RECOMMENDATIONS ON THE USE OF ADAPTIVE DEVICES FOR PEDIATRIC FUNCTIONAL NEUROLOGICAL DISORDER

Purpose: To provide recommendations and considerations on the use of adaptive devices as part of treatment for pediatric functional neurological disorder.

Description: Functional neurological disorder (FND) is defined as abnormal motor behaviors that are inconsistent with an organic etiology. It is estimated that 23% of patients referred to neurology clinics are diagnosed with FND, which in turn has been reported to result in an annual healthcare cost of $57-92 million in the United States. The diagnosis often has a profound negative impact on a patient's functional status and quality of life.

Historically, it has been recommended that physical therapists should always avoid the use of adaptive devices as part of treatment for patients with FND. However, when considering that the primary goal of treatment is to restore movement and return to participation in daily life, the use of adaptive devices may allow for improved patient mobility and participation. As a result, current FND treatment should thoughtfully consider and manage the use of adaptive devices to initiate a patient's return to baseline function.

A series of recommendations were developed on the use of adaptive devices in the treatment of pediatric FND across a variety of settings: acute care, inpatient rehab, outpatient and school settings. The recommendations include a review of the primary goals of using adaptive devices, development of a setback plan for when a patient's symptoms change and considerations of treatment ideas to reinforce and avoid when using devices. The recommendations were developed in collaboration with the pediatric special interest group of the Functional Neurological Disorder Society.

Summary of Use: The recommendations and considerations should be used to help guide decision making when using adaptive devices for patients with FND. It is important to remember that adaptive devices should first be avoided as able, but if the use of a device will help a patient initiate the return to function, it should be included in treatment. As part of the use of adaptive devices, specific recommendations for when to use the devices as well as a plan to wean from the devices should be established. Physical therapists should also assist with creating a setback plan for times in which a patient's symptoms return and how an adaptive device should be used during those times.

Importance to Members: The recommendations developed will assist members in improving their patient's ability to functionally participate in preferred daily activities as part of their FND recovery. Additionally, the ideas outlined will serve to guide practice in weaning from the equipment as symptoms improve as well as ensure function is maintained if symptoms return.