IMMOBILITY

Managing Functional Neurological Disorder (FND) with Immobility

Immobility in Functional Neurological Disorder (FND) may range from intermittent weakness to full-body functional paralysis. This symptom is real and can be profoundly disabling. It requires careful support, a nonjudgmental approach, and a personalized plan that balances safety with rehabilitation.

Spectrum of Immobility in FND

Possible Presentations:

• Dragging a leg or foot drop

• Collapsing episodes or buckling knees

• Functional limb non-use (arm, hand, or leg)

• Temporary or long-term inability to walk

• Full functional paralysis or bedbound state

Common Triggers:

• Fatigue or overexertion

• Emotional distress, sensory overload

• POTS or orthostatic intolerance

• Dissociation or trauma response

Core Principles of Management

1. Validation and Safety First

• Immobility is a real, functional neurological symptom

• Avoid accusations of malingering or exaggeration

• Prevent injury: fall risk assessments, safe transfers, mobility aids

2. Physiotherapy (Functional Neurological Rehabilitation)

• Goal: Restore voluntary movement through neuroplasticity

• Focus:

  • Retraining walking, posture, balance

  • Distraction and dual-task movement

  • Guided motor imagery

  • Task-specific exercises (e.g., sit-to-stand, reaching)

  • Mirror therapy for limb non-use

3. Walking Aids and Equipment

• Use assistive devices as needed for safety:

  • Canes, walkers, rollators

  • Wheelchairs for long distances or flare periods

  • Transfer boards or hoists for full immobility

• Goal is to support mobility, not discourage it

• Reassess regularly to prevent overdependence

4. Occupational Therapy

• Adapt home for accessibility (grab rails, chair risers)

• Training in ADLs with limited mobility

• Energy conservation and pacing tools

5. Postural and Skin Care

• For patients with prolonged immobility:

  • Regular repositioning (every 2 hours if bedbound)

  • Pressure-relieving cushions/mattresses

  • Monitor for sores, joint stiffness, and circulation issues

6. Mental Health and Psychological Support

• Address feelings of loss, identity, fear of symptoms

• CBT, ACT, or trauma-informed therapy as appropriate

• Treat comorbid anxiety, depression, or PTSD

7. Speech & Communication Considerations

• Patients may also have concurrent mutism or brain fog

• Offer non-verbal tools: whiteboards, text-to-speech apps, cue cards

• Ensure informed consent and autonomy through accessible means

Flare-Up and Paralysis Support

• Do not force movement or pressure the patient to "just try harder"

• Create a calm, low-stimulus environment

• Focus on passive range of motion to prevent contractures

• Allow rest and resume active therapy when stable

Emergency Planning

• Ensure emergency staff know the patient’s baseline

• Prepare an FND medical alert card or letter

• Avoid unnecessary invasive investigations when FND is confirmed

Multidisciplinary Team Involvement

• Neurologist: Confirm diagnosis, monitor for changes

• Physiotherapist: Movement re-training, balance

• Occupational Therapist: Environmental support, mobility aids

• Psychologist/Psychiatrist: Emotional and trauma support

• Nursing/Carer Support: Pressure care, ADLs, safety

• Speech and Language Therapist (if needed): Communication and swallowing

Levels of Care Consideration

• Home-based care with aids for mild/moderate mobility limits

• Part-time carer or rehab support for moderate disability

• Full-time care or facility-based rehab for those unable to transfer or self-care

• Reassess regularly for progress or regression

Immobility in FND is challenging but often reversible. With the right approach—focused on neuroplasticity, compassion, and pacing—patients can regain mobility, safety, and independence over time.