neuro-rehab: my physical therapy plan
Over the past several months, I’ve been recovering from Functional Neurological Disorder. A large part of that has consisted of Physical Therapy and exercise. The purpose of such interventions is to stimulate and strengthen the connections between regions of the brain responsible for motor planning and control, as well as those involved in proprioception and other forms of sensory integration. (If you’re interested in further explanation, read about it here.)
Since sharing the basic outline of my neuro rehab plan and the exciting progress that I’ve made, I’ve had numerous requests for more detailed information about what exactly I’ve been doing so that others can incorporate these things into their own recovery plans.
As I’ve mentioned before, I am not a doctor and anyone reading my writing with a mind to employ information in their recovery plans ought to keep this in mind. But as has also been mentioned, there’s a shortage of physicians able or willing to give proper recovery-oriented care to those with FND, so those wanting to make improvements are left to their own devices with startling regularity. It is due to these cases that I’m writing this guide.
The biggest piece of advice I can give is to seek out a physical therapist who is experienced with working with people with neurological disorders. Given FND’s relative obscurity it is likely that you will not find a PT who knows about it specifically, especially if you do not live in a large city. But most people should be able to find a PT who has worked with individuals recovering from other disorders, such as stroke, traumatic brain injury, etc. The goal of therapies for these sorts of conditions is not so different from FND rehabilitation - one must re-learn healthy patterns of movement in order to stimulate the brain network which controls movement and sensory integration, and eventually foster the development of healthier connections between regions involved in this network. Successful therapy for a neurological condition affecting movement should lead to improved health of the sensorimotor network. While there are differences between FND and other conditions, there is a large overlap between the appropriate exercises to assign to someone recovering from it versus another type of neurological event.
Specifically, exercises which force one to “cross the midline” are important to recovery in either case. This means that one must coordinate movements that involve the right and left sides of the body. This is important because of the way the brain is organized into left and right hemispheres (halves). Each half of the brain controls a corresponding half of the body. Normally, the left and right sides can work together without a problem, but in cases where neurological disease impairs the functioning of the sensorimotor network the ability to coordinate movements involving the left and right sides of the body can be disrupted. By the same token, practicing movement patterns which involve both the left and right motor cortices can help to strengthen the sensorimotor network. There are many forms which this can take, but what I encountered most often were exercises which involved both the left and right hands, or which involved an arm and a leg from opposite sides.
Some of the exercises which I did most often in therapy were:
Walking or running on an elliptical machine
Cycling on an exercise bike
Suitcase carries (weighted walking)
If you like to exercise, you’ll recognize at least some of these. But if not, I’ve linked some instructional videos for most exercises mentioned.
Outside of physical therapy, I also began incorporating exercise into my recovery routine. At first I supplemented PT sessions with gym visits, but once I reached a certain point of progress I decided that I was able to stop with PT and focus on improving my body with my regular exercise routine.
The biggest things that I changed from my pre-FND fitness approach were adding lifting, and decreasing the numbers of high-impact exercises I did on a regular basis.
The simple explanation for lifting - in the isolated context of FND recovery - is that it helps me to develop better proprioception as well as better muscular balance between the left and right sides of my body. The intentional focus on movement required to maintain good form helps train the brain to understand where it is in space - because information about body position is sent to the brain from nerve endings in the connective tissue in and around one’s joints, repeated highly intentional movement can help to improve the brain’s ability to properly integrate those incoming signals so as to build better proprioceptive skills. In simpler terms, that is, it builds up a better mind-body connection so that one’s brain understands where the rest of the body is in space.
The reason for lower intensity exercise is a bit simpler - people with FND just tend to get fatigued. If you have FND, you didn’t need me to tell you this. I found that my old high intensity interval training routines were just too taxing on my system. For whatever reason, I wasn’t recovering from them nearly as quickly as I needed to. Not only that, but for whatever reason a massively elevated heart rate seems to be a trigger for some of my symptoms. Getting my exercise in more gentle ways allowed me to stick with it without burning out or (as was almost the case several times before I learned better) passing out. I use the elliptical for cardio a lot, as well as jogging at a mild pace. Of course, as I’ve recovered I’ve been incorporating more of my old activities back into my routines. I handle them increasingly well, as my neurological and holistic health continue to improve. It’s still hard for me to really push myself into a high heart rate zone, though, and I suspect that it may continue to be for a while. So if you are in the middle of FND recovery, take care to pay attention to your triggers and what works for your body. If something just doesn’t work for you, don’t be afraid to look for alternatives. There are often many ways to get the same result when it comes to fitness. If you need guidance, consult a physical therapist, a doctor, or at the very least a physical trainer who has some understanding of illness and the need for modifications for certain medical conditions.
And of course, there are many more exercises than are mentioned here that could be a healthy part of an FND recovery plan. If you or your physical therapist find something different, don’t be afraid to try it. What I’ve written here are merely suggestions based on what has been working for me personally so far. If you find that something totally different works for you, go for it! And, please let me know as I’m always open to suggestions both for myself and to share with others.
Trying to form a recovery plan when you don’t have access to medical expertise is daunting. But hopefully with a community full of growing support and encouragement, we can make the journey of each person to come after us just a little bit easier. Ideally we would all have access to in-patient neuro rehab programs in a timely manner after diagnosis. But while we hope and advocate for this, let's not sit in anguish thinking there is nothing we can do. Recovery is possible, one step and outpatient (or at-home) treatment session at a time. Together we can build knowledge and resources, and strive to make the world of FND recovery a much better place than what we inherited.