FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Practising the Conversations You Want to Have

Most likely fit: A strategy helps in therapy but has not yet become usable in the conversations, calls or everyday exchanges that matter. [Professional consensus; participation goals and practice demands should be individualized]

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

The point of therapy is not to become good at therapy exercises. It is to help you take part in your life. A useful practice goal might be asking a question at an appointment, telling a partner something funny or speaking briefly to a friend.

Choose a conversation you want, rather than the one someone else thinks you should manage. A shorter exchange, a written prompt or a communication aid can make it possible. These are ways of participating now, even while you work on speech.

A few useful words

Carryover means using something learned in one setting in another. Participation means taking part in activities and relationships. A communication repair is a way to handle misunderstanding, such as pointing, rephrasing or typing a key word.

What this might look like

For example, practise one question you want to ask at your next appointment. You might say it to a familiar person, record it privately if you choose, or keep it written where you can show it. The next step could be asking the clinician directly, with the written version still available.

Change one demand at a time: length, spontaneity, listener familiarity or setting. You do not need to add noise to make practice realistic. During a flare, use the backup message and continue the appointment; trying to speak again can wait until you choose.

The examples here are suggestions to discuss with your clinician, not a fixed exercise prescription. [1]

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 what role the person wants you to take: listener, practice partner, reminder, or someone who helps if a message is missed. Agree before a call or appointment rather than taking over automatically.

Keep the exchange worthwhile even when speech is difficult. Do not turn every family conversation into a practice session or withhold an answer until a sentence is spoken correctly.

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

Selecting the approach

Connect the chosen strategy to a participation goal and assess environmental barriers. A clinic performance may not predict a telephone call, group discussion or noisy workplace. Consider accessible appointments, interpretation, fatigue, sensory needs and vocational demands.

Putting it into practice

  1. Ask the person to choose one real communication situation.
  2. Identify the smallest useful version and the support required to attempt it.
  3. Rehearse the message and one way to repair a misunderstanding.
  4. Trial it with an agreed listener, keeping alternative communication available.
  5. Review what was achieved and the effort or delayed burden involved.
  6. Adjust one demand or improve the environment; do not escalate difficulty automatically.

Review and stopping points

Success can mean getting a need understood, keeping a place in a conversation or avoiding exhaustion. A symptom flare does not invalidate that outcome. If practice repeatedly costs more than it gives, change the plan and address access barriers.

The procedure is an educational adaptation for individual clinical review, not a validated standalone protocol. [1]

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

Research and Sources

The consensus recommends transfer to meaningful communication. The appointment example and demand-by-demand planning are educational adaptations, not a prescribed exposure ladder. Improvement in a clinic and everyday participation should be assessed separately.

Citation Full citation Figure
[1] Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. Journal of Neurology, Neurosurgery & Psychiatry. 2021;92(10):1112–1125. FND-CIT-0025. Source —

Sources checked September 17, 2026 · Speech-language pathology, relevant medical specialties, 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 —