What are some common misconceptions about functional neurological disorder (FND)? 

One misconception is that if a symptom can’t be mimicked, it’s unlikely to be FND. This is false. Many functional symptoms are difficult or impossible to reproduce voluntarily, including functional facial asymmetry caused by unilateral tonic platysma contraction; functional fixed dystonia, where limbs remain locked at end range without muscle fatigue; and insensate limbs. 

Another myth is that symptoms are explained by secondary gain— the conscious or unconscious benefits of illness (eg, work absenteeism providing protection from an intolerable situation). While secondary gain may influence the illness experience, it is not specific to FND and can be present in any health condition. 

A third misconception is that mobility aids are always contraindicated. While early use of aids can sometimes limit recovery by discouraging automatic movement, many people remain symptomatic in the long term. Aids may be essential for maintaining independence and quality of life. 

Are there any new research findings or emerging therapies you’ll be highlighting? 

Yes. I recently led a multicentre randomised controlled trial comparing specialist physiotherapy for motor FND to usual care. I’ll be discussing the clinical outcomes and cost-effectiveness data and what they mean for clinical physiotherapy practice. 

What role does interdisciplinary care play in managing FND? 

Dr Glenn Nielsen will present current research into FND treatments and interventions at APASC25.

Interdisciplinary care is considered the gold standard but there’s no one-size-fits-all approach. While specialist multidisciplinary programs are often most effective, they are costly and not widely available. In settings without integrated teams, a modular approach to treatment across specialties or even siloed treatment can be beneficial. 

Where do you see the field of FND heading in the next five to 10 years? 

Understanding FND through the lens of predictive processing models has led to a rise in neuroscience research. A hot topic within this area is the role of impaired interoceptive awareness. Efforts are underway to identify potential biomarkers to support earlier diagnosis, along with research into risk factors, including links with neurodiversity and epigenetics. Despite interest in novel treatments, I don’t see any replacing high-quality multidisciplinary rehabilitation in the near future. 

What do you hope professionals in the room will do differently after hearing your talk? 

FND remains highly stigmatised. People are often embarrassed to talk about it and some doctors are reluctant to diagnose it, leaving patients vulnerable to iatrogenic harm and exploitation. I hope attendees leave feeling more confident about discussing FND with sensitivity and more willing to engage with patients with curiosity and respect. I also want to emphasise that physiotherapy for FND can be highly effective. 

>> Dr Glenn Nielsen is a senior lecturer in neurological physiotherapy at St George’s University of London and a clinical physiotherapist at St George’s University Hospital, specialising in neurology and FND. 

>> Glenn will present a keynote session titled ‘Psychologically informed physiotherapy for functional neurological disorder: evolving evidence and practical application’ on Saturday 25 October at 1.40 pm.

Click here for more information about APASC25