Disclosures: Neha A. Shah, DO: Nothing to disclose.

Case Description: 25-year-old male presented to our acute rehabilitation hospital with a recently diagnosed functional movement disorder (FMD). The patient had a 7-year history of involuntary movements and cognitive decline causing significant disability and psychosocial distress. For 7 years, he had tremors in all four extremities, which became constant 5 months prior and worsened his balance, leading to multiple falls. He would hit his head during these falls and lose consciousness with bowel/bladder incontinence. He improved significantly with a multidisciplinary treatment inpatient regimen emphasizing physical and cognitive-behavioral therapy.

Setting: Acute Inpatient Rehabilitation Hospital

Patient: 25-year-old male

Assessment/Results: CT Head/MRI Brain- Negative, EEG: negative, B12/Thyroid/Copper: normal. Neurology Movement Clinic evaluation- postural and action tremor with myoclonic jerks of unknown origin. Neuropsychology testing: impaired language, visuospatial perception, memory, and processing speed.

Discussion: The patient underwent a structured motor-reprogramming treatment protocol involving physical and occupational therapy three times a daily for 13 consecutive days. Therapy also involved distracting motor tasks to extinguish abnormal movements. He required moderate assistance for activities of daily living and minimum assistance for his mobility deficits prior to rehabilitation and improved markedly throughout his treatment. By the time of discharge, he was able to perform activities of daily living at supervision level and ambulate independently with a walker.

Conclusion: The diagnosis of FMD currently requires the presence of characteristic clinical features, including symptoms that are inconsistent with organic movement disorders, and decreased movement with distraction. Psychologic factors are supportive features for the diagnosis. This case provides support for intensive inpatient rehabilitation in the treatment of FMDs. Multidisciplinary inpatient treatment of FMD lasting weeks to months has been employed by a few specialized centers in Canada and the United Kingdom. Given the available data and our clinical experience, we suggest an intensive multidisciplinary treatment at a rehabilitation facility for patients with FMD rather than outpatient treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multidisciplinary-inpatient-rehabilitation-improves-functional-movement-disorder-a-case-report/