DYSTONIA

Managing Functional Neurological Disorder (FND) with Dystonia

Functional dystonia is a subtype of Functional Neurological Disorder (FND) where muscles contract abnormally, leading to postures or twisting movements. It may look similar to other dystonias but has distinct functional features and requires a tailored approach.

Recognizing Functional Dystonia

Common Features:

• Sudden onset or progression

• Fixed abnormal postures (e.g., twisted limb, clenched hand)

• Symptoms fluctuate with distraction or emotion

• Often co-occurs with pain, tremors, or weakness

• May be accompanied by other FND symptoms (e.g., seizures, paresthesia)

Key Diagnostic Tools:

• Detailed neurologic exam

• Neurophysiologic studies (rule out structural causes)

• Positive signs (e.g., entrainment, variability, inconsistency)

• Multidisciplinary assessment

Holistic Management Plan

1. Neurological Physiotherapy

• Goal: Retrain normal movement patterns

• Techniques:

  • Graded motor imagery

  • Sensory tricks (gestures that temporarily relieve posture)

  • Task-specific training (e.g., handwriting, walking)

  • Distraction and dual-task exercises

2. Occupational Therapy

• Adapt daily activities to avoid overexertion

• Introduce assistive devices when needed

• Practice functional tasks (e.g., grooming, typing) in safe environment

3. Speech & Language Therapy (if facial/neck dystonia present)

• Support communication and safe swallowing

• Voice relaxation and breath support

4. Pain Management

• Dystonia can be painful due to sustained contractions

• Treatments:

  • Heat/cold therapy

  • Neuromodulation (TENS)

  • Low-dose medications (e.g., baclofen, gabapentin)

  • Pain-focused CBT or ACT

5. Psychological Support

• Address co-existing anxiety, trauma, or dissociation

• Trauma-informed CBT or ACT

• EMDR (if trauma is a driver)

• Mindfulness for symptom regulation

6. Education & Validation

• Reassure that symptoms are real, common in FND, and treatable

• Provide written or visual aids for the patient and family

Flare-Up Management

• Rest the affected limb but avoid total immobilization

• Gentle stretching or passive movement

• Distraction activities (listening to music, puzzles)

• Cold packs or warm compress depending on comfort

• If walking is affected, temporarily use walking aids

Communication Notes (If Affected by Dystonia)

• Speech may be slurred, stuttered, or absent

• Allow extra time to respond

• Offer written communication tools (apps, notebooks)

• Avoid assumptions of intoxication or lack of comprehension

When to Escalate

• New or rapidly worsening symptoms

• Inability to perform basic ADLs

• Severe pain unrelieved by usual methods

• Signs of comorbid condition worsening (e.g., CRPS, POTS)

Multidisciplinary Team Roles

• Neurologist: Confirm diagnosis, coordinate care

• Physiotherapist: Movement retraining, safety

• OT: Daily functioning, adaptations

• Psychologist: Mental health support

• SLT: Communication and swallowing help

• Pain Specialist (if needed): Medication or advanced techniques

Note: Functional dystonia is treatable. Progress takes time, patience, and a supportive, skilled team.