The effect of individualized sensory retraining on the rehabilitation of adults with functional neurological disorders: An unexplored field in physical therapy practice

Georgios Tsigaras; Anna Chalkia; Onoufrios Poimenidis; Alexandra Kallistratou; Emanouil Trevlakis; Pavlina Chondromatidou; Konstantina Armanidou; Leonidas Kozyrakis; Diogenis Vasiliadis; Ilias Kallistratos

doi:10.21744/ijhms.v8n3.2421

Authors

Georgios Tsigaras
tsigarasphysiopediatric@gmail.com
1st Department of Pediatrics, Aristotle University Thessaloniki Hippokratio General Hospital
Anna Chalkia Αssistant Professor at the International University of Greece, Department of Physiotherapy
Poimenidis Onoufrios PT,PhDc, International University of Greece, Department of Physiotherapy
Kallistratou Alexandra MSc, Physiotherapis in National Health Service (NHS), UK
Trevlakis Emanouil PT,PhD, International University of Greece, Department of Physiotherapy
Chondromatidou Pavlina Nurse in the Intensive Care Unit (ICU) / Hellenic University of Thessaloniki, Greece
Konstantina Armanidou Philologist Msc, School of French Language and Literature, (Faculty of Philosophy) AUTH, Greece
Kozirakis Leonidas Speech-language therapist MSc, Occupational therapy Student, University of Western Macedonia, Department of Occupational Therapy
Vasiliadis Diogenis Μedical student,School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
Kallistratos Ilias Professor , International University of Greece, Department of Physiotherapy

Keywords:

FND (Functional Neurological Disorder), physical therapy model, neurological symptoms

Abstract

The purpose of this article is to introduce a new integrated model of physical therapy in managing adults with Functional Neurological Disorder (FND), which is a disabling, common health issue with no form of standardized treatment. The approach includes integrating incongruent lines of evidence through adopting a complete synthesis of the qualitative research of the lived experience of the patient, neurobiological research on sensory perception, and clinical research regarding physical and mental therapy. The primary results of this synthesis argument lead to a paradigm shift towards the participatory model of sensory retraining that rejects pure motor-based rehabilitation. This model is constructed on the base of co-creation, in which the patient-narrative construction and subjective state are the central sequences in creating a treatment alliance and the improvement of treatment compliance. The main ones are the introduction of affordably individualized classical sensory retraining focused on retraining the central nervous system-interpretation, the use of a personalized dental, or sensory diet to enhance self-regulation, and the introduction of what we call the sensory mindfulness to uncouple painful sensations with maladaptive/ unresponsive movements/dissociation reactions.

Downloads

Download data is not yet available.

References

Ali, S., D'Souza, A., & Khan, M. (2023). Physical rehabilitation of motor functional neurological disorders: A narrative review. Medicina, 59(5), 966.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders [Internett].

Annam, M. (2020). Conversion disorder. StatPearls Publishing.

Arya, K. N. (2021). Neuro-plasticity and principles of neuro-rehabilitation. In Sensory-motor rehabilitation in neuro-disorders (pp. 1-20). Jaypee Brothers Medical Publishers.

Baslet, G., Dworetzky, B., Perez, D. L., & Oser, M. (2015). Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series. Clinical EEG and neuroscience, 46(1), 54-64.

Baslet, G., Ehlert, A., Oser, M., & Dworetzky, B. A. (2020). Mindfulness-based therapy for psychogenic nonepileptic seizures. Epilepsy & Behavior, 103, 106534. https://doi.org/10.1016/j.yebeh.2019.106534

Baslet, G., Dworetzky, B. A., & Perez, D. L. (2023). Outpatient approach to occupational therapy for paroxysmal functional neurologic symptoms: Sensory modulation training as an emerging treatment. General Hospital Psychiatry, 85, 103–110.

Boon, T., Saetta, G., De-Wit, L., & Cras, P. (2023). Perception-action integration is altered in functional movement disorders. Movement Disorders, 38(8), 1469-1478.

Brigham & Women's Hospital, Department of Rehabilitation Services. (2019). Standard of care: Functional neurologic disorder.

Cramer, S. C., Dodakian, L., & Le, V. (2013). The role of the unaffected hemisphere in stroke recovery. Stroke, 44(6 Suppl 1), S97-S100.

Baslet, G., Ridlon, R., Raynor, G., Gonsalvez, I., & Dworetzky, B. A. (2022). Sustained improvement with mindfulness-based therapy for psychogenic nonepileptic seizures. Epilepsy & Behavior, 126, 108478. https://doi.org/10.1016/j.yebeh.2021.108478

Espay, A. J., Aybek, S., & Carson, A. (2020). Functional neurological disorders: A patient-centered, evidence-based approach. JAMA Neurology, 77(6), 693-695.

Finkelstein, S. A., Pareés, I., & Macerollo, A. (2025). The role of sensory attenuation in symptomatic and healthy individuals: a scoping review. Frontiers in Neuroscience, 19, 1590127.

FND Hope. (n.d.). Sensory changes. Retrieved July 22, 2025, from https://fndhope.org/fnd-guide/symptoms/sensory-changes/

Gnanavel, S. (2024). Functional neurological disorder. Medscape.

Gore, S., Edgar, V., & O'Brien, J. (2024). Functional neurological disorder (FND) in pediatric rehabilitation: A primer for the outpatient therapist. Rhode Island Medical Journal, 107(9), 19-23.

Hadas, I., Shafir, T., & Levy, D. A. (2022). Functional neurological symptom disorder: Preliminary findings of factors associated with walking ability post integrative pediatric rehabilitation. Journal of Pediatric Rehabilitation Medicine, 15(3), 433-446.

Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J. (2022). Functional neurological disorder: new subtypes and shared mechanisms. The Lancet Neurology, 21(6), 537-550.

Korner, A. J., & McLean, L. (2025). The journey to a diagnosis of Functional Neurological Disorder (FND). ResearchGate.

Kim, Y. N., Gray, N., Jones, A., Scher, S., & Kozlowska, K. (2022). The role of physiotherapy in the management of functional neurological disorder in children and adolescents. In Seminars in pediatric neurology (Vol. 41, p. 100947). WB Saunders. https://doi.org/10.1016/j.spen.2021.100947

LaFaver, K., Epstein, S. A., & Maurer, C. W. (2021). Functional neurological disorder: Engaging patients in treatment. Current Treatment Options in Neurology, 23(12), 1-15.

LaFrance, W. C., Jr., Baird, G. L., & Goldstein, L. H. (2022). A randomized controlled trial of cognitive behavioral therapy for psychogenic nonepileptic seizures. JAMA Psychiatry, 79(7), 643-651.

Lumsden, C., Jones, R., & Reuber, M. (2024). The lived experience of functional neurological disorder in Australia: A qualitative study. Disability and Rehabilitation, 1-11.

Maclean, J., Ranford, J., & Perez, D. L. (2024). Sensory processing difficulties and occupational therapy outcomes for functional neurological disorder: A retrospective cohort study. General Hospital Psychiatry, 89, 23-30.

Maggio, J., Kyle, K., Stephen, C. D., & Perez, D. L. (2023). Lessons learned in outpatient physical therapy for motor functional neurological disorder. Journal of Neurologic Physical Therapy, 47(1), 52-59.

McBain, H., Campbell, C., & Lamontagne-Godwin, F. (2022). A co-creation centre for accessible rehabilitation technology. BMC Health Services Research, 22(1), 1063.

McBain, H., Campbell, C., & Lamontagne-Godwin, F. (2024). A participatory model for cocreating accessible rehabilitation technology for stroke survivors: User-centered design approach. Journal of Medical Internet Research, 26, e54321.

Savio, M., Kearney, H., & Giunti, G. (2025). Evaluating the evidence behind multidisciplinary roles for a multiple sclerosis unit: A systematic literature review. Multiple Sclerosis and Related Disorders, 95, 106342. https://doi.org/10.1016/j.msard.2025.106342

National Institute of Neurological Disorders and Stroke. (2023). Functional neurologic disorder.neurosymptoms.org. (n.d.). Occupational therapy.

NHS. (n.d.). Functional neurological disorder. NHS inform. Retrieved July 22, 2025, from https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/functional-neurological-disorder/NHS Grampian. (n.d.). About FND.

Nielsen, G., Busse, M., & Edwards, M. J. (2015). Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry, 86(10), 1113-1119.

Nudo, R. J., Friel, K. M., & Delia, S. W. (2017). The role of sensory information in motor learning and recovery after stroke. Restorative Neurology and Neuroscience, 35(5), 489-503.

Perez, D. L., Baslet, G., & LaFrance, W. C., Jr. (2017). Neuropsychiatric factors linked to adherence and short-term outcome in a U.S. functional neurological disorders clinic: A retrospective cohort study. The Journal of Neuropsychiatry and Clinical Neurosciences, 29(4), 359-366.

Perez, D. L., Friedman, S., & Chou, Y. H. (2021). Sensory processing difficulties in functional neurological disorder: A possible predisposing vulnerability? General Hospital Psychiatry, 69, 55-62.

Ranford, J., MacLean, J., Alluri, P. R., Comeau, O., Godena, E., LaFrance Jr, W. C., ... & Perez, D. L. (2020). Sensory processing difficulties in functional neurological disorder: a possible predisposing vulnerability?. Psychosomatics, 61(4), 343-352. https://doi.org/10.1016/j.psym.2020.02.003

Schwarz, G., Banerjee, G., Hostettler, I. C., Ambler, G., Seiffge, D. J., Brookes, T. S., ... & Staals, J. (2022). Magnetic resonance imaging-based scores of small vessel diseases: Associations with intracerebral haemorrhage location. Journal of the neurological sciences, 434, 120165. https://doi.org/10.1016/j.jns.2022.120165

Pick, S., Anderson, D. G., Asadi-Pooya, A. A., Aybek, S., Baslet, G., Bloem, B. R.,... & Nicholson, T. R. (2020). Outcome measures for functional neurological disorder: A systematic review. Journal of Neurology, Neurosurgery & Psychiatry, 91(10), 1037-1044.

Reactive Physical Therapy. (2024). Why does sensory training work in FND? [Video]. YouTube. https://www.youtube.com/watch?v=zA2lX9soh1g

Ricciardi, L., De Gusmao, C. M., & Gasser, T. (2020). Using patient-centered clinical neuroscience to deliver the diagnosis of functional neurological disorder (FND): Results from an innovative educational workshop. Academic Psychiatry, 44(6), 714-720.

Robson, C., Stone, J., & Edwards, M. J. (2020). Occupational therapy consensus recommendations for functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry, 91(10), 1037-1044.

Rosen, B. (2011). Sensory retraining as a cognitive behavioral therapy for altered sensation. Journal of Hand Therapy, 24(2), 166-174.

Schabrun, S. M., & Hillier, S. (2019). Evidence for the effectiveness of sensory retraining in stroke rehabilitation: A systematic review. Clinical Rehabilitation, 33(6), 959-972.

Stone, J., Burton, C., & Carson, A. (2021). A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine, 21(1), 28-36.

Szasz, A., Korner, A., & McLean, L. (2025). Qualitative systematic review on the lived experience of functional neurological disorder. BMJ Neurology Open, 7(1), e000694.

The Neuro Collaborative. (2023). Using a sensory-based approach for treating functional neurological disorders.

Toljan, K., Baslet, G., & Dworetzky, B. A. (2020). Mindfulness-based therapy for psychogenic nonepileptic seizures. ResearchGate.

University of Oulu. (2025). New study explores the evidence behind members of the multidisciplinary team in multiple sclerosis care.

van der Sar, S. A., van Beilen, M., & Tijssen, M. A. J. (2024). Outcome measurement in functional neurological disorder: A qualitative study on the views of patients, caregivers, and healthcare professionals. Journal of Neurology, 271(3), 1345-1356.

Zickert, D., Freeman, J., & Marsden, J. (2024). The experience of physiotherapy for functional movement disorders: A qualitative study. Disability and Rehabilitation, 1-10.