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Dahlhauser and Theuer
MOTA Conference 2014
Perceived Satisfaction and Occupational
Performance in Patients with Functional Movement
Disorder
Sarah Dahlhauser, OTR/L and Amanda Theuer, OTR/L from the Mayo Clinic Physical Medicine and
Rehabilitation Department
Functional Movement Disorder
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Somatization: “conversion of a mental state (as depression or anxiety) into
physical symptoms; the existence of physical bodily complaints in the absence of
a known medical condition (Somatization, 2012).
Replaces Psychogenic Movement Disorder
Manifestation/Features
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Common presentations:
o Abnormal gait
o Loss of balance / gait unsteadiness
o Myoclonus
o Tremor of one or all extremities or dystonia
o Hemiparesis/Hemiparalysis
o Abnormal head movements, shoulder movements, trunk movements
o Altered speech (Kranick, Ekanayake, Martinez, Ameli, Hallett & Voon,
2011)
Physical Exam
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Paralysis does not follow a particular nerve pattern
Reflexes are normal
Protective and righting responses are intact
Large exaggerated movements
Co-contraction of agonist and antagonist groups
Physical findings are NOT consistent with function
Functional Movement Disorder in healthcare
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10-15% (Kroenke, 2007) of mental health disorders in general medicine
Multiple visits to multiple providers seeking out cause for symptoms and
treatment
$256 billion per year is the estimate cost to the US health care system (Barsky,
Orav & Bates, 2005).
Dahlhauser and Theuer
MOTA Conference 2014
Behavioral Shaping Therapy (BeST)
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All organic causes ruled out
Therapy plan focuses on motor reprogramming
o Hardware versus Software
Patient is scheduled for one week of outpatient therapy:
o Set-up with our physiatrists
o Occupational therapy two times per day
o Physical therapy two times per day
o Psychological visit during this week or prior
o Speech therapy, as needed
Therapy Evaluations
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Occupational therapy
o Patient interview
 Interests and hobbies
 Identifying stressors
o Canadian Occupational Performance Measure (COPM)
 Goal setting
Canadian Occupational Performance Measure (COPM)
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Semi-structured interview with patient report
Three activity subtypes:
o Self-cares
o Productivity,
o Leisure
Pick five of the most important
On a scale of 1-10 (1 being lowest, 10 being highest)
o Performance
o Satisfaction
Key approaches
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Once the diagnosis is of FMD is made, do not encourage additional
investigations
Team is positive and non-threatening
Give the patient permission to get better
Avoid assistive devices
Reinforce the internal motivating factors
Communication and collaboration between the treatment team is VITAL
Dahlhauser and Theuer
MOTA Conference 2014
Therapy Treatment Techniques
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Occupational therapy
o Relaxation and breathing
 Relaxed vs Tense
o Body mechanics
 Right muscle = less repetitive strain
o Object manipulation (large and small)
o Dynamic balance
o Integration of ADLs and IADLs tasks
Dismissal from therapy
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After FIVE days of treatment OR when therapy goals are met
OT dismissal includes:
o Re-assessment of the COPM
o Engagement in functional wrap-up task
o Creating a home maintenance plan
o LOCUS OF CONTROL!
BeST Program Study
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Using the COPM as an outcome measure, what is the patient’s perceived
change in occupational performance and satisfaction between initiation and
termination of the BeST program?
Participants:
o N = 36
o Age range from 18-75 years (mean=46±14)
o 72% female
o Ranged from 2-10 sessions of OT (mean=7±2)
o Participants saw between one and four occupational therapists throughout
their episode of care.
Results
o Dependent t-test controlling for:
 Age
 Gender
 Number of treatment sessions
 Number of treating occupational therapists
o Significant change in pre-intervention and post-intervention scores
 Performance = +3.4 points
 Satisfaction = +4.7 points
o None of covariates interacted significantly with the change is scores
Dahlhauser and Theuer
MOTA Conference 2014
References
Barsky, A.J, Orav, E.J., Bates, D.W. (2005). Somatization increases medical utilization
and costs independent of psychiatric and medical comorbidity. Archives of
General Psychiatry, 62, 907.
Czarnecki, K., Thompson, J.M., Seime, R., Geda, Y.E., Duffy, J.R., & Ahlskog, J.E.
(2012). Functional movement disorders: Successful treatment with a physical
therapy rehabilitation protocol. Parkinsonism and Related Disorders, 18, 247
251.
Hinson, V.K., Weinstein, S., Bernard, B., Leurgans, S.E. & Goetz, C.G. (2006). Single
blind clinical trial of psychotherapy for treatment of psychogenic movement
disorders. Parkinsonism and Related Disorders, 12, 177-180.
Kranick, S., Ekanayake, V., Martinez, V., Ameli, R., Hallett, M., & Voon, V. (2011).
Psychopathology and psychogenic movement disorders. Movement Disorders,
26(10),1844-1850.
Kroenke, K. (2007). Efficacy of treatment for somatoform disorders: A Review of
randomized controlled trials. Psychosomatic Medicine, 69, 881-888.
Law, M., Baptiste, S., Carswell, A., McColl, M.A., Polatajko, H. & Pollock, N. (2005).
Canadian Occupational Performance Measure (4th Ed.). Ottawa: CAOT
Publications ACE.
Ness, D. (2007). Physical therapy management for conversion disorder: Case series.
Journal of Neurologic Physical Therapy, 31, 30-39.
Somatization. (2012). In Merriam-Webster’s online dictionary. Retrieved from
http://www.merriam-webster.com/dictionary/somatization.
Speed, J. (1996). Behavioral management of conversion disorder: Retrospective study.
Archives of Physical Medicine and Rehabilitation, 77, 147-154.
Trieschmann, R.B., Stolov, W.C. & Montgomery, E.D. (1970). An approach to the
treatment of abnormal ambulation resulting from conversion reaction. Archives
of Physical Medicine and Rehabilitation, 198-206.