Reply To: Live Workshop 2

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David SchwarzDavid Schwarz

I am excited that I was able to reorganize my schedule to be able to make the meeting on Wednesday.

Some of the publication related to misdiagnosis of mind-body disorders such as Functional Neurological Disorders (FND)/conversion disorder as issues stemming from structural problems are interesting. (For context, I am a DPT/physio in the US working on my PhD) I had a patient who I could not convince the doctor to have better assessment performed on her. She had two strokes in a 4-5 years period with the first one triggering significant depression which improved in the 6-8 months prior to the seconds stroke, and the second stroke having episodes of dizziness that became problematic 2-3 months after the stroke. She became fearful and stopped walking due to the dizziness and falling. She had a particular movement pattern that appear with symptoms that included reduced reaction to environmental stimuli and rotating her head to one side. I was able to help her understand better the recongition of kinesiophobia related to dizziness/fatigue/pain and her symptoms initially resolved within a couple of days so we could progress improving her confidence with movement. At times throughout care these symptoms would return and I tried to get the doctors office to stop telling her it is all because of her stroke. Unfortunately, I was unsuccessful at that (I would like to think that I am typically successful with educating the physicians I have worked with, but pobody’s nerfect, right?). I have the way I learned for educating physicians and other healthcare professional on mind-body, FND/conversion, whole person problems, but are there any favorite ways that you all have?

The way I learned/taught myself: Typically, I describe the symptoms and the current assumed aetiology. I then describe what I see with movement and function and describe how these are not consistent with the current problem (or what parts are consistent and what are not). Then I describe the current context of stressors and some of the conversations I have had with the patient. Finally, suggesting that the condition appearred to be of a functional nature and describing how I came to that conclusion through testing such as cognitive initiation of sensory provcation (motor imagery, memory, imagined context changes), Hoover’s sign, hip abductor test, modulation of attention, etc. After all of that, I asking what questions, comments, or concerns they have.

David J Schwarz