Functional Neurological Disorder and The Role of Occupational Therapy

What is Functional Neurological Disorder

Functional Neurological Disorder (FND) is a condition where the brain has difficulty sending and receiving signals to the body¹. There is no physical damage to the brain in FND. Instead, there are changes in how brain networks communicate, producing symptoms that affect how we feel and move². Comparing this to how a computer works, with FND it is as if the “hardware” of your computer system remains intact, while the “software” is experiencing malfunctioning issues.

Many factors can influence FND, including mental, social, and physical factors, which can cause, trigger, or worsen the condition². Because of this, people with FND may experience different symptoms that can interfere which their daily activities³. Studies show that FND affects about 50 out of every 100,000 people. Interestingly, women are diagnosed with FND more often than men, making up 60-70% of the people with this condition^2,4.

Common symptoms of FND¹

• Gait and balance problems
• Headaches
• Functional seizures
• Functional movement disorders, including weakness or tremors
• Speech difficulties
• Sensory changes: numbness, tingling, vision disturbances
• Cognitive changes: brain fog, memory problems, mental fatigue
• Problems with vision or hearing
• Fatigue
• Chronic pain
• Sleep disturbances
• Bladder and bowel changes

Functional Seizures

Functional seizures are a common type of FND. These seizures can look like epileptic seizures but are not caused by abnormal electrical signals in the brain¹. During a functional seizure, a person might experience shaking all over the body, side-to-side head movements, hyperventilation (fast breathing), or feel confused or disconnected from their thoughts or feelings¹. These episodes can affect movement, sensation, behaviour, attention, or memory¹.

Functional Movement Disorder

Functional movement disorder (FMD) is another type of FND that affects how the body moves,involving involuntary or unwanted movements⁵. People with FMD might experience tremors, sudden and brief involuntary twitching or jerking, involuntary muscle contractions that cause slow repetitive movements, abnormal postures, muscle spasms, tics, leg and/or arm weakness^1,5.

The Role of Occupational Therapy in FND Management

While FND is not caused by structural damage to the brain, it can make daily activities incredibly challenging for individuals living with this condition.

Occupational Therapists (OTs) play a crucial role in helping individuals with FND manage their symptoms, improve daily functioning, and regain independence⁶. Since FND affects both physical and cognitive abilities, OTs use a holistic approach. This means they look at the whole person to address movement, daily activities, energy, and emotional well-being³. OTs can also help to identify strategies or tools that make everyday tasks easier and more enjoyable. By addressing cognitive (thinking), sensory, emotional and physical challenges as well as working with clients to identify stressors and implement helpful strategies, OTs can assist in varying ways^3,6.

Here are some specific examples of how OTs can support individuals with FND:  

1. Symptom Management and Activity Modification
   • Help people understand and manage their symptoms in ways that reduce impact on daily life.
   • Simplify tasks, use aids, or make changes in the environment to make activities easier.
2. Functional Movement Retraining
   • Light cardio exercises to improve movement.
   • Practice tasks to re-learn motor patterns.
   • Gradually increase activity to build confidence in movement and tolerance for activities.
3. Fatigue and Energy Conservation Strategies
   • Teach strategies to conserve energy such as the 4Ps (Prioritize, Plan, Pace, Position) to balance activity and rest without overexertion.
4. Sensory Regulation Strategies
   • Assist with sensory changes such as numbness or tingling.
   • Use activities to gradually desensitize or get used to sensations or otherwise compensate for them.
5. Cognitive and Emotional Support
   • Provide strategies to improve memory and attention (e.g., using planners, to-do lists, and timers).
   • Teach mindfulness and relaxation techniques to manage stress and anxiety.
   • Help with coping strategies to improve resilience and participation in meaningful activities.
   • Help to manage stress, low mood and low motivation.
6. Return to Work, School and Daily Activities
   • Assist with returning to work, school, or community roles.
   • Help to identify how symptoms may impact abilities in the workplace and school environment.
   • Assist with workplace or school accommodations, creating a gradual return-to-work or school plan and teaching self-advocacy skills to navigate accommodations and support services.
   • Liaise with employers or education providers regarding accommodations and how an individual can best be supported.  
     
     

Promoting Independence and Participation in Daily Activities

Occupational therapy is key in helping individuals regain independence, manage symptoms, and re-engage in meaningful activities. If you or someone you know is struggling with FND, don’t hesitate to seek support. Through education, therapy, and community, individuals with FND can learn to navigate their symptoms and lead meaningful and productive lives.

–

References

Functional neurologic disorder | National Institute of Neurological Disorders and stroke. (n.d.-a). https://www.ninds.nih.gov/health-information/disorders/functional-neurologic-disorder 

Peeling, J. L. (2023, May 8). Functional neurologic disorder. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK551567/ 

Gollega, A. (2025, January 20). The role of occupational therapy in FND Rehabilitation. Propel Physiotherapy. https://propelphysiotherapy.com/occupational-therapy/fnd-rehabilitation/#_Definition_of_FND

Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., LaFaver, K., LaFrance, W.

C., Lang, A. E., Nicholson, T., Nielsen, G., Reuber, M., Voon, V., Stone, J., & Morgante, F. (2018). Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurology, 75(9), 1132–1141. https://doi.org/10.1001/jamaneurol.2018.1264

Park, J. E. (2024). Functional Movement Disorders: Updates and Clinical Overview. Journal of Movement Disorders, 17(3), 251–261.

Occupational therapy – functional neurological disorder (FND). Functional Neurological Disorder FND (n.d.). https://neurosymptoms.org/en/treatment/occupational-therapy/ 

 

Disclaimer: The content provided on this website is for informational and educational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a qualified professional with any questions you have regarding your health.