FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Mobility Aids, Guarding and Fall Planning for Functional Gait Disorder

Most likely fit: Knee buckling, swaying, sudden gait loss, fatigue, pain or injury risk limits safe transfers and participation, or a current aid no longer matches the person, task or environment. [Clinical consensus; falls assessment is supported by observational evidence]

Not the same as: Removing equipment to prevent “reinforcement,” prescribing the largest device without assessment, or promising that every aid will later be reduced. The correct plan may include temporary use, different devices in different settings or optimized long-term use.

For the Person With FND
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What equipment is meant to do

A mobility aid should reduce a specific risk or barrier: help with balance, share load, provide a place to rest, make a transfer safer or allow access that walking alone cannot provide. A cane, crutches, walker, rollator, wheelchair or environmental support changes movement in a different way.

Using an aid is not proof of recovery or failure. If it lets you reach the bathroom safely, avoid repeated falls or participate in family and community life, those are meaningful outcomes. The device should still be reviewed when your symptoms, body, environment or goals change.

Anatomy and equipment in everyday language

An aid changes the base of support, the area keeping you balanced, and may transfer some force through the hands, wrists, elbows and shoulders. A cane can add one contact point. A walker provides a larger surrounding base but requires controlled placement, turning and often upper-limb loading.

A wheelchair changes pressure under the pelvis, thighs and feet and affects posture, transfers and skin. The seat width, depth, back, cushion, foot supports and controls all matter. In plain language, the device becomes part of the movement system; poor fit can create pain, skin injury and new instability.

A personal fall plan

Your plan can state which device is used for each setting, how a supporter guards, where to sit during a flare, what to do after a fall and which changes require urgent care. It should also identify when not to walk—for example, during altered awareness or a new medical event.

Do not change device height, remove brakes or practise without the aid because one session went well. Report new hand or shoulder pain, skin redness, repeated near-falls, brake or wheel problems, and any device that cannot fit through the needed environment.

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

Learn how the device is positioned, braked, folded, transported and checked. Ask the therapist to teach guarding and transfers; do not hold around the neck, pull an arm or catch a falling adult in a way likely to injure both people.

During a gait flare, bring the established device or seat and clear the route. Do not hide an aid, move it farther away as motivation or insist on walking because the person managed earlier. After a fall, follow the agreed medical and lifting plan rather than immediately pulling the person upright.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For Clinicians and the Care Team

Person–task–environment assessment

Identify the risk and participation target before choosing equipment. Document falls, near-falls, injury, gait phenotype, upper- and lower-limb capacity, pain, fatigue, cognition, vision, sensation, vestibular and cardiovascular symptoms, seizure or altered-awareness risk, skin, transfers, transport and home geometry. Consider bone health and anticoagulation when evaluating consequences of a fall.

Assess device-specific mechanics. Cane-side selection depends on the intended support and individual pattern; do not transfer a musculoskeletal rule without testing. Check elbow position, grip, shoulder loading, device placement, brake use, turning radius and speed control. For wheelchairs, assess seating dimensions, cushion and pressure management, foot support, propulsion or attendant needs, transfers and symptom-specific safety.

Explicit procedure

  1. Define the settings and functions for which an aid is needed.
  2. Test the least complex device that safely meets those needs, while remaining open to different devices by setting.
  3. Fit and inspect the device according to manufacturer and professional guidance.
  4. Teach level movement, starts, stops, turns, thresholds, transfers and emergency responses relevant to actual use.
  5. Train supporters in guarding and equipment operation, including what not to do.
  6. Document fall response, head-injury or fracture red flags and when emergency assessment is required.
  7. Integrate the aid into movement retraining rather than withholding it until gait appears normal.
  8. Review skin, pain, upper-limb load, falls, participation and device condition.
  9. Trial reduction only when it serves the person’s goal and remains safe; long-term optimization is an equally valid outcome.

Outcomes and evidence boundary

Track falls, near-falls, injuries, transfers, assistance, route access, device reliability, pain, skin, confidence and caregiver burden. Device reduction alone is not an adequate outcome.

Physiotherapy and occupational-therapy consensus support individualized equipment review. A 2026 cross-sectional study supports multidimensional falls assessment in motor FND but cannot identify which device prevents falls. No trial establishes routine aid removal as a treatment for functional gait disorder. [1][2][3]

For the Person With FND
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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] Mohammadi Z, Keyvanfar A, Higgins R, et al. Falls in Functional Neurological Disorder: Prevalence, Risk Factors and Clinical Implications. European Journal of Neurology. 2026;33(6):e70665. FND-CIT-0085. https://doi.org/10.1111/ene.70665

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

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —