A systems-based inpatient model for functional neurological disorder rehabilitation shows potential

A team from Spaulding Rehabilitation Hospital shares its experiences and successes designing and implementing a multidisciplinary clinical inpatient rehabilitation pathway for patients with acute-onset motor functional neurological disorder (FND) in NeuroRehabilitation. They hope their approach will provide a roadmap for other institutions and encourage broader development of practice recommendations for inpatient rehabilitation for FND.

FND is frequently encountered but sometimes misdiagnosed. Approximately 18% of patients presenting to inpatient hospitals with new acute-onset FND symptoms remain too functionally impaired to safely return home by the time of hospital discharge. These individuals subsequently receive inpatient rehabilitation.

"No how-to guides exist for delivering FND care at the inpatient rehabilitation facility," explained lead investigator Ginger Polich, MD, Spaulding Rehabilitation Hospital, Charlestown, MA. "Thus, we wanted to share our institution's systems-level experiences developing a clinical pathway for inpatient rehabilitation of FND using consensus or evidence-base strategies. We hope to help other inpatient rehabilitation units provide more targeted care to improve function and quality of life for individuals with FND."

Dr. Polich and colleagues describe Spaulding Rehabilitation Hospital's efforts to design and implement a clinical pathway for 18 patients with acute-onset motor FND. The FND pathway involved collaboration among case managers, physicians, psychologists, therapists, admission coordinators, and nurses to optimize the function of patients with FND.

Some of the more recent efforts of the group have involved streamlining plans for post-discharge aftercare, including efficiency of referrals for physicians, mental health providers, and outpatient rehabilitation therapists. Efforts were made to train in-network home care therapists in FND techniques.

"The team really rallied around providing better services and support for these patients that are so often written off," added coauthor Stacey Zalanowski, PT, DPT, Spalding Rehabilitation Hospital and Department of Physical Therapy, Massachusetts General Hospital, Boston, MA. "It has been very rewarding to see staff improve in their knowledge and skills with this patient population. It has been so fulfilling to see many of them improve so dramatically during their time with us."

"The future holds promise for continued trials within the realm of rehabilitation, neurology, psychiatry, and psychology to develop a better understanding of the pathology and treatment of FND. We are motivated and driven by the challenges ahead of us to counteract the stigma surrounding FND and continue to develop patient-focused approaches applying the latest clinical and neuroscience advancements," commented senior author Seth Herman, MD, Department of Physical Medicine and Rehabilitation, California Rehabilitation Institute, Los Angeles, CA.