Advisor
Susan Tomlimson
Degree Name
Master of Public Health/ Doctorate of Physical Therapy
Description
COinS
Apr 17th, 12:00 AM
Impact of cognitive distraction on Six-Minute Walk Test and gait mechanics in a patient with functional movement disorder: A case report.
Comments
Abstract
Introduction: The term functional movement disorder is used to describe symptoms such as paralysis, weakness, tremor and dystonia that are not caused by a standard neurological disease and which is assumed to be due to psychological factors. Patients tend to have poor outcomes with symptoms persisting in 65-95% of cases. Treatment for functional movement disorders is not well established; however, Nielsen et al. recommend cognitive distraction techniques. This case report examines two different treatment approaches to functional movement disorder, one which focused on emphasizing gait mechanics and one that de-emphasized gait mechanics and used cognitive distraction during upright activities.
Case description: The patient is a 28-year-old female who began experiencing alternating internal and external rotation of her left lower extremity during gait about 10 years ago. She began treatment at this facility one year ago. She uses a standard wheelchair for community distances but can ambulate with forearm crutches for short distances. Her gait pattern is four-point pattern with her left lower extremity in extreme hip internal rotation then abruptly switching mid-gait to extreme hip external rotation with trunk and knees in flexion. For the first 8 months, treatment focused on improving gait mechanics through traditional means: dorsiflexion wrap to assist with foot clearance, focus on promoting external rotation of hip throughout gait, and providing cues for gait performance. Following this, treatment principles suggested by Nielsen et al. were used. This included de-emphasizing gait mechanics, use of distraction techniques to draw attention away from walking, and psychological principles such as rewarding positive performance with attention and praise and ignoring poor performance.
Outcomes: The primary outcome measure for this patient has been the Six-Minute Walk Test (6MWT). At initial evaluation, her 6MWT distance was 46 feet with use of forearm crutches and a wrap for dorsiflexion assist. After 8 months of traditional therapy, patient increased 6MWT distance from 46 feet to 80 feet. Following four sessions of an approach de-emphasizing gait mechanics, she was able to ambulate 263 feet during 6MWT.
Discussion: Though physical therapy is often cited as an important component in treating functional movement disorders, there is very little evidence for the best management approach. This case study highlighted two different treatment approaches for functional movement disorder and the effect of these treatments on walking endurance. By de-emphasizing gait mechanics and instead focusing on increased standing/walking tolerance while performing distracting tasks, patient was able to improve her walking endurance.