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Multi-disciplinary treatment of a patient with Functional Neurological Symptoms Disorder hospitalized at a rehabilitation center - A case study

Anat Simon Florentin, Kfir Fingerman
 

Abstract

Background: Functional Neurological Symptoms Disorder (FNSD) causes great suffering to those affected. There is a degree of difficulty in diagnosing this disorder and providing an effective theraputic framework. This disorder has a variety of bio-psycho-social contributing factors. There is lack of evidence in the liturature indicating whether multi-disciplinary treatment may be effective in these cases.

Objective: To present a case study of a patient with FNSD who underwent multi-disciplinary rehabilitation using a model that could serve as a successful treatment for other patients with the same morbidity.

Case Description: The patient was a 60-year-old man in need of full assistance in everyday living activities, following functional deterioration that began seven years earlier, without any neurological explanation for the symptoms that presented. He was reffered to a rehabilitation center. Upon admission, the patient underwent an extensive evaluation, and a treatment plan was established by a multi-disciplinary team.

Tools of Measure: Various tests were selected for evaluation of the change in the patient’s functional status during hospitalization: test for everyday functional abilities (BEITI), (SCIM) Spinal Cord Independence Measure III, and mobility tests: Ten Meter Walk Test (TMWT) and Timed Up and Go test (TUG).
The Intervention Process: A five month multi-disciplinary treatment, which included treatments in the following fields: physiotherapy, psychology, occupational therapy, social work, psychiatry, rehabilitation medicine and nursing.

Outcomes: There was a positive change in the patient’s functional status, based on the BEITI test (57/126 at  admission and 74/126 at  discharge), and the SCIM test (26/100 at  admission and 44/100 at  discharge). Additionally, there was an improvement in mobility, according to the TMWT (unable to perform in admission and 0.033 m/s after five months), and TUG test (unable to perform at  admission and nine minutes after five months).

Conclusions and Discussion: This case study reports on the successful ourcome  of a multi-disciplinary rehabilitation program for treating a patient with FNSD, which stopped the process of continuous functional deterioration and enabled the patient to achieve new functions. The multi-disciplinary cooperation significantly contributed to the success of the process.  In short order, the health system should identify those affected by this disorder, and refer them to an appropriate multi-disciplinary therapeutic framework.

Key words: Conversion disorder, Functional neuro-logical symptom disorder, interdisciplinary, Physiotherapy

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