Pediatric Functional Neurological Disorder Triggered by Concussion: Physical Therapy Intervention with a 12-year-old male and 2-year follow up

Research Objectives: To describe the physical therapy management of a 12-year-old male with Functional Neurological Disorder triggered by concussion demonstrating ability to maintain functional gains following interventions which were maintained, without regression for 24 months

Design: Single case design.

Setting: Physical therapy setting was in a community hospital-based outpatient facility.

Participants: The single subject was a 12-year-old male diagnosed with concussion and Functional Neurological Disorder. Selection was determined by the diagnosis and response of the condition with physical therapy.

Interventions: Interventions 1-2x/week over 18 weeks, and 1x/month for 3 additional months for a total of 35 visits. Skilled activity training including gait and static and dynamic balance training. Interventions progressed from gravity minimized environments such as aquatic interventions, body weight supported training over ground, to therapist assistance or assistive device training. Also utilized lower extremity strengthening, and home exercise program training and prescription. Secondary cognitive loads were used throughout the training process.

Main Outcome Measures: Ataxic movement resolved and independent ADL tasks were restored within 8 weeks of initial evaluation. Patient demonstrated guided progression from dependent use of 4-wheeled walker initially to no assistive device or upper extremity support during walking tasks status post 7 months from concussive event. These changes corresponded to return to school and usual age appropriate activity levels. At 24-month follow up, pt demonstrates return to functional movement within normal limits, including no use of assistive device, no falls for the past 20 months and ability to participate in age-appropriate activities such as participation in high school sports and full academic schedule.

Results: Reduced ataxic movement, Independent ADLs in 8 weeks, gait without assistive device, return to full school academic schedule, school sports participation, age appropriate activities.

Conclusions: 12-year-old male with FND triggered by concussion demonstrates ability to maintain functional gains following physical therapy interventions which were maintained, without regression for 24 months.

Author(s) Disclosures: All authors have no conflicts.