of the following themes:

- Clarify diagnostic and disability inclusion criteria for FND rehabilitation trials, given that at present there is no golden standard for diagnosis

- Review neurological rehabilitation methods that have thus far been employed in FND trials, to identify techniques that are shared with rehabilitation for other neurological disorders and how they differ

- Address whether and how psychological treatment should be included in neurological rehabilitation for FND

- Review outcome measures for neurological rehabilitation FND and proposals for how to improve them

- Address the pros and cons of FND rehabilitation in inpatient, outpatient, vs. virtual approaches

- Identify how biopsychosocial characteristics of FND can guide rehabilitation

- Propose new directions for neurological rehabilitation for FND

Keywords: Functional Neurological Disorder

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