FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Supported Return to Activities for Functional Seizures

Most likely fit: When seizures or fear of an unsafe event restrict a valued activity and a safer, accessible version can be planned. [Clinical and occupational-therapy guidance; programme evidence does not establish a fixed activity dose]

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Start with something that matters to you

Choose an activity you want, not a test of how much you can endure. It might be a short visit, a seated hobby or part of a household task. Ask what makes the activity difficult: loss of awareness, falls, noise, fatigue, transport or the reaction of other people. [1][2][3]

Make one version easier and safer. For a seated hobby, that could mean avoiding hot or sharp tools, having a safe resting place and agreeing how someone should help. Success might be access to the activity with appropriate support; you do not need a seizure-free attempt for the activity to matter.

Change one demand at a time

If the activity is manageable, discuss changing its length or setting, not everything together. Keep equipment, rest and assistance that remain useful. Stop to review repeated injury, marked exhaustion or delayed worsening. An activity plan is not a fixed daily increase.

At a familiar warning, stop the hazardous part, use your safe position and one rehearsed cue if appropriate. With no warning, the surroundings must already be arranged for safety. Return when alert and physically ready, possibly to a smaller version or on another day.

Driving, swimming, heights, machinery and responsibility for someone else’s safety need specific professional and local advice. Do not use this page to decide those activities are safe.

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Help create the agreed setup and exit plan. Ask whether the person wants company or privacy and avoid surprise increases in duration or sensory load. Do not remove an aid to encourage independence.

If an episode interrupts the activity, follow the safety plan without treating the attempt as a mistake. Later ask what adjustment would make access easier. Participation should not be a reward for symptom suppression.

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

Explicit procedure

  1. Identify one meaningful activity and the person’s preferred level of support.
  2. Analyse event unpredictability, awareness, recovery, falls, sensory demands, fatigue and any comorbid limitations.
  3. Separate remediable barriers from genuine hazards; do not frame all avoidance as irrational fear.
  4. Select a lower-risk version and retain needed assistance, equipment and accommodations.
  5. Specify a stop point, event response and route home or to recovery support.
  6. Review tolerability and delayed effects before increasing one demand.
  7. If the plan is not workable, reduce the demand or change the setting; reassess persistent deterioration.

Function, anatomy and safety

Post-event balance, limb strength, coordination and alertness may be temporarily insufficient for transfers even after visible shaking stops. Assess the task the person must actually perform rather than equating the end of movement with readiness to stand.

Measure access, assistance, injuries, delayed burden and satisfaction. Do not supply a universal driving restriction period; refer to the applicable licensing requirements and responsible clinician. Component-specific efficacy of this example activity sequence has not been established.

Basis and evidence boundary

Occupational-therapy guidance informs task adaptation. Adult psychotherapy programme outcomes support considering daily function, but do not validate a universal graded-activity schedule. [1][2][3]

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Research and Sources

Citation Full citation and source
[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.
[2] Goldstein LH, Robinson EJ, Mellers JDC, et al.; CODES study group. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. The Lancet Psychiatry. 2020;7(6):491–505. https://doi.org/10.1016/S2215-0366(20)30128-0 FND-CIT-0033.
[3] Tolchin B, Goldstein LH, Reuber M, Stone J, Perez DL, LaFrance WC Jr, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. https://doi.org/10.1212/WNL.0000000000214466 FND-CIT-0010.

Created September 14, 2026 · Neurology, relevant therapy, lived-experience, caregiver and accessibility review pending

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