Functional Movement Disorders
Welcome to the Functional Movement Disorders (FMD) page at the University of Miami's Division of Movement Disorders. Our program is dedicated to the diagnosis, treatment, and study of FMD, a complex condition characterized by abnormal movements that are genuine but do not result from underlying neurological damage. At our center, patients benefit from a holistic and integrated approach led by a team of experts in neurology, psychiatry, psychology, and physical therapy.
Our clinic emphasizes the importance of a comprehensive evaluation to accurately diagnose and differentiate FMD from other movement disorders. Treatment plans are personalized and may include physical therapy, psychological counseling, and medication when appropriate, focusing on improving functional outcomes and quality of life.
We are also committed to advancing research in FMD to better understand the underlying mechanisms and develop more effective treatments. Our interdisciplinary team collaborates on various studies, aiming to enhance both clinical care and educational efforts about this often misunderstood condition.
Explore our resources and learn more about how we can support you or your loved ones in managing Functional Movement Disorders.
Definition of Functional Movement Disorder
“Neurological symptoms (such as limb weakness, numbness, shaking or blackouts) which are REAL (and not imagined) caused by a problem with the functioning of the nervous system not due to damage or structural disease of the nervous system causing difficulties for the person who experiences them.”- neuropt.org
- Functional neurological disorders (FND) are caused by a change in function of the nervous system that results in a problem with the way signals are sent to and from the brain.
- FND is an umbrella term which encompasses physical, sensory, motor, and cognitive symptoms.
- Functional movement disorders (FMD) include involuntary movements such as tremors, muscle jerks, or spasms that are due to changes in signals in the brain.
- In their essence, these are disorders of communication between the brain and the body.
Our Process
- Initial consultation: Confirm diagnosis and develop an individualized treatment plan.
- Patient and family education: Education can be provided both in person and with a variety of online resources to ensure access to reliable information and a clear understanding.
- Multidisciplinary therapies: These include but are not limited to physical therapy and psychological treatment, depending on your individualized needs.
- Hospital based therapy: Evaluation for an Inpatient rehabilitation program through Jackson Rehabilitation Hospital could be considered for specific clinical scenarios.
- Follow up: Ongoing support and assessment.
What is required* for recovery?
- Readiness to change
- Commitment
- An open mind
- Understanding of and connection with your diagnosis of FMD
*Don’t worry, we can help you get here
Team Members (specialty roles)
- Neurology
- Many neurologic conditions involve abnormal movements (movement disorders), which resemble the abnormal and involuntary movements seen in Functional Movement Disorders. The diagnosis can be made during a clinic visit, often without further laboratory or imaging testing. While the exact cause of FMD is not fully understood, the clinical characteristics are well defined, and a clinician can make the diagnosis based on a person’s medical history and their neurologic exam. Importantly, there is treatment, and treatment starts with understanding the diagnosis. We believe our interdisciplinary approach will provide optimal care to the FMD community. Together with my colleagues, we will formulate an individualized treatment plan, and initiate the therapies that can help you regain control of your body.
- Health Psychology
- Psychological factors are not always the cause of FMD, but individuals with FMD often benefit from psychological treatment.FMD can be a complicated and frustrating condition with which to live. Difficulties dealing with the health care system, stigma, loss of independence, and the burden associated with coping with a chronic condition are all factors that can lead to elevated stress levels and depression. Emotional distress, in turn, is known to exacerbate existing medical conditions and motor problems in particular. In addition, there is growing evidence from brain imaging studies that show for some individuals with FMD there is a disruption in brain networks involving emotion regulation and motor control. Studies suggest that for some people these disruptions are associated with stressful life events. While one size does not fit all, regulating mood is an important component for optimal management of FMD.Health psychology is a branch of psychology that focuses on biological, social and psychological factors that influence health. Health psychologists focus on helping people engage in behaviors to improve health and improve coping with chronic medical conditions. They are ideally positioned to treat patients with FMD.Our clinic provides evidenced-based interventions that have proven to be successful in the treatment of FMD, including Cognitive Behavioral Treatment (CBT), Dialectical Behavioral treatment (DBT), and Acceptance Commitment Therapy (ACT).
- Neuropsychology
- Some patients with FMD experience a cognitive decline in areas, such as attention, memory, processing speed and other thinking abilities.Our neuropsychology group is available to assess and track these cognitive difficulties and recommend appropriate resources and strategies to help patients compensate for the areas in which they are struggling.What to expect during a neuropsychological evaluation: A neuropsychological evaluation includes an interview, completion of self-report questionnaires, and paper and pencil or computerized tests. Assessments are completed either in the office or virtually. The entire evaluation usually takes approximately 4 hours. Breaks are provided as needed. You may take your medications as usual prior to and during our evaluations.
- Physical Therapy
- Physical Therapists (PT) can be a vital part of your healthcare team, especially in the process of healing from a FMD. They can help you understand the diagnosis of FMD, regain normal movement and sensation, guide you in forming more optimal brain connections, and work with you to pursue your functional goals, allowing you to thrive in your everyday life. Our PTs are devoted to following best evidence based practice with special emphasis on individualized needs and goals. Our mission is to restore hope, control, and confidence in self management of your condition.
- Speech Language Pathology
- Speech-Language Pathologists (SLP) specialize in treating swallowing, speech, voice, and cognitive-communication disorders. As FMD progresses, changes to both speech production and swallowing function may occur. SLPs are vital members of the team who evaluate and monitor these changes, along with helping to improve function in these areas that may be impacting quality of life.
- Interdisciplinary FMD Clinic
- People with an established diagnosis of FMD and who are ready to engage in treatment can be referred to our interdisciplinary clinic. Over the course of about two hours, you will be seen by a neurologist, physical therapist, and neuropsychologist in a single visit. Prior to the visit we suggest reviewing an educational FMD website. And we request participants complete a pre-visit questionnaire returned via email to complement the clinic assessment. Patients will have the opportunity to ask questions about FMD and will be evaluated to determine the need for physical, speech, occupational, and/or cognitive behavioral therapies. At the end of the visit, the team will collaborate to determine a plan and to facilitate the next steps in treatment. We operate from the University of Miami Medical Campus in Downtown Miami, Florida. While we can evaluate any patient, and telemedicine may be suitable in unique situations, optimal follow-up care and treatment by our team would occur via in-person visits in Miami.
Patient Resources
Websites
- neurosymptoms.org
- FNDSociety.org
- What Is FND - FND Hope International
- https://www.fndaction.org.uk/what-is-functional-neurological-disorder/
- rarediseases.org/rare-diseases/fnd/videos
- FND Australia “What are Functional Neurological Disorders?”
- FND Australia “What Causes Functional Neurological Disorders?”
- FND Australia “How are Functional Neurological Disorders Diagnosed?”
- FND Australia “How are Functional Neurological Disorders Treated?”’
Books and additional reading materials
- Overcoming Functional Neurological Symptoms: A Five Areas Approach by Christopher Williams, Alan Carson, Sharon Smith, Michael Sharpe, Jonathan Cavanagh, Catriona Kent
- Provides a self-guided, self-help, cognitive behavioral strategy to be read and practiced by the interested FMD patient.
- “A leg to Stand On” by Oliver Sacks
Patient and Clinical Education Handouts
- Gilmour, G.S., Nielsen, G., Teodoro, T. et al. Management of functional neurological disorder. J Neurol 267, 2164–2172 (2020). https://doi.org/10.1007/s00415-020-09772-w
- Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry 2015;86:1113-1119. https://jnnp.bmj.com/content/86/10/1113
Centers of Excellence at University of Miami
The Division received the designation as a Center of Excellence from the Parkinson’s Foundation in 2007. Since then the team has also been designated an American Parkinson’s Disease Information and Referral Center, Cure PSP Center of Care, Huntington Disease Center of Excellence, and Wilson’s Disease Center of Excellence. The division also comprises part of Cognitive Neurology’s Lewy Body Disease Center of Excellence, and the Department of Psychiatry’s Tourette Center of Excellence.