title: Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol.
abstract: BACKGROUND
  Functional ("psychogenic") gait and other movement disorders have proven very difficult to treat.
  
  
  OBJECTIVE
  Describe the Mayo Clinic functional movement disorder motor-reprogramming protocol conducted in the Department of Physical Medicine and Rehabilitation (PMR), and assess short-term and long-term outcomes.
  
  
  METHODS
  Historical-cohort-study assessing non-randomized PMR intervention.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Interventional group: 60 consecutive patients with a chronic functional movement disorder that underwent the PMR protocol between January 2005 and December 2008.
  
  
  METHODS
  age- and sex-matched patients with treatment-as-usual (n = 60).
  
  
  METHODS
  An outpatient, one-week intensive rehabilitation program based on the concept of motor-reprogramming following a comprehensive diagnostic neurological evaluation, including psychiatric/psychological assessment.
  
  
  METHODS
  Improvement of the movement disorder by the end of the week-long program (patient- and physician-rated), plus the long-term outcome (patient-rated).
  
  
  RESULTS
  Patient demographics: median symptom duration, 17 months (range, 1-276); female predominance (76.7%); mean age 45 years (range, 17-79). Physician-rated outcomes after the one-week treatment program documented 73.5% were markedly improved, nearly normal or in remission, similar to the patient-ratings (68.8%). Long-term treatment outcomes (patient-rated; median follow-up, 25 months) revealed 60.4% were markedly improved or almost completely normal/in remission, compared to 21.9% of controls (p < 0.001).
  
  
  CONCLUSIONS
  Short-term and long-term successful outcomes were documented in the treatment of patients with functional movement disorders by a rehabilitative, goal-oriented program with intense physical and occupational therapy. The rapid benefit, which was sustained in most patients, suggests substantial efficacy that should be further assessed in a prospective, controlled, clinical trial.
authors: Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
authors: Kathrin
authors: K
authors: Czarnecki
authors: Jeffrey M
authors: JM
authors: Thompson
authors: Richard
authors: R
authors: Seime
authors: Yonas E
authors: YE
authors: Geda
authors: Joseph R
authors: JR
authors: Duffy
authors: J Eric
authors: JE
authors: Ahlskog
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult