FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Sensory-Profile Assessment and Environmental Adaptation

Most likely fit: Multiple forms of sensory input interfere with washing, appointments, rest or other activities, and a tailored OT assessment is needed. [Emerging sensory-based OT evidence; uncontrolled cohort outcomes do not establish causation]

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

For the Person With FND

What this approach is for

An occupational therapist can explore which inputs are difficult, when they matter and what helps you participate. The result should be a practical plan for your day, not just a questionnaire score or a list of things to tolerate.

An accessible appointment might use quieter surroundings, comfortable lighting, breaks and one speaker at a time. Such changes can support care while a separate rehabilitation trial is considered.

Terms in everyday language

Sensory processing is a broad term for how sensory information is detected, interpreted and responded to. Sensory modulation describes adjustment of responses to input. These terms do not identify one proven FND mechanism. Sensitivity can also accompany migraine, autism, hearing or eye conditions, pain and other diagnoses.

A practical example and flare adaptations

Choose a difficult activity and describe its demands. For washing, the problem might be spray pressure, sound, temperature, standing or the combination. Change one relevant feature where possible and see whether washing becomes more manageable.

If graded exposure is proposed, agree its purpose, starting dose and stopping rules. Keep needed protection available. During a flare, a quieter or simpler setting may be helpful; it is not a universal requirement, and a new sensory exercise need not be introduced.

These are choices to discuss with your care team, not a required exercise schedule. Helpful activity, comfort and access matter even when sensation remains altered. The evidence and its limits are explained below. (Sources: 1, 2)

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 change matters most rather than assuming all sensory input should be removed. Explain environmental changes beforehand and protect the person’s ability to communicate.

Never remove ear protection or dark glasses to test tolerance. Help arrange accessible visits and document barriers that require service changes rather than more practice by the person.

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

Selection and assessment

Use history, observation and, where appropriate, a sensory-profile instrument to generate hypotheses about activity barriers. A questionnaire neither diagnoses FND nor distinguishes all comorbid causes. Integrate migraine, neurodevelopmental, audiological, visual, pain and fatigue assessment as indicated.

Explicit procedure

  1. Identify two or three priority activities and the input associated with difficulty.
  2. Separate lifelong preferences from new symptoms and identify relevant coexisting conditions.
  3. Observe a tolerable version of the activity or use the person’s description when observation is inaccessible.
  4. Trial an environmental adaptation with a defined participation goal.
  5. If a therapeutic sensory activity is considered, obtain consent and specify the response that would prompt stopping.
  6. Review immediate and delayed function; retain accommodations that enable participation.

Review, progression and stopping

Track access, task completion, recovery time and adverse effects. The 2020 OT consensus proposes reducing certain protective strategies in some circumstances. This draft does not treat that as a universal rule: changes require an individualized rationale, agreement and preserved access. A worsening response should prompt revision, not forced continuation.

The procedures are educational implementation examples requiring clinical adaptation, not validated standalone protocols. (Sources: 1, 2)

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

Research and Sources

A 2024 retrospective study included 77 adults with FND receiving sensory-based OT; 62% were rated improved by clinicians. Without randomization, a control group or blinded outcome assessment, this Class IV evidence cannot determine treatment causality or predict an individual response. It concerns mixed FND presentations, not a trial of isolated numbness.

Citation Full citation
[1] Nicholson C, Edwards MJ, Carson AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. JNNP. 2020;91:1037–1045. FND-CIT-0011. Source
[2] McCombs KE, MacLean J, Finkelstein SA, Goedeken S, Perez DL, Ranford J. Sensory processing difficulties and occupational therapy outcomes for functional neurological disorder: a retrospective cohort study. Neurology: Clinical Practice. 2024;14(3):e200286. FND-CIT-0035. Source

Source check: September 15, 2026 · Occupational-therapy, physiotherapy, neurology, pain, equipment, lived-experience, supporter and accessibility review pending.

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