FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Individualized FND-Informed Rehabilitation and Relapse Planning for Functional Gait Disorder

Most likely fit: Gait disability is persistent, episodic or mixed and cannot be addressed by one transformation alone; walking interacts with weakness, pain, fatigue, dizziness, falls, equipment, daily tasks, other FND symptoms or coexisting medical conditions. [Functional-gait-specific and mixed functional-motor programme evidence; no single component is established as the active ingredient]

Not the same as: Requiring every discipline, assuming psychotherapy is always necessary, delivering a fixed exercise package, or making symptom disappearance the only acceptable outcome.

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

Build a programme around your walking life

An individualized programme begins with what you need walking or mobility to make possible. That might be transferring safely, reaching the bathroom, getting through your home, walking part of a community route, using a wheelchair for the remainder or reducing the cost of a flare.

The programme may combine one or two gait transformations with strength or endurance work when those are actual barriers, equipment, daily-task adaptation, education and treatment of pain, dizziness, sleep, migraine or another condition. Psychological therapy can be included when it addresses a relevant goal; it is not a test of whether symptoms are real.

Anatomy in everyday language

Walking is a whole-body activity. The motor system coordinates the trunk, pelvis, hips, knees, ankles and feet while sensory systems report balance and position. Cardiovascular and respiratory systems supply the activity, and attention helps select the route and respond to hazards.

Because several systems contribute, two people with a similar-looking gait may need different treatment. One may need help with weight transfer; another may need equipment and a fall plan; another may need community practice or management of a coexisting vestibular problem.

A useful written plan

Your plan can record:

  1. the activities that matter most;
  2. the gait cue or transformation that helps each pattern;
  3. the aid and support needed in each setting;
  4. early signs of reduced available capacity or a gait flare;
  5. the first safe response and a smaller return step;
  6. new or changed symptoms that require medical review; and
  7. what counts as progress for you.

A setback does not erase learning or prove treatment has failed. It may require temporary support, a smaller dose, reassessment or a different goal.

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

Ask which goals and forms of help the person wants. Learn the agreed cue, guarding method, equipment and emergency boundaries. Support participation without turning every movement into therapy.

During a setback, help the person use the written plan: prevent a fall, reduce the relevant demand, bring the appropriate aid and restart at a smaller safe level when wanted. Do not interpret symptom recurrence as poor effort, hidden resistance or loss of all progress. Supporters may also need respite, education and boundaries of their own.

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

Formulation and team selection

Confirm and explain positive diagnostic features while preserving diagnostic openness to change. Map gait phenotype, falls, assistance, equipment, environmental variation, pain, fatigue, autonomic and vestibular symptoms, cognition, other functional symptoms, coexisting disease, social demands and access barriers. Include only disciplines with a defined role.

Physiotherapy may lead movement retraining, conditioning and mobility safety. Occupational therapy may address transfers, home tasks, equipment, routines and community participation. Neurology or another medical discipline should review new features and coexisting conditions. Psychology or psychiatry may address coping, fear, trauma, mood or another agreed target without being made the universal explanation.

Explicit procedure

  1. Establish shared diagnostic understanding and one or more functional goals.
  2. Record baseline gait, falls, assistance, routes, aid use, symptoms and delayed activity cost.
  3. Select the smallest set of phenotype-matched techniques rather than prescribing every drill.
  4. Identify structural, vestibular, cardiovascular, pain, fatigue and equipment issues requiring parallel management.
  5. Practise the easier movement condition and transfer it promptly to meaningful activity.
  6. Progress one demand at a time while retaining safe aids and a defined regression.
  7. Coordinate messages across disciplines so the person does not receive conflicting advice about effort, aids or psychological causes.
  8. Review both observed movement and participation outcomes at agreed intervals.
  9. Write a flare and relapse plan that distinguishes familiar variation from red flags requiring reassessment.
  10. Change the formulation and programme when evidence from the person’s response shows the current approach is not useful.

Interpreting the treatment evidence

The 2014 gait-specific randomized crossover study included 60 participants and compared a three-week inpatient programme with a waiting period. It reported improvements in walking, independence and quality of life that were maintained at follow-up. It used the older diagnosis “psychogenic gait disorder” and combined adapted physical activity with a cognitive-behavioural framework, so it cannot show which component worked or establish the result for modern outpatient populations.

Physio4FMD was a much larger mixed functional motor-disorder trial. Its primary 12-month physical-function outcome did not clearly favour specialist physiotherapy, though several secondary and self-rated outcomes did. Another smaller trial studied combined physiotherapy and CBT in mixed functional movement disorders. Together, these studies justify offering individualized rehabilitation with honest uncertainty; they do not support promises, blame after non-response or a single mandatory pathway.

Outcomes

Measure falls and near-falls, transfers, assistance, meaningful-route completion, aid use, symptom and pain burden, available-capacity cost, recovery time, confidence, participation and quality of life. Keep meaningful support available when symptom remission is incomplete.

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

Research and Sources

Citation Full citation
[1] Jordbru AA, Smedstad LM, Klungsøyr O, Martinsen EW. Psychogenic gait disorder: a randomized controlled trial of physical rehabilitation with one-year follow-up. Journal of Rehabilitation Medicine. 2014;46(2):181–187. FND-CIT-0094. https://doi.org/10.2340/16501977-1246
[2] 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
[3] 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
[4] Nielsen G, Stone J, Lee TC, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial. The Lancet Neurology. 2024;23(7):675–686. FND-CIT-0029. https://doi.org/10.1016/S1474-4422(24)00135-2
[5] Macías-García D, et al. Combined physiotherapy and cognitive behavioral therapy for functional movement disorders: a randomized clinical trial. JAMA Neurology. 2024;81(9):966–976. FND-CIT-0030. https://doi.org/10.1001/jamaneurol.2024.2393

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 —