COURSE · PART 3 · MODULE 9 · PAGE 2
Choosing Practice That Fits Your Life
Lesson 28 explores what receiving rehabilitation can feel like, from early uncertainty through gradual change, setbacks and different kinds of benefit.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
For the Person With FND
What might rehabilitation feel like?
Natalie knows what neuroplasticity means now. She’s learned that the nervous system can change through experience and that rehabilitation sometimes uses this ability to help people regain or improve skills.
But what would rehabilitation actually be like for her?
Would she leave an appointment feeling hopeful? Exhausted? Disappointed? Would she notice a change immediately, or need months before something became easier?
People with FND have described all kinds of experiences.
Some were surprised by an improvement during their first appointments. Others struggled to notice any benefit for weeks or months. Some found treatment physically or mentally demanding, while others discovered that an activity they thought they’d lost was becoming possible again.
Let’s look at what people have experienced across different symptoms.
An unexpected improvement
Imagine Natalie attending physiotherapy for her unreliable walking.
She’s arrived after a tiring journey, and her symptoms are particularly difficult that morning. The therapist explores some supported movements, but the activities seem quite different from what Natalie expected.
She wonders how they’re supposed to help her walk.
For someone else, the first appointment might bring an unexpected change.
One person with functional tremor described their physiotherapist giving them a different hand movement to perform:
“She handed me a rainbow coloured dodgeball and asked me to rotate it … And the tremors stopped.”
Figure 1. A community member describes a change during physiotherapy for functional tremor. (Original community discussion; citations 2)
Imagine struggling with a persistent tremor and suddenly watching it settle while you perform an unfamiliar activity.
That could be an exciting moment. It might also leave you wondering whether the same movement will be available tomorrow.
In Lesson 27, we learned how neuroplastic learning can help useful actions become more familiar. A movement that’s easier during one activity may provide an opportunity to develop something more reliable over time.
For this person, the experience showed that their tremor could change during a particular task. Their account doesn’t tell us how much improvement they retained or what happened in the following months.
But it gives us a glimpse of what an early change can feel like.
When improvement happens gradually
Rehabilitation may also involve changes that are so gradual they’re difficult to notice.
Consider someone receiving therapy for functional speech difficulties.
At first, speaking may still require considerable effort. Perhaps the person finds certain sounds easier during an appointment but struggles with longer conversations.
Over time, a few more words might become available. Starting a sentence might require less concentration, or difficult periods might happen less often.
One community member described their experience after receiving help from a speech therapist:
“They gave me some tools to help … I still will have times where it’s difficult to speak, but not as frequently.”
Figure 2. A person describes improvement alongside continuing speech difficulties. (Original community discussion; citations 3)
The person still has difficulty speaking sometimes, but it happens less frequently. That could make an enormous difference during everyday conversations.
Other people describe taking considerably longer to regain speech, while some continue relying on communication aids.
One of the interesting things about neuroplastic learning is that an improvement may become noticeable only after a skill has grown more familiar.
You might not remember the first day that speaking became a little easier. But eventually, you may notice you’re doing something that used to require much more effort.
When thinking is exhausting
For people with functional cognitive difficulties, rehabilitation can present a particular challenge.
Imagine Natalie attending an appointment to work on her memory and concentration.
She understands the explanation at the beginning, but halfway through an activity she loses track of the instructions. By the time she gets home, she’s struggling to remember much of what was discussed.
She might wonder how she’s supposed to benefit from rehabilitation when simply concentrating on it is so demanding.
Cognitive rehabilitation can involve different kinds of activities, including learning ways to organize information or making everyday tasks easier to manage. Some of this work may involve neuroplastic learning as routines and useful strategies become more familiar.
Some people report improvements in their cognitive abilities. Others find that using helpful supports becomes easier, even though their symptoms continue.
One person in the FND community described their experience:
“I worked tirelessly with a speech therapist … and regained a lot of cognition.”
Figure 3. A community member reports cognitive improvement during therapy. (Original community discussion; citations 4)
Their account also described a problem.
Some traditional therapy methods made their overall FND symptoms worse. They valued eventually working with a therapist who understood FND and helped them recognize when to pace their efforts.
That experience gives us two important parts of their rehabilitation journey: they regained cognitive abilities, and not every approach they encountered was suitable for them.
It also raises a question relevant to anyone with significant cognitive difficulties.
How can someone make use of rehabilitation when the treatment itself requires abilities they’re struggling with?
That is something their rehabilitation professionals need to consider. The person’s experience of the appointment can help inform the care they receive.
Functional seizures can be a different experience
For someone with functional seizures, rehabilitation may look very different from practising movements or speech.
Imagine Natalie attending seizure-focused psychological treatment.
She might begin by discussing what happens during her episodes, what she experiences before or afterward, and how seizures affect her daily life.
Perhaps she finds it difficult to describe the episodes. Some are hard to remember, and talking about them may sometimes increase her symptoms.
She may also wonder how the discussions relate to improving her seizures.
Different seizure-focused treatments work with different problems. Some help people recognize useful patterns or responses. Others explore different ways of responding to seizures or difficulties that affect daily functioning.
With time, neuroplastic learning might make a useful response more familiar. Natalie might find that she understands her episodes better or feels more prepared for certain situations. Perhaps she discovers a useful way to explain what happens during an appointment.
For other people, suitable treatment may reduce seizure frequency.
Some experience little benefit from a particular approach.
There isn’t one experience that everyone undergoing seizure-focused treatment should expect.
We’ll examine what research has found about these different treatment outcomes in Lesson 29.
When rehabilitation is overstimulating
Natalie already knows how tiring a medical appointment can be.
The journey, waiting room, bright lights and background conversations can affect her before the appointment even begins.
Now add the concentration or physical effort involved in rehabilitation. By the time she gets home, the cost may be considerable.
A community member who received treatment for multiple sensory difficulties described a mixed experience:
“Treatment at a clinic … has helped a little, but I’m still extremely sensitive and can crash if I push past my threshold even slightly.”
Figure 4. A person describes modest benefit alongside continuing sensory sensitivity and significant worsening when overwhelmed. (Original community discussion; citations 5)
Their experience shows how an improvement in one area can exist alongside considerable difficulty tolerating treatment.
It’s possible to value something gained during rehabilitation while finding the process exhausting or overwhelming.
For someone with migraine, sensory sensitivity, fatigue or other medical conditions, the demands of attending appointments may affect what treatment is manageable. The conditions in which neuroplastic learning is attempted can matter as much to the person as the activity itself.
This isn’t something the person needs to solve by choosing their own exercises or deciding how hard to push.
They can describe what they’re experiencing and how long the effects last. Their care professionals can then consider what those experiences mean for treatment.
How long does it take?
This may be the question people most want answered.
And the community accounts are strikingly different.
One person who struggled with walking reported:
“Neurological physical therapy has given me the ability to walk and function again.”
They described recovery as gradual, taking months or years.
In the same discussion, another person reported:
“In my case PT did not help … I went for 6 months with no progress.”
Figure 5. Two community members describe very different outcomes after physiotherapy. (Original community discussion; citations 6)
The first person eventually regained important abilities. The second didn’t experience the progress they had hoped for during six months of treatment.
Neither account can tell us how long rehabilitation will take for someone else. But together they raise an important question about patience.
Neuroplastic learning can take time. An ability may gradually become more familiar, or progress may only become noticeable when someone returns to an everyday activity.
Yet continuing without improvement isn’t automatically the right approach. Perhaps a treatment needs reconsidering, another medical problem is affecting progress, or the person’s goals and support needs have changed.
Patience can be part of rehabilitation without becoming an obligation to continue an approach indefinitely.
When progress includes setbacks
Jenna’s mother shared her daughter’s experience of functional limb weakness and pain, with Jenna’s permission.
Jenna’s rehabilitation journey included progress, a significant setback and further improvement with support from different professionals.
Her mother wrote:
“Jenna managed to start to see progress and sometimes setbacks too.”
Figure 6. Jenna’s mother describes improvement that included setbacks. (Jenna’s Story; citations 7)
That experience may sound familiar to someone whose abilities change from day to day. A skill might become easier during therapy but remain unreliable during a demanding week. Another ability might improve while a different symptom continues to cause considerable disability.
Sometimes the person’s rehabilitation goals change as they discover what is possible or what matters most to them. Jenna’s account reminds us that a rehabilitation journey can contain both meaningful progress and substantial difficulties.
What does benefiting from rehabilitation feel like?
Sometimes the change is obvious. A person begins walking again or finds that a movement which seemed impossible has become available.
Other improvements may be quieter. You finish a conversation and realize you didn’t have to concentrate so carefully on producing every word. You complete a task that previously left you confused, or find yourself using a skill outside therapy without thinking through every step.
You might also discover that an activity you missed is becoming enjoyable again, perhaps with an aid or some assistance.
These experiences connect naturally with neuroplastic learning from Lesson 27. An ability may become more familiar and reliable, or something learned during therapy may become useful in everyday life.
But not every improvement needs to involve a change in the symptom itself. A person may gain more independence or participate in something meaningful while continuing to need substantial support.
The experience of benefiting can also be complicated. Someone might feel delighted by a new ability while worrying that it won’t remain available. Others may notice a change so gradually that they struggle to remember when it happened.
Your experience is part of rehabilitation
Natalie has been thinking about the different community experiences.
She can imagine how surprising it might be to discover that a difficult movement suddenly becomes easier during an appointment. She can also recognize the frustration of concentrating on a rehabilitation activity when her cognitive difficulties make the instructions hard to follow.
And she understands why someone might be pleased with a small improvement while still finding treatment exhausting.
She knows that some people regain important abilities through rehabilitation. Others experience smaller gains or need a different approach.
Natalie doesn’t have to decide which neurological techniques would be best for her or how much practice is required. But she can contribute something that matters: what she actually experiences.
She can tell her care professional that an activity was easier than expected, that something which worked during therapy wasn’t available at home, or that she was exhausted for hours afterward. She can ask why an activity has been suggested when its purpose isn’t clear, and explain what she’d most like rehabilitation to help her enjoy or manage.
Rehabilitation may involve neuroplastic learning, but the person’s experience helps reveal whether that learning is becoming useful in their life.
Something to think about
Which of these rehabilitation experiences surprised you, or reminded you of something you’ve experienced yourself?
How might that feel?
How might you feel if you began noticing small improvements without knowing how much further you might progress?
One small step
If you’re receiving rehabilitation, think about one experience you’d like your care professional to understand better.
Perhaps an activity felt easier, the appointment was particularly tiring, or you noticed a change when you got home.
You could describe what happened without needing to explain why.
In Lesson 29, we’ll examine what treatment studies have found about different FND symptoms and how to judge claims about recovery and neuroplasticity.
Optional crossword
Revisit the lesson with a crossword. The easy edition includes a word bank.
Optional colouring activity
Open the Lesson 28 colouring PDF (new tab), or browse the colouring collection.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
For Family, Friends, and Other Supporters
A very productive Tuesday
Priya is rather pleased with herself. Her husband Daniel has FND, and his hand movements have become unreliable. He’s been working with a physiotherapist and an occupational therapist, hoping to regain some of the abilities that have become difficult. Today, Priya has managed to arrange both appointments on the same afternoon.
It’s taken quite a bit of organizing. Daniel doesn’t drive at the moment, the clinics are forty minutes from home, and Priya has arranged her work schedule so she can take him.
“Two appointments, one trip,” she announces as they leave the house. “I think I’ve invented efficiency.”
Daniel laughs.
“Have you considered running the health service?”
“I’d start by improving the parking.”
Their first appointment goes well. Daniel has been practising movements with his physiotherapist, and today he manages an activity more comfortably than before. He’s encouraged.
At the second appointment, his occupational therapist works with him on a familiar household task. Daniel makes progress there too, although he’s finding it harder to concentrate by the end.
Neuroplastic learning means the nervous system can change through experience, sometimes making an ability easier or more reliable with practice. Daniel hopes the useful movements he’s finding in therapy will become more dependable. But one productive afternoon isn’t the same as a change that lasts.
When they arrive home, Priya is delighted.
“That was a good day!”
Daniel agrees. He’s pleased with what he managed, but he’s also exhausted. After supper, he settles into his chair and falls asleep halfway through a television programme. Priya smiles and switches it off.
They’ve accomplished quite a lot.
The part that wasn’t on the calendar
Wednesday is more difficult. Daniel wakes with his hand movements less reliable than usual. He’s tired, his concentration is poor, and several household tasks he’d hoped to manage will have to wait. By Thursday, he’s feeling somewhat better.
Priya notices that he hasn’t done much since Tuesday.
“Do you think the exercises were too much?” she asks.
“I don’t know. I actually felt good about them.”
“Maybe doing both appointments together was a bit ambitious.”
Daniel thinks for a moment.
“I was already tired when we got to the second one. And I still had the journey home afterward.”
Priya looks at the calendar on the kitchen wall. They’d been trying to save time and travel. But perhaps their very efficient Tuesday had cost Daniel much of Wednesday.
There’s another complication. Priya can’t easily take time off work twice a week. Combining appointments means fewer trips and less disruption to her schedule. Daniel understands that. He’s grateful for the help, and he doesn’t want Priya spending every spare afternoon driving him around.
Neither of them has been unreasonable. They’ve simply discovered that what makes appointments easier to arrange doesn’t always make them easier to manage.
The appointments may have offered useful opportunities for neuroplastic learning. But if Daniel is too exhausted to return to everyday activities for days afterward, they need a fuller picture of what those opportunities cost him.
A different kind of planning
At Daniel’s next appointment, he mentions how he’d felt afterward. His therapist is interested in what happened during the activities, but also in how Daniel managed the rest of the day and the following morning.
They discuss whether some aspects of his rehabilitation could be arranged differently. There isn’t an obvious perfect solution.
Separate appointments would mean more driving. Combining them could make the day exhausting. Some discussions might be possible without a trip to the clinic, while other activities require hands-on professional guidance.
Priya and Daniel talk about what might work for both of them.
“I can still drive on Tuesdays,” Priya says. “We might just have to stop trying to fit the entire medical profession into one afternoon.”
Daniel laughs.
“Shame. I was hoping to squeeze in a dentist.”
They begin looking at their schedule a little differently. Rather than measuring a good week by how many appointments they complete, they become interested in how much Daniel can actually gain from them.
That doesn’t mean abandoning rehabilitation. Daniel still wants to improve, and Priya still wants to help him get there. It means recognizing that the journey, the appointment and the recovery afterward all belong to the same experience.
When progress takes longer than expected
Several months pass. Daniel continues rehabilitation, although progress doesn’t follow a tidy schedule. Some activities become easier, then seem difficult again. Others improve so gradually that neither of them notices until Daniel does something he hasn’t managed comfortably in a long time.
One morning, Priya comes downstairs and finds him fastening his jacket. He’s almost finished before she realizes what she’s seeing.
“Hang on. Did you just do that yourself?”
Daniel looks down.
“I think I did.”
“That’s brilliant!”
He grins.
“Don’t get too excited. I still can’t manage that little button on the cuff.”
Priya laughs.
“Well, nobody likes those buttons.”
The improvement is encouraging. It doesn’t mean Daniel’s hand movements have fully recovered, but it’s something he can use in ordinary life.
This is one way neuroplastic learning may become visible: a movement that once needed repeated support becomes easier to use in ordinary life. That doesn’t prove which neurological changes occurred, but it gives Daniel a concrete reason to recognize progress.
He’s glad they kept looking for ways to make rehabilitation manageable. Priya is glad they didn’t give up simply because progress had been slow.
Their experience illustrates something worth remembering: a long course of rehabilitation may still be valuable, while the demands of receiving that care may need to change along the way.
Professional occupational therapy recommendations recognize the importance of understanding everyday activities and the circumstances in which people carry them out. [1]
Daniel and Priya have learned why that matters outside the treatment room.
Meanwhile, at Natalie’s house
Leah has been looking forward to visiting Natalie on Thursday. She’s promised to bring something from the bakery, and they’ve been planning to watch another episode of their favourite programme together.
On Wednesday evening, Natalie sends her a message.
I’m sorry, but I don’t think I’ll manage tomorrow. I’ve got a medical appointment in the morning.
Leah feels a little disappointed. Their visits are one of the few regular opportunities they have to catch up. She knows the appointment matters, though, and replies:
No problem. Hope it goes well. We can find another day.
The following afternoon, Natalie sends another message.
Home now. Migraine is awful. That was quite an adventure.
Leah phones briefly to check how she’s doing. Natalie explains that her headache had become much worse before she even reached the doctor.
The sunlight had been uncomfortable during the journey. Walking through an unfamiliar part of the building was difficult, and the waiting room was busy.
“I was practically finished before the appointment started,” Natalie says.
Leah knows that Natalie’s functional seizures and walking difficulties can make medical visits challenging. But she hadn’t quite appreciated how much could happen before Natalie saw the clinician.
“Were you able to get what you needed from the appointment?”
“Yes, actually. I’m glad I went.”
There’s a pause.
“I just wish I didn’t have to spend the rest of the day recovering from getting there.”
Leah understands a little more now. Natalie can be pleased about receiving medical care and miserable about what receiving it has required. Those feelings aren’t contradictory.
Making an appointment accessible isn’t itself neuroplastic learning. It may, however, leave Natalie better able to benefit from rehabilitation that depends on learning over time.
The appointment takes more than an hour
A week later, Leah visits as usual. Natalie has arranged the room so the light is comfortable, and the two friends settle down with tea.
Leah asks how the medical appointment turned out. Natalie explains that she’d been struggling with several appointments close together. Sometimes she barely recovered from one before another came around.
“Then I start having more difficult days,” she says. “And everything gets harder. Even the things I’m usually able to manage.”
Leah thinks about the visits Natalie has cancelled recently. She’d assumed Natalie was simply having more unpredictable symptoms. Now she understands that the appointments themselves may be taking up much of what Natalie can manage.
“Does that mean you want me to visit less often?” Leah asks.
Natalie looks surprised.
“No! I like having you here. It’s one of the things I look forward to.”
“I don’t want to make things harder.”
“You’re not. Well, unless you bring that dreadful cake again.”
Leah laughs.
“That cake was perfectly respectable.”
“It could’ve been used as a doorstop.”
They both laugh, and for a moment there’s no discussion of symptoms or appointments.
Leah is relieved. She’d been wondering whether stepping away would be more helpful than visiting. Instead, she discovers that Natalie values their time together, even when other parts of life have become difficult.
Help doesn’t have to solve everything
Leah can’t take Natalie to every appointment. She has work, family responsibilities and her own life. Natalie doesn’t expect her to become a full-time caregiver.
Sometimes Leah can help with transportation. Sometimes she can bring something for lunch or rearrange a visit when Natalie needs a quieter day. Other times, she can only offer a conversation.
When Natalie mentions an upcoming appointment, Leah asks whether there’s anything practical she’d find helpful.
“Actually,” Natalie says, “would you mind reminding me to ask about the waiting room? Last time I was sitting there forever.”
“Of course.”
Leah makes a note on her phone.
Then Natalie adds, “But don’t start managing my calendar. It’s complicated enough already.”
“Trust me,” Leah replies. “I’ve seen your calendar. I’m not going anywhere near it.”
They’re both smiling. Leah hasn’t solved the difficulty of attending treatment, and she doesn’t need to. She’s learning which parts of Natalie’s life are demanding and where an occasional offer of help might make a difference.
Their friendship can still be a friendship.
What the two relationships teach us
Priya and Leah have different places in the lives of the people they support.
Priya lives with Daniel. She sees the appointments, the tired evenings and the difficult mornings afterward. She’s also responsible for arranging much of the transportation.
Leah sees Natalie occasionally. She may hear about an appointment without witnessing everything it takes to attend or recover from it.
Yet both have discovered something similar: rehabilitation doesn’t happen in isolation from the rest of someone’s life.
Priya and Daniel learned that fitting more care into one afternoon wasn’t necessarily helping Daniel make better use of that care. Leah discovered that Natalie could genuinely value medical treatment while finding the journey and recovery exhausting.
Neither supporter needed to become an expert in rehabilitation to understand that difference. They needed a fuller picture of what the person was experiencing.
Slow, manageable opportunities to practise may support neuroplastic learning over time, even while recovery remains uncertain. And both pairs found ways to make room for the relationships that existed before FND became such a large part of life.
The little things that remain
One evening, Daniel fastens his jacket and goes out with Priya for a short visit with friends. He’s still having difficulties, but he’s pleased to manage something that used to be much harder.
Across town, Natalie and Leah finally watch the television episode they’d postponed. Leah has brought another bakery treat.
Natalie examines it suspiciously.
“Is this the same baker who made that cake?”
“No,” Leah says. “I’ve learned from my mistakes.”
“Good. So have I.”
Their evening isn’t rehabilitation. It doesn’t have to be. There’s room for treatment, for gradual improvement, for difficult days and for the ordinary pleasures that make all that effort worthwhile.
Something to discuss together: “When you have an appointment, is there something about getting there or recovering afterward that I might not realize?”
One small thing: If someone tells you an appointment went well, you might also ask how the rest of their day went. The answer may tell you something important.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
For Clinicians and the Care Team
When the appointment begins before treatment
Natalie has longstanding FND, including functional seizures, cognitive difficulties and unreliable walking. She also experiences continuous migraine with severe light and sound sensitivity.
An occupational therapist is helping her manage everyday activities that require memory and concentration.
During one appointment, Natalie works on organizing her medical letters. With a clearer arrangement of the information, she completes the activity with fewer reminders.
The therapist sees encouraging progress.
But at their next appointment, Natalie explains something important.
“My migraine is usually around a two or three when I’m at home. By the time I get here, it can be a seven or eight.”
She describes sunlight flickering between trees during the drive, glare from passing vehicles, unfamiliar walking routes and noisy waiting rooms. She’s also concerned about having a seizure before reaching the appointment.
On some previous visits, that’s exactly what happened.
Natalie now uses a wheelchair to reduce the demands of getting into and through medical buildings. Her friend Leah can accompany her occasionally, but Natalie lives alone and doesn’t have daily assistance.
The occupational therapist has another piece of information to consider.
The demands of rehabilitation can begin long before the therapeutic activity starts.
What did the appointment actually achieve?
Natalie completed the cognitive task more easily during treatment. That’s a useful observation, but it doesn’t describe the full experience.
Treatment burden: The time, effort, discomfort and recovery involved in receiving care, including the demands of attending appointments.
Natalie may have benefited from the activity itself while experiencing substantial difficulty from everything required to reach it.
This distinction changes the clinical question.
Rather than asking only whether the activity helped, the therapist might consider whether the benefit was worth the total demands of the visit.
The next consideration is whether those demands can be changed without losing the opportunity for rehabilitation.
Where does the difficulty arise?
Natalie’s worsening migraine begins before the appointment. That makes it difficult to attribute the entire experience to the cognitive activity.
The drive, sensory environment and physical demands of reaching the clinic may all contribute.
Her concern about having a seizure is also understandable given her previous experiences. It may influence the demands of attending, although that doesn’t establish that anxiety caused any particular episode.
The occupational therapist could learn more by comparing Natalie’s experiences across appointments.
For example, does she arrive feeling less unwell when the journey is easier? Does the cognitive activity remain manageable in a quieter setting? How does she feel afterward?
These observations could help distinguish difficulties associated with attending treatment from difficulties associated with the activity itself.
The familiar biopsychosocial formulation provides a way to consider these influences together.
But another piece of Natalie’s history makes the situation more complicated.
When appointments begin to accumulate
Natalie describes a period when she was attending several different services.
Some appointments were for rehabilitation. Others involved medical treatment, including injections for her migraine.
She was motivated to attend because she hoped the treatments would help.
Unfortunately, recovery from one appointment sometimes extended into the next. After several visits close together, she noticed that her symptoms remained more intense between appointments.
Eventually, she stopped attending some of the additional appointments because she couldn’t recover sufficiently between them.
Her experience raises a different clinical question from whether one appointment was tolerable.
What happens when the demands of treatment accumulate across a person’s week or month?
A single appointment might be manageable. Several appointments, each requiring travel, sensory exposure, concentration and recovery, may produce a very different experience.
Natalie’s description suggests a possible cycle in which increased demands are followed by worsening symptoms and reduced ability to manage later activities.
That pattern deserves investigation, although her account alone doesn’t establish the neurological mechanism responsible.
The important observation is that the current arrangement may be reducing her ability to participate in the very treatments intended to help her.
What might make rehabilitation more manageable?
The occupational therapist now has a reason to examine more than the cognitive activity.
Perhaps some appointments could take place in a quieter setting. Certain discussions might be suitable for remote visits, while other care would still require attendance.
Appointment timing, accessible entry and the demands of waiting could also influence what Natalie can manage.
These aren’t treatments for FND themselves. They are possible ways to reduce the demands surrounding treatment.
Occupational therapy recommendations support individualized activity analysis and environmental adaptations as part of FND care. They provide a framework for considering these possibilities rather than a fixed approach suitable for everyone. [1]
There’s also a trade-off worth recognizing.
Combining appointments might reduce the number of difficult journeys, but it could make one day too demanding. Spreading them apart might allow more recovery while requiring additional travel.
The more suitable arrangement depends on what Natalie experiences.
Her family doctor could contribute by considering the migraine treatment, coordinating necessary medical care and helping the team understand the combined demands of her appointments.
The occupational therapist could then assess whether changes to the rehabilitation setting or activity make the treatment more useful.
Neither professional needs to assume that one adjustment will solve every difficulty.
Slow rehabilitation can still be successful
A demanding appointment isn’t necessarily an unsuccessful one.
Consider another person recovering from a herniated spinal disc.
Their physiotherapy continues for eighteen months. Early sessions require a slow approach, and familiar activities must be repeated many times before progress becomes reliable.
The treatment may feel frustratingly gradual.
Yet over that period, the person regains important abilities.
This example offers a useful contrast with Natalie’s experience. It illustrates why duration and burden deserve separate consideration; it is not evidence about rehabilitation outcomes in FND.
The time rehabilitation takes and the demands it creates are different questions from whether useful recovery is occurring.
Some people may need lengthy, repeated rehabilitation to develop more reliable abilities. The value of that work becomes clearer when its benefits are considered alongside the person’s ability to tolerate and continue it.
For Natalie, a slower arrangement might preserve useful rehabilitation while reducing the difficulties associated with attending.
But if an activity repeatedly produces substantial worsening without meaningful benefit, the team may have reason to reconsider its suitability.
Neither outcome can be decided from the number of appointments alone.
What would the next appointment tell us?
Imagine that Natalie’s next occupational therapy appointment takes place with fewer travel and waiting demands.
She arrives with a less intense migraine and is better able to participate.
The medical-letter activity becomes easier again. Later, she reports that she was able to use part of what she’d learned at home without losing the rest of the day to exhaustion.
That would offer more useful information than the earlier session alone.
The therapist could now see both an encouraging response to the activity and a possible improvement in the cost of receiving treatment.
Alternatively, Natalie might continue experiencing considerable worsening despite the changes. That would invite further consideration rather than assuming the treatment simply needs more repetition.
What should clinicians take from this lesson?
Natalie’s experience demonstrates why the cost of rehabilitation cannot be understood by observing the treatment session alone.
Her symptoms may become more difficult before treatment starts. The consequences of one appointment may also affect her ability to participate in another.
At the same time, slow and repeated rehabilitation can be valuable when meaningful improvement develops over time.
Rehabilitation practitioners can investigate the relationship between treatment activities, their demands and the benefits that become available in everyday life.
Family doctors can contribute by understanding the combined effects of medical care, coexisting conditions and access requirements.
Clinical insight: The usefulness of rehabilitation depends not only on what someone gains during treatment, but also on what receiving that treatment requires of them. Understanding both can help the team recognize when continued practice is valuable and when the conditions of care deserve reconsideration.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
Research and Sources
General neuroscience, FND research findings, proposed mechanisms, professional consensus and treatment trials are distinguished in this lesson. Practical scenes and suggested conversations are illustrative; they are not tested treatment protocols. Community excerpts are individual accounts and do not establish diagnoses, typical outcomes or treatment effects.
| Citation | Figure | Full citation |
|---|---|---|
| [1] | — | Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. JNNP. 2020;91:1037–1045. doi:10.1136/jnnp-2019-322281. Original · PubMed. FND-CIT-0011. |
| [2] | Figure 1 | Public Reddit contribution, r/FND. Original. FND-CIT-0337. Figure 1 excerpt and first-person context checked November 11, 2026. The post also describes immediate return of tremor after stopping the ball, further rehabilitation and two symptom-free weeks; no isolated treatment-effect inference. |
| [3] | Figure 2 | Public Reddit contribution, r/FND. Original. FND-CIT-0338. The original excerpt was no longer available during verification on November 11, 2026. Wording and speaker context could not be independently verified. |
| [4] | Figure 3 | Public Reddit contribution, r/FND. Original. FND-CIT-0339. The original excerpt was no longer available during verification on November 11, 2026. Wording and speaker context could not be independently verified. |
| [5] | Figure 4 | Public Reddit contribution, r/FND. Original. FND-CIT-0285. Original post checked November 11, 2026: post-concussion symptoms and coexisting conditions; FND diagnosis and clinic intervention unclear. Published excerpt compresses the opening and changes capitalization. Individual account, not evidence that treatment caused worsening. |
| [6] | Figure 5 | Two public Reddit contributions, r/FND. Original discussion. FND-CIT-0340. Two different commenters: gradual benefit over months/years and no progress after six months. Both excerpts and context checked November 11, 2026; comments remain visible despite deleted parent post. Not comparative clinical evidence. |
| [7] | Figure 6 | Jenna’s mother, with Jenna’s permission. Jenna’s story. Neurosymptoms. Original. FND-CIT-0341. Exact excerpt, maternal perspective and permission statement checked November 11, 2026. Multiple interventions and setbacks; not an isolated treatment effect. |
Authoring and review status: All three audience sections are human authored and project-lead approved November 10, 2026. Chat Audit 1 and Work evidence/citation review completed; accepted corrections applied November 12, 2026. Source-access limits and owner-retained findings are recorded in the audit. Independent clinical review and publication decision remain pending.