FND Education Project

REFERENCE · DIAGNOSIS

Functional Gait Disorder

Refers to:

  • difficulty walking, such as hesitation, dragging, knee giving way or unusual unsteadiness; and
  • episodic, fluctuating or persistent gait difficulty requiring assessment of its cause.

Scope boundary: Primary limb weakness also belongs on the weakness page, complete movement loss on the paralysis page, a sudden fall without definite blackout on the drop-attacks page, and persistent dizziness on the PPPD page. Gait comparisons apply only when standing and walking can be assessed safely.

Quick Reference

Presentation: Walking difficulty assessed by comparing safe tasks with appropriate support.

More techniques: See the full list below.

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Walking may become hesitant or unusually slow. A foot may drag, a knee may give way, or your body may sway even while you are trying to stay steady. Functional gait disorder can take these and other forms. This page explains how clinicians assess the walking difficulty and distinguish it from other conditions that can look similar.

A clinician looks for the pattern across tasks. For example, a gait difficulty may unexpectedly improve during safe backward walking, tandem walking, rhythmical stepping or another task that is normally more demanding. The improvement is not proof that the original difficulty was chosen. It may demonstrate that a more effective walking pattern remains available under different conditions. [1]

Not every person can safely perform every comparison. The examination should be adapted to falls, pain, weakness, dizziness, equipment and the person’s own limits.

Gait problems can be episodic or long-lasting

Functional gait difficulty may be present most of the time, fluctuate over a day, or appear mainly in episodes or particular situations. Some people notice marked changes when walking while distracted, in visually or socially busy places, when fatigued, or around other FND symptoms. These contexts vary from person to person and are not diagnostic by themselves.

If a familiar gait problem starts suddenly, preventing a fall comes first. Stop before continuing into an unsafe step, use the usual wall, rail, seat, mobility aid or trained supporter, and reduce extra tasks or stimulation if that is part of the person’s plan. Once safe, use one gait cue already practised with rehabilitation—such as an external target or rhythm—rather than trying multiple difficult walking tests. New inability to walk, new one-sided weakness, severe dizziness or another changed neurological pattern needs reassessment.

What the examination is trying to understand

Walking usually happens without having to plan each muscle contraction. Functional gait disorder can make that familiar activity unreliable. Changing a task gives the clinician another view of how movement is working; it is not a challenge to prove yourself. Ask them to show you which comparison matters and explain why other causes do not account for it.

Internal inconsistency: A meaningful mismatch between related functions in the examination. Ordinary good days and bad days are not enough to establish it.

A scan may investigate another suspected cause, but a normal scan does not itself diagnose functional gait disorder. Another neurological or joint condition can coexist. Anxiety, trauma or stress need not be present for a positive diagnosis. [1]

Walking in the clinic and living your life

A short walk down a quiet corridor leaves many questions unanswered. Can you get to the bathroom at night, negotiate a kerb, carry something, or repeat the distance after lunch? How much help do you need, and how long does it take to recover? Bring those details to the assessment, even if your walking looks better during the appointment.

A 2025 online survey of 156 people reporting FND with walking difficulties found substantial effects on work, social life and quality of life. Pain, fatigue and emotional symptoms were among the associated difficulties. This does not show that mood caused the gait disorder or describe everyone’s experience. [10]

A helpful care plan records both the diagnostic findings and your actual mobility needs. Physiotherapy and occupational therapy can assess the routes, activities, equipment and assistance that matter to you. See assessment and everyday function and the separate gait recovery techniques.

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Do not ask the person to walk without their usual aid or try harder tasks to see whether they “can really walk.” Gait comparison has to be selected and guarded by a clinician. A safer role is to report what walking looks like in ordinary settings and which supports, surfaces or tasks seem to change it.

When a gait episode starts

A person may walk relatively well in one setting and suddenly need an aid, seat or hands-on spotting in another. Treat the change as a safety problem first, not a test. Clear the path, bring the usual aid, use one agreed cue, and reduce competing instructions. Do not pull the person forward or insist that they push through an unsafe gait pattern.

Afterward, useful details include the environment, walking task, other symptoms, duration, falls or near-falls, and what helped the person resume safe movement.

Helping the assessment reflect ordinary life

With the person’s agreement, bring a short account of their usual distances, aids, assistance and recovery time. Describe what you observed rather than interpreting whether they were trying. A video already recorded safely may help with an intermittent problem; do not provoke an episode to obtain one.

Leave room for the person to describe their experience. Afterward, ask what the examination established, what remains uncertain, and whether there is a separate plan for falls, equipment and getting around outside the clinic. A diagnosis does not by itself answer those practical questions.

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Episodic and prolonged presentations

Document baseline walking as well as episodes: onset, frequency, duration, warning, environmental and dual-task context, associated motor, sensory, vestibular or seizure-like symptoms, aid use, falls and recovery. Functional gait disorder may be recurrent, situational or persistent. A normal-looking walk in the clinic does not invalidate a reproducible community problem, and situational variability alone does not establish FND.

When appropriate, review safely obtained video from the person’s usual environment. Translate positive gait transformations found in examination into a brief flare plan that starts with fall prevention and uses a previously successful rhythm, direction, external target or automatic stepping strategy only when it is safe for that person.

Differential, coexistence and investigations

Describe the gait before assigning a cause. Consider weakness, sensory loss, cerebellar or vestibular dysfunction, parkinsonism and freezing, dystonia, negative myoclonus, pain, joint disease and medication effects as appropriate to the history and examination. Several can coexist with a functional component. Task-dependent improvement can also occur in other movement disorders. [1]

Negative myoclonus: Brief interruptions of muscle activity that can cause a limb to give way. Freezing: A brief difficulty starting or continuing movement despite the intention to move.

Choose imaging, nerve studies or vestibular assessment to answer a specific unresolved question; they are not a universal battery for this diagnosis. Record what the positive findings explain and what they leave unexplained. New neurological deficits, injury or a substantially changed gait need reassessment.

Technique outline: sign-based gait comparison

The original seven-step outline is preserved in the detailed comparison page, with preparation, definitions, interpretation and evidence limits. The chair assessment has its own source-based protocol and accuracy discussion.

Documenting diagnosis and function separately

Record the exact tasks, usual aid, assistance, pain, fatigue, observed change and competing explanations. Avoid a bare statement such as “better with distraction.” Explain the comparison to the patient and record their understanding and remaining questions.

Ask about repeated walking, stairs, uneven ground, time pressure, visual/cognitive demands, near-falls and recovery afterward. Nursing, rehabilitation and occupational assessments may reveal support needs that a neurological examination cannot measure. A better brief performance does not justify withdrawing assistance. Ask about wellbeing as part of care, without making a psychiatric history a prerequisite for diagnosis. The gait-specific survey supports broad assessment but cannot identify causes or individual prognosis. [10]

Media contributor brief

The original filming sequence and safeguards are retained on the comparison page. No patient footage or attributed lived-experience quotation has been added.

Diagnostic techniques at a glance

The inventory explains each observation or investigation. Not everyone needs every comparison.

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Research and Sources

Evidence notes

Start with the sign-based clinical review, then the later blinded chair-sign study for that specific comparison. The review explains clinical reasoning; the chair study tests a particular sign. Neither turns a brief examination into a measure of everyday mobility. [1][6]

A 2026 study found limited agreement when clinicians classified gait videos using existing descriptive frameworks. Describing a walking pattern and establishing its cause are separate tasks. [11]

Visible effort deserves a clinical explanation that considers pain, breathlessness and the demands of the task. Earlier effort-behaviour research excluded people whose major symptom was pain, so it should not be used to dismiss these difficulties. The 2025 survey adds evidence about daily impact, although it excluded nonambulant people and cannot represent everyone with functional gait disorder. [7][10]

Citation table

Citation Figure Full citation
[1] — Nonnekes J, Růžička E, Serranová T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093–1099. FND-CIT-0020. https://doi.org/10.1212/WNL.0000000000009649
[2] — Daum C, Gheorghita F, Spatola M, et al. Interobserver agreement and validity of bedside ‘positive signs’ for functional weakness, sensory and gait disorders in conversion disorder: a pilot study. Journal of neurology, neurosurgery, and psychiatry. 2015;86(4):425-430. DOI. PMID: 24994927. FND-CIT-0130.
[3] — Hayes MW, Graham S, Heldorf P, et al. A video review of the diagnosis of psychogenic gait: appendix and commentary. Movement disorders : official journal of the Movement Disorder Society. 1999;14(6):914-921. DOI. PMID: 10584664. FND-CIT-0143.
[4] — Gandolfi M, Fiorio M, Geroin C, et al. Dual tasking affects gait performance but not automaticity in functional gait disorders: A new diagnostic biomarker. Parkinsonism & related disorders. 2023;108:105291. DOI. PMID: 36764083. FND-CIT-0132.
[5] — Okun MS, Rodriguez RL, Foote KD, Fernandez HH. The “chair test” to aid in the diagnosis of psychogenic gait disorders. The neurologist. 2007;13(2):87-91. DOI. PMID: 17351529. FND-CIT-0127.
[6] — Lagrand TJ, Brusse-Keizer M, Charmley A, et al. A Critical Appraisal of the Whack-a-Mole and Swivel Chair Signs in the Diagnosis of Functional Movement Disorders. Movement disorders clinical practice. 2024;11(1):63-68. DOI. PMID: 38291841. FND-CIT-0181.
[7] — Laub HN, Dwivedi AK, Revilla FJ, et al. Diagnostic performance of the “Huffing and Puffing” sign in psychogenic (functional) movement disorders. Movement disorders clinical practice. 2015;2(1):29-32. FND-CIT-0145.
[8] — Wolfsegger T, Pischinger B, Topakian R. Objectification of psychogenic postural instability by trunk sway analysis. Journal of the neurological sciences. 2013;334(1-2):14-17. DOI. PMID: 23932398. FND-CIT-0160.
[9] — Lin D, Castro P, Edwards A, et al. Dissociated motor learning and de-adaptation in patients with functional gait disorders. Brain : a journal of neurology. 2020;143(8):2594-2606. DOI. PMID: 32779724. FND-CIT-0117.
[10] — Issak S, Williams G, Kanaan RA, Fini NA, Nielsen G. Self-Reported Motor and Non-Motor Symptoms in People With Functional Gait Disorder: A Cross-Sectional Study. Brain and Behavior. 2025;15(2):e70208. DOI. Full text. FND-CIT-0232.
[11] — Issak S, Kanaan R, Fini NA, Nielsen G, Williams G. Phenotyping Functional Gait Disorder: An Exploratory Analysis of Existing Frameworks. Movement Disorders Clinical Practice. 2026;13(4):1006–1013. Published online November 11, 2025. DOI. FND-CIT-0265.

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