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Parkinsonism Relat Disord. 2012 Mar;18(3):247-51. doi: 10.1016/j.parkreldis.2011.10.011. Epub 2011 Nov 22.

Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol.

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1
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.

Abstract

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 sex-matched patients with treatment-as-usual (n = 60).

INTERVENTIONS:

An outpatient, one-week intensive rehabilitation program based on the concept of motor-reprogramming 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, 1-276); female predominance (76.7%); mean age 45 years (range, 17-79). 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.

[Indexed for MEDLINE]

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