REFERENCE · RECOVERY TECHNIQUE
Getting the Team Working From One Plan
When this may help: When movement, personal care, symptoms and practical support involve several services, agree who does what and how the plans fit together. [Multidisciplinary clinical consensus; broader programme evidence with important limits]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For the Person With FND
Why coordination is part of recovery care
It is exhausting to repeat your story and then receive instructions that do not fit together. A shared plan gives each clinician the same picture of your current abilities, safety needs and priorities. It is a way of organizing care, not another exercise you must perform successfully. [1][2]
You do not need every profession listed below. The useful team is the one that can address your particular needs and communicate with one another.
Give each part of the plan an owner
| Need | Who may help | What to ask for |
|---|---|---|
| Movement, balance and transfers | Physiotherapy | An assessed starting task and the assistance it requires |
| Dressing, bathing, seating and home access | Occupational therapy | Practical adaptations and equipment review |
| Skin, positioning and continence care | Nursing and relevant medical services | A daily plan and a route for new problems |
| Diagnosis, changed symptoms and other conditions | Neurology, primary care and relevant specialists | Clear diagnostic reasoning and review criteria |
| Fear, distress or coping that you want help with | A suitable psychological therapist | Agreed goals, consent and treatment without blame |
| Communication, eating or swallowing difficulties | Speech-language therapy and the relevant team | Assessment and access support for those specific needs |
These are examples of roles, not proof that every service is required or effective for each person. Psychological care can be useful without being a condition for receiving physical care. Communication or swallowing symptoms need their own assessment rather than being inferred from limb paralysis. [1][2]
Make the shared plan short enough to use
Ask for a named contact and a brief record of the current transfer method, equipment, one chosen activity, familiar-episode response and changes requiring review. Include your preferences and what supporters can safely do. Decide who will contact another service if plans conflict; that should not always fall to you.
For example, if physiotherapy proposes more upright practice while nursing is treating a pressure injury and you are becoming faint when seated, the team needs to reconcile those needs before increasing practice. This is a planning example, not a reason to stop all rehabilitation.
If a programme offers ambitious results
Ask who was studied, what improved and whether people with your level of immobility were represented. Physio4FMD did not find specialist physiotherapy superior to community neurological physiotherapy on its primary physical-function measure at 12 months, although some secondary outcomes favoured specialist care. That does not mean nobody benefits; it means the study cannot promise a particular result for you. [3]
Research note, not an additional original technique: repetitive transcranial magnetic stimulation (rTMS) uses a coil outside the head to deliver magnetic pulses. A randomized trial in functional paralysis found no significant advantage of active over sham stimulation. It does not establish this treatment as a neurological “reset.” Any proposed use needs specialist discussion of uncertainty and risks. [4]
If services are unavailable, ask what primary care, local rehabilitation and remote specialist advice can realistically provide. Keep basic care and access going during waits. During a flare, use the current written plan rather than trying several conflicting strategies. [1]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For Family, Friends, and Other Supporters
With the person’s permission, help bring the short plan to appointments and record decisions. A useful question is, “Who will follow up on this?” Avoid taking over decisions simply because the person needs physical assistance.
Tell the team about tasks you cannot safely provide and the effect of care demands on you. A plan that requires unavailable or untrained help is not yet a workable plan.
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
Assign responsibility for transfers, equipment, pressure care, continence, symptom treatment, emergency planning and follow-up. Agree meaningful outcomes with the person and separate motor change from access and quality-of-life outcomes. Do not interpret nonresponse as proof of a psychological barrier. [1][2]
For evidence discussions, distinguish component consensus from programme trials. Physio4FMD used an active physiotherapy comparator and did not demonstrate primary-outcome superiority. The Chastan trial directly studied functional paralysis, correcting the old blanket statement that no controlled trial existed; it did not demonstrate a specific active-stimulation advantage. [3][4]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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Research and Sources
The seven original entries remain unchanged in number. The rTMS paragraph is a newly sourced evidence correction within care planning, not a newly endorsed intervention or an eighth technique page. Results from two stimulation sessions do not settle every possible protocol, but cannot justify a cure claim. [4]
Evidence reviewed: September 23, 2026. Practical scenarios are illustrative, not patient quotations or tested protocols.
| Citation | Full citation and stable record | Support and limits | Figure |
|---|---|---|---|
| 1 | 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. https://doi.org/10.1136/jnnp-2019-322281 FND-CIT-0011 | FND occupational therapy consensus: activity, adaptations and coordinated support; component efficacy has not been established. | — |
| 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. https://doi.org/10.1136/jnnp-2014-309255 FND-CIT-0028 | Functional motor physiotherapy consensus, including weakness/paralysis; recommendations and examples are not proof of isolated treatment efficacy. | — |
| 3 | Nielsen G, Stone J, Lee TC, et al.; Physio4FMD study group. 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. https://doi.org/10.1016/S1474-4422(24)00135-2 FND-CIT-0029 | Physio4FMD randomized trial in a broader functional motor population; no significant difference in primary physical function at 12 months versus community neurological physiotherapy. | — |
| 4 | Chastan N, Etard O, Parain D, et al. Repetitive transcranial magnetic stimulation for patients with functional paralysis: a randomized controlled study. Eur J Neurol. 2022;29(5):1293–1302. doi:10.1111/ene.15264. FND-CIT-0215 | Sham-controlled trial, 62 participants: two active sessions did not outperform sham. Direct paralysis research, but no demonstrated specific benefit for that stimulation protocol. | — |
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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