FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Mirror and Visual Feedback for Functional Gait Disorder

Most likely fit: A brief external view of trunk, pelvic, knee or foot position makes one movement correction easier or helps the person recognize a safer, more organized pattern. [Clinical consensus; direct component evidence is limited]

Not the same as: Watching the whole body continuously, asking the person to make gait look normal, or using a mirror when visual motion, migraine, dizziness, dissociation, body-image distress or self-monitoring becomes worse.

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What visual feedback can add

A mirror, floor line, video image or visible target can provide outside information about one part of the task. You might see that your weight has moved over one foot, that the knee stayed aligned during a step, or that your trunk can remain more centred than it feels.

The feedback should answer one useful question and then be reduced. Watching every step can increase self-monitoring, so more visual information is not automatically better.

Anatomy in everyday language

The pelvis and trunk help position the body’s centre of mass over the feet. At the lower limb, the hip, knee, talocrural joint (the main ankle hinge) and subtalar joints (which help the foot adapt side to side) contribute to alignment and progression.

Vision is only one part of balance. The vestibular system in the inner ear and somatosensation from skin, muscles and joints also report movement and position. In plain language, the body combines what you see, feel and sense about balance. If visual input dominates or conflicts with the other information, a mirror may increase rather than reduce difficulty.

What practice may look like

The therapist may position a mirror for a front or side view and choose one target, such as keeping the pelvis over the stance foot for a single step. The mirror may then be covered, moved or replaced by a destination cue so the pattern can continue without constant watching.

Visual feedback can also be a line on the floor, a coloured foot target or a short video reviewed after walking. Stop if dizziness, nausea, visual overload, headache, dissociation or body-focused distress rises, or if looking at the mirror takes attention away from hazards.

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Do not film or position a mirror without consent. Use the one visual target selected in therapy and avoid commenting on the person’s whole appearance. The relevant question is whether the feedback supports a safer task.

Keep guarding and the route unchanged while visual feedback is introduced. Remove or cover the visual cue if it causes overload, dizziness or increased self-consciousness; that response is useful clinical information.

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Selection and visual-access screen

Define the single movement variable visual feedback is intended to change. Assess visual acuity and field, ocular-motor and vestibular symptoms, visual-motion sensitivity, migraine, PPPD, dissociation, body-image or trauma-related distress and capacity to divide gaze between feedback and the route. A visually dependent balance strategy may worsen with prolonged mirror use.

Choose the viewing plane deliberately. A frontal view may show lateral trunk and pelvic shift, knee position and base width. A sagittal view may show trunk inclination, hip extension, knee flexion and foot progression. Video introduces delay and privacy requirements that differ from live feedback.

Explicit procedure

  1. Record the baseline task without visual feedback and define a functional outcome.
  2. Establish guarding and ensure the person can still see relevant hazards or use an appropriately controlled stationary task.
  3. Introduce the least complex visual cue: one target, line, mirror segment or brief video.
  4. Direct attention to the task result rather than cosmetic symmetry.
  5. Practise a small number of repetitions while monitoring visual and vestibular symptoms.
  6. Remove or reduce the feedback and test whether the movement persists.
  7. Link the change to an external destination or ordinary route.
  8. Use nonvisual tactile or auditory alternatives if visual feedback is not tolerated.
  9. Obtain explicit consent and define storage or deletion before recording video.

Outcomes and evidence boundary

Track task success, assistance, selected alignment variable, carryover without the mirror, visual symptoms, dizziness, falls and delayed response. Do not interpret an accurate mirror correction as evidence that gait is consciously produced.

Visual feedback is included in functional-motor consensus, and sign-based gait work supports observing task-dependent change. Controlled trials do not isolate mirror or video feedback as treatment for functional gait disorder. [1][2][3]

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Research and Sources

Citation Full citation
[1] Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry. 2015;86(10):1113–1119. FND-CIT-0028. https://doi.org/10.1136/jnnp-2014-309255
[2] Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry. 2020;91(10):1037–1045. FND-CIT-0011. https://doi.org/10.1136/jnnp-2019-322281
[3] 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

Detailed technique page created September 12, 2026 · Clinical and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
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