Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol

Abstract

Background: Functional ("psychogenic") gait and other movement disorders have proven very difficult to treat.

Objectives: Describe the Mayo Clinic functional movement disorder motor-reprogramming protocol conducted in the Department of Physical Medicine and Rehabilitation (PMR), and assess short-term and long-term outcomes.

Design: Historical-cohort-study assessing non-randomized PMR intervention.

Setting: Tertiary care center.

Patients: Interventional group: 60 consecutive patients with a chronic functional movement disorder that underwent the PMR protocol between January 2005 and December 2008.

Control group: age- and sex-matched patients with treatment-as-usual (n = 60).

Interventions: An outpatient, one-week intensive rehabilitation program based on the concept of motor-reprogramming following a comprehensive diagnostic neurological evaluation, including psychiatric/psychological assessment.

Main outcome measures: Improvement of the movement disorder by the end of the week-long program (patient- and physician-rated), plus the long-term outcome (patient-rated).

Results: Patient demographics: median symptom duration, 17 months (range, 1-276); female predominance (76.7%); mean age 45 years (range, 17-79). Physician-rated outcomes after the one-week treatment program documented 73.5% were markedly improved, nearly normal or in remission, similar to the patient-ratings (68.8%). Long-term treatment outcomes (patient-rated; median follow-up, 25 months) revealed 60.4% were markedly improved or almost completely normal/in remission, compared to 21.9% of controls (p < 0.001).

Conclusions: Short-term and long-term successful outcomes were documented in the treatment of patients with functional movement disorders by a rehabilitative, goal-oriented program with intense physical and occupational therapy. The rapid benefit, which was sustained in most patients, suggests substantial efficacy that should be further assessed in a prospective, controlled, clinical trial.