Publication details
PHYSIOTHERAPY FOR FUNCTIONAL GAIT DISORDER AND FUNCTIONAL DYSKINESIA USING GLOBAL MOTOR PATTERNS OF DEVELOPMENTAL KINESIOLOGY – CASE REPORT
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| Year of publication | 2024 |
| Type | Appeared in Conference without Proceedings |
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| Description | Objective Aim is to report physiotherapy approach using global motor patterns of developmental kinesiology in movement retraining of patient with severe functional gait disorder and functional dyskinetic movements. The purpose of this report is to set out new possibilities in physiotherapy as part of motoric retraining. Background Physiotherapy for functional neurological disorder (FND) is one of the most effective therapy. It is based on education, functional evaluation, changing of habitual postures, movement retraining, distraction of attention and supporting self-management [1]. Movement retraining includes automatic movements, retraining activities, redirection attention, feedback, motor learning methods. For this part of physiotherapy, we used positions from developmental kinesiology, especially concept of Dynamic Neuromuscular Stabilization. These automatic postural patterns are derived from postnatal ontogenesis of human to 16 months development [2]. We expected improvement in cocontraction and coordination of dyskinesia and well-activated global movement patterns of locomotor system. These physiotherapy approaches are not public in current literature of FND. Methods We treated and analyzed patient, female 21y, with FND - functional gait disorder and "functional dyskinesia". The finding corresponds to disturbed explicit motor movement during preserved automatic and goal-oriented movements – a finding similar to upper and lower limbs. Patient was treated from 12/2019 and previous physiotherapy procedures didn´t have a significant effect on gait and dyskinesia. Subjective health and well-being was evaluated by self-assessment questionnaires – Quality of Life SF 36, Multidimensional Assessment of Fatigue Scale (MAFS), Short-form McGill Pain Questionnaire 2 (SF-MPQ-2). Objective assessment was evaluated by physiotherapist using Hinson video-protocol and The Simplified Functional Movement Disorders Rating Scale (S-FMDRS). Physiotherapy program was consisted of 20 sessions per 2 blocks (10 therapies per 1 block), 8/2022 – 11/2022 and 11/2023 – 3/2024. Physiotherapy treatment consisted of recommended approaches according recommendation of Nielsen [1]. Movement retraining was enriched for exercise in positions from developmental kinesiology derived from ontogenesis. Results Results showed effect of physiotherapy based on developmental kinesiology. Functional disability by S-FMDRS were decreased from 31/54 to 17/54. After second block of physiotherapies followed up after 1-year, scoring of functional disability by S-FMDRS was decreased to 8/54. Improvement was mainly in functional dyskinesis and after second block of physiotherapies also in gait. Self-assessment test was also improved in some modalities. Quality of Life SF-36: Physical functioning: 25%-35%. Energy/fatigue: 15%-25%; Emotional well-being: 84%-96%, Social functioning: 50%-100%; General health: 50%-75%; Health change: 25%-50%. Global Fatigue Index by MAF scale was decreased from 39.7/50 to 34.3/50. Pain was decrease in SF-MPQ-2 from 76/220 to 33/220. Conclusions Our data suggest high effect of movement retraining physiotherapy based on developmental kinesiology using global automatic postural patterns in the treatment of functional gait disorder and functional dyskinesia. In some cases of FND, this kind of physiotherapy could be an effective physiotherapy method. Future statistical analysis is needed to conclude these pilot results. |