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. Objectives 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. Design Historical-cohort-study assessing non-randomized PMR intervention. Setting Tertiary care center. Patients Interventional group: 60 consecutive patients with a chronic functional movement disorder that underwent the PMR protocol between January 2005 and December 2008. Control group: age- and sex-matched patients with treatment-as-usual ( n = 60). Interventions An outpatient, one-week intensive rehabilitation program based on the concept of motor-reprogramming following a comprehensive diagnostic neurological evaluation, including psychiatric/psychological assessment. Main outcome measures 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