Maybe you’ve started having tremors that you don’t understand — and can’t control. What’s happening?
Functional movement disorders (FMD) are neurological disorders — but they may sometimes appear to others to be a mental health condition. Our understanding of FMDs has evolved, though, and we now focus first on the neurological aspect of the disorders. The good news is that we can retrain how your brain works. Many people with FMD can improve with a better understanding of the disorder and personalized treatments.
Still, if you have a functional movement disorder, you probably have a lot of questions about your condition. Why do I have it? How can I stop it? Will I be OK? Cleveland Clinic’s functional movement disorder specialists work together to find the answers. Your personalized treatment plan helps us care for you physically, mentally and emotionally. We’re here to help you get back to enjoying life.
Treating functional movement disorders takes the knowledge of experienced providers. Our team from neurology, physical therapy, occupational therapy, speech therapy, psychology and other specialties works together to confirm a diagnosis and pinpoint factors influencing your symptoms. They’ll craft a treatment plan that balances physical and mental health care based on your specific needs.
We understand how unsettling an FMD can be — and recognize the emotions and frustrations that can come with it. Our compassionate providers offer the support you need. They’ll listen to your concerns, answer your questions and explain what to expect in a clear, easy-to-understand way. Meet our team.
Cleveland Clinic consistently leads and takes part in research and clinical trials to find more effective treatments. Our studies let us try new interventions and therapies before they’re widely available. If you’re interested in taking part in a clinical trial, your provider can let you know if you qualify for one.
Not all check-ins with your providers need to be in person. When you don’t feel like coming to us, sometimes we can come to you — virtually. Cleveland Clinic’s virtual visits let you connect online from the comfort of home.
Our FMD team has also developed a unique virtual platform called Virtual Shared Medical Appointments (VSMA). Through this platform, you and your caregiver can learn more about the disorder, how to better manage symptoms and even virtually meet others who’ve also been diagnosed with FMD.
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Everyone’s FMD journey is unique. Maybe it took just one neurology visit to confirm you have a functional movement disorder. Or you may have seen several different neurologists to reach the FMD diagnosis if your condition is more complex.
We also know that many people with FMD feel as if others — especially medical professionals — don’t believe them. In fact, traditionally, FMDs had been viewed primarily as a psychological disorder. We now understand that these disorders happen as a malfunction in the circuitry or signaling level of the brain. In other words, there are breaks in the signals between your brain and body — but without tissue or nerve damage. This can trigger physical symptoms like tremors, balance problems, spasms and more.
So, when you come to see us, your healthcare provider will want to hear your story first. We want to know about your symptoms and medical history. You’ll have a physical exam and a neurological exam, and your provider will check things like your reflexes, coordination, muscle tone, walking pattern and mobility. Your care team may ask you about certain triggers, patterns and things that seem to make your symptoms better or worse. All of this information will help us to better understand your condition.
Conditions like functional tremor, functional dystonia, functional gait (walking patterns), functional myoclonus and functional parkinsonism can look like their brain-related counterparts. They can cause the same kind of communication breakdown through your nervous system. And they can cause the same disruptive symptoms as other neurological conditions, like:
Working with healthcare providers familiar with functional movement disorders is an important part of confirming the diagnosis and moving forward with treatment. Cleveland Clinic has a team of providers from related specialties ready to help.
As we uncover the “why” and “what” behind your symptoms, your story is another important part of the diagnostic puzzle. You’re more than your symptoms. And we want to understand the person you are behind them. That’s why your provider will start off your first visit by asking:
Your provider will listen carefully to you, answer your questions and talk with you about your worries. Our team knows your symptoms are real. And your provider is here to find out how they can best help you.
Additional testing isn’t always necessary if your neurologist is able to confirm an FMD diagnosis based on history and examination alone. Only if needed, they may discuss other tests to make sure your condition isn’t one that mimics FMD. You may have already undergone various neurological tests before coming to see us. If so, please bring the results of prior testing and any neuroimaging on a disc for your care team to review.
If you choose Cleveland Clinic for treatment, you’ll have a team of providers from different specialties. This team works together to confirm a diagnosis — and plan and manage your care. You may see:
Others who could be on your team include chronic pain specialists, headache specialists, postural orthostatic tachycardia syndrome (POTS) specialists, integrative medicine/wellness providers and psychiatrists.
Additional testing is not always necessary if the neurologist is able to confirm FMD diagnosis based on history and examination alone. Only if indicated, the neurologist may discuss other tests to ensure it is not one of the mimickers of FMD. It is possible that you have already undergone various neurological testing prior to coming to see the FMD specialist. Please bring the results of prior testing, and any neuro-imaging on a disc for your care team to review.
Current core team: movement disorder neurologist, psychologist, physical therapist, occupational therapist, speech therapist. Other subspecialities outside of core team: chronic pain specialist, headache specialists, POTS specialists, integrative medicine/wellness providers, psychiatrist
Finding out that you have a movement disorder isn’t easy. You finally have answers, but you also face a lifetime of managing your condition ahead of you. We know it can be hard to wrap your head around this kind of news. That’s why our movement disorder team focuses on taking care of you in every way you need. We guide and support you as you move forward with treatment — so you can enjoy the best possible life and live it to the fullest.
Our healthcare providers see patients at convenient locations throughout Northeast Ohio, and Nevada.
Our providers focus on both your physical symptoms and your mental health in a holistic approach when treating you for a functional movement disorder. We tailor your treatment plan to your unique diagnosis and needs.
Depending on your physical symptoms, your care team may recommend any or all of these therapies. Each can help you manage your symptoms in different ways, and they’ve been proven effective in improving FMD symptoms. We can show you how to move better, simplify daily tasks that have become difficult and even swallow easier if your condition has affected your ability to do that.
Physical therapy is a cornerstone of FMD treatment. Physical therapists will help you with symptoms like tremors, jerks and tics, weakness, gait and balance impairment, dystonia, pain and dizziness. Treatment may include motor retraining, education, activity pacing, diverted attention techniques, gait and balance training, aerobic and strength training, graded motor imagery and sensory retraining techniques.
Occupational therapists can help you become more independent with self-care, household responsibilities and work activities. Occupational therapy also helps with stress management, self-management, coping skills and diverted attention training. The goals of occupational therapy are to help you become more independent and to teach you how to adjust or find new ways to do challenging tasks.
Speech therapists evaluate and treat speech, cognitive (memory /attention), and swallowing symptoms associated with a functional movement disorder. Your speech therapy will be specific to FMD and tailored to your needs.
Both research and our clinical experience have shown that cognitive behavioral therapy (CBT) can help manage FMD symptoms. Your therapist will help you understand how your thoughts, feelings and behaviors influence each other — and your health. We’ll dive into how you respond to your symptoms so you can recognize what’s going through your mind when they flare up, and gradually re-incorporate activities into your daily routine. You’ll also learn ways to identify FMD triggers, manage health-related stress, and add relaxation training to your treatment plan.
Sometimes, functional movement disorders may be associated with conditions such as POTS, chronic pain, headache, fibromyalgia, anxiety or depression. If so, you may need medications or other treatments.
We also offer other therapies (known as Integrative and Lifestyle Medicine) that may fit in well with your current treatment plan and support your body’s natural ability to heal. Incorporating these therapies into your healthcare routine may help you make positive changes that affect your health and well-being.
Some people may achieve remission for years, and others may experience flare-ups of their symptoms off and on. Your care team will help monitor your condition over time. The strategies you learn from your treatment team will help you gain confidence in identifying triggers and managing flare-ups. Sometimes, revisiting the therapies and learning additional strategies can help with the flare-ups. And we’ll keep the lines of communication open so you can feel comfortable reaching out to us at any time.
Having physical symptoms but not knowing why can take a big toll on your physical and mental well-being. Perhaps you’ve seen many different providers but still have no answers. And maybe you’ve felt unheard when you try to explain what’s going on and how you feel. Cleveland Clinic’s team of expert providers is here to listen and help you make sense of your functional movement disorder. We want you to feel confident and empowered — so you can move ahead with living your best life.
Getting an appointment with one of our functional movement disorders experts is easy. We’ll help you get the care you need.
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