Functional Neurological Disorder (FND) occurs due to a problem with the functioning of the nervous system, rather than by a specific physical neurological disease or disorder, and patients with FND can experience a wide range and combination of physical, sensory and/or cognitive symptoms that can be continuous, fluctuate or happen from time to time.

Common functional symptoms include, Physical/Motor Dysfunction, Sensory Dysfunction, Episodes of Altered Awareness and Concentration, Memory and Fatigue.

While treatment should always start with a clear and supportive explanation of the specific clinical features that have contributed to the FND diagnosis, there is clear evidence for the efficacy of certain treatments, for example, physiotherapy for the treatment of motor symptoms or occupational therapy for regaining confidence engaging in activities of daily living.

However, increasingly Neurologic Music Therapy (NMT) is also being used as a treatment for people with FND.

Chroma is currently working with STEPS Rehabilitation, a specialist residential and day rehab facility in Sheffield for clients with neurological conditions, acquired brain injury, spinal cord injuries, stroke, orthopaedic and other complex trauma injuries to support people with FND.

STEPS is seeing an increasing number of patients with FND referred to their service for short- and long-term rehabilitation. As well as traditional treatments such as physiotherapy, speech and language therapy, occupational therapy and psychology, STEPS Rehabilitation is offering FND clients the opportunity to also engage with NMT.

NMT is proving to be a useful intervention largely due to its multiple benefits. Because FND clients often present with a combination of neurological symptoms, NMT offers a unique approach to treatment in that it can address a wide range of symptomatology – physical/motor dysfunction, sensory dysfunction, speech dysfunction and cognitive problems. It can also help clients work through psychological and emotional symptoms.

I am currently working with a client with FND, and this case study perfectly exemplifies the positive impact of NMT.

The patient I am working with is a woman in her 50’s, a high-flying professional, fit and healthy. Six years ago, she experienced a gradual onset of symptoms that lasted a couple of years. She stabilised and life appeared to be back to normal until a year ago when she noticed symptoms recurring, which led to a fall after which things deteriorated and her anxiety increased.

The patient displayed physical/motor symptoms characterised by slow movements, which affected gait, walking and hand/arm movement and a combination of muscle weakness and muscle tension which increased stiffness.

Over a four-week intensive rehabilitation period, which consisted of one NMT session per week, we were able to help the patient make positive progress and improvement in the areas of motor movement.

She learnt techniques that she could continue to use after her short time at STEPS. Her anxieties around movement lessened and she appeared to focus less on affected areas of her body allowing movements to become more automatic.

The intervention covered:

  • Rhythmic Auditory Stimulation (RAS) – using the physiological effects of auditory rhythm on the motor system to improve the control of movement in the rehabilitation of functional, stable and adaptive gait patterns. The patient appeared to have developed some ineffective movements and engrained habits that were contributing to slowed walking speed and undesirable gait. She described RAS as learning how to walk again. Rhythmic cues helped her to retrain effective movement and entrain this through repetition. As a result, she was able to begin to correct her gait and increase her walking pace. Walking became automatic again rather than over thought and anxiety provoking.
  • Patterned Sensory Enhancement (PSE) – music and rhythm were used to cue and pattern specific motor movements and sequences of movement enabling greater strength and endurance, increased control and fluidity and a wider range of movement. The patient used PSE to improve her movement from sitting to standing and also to break down the movement patterns necessary when taking a single stride. Through repetition she showed greater control and precision. She became physically less restricted, her muscle stiffness reduced, her muscle weaknesses were strengthened, and she accurately carried out movements in a more automatic way.
  • Therapeutic Instrumental Music Performance (TIMP) – instruments were used to exercise and stimulate functional movement patterns. Handheld instruments contributed helped the patient improve hand and arm function, fine motor dexterity, co-ordination and speed of movement.

NMT is proving to be an invaluable therapeutic intervention within the treatment of patients with FND. The wide range of techniques and adaptability to the individual and unique needs of patients make it an accessible and purposeful treatment.

Music and rhythm give patients a creative distraction and motivation within their rehabilitation as the focus is not solely on a person’s difficulties and in-affective function, but rather it is on the potential for regaining function.

As shown above, integrating NMT into any therapeutic team where the primary focus is on neurological rehabilitation can contribute to the assessment, treatment and continued rehabilitation of patients.

For more information email or call 0330 440 1838.

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