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Physiotherapy for functional motor disorders: a consensus recommendation
  1. Glenn Nielsen1,2,
  2. Jon Stone3,
  3. Audrey Matthews4,
  4. Melanie Brown4,
  5. Chris Sparkes5,
  6. Ross Farmer6,
  7. Lindsay Masterton7,
  8. Linsey Duncan7,
  9. Alisa Winters3,
  10. Laura Daniell3,
  11. Carrie Lumsden7,
  12. Alan Carson8,
  13. Anthony S David9,10,
  14. Mark Edwards1
  1. 1Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
  2. 2Therapy Services, The National Hospital for Neurology and Neurosurgery, London, UK
  3. 3Department Clinical Neurosciences, Western General Hospital, Edinburgh, UK
  4. 4Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  5. 5Therapy Services, The Ipswich Hospital NHS Trust, Ipswich, UK
  6. 6South London & Maudsley NHS Foundation Trust, London, UK
  7. 7Community Rehabilitation and Brain Injury Service, West Lothian, UK
  8. 8Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
  9. 9Institute of Psychiatry, King's College London, London, UK
  10. 10National Institute of Health Research Biomedical Research Centre at the South London & Maudsley NHS Foundation Trust and Institute of Psychiatry KCL, London, UK
  1. Correspondence to Glenn Nielsen, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, Box 146, Queen Square, London WC1N 3GB, UK; g.nielsen{at}


Background Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment.

Methods A meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience.

Results We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms.

Conclusions Physiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package.


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