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

[Farooqji]

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 sexmatched patients with treatment-as-usual (n ¼ 60).

Interventions: An outpatient, one-week intensive rehabilitation program based on the concept of motorreprogramming 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, 1e276); female predominance (76.7%); mean age 45 years (range, 17e79). 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

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[MBAnderson]

Do you think they have abandoned this program because it took place 10 or 12 years ago and if they were continuing to build on it, wouldn't we have heard about it lately?

[Farooqji in reply to MBAnderson]

I think they abandoned this program because there was no financial charm in it. There is no doubt about its efficacy as they observed the gains/improvements till 2 years of follow up. The benefits were long lasting

[Farooqji in reply to Farooqji]

There are also videos as supplement to this report which shows pre/post conditions of the patients. I tried my best to get the videos but it's beyond the pay wall

[MBAnderson in reply to Farooqji]

If the program worked that well, you would think somebody would offer a certified version just like the the LSVT program.

[Farooqji in reply to MBAnderson]

I think there should have been a follow up program by mayo clinic. Trying to find why they didn't do so