Affiliations: [a] Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| [b] Department of Physical Medicine and Rehabilitation, Mayo Medical School, Rochester, MN, USA
| [c] Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA, USA
| [d] Department of Physical Medicine and Rehabilitation, California Rehabilitation Institute, Los Angeles, CA, USA
| [e] Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
Correspondence:
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Address for correspondence: Ginger Polich, Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown 02129, MA, USA. Tel.: +1 617 952 5000; Fax:+ 1617 952 5940; E-mail: ginger.polich@mgh.harvard.edu.
Abstract: BACKGROUND:Higher levels of care in the form of intensive rehabilitation may be appropriate for select patients with a diagnosis of functional motor disorder (FMD). Intensive rehabilitation, as delivered through an outpatient day program or through admission to an inpatient rehabilitation facility, can offer a greater frequency and variety of integrated clinical services than most lower levels of care. OBJECTIVE:Higher levels of rehabilitation for FMD have not yet been well characterized in the literature. In this article, we will focus on the population of FMD patients who begin receiving care in the outpatient setting. METHOD:In this review, we describe a range of options for higher levels of FMD care, evaluate the supporting literature, and weigh the pros and cons of each approach. Several specific examples of intensive rehabilitation programs in the United States will be described. Finally, we will consider existing health systems barriers to each of these outpatient and inpatient higher levels of care. RESULTS:Within a stepped model of care, intensive outpatient day-programs and inpatient rehabilitation may be considered for individuals who present with complex, refractory motor deficits from FMD. For appropriately selected patients, a growing body of literature suggests that time-limited, goal-oriented intensive rehabilitation may provide an effective treatment avenue. CONCLUSION:It remains to be determined whether treatment in intensive care settings, while more costly in the short term, could lead to greater cost savings in the long term. The prospect of telemedicine rehabilitation for FND in terms of efficacy and cost also remains to be determined.
