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Occupational therapy consensus recommendations for functional neurological disorder
  1. Clare Nicholson1,
  2. Mark J Edwards2,
  3. Alan J Carson3,
  4. Paula Gardiner4,
  5. Dawn Golder5,
  6. Kate Hayward1,
  7. Susan Humblestone6,
  8. Helen Jinadu7,
  9. Carrie Lumsden8,
  10. Julie MacLean9,
  11. Lynne Main10,
  12. Lindsey Macgregor11,
  13. Glenn Nielsen2,
  14. Louise Oakley12,
  15. Jason Price13,
  16. Jessica Ranford9,
  17. Jasbir Ranu1,
  18. Ed Sum14,
  19. Jon Stone3
  1. 1Department of Therapy Services, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
  2. 2Neurosciences Research Centre, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
  3. 3Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
  4. 4Centre for Clinical Brain Services, University of Edinburgh, NHS Lothian, Edinburgh, UK
  5. 5FND Hope UK, London, UK
  6. 6Department of Neuropsychiatry, University College London Hospitals NHS Foundation Trust, National Hospital for Neurology & Neurosurgery, London, United Kingdom
  7. 7The Lishman Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
  8. 8Community Rehabilitation and Brain Injury Service, West Lothian Community Health and Care Partnership, Livingston, West Lothian, United Kingdom
  9. 9Occupational Therapy Department, Massachusetts General Hospital, Boston, Massachusetts, United States
  10. 10Neurological rehabilitation out-patient services, Astley Ainslie Hospital, NHS Lothian, Edinburgh, Scotland, United Kingdom
  11. 11Falkirk Community Mental Health Service for Adults, NHS Forth Valley, Falkirk, Scotland, United Kingdom
  12. 12National Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
  13. 13Department of Neuropsychology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
  14. 14Integrated Community Neurology Team, East Coast Community Healthcare CIC, Lowestoft, United Kingdom
  1. Correspondence to Mrs Clare Nicholson, Therapy Services, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London WC1E 6BT, UK; clare.nicholson6{at}


Background People with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention.

Methods The recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved.

Results We recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document.

Conclusions Occupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.

  • functional neurological disorder
  • rehabilitation
  • neuropsychiatry

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  • Contributors CN developed the assessment and intervention surveys, collated and summarised the survey data. The occupational therapists in the group: CN, KH, SH, HJ, CL, JM, LyM, LiM, LO, JeR, JaR and ES completed the online surveys and follow up discussions. All authors attended the consensus meeting and agreed on content to be included in the manuscript. CN, GN, KH, JS, MJE and AC prepared the first draft of the manuscript. All authors were given the opportunity to review and revise the manuscript.

  • Funding MJE has received research funding from the Medical Research Council, National Institute for Health Research and the Guarantors of Brain; honoraria from Merz Pharma, TEVA and UCB; and publishing royalties from Oxford University Press. GN receives research funding from the National Institute for Health Research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.